Skip to main content

Full text of "London medical and surgical spectator. Volume 2, 1809."

See other formats 


M&-?..:  •■■.■  ■  £’?  ■  ’ -:’>V  v*,:- 


f’V'H'V' 


8y  't':?M?;8 

-  -:  ■ 


vV'  ■•■•,' 

,  1  ■ '  : 


'V,»  ’  -■  '-  fe 

&jK&QlHEKgra 

%  •#  VMS “.,•••■•  •.  :•  •• 


?s-  .  .  .  -  :  .  ■■■■:■•  / 


Mir'" 


/t. 


*  -  ’ *  ■  ’  : ".  -Jf3S  £  .  ^t*-'  "’x  ■'■'  -  *  \w  .v , .  j  ,*/.'* .  .  '■  • 

K^R§Mifc: 


’■’/.j;.  .;^..»  ^  :,;  s;.\ 


?»•.. 


urasai 


;'■  ■'■■:  t  - 


Jgl 


ICv 

1  ,'!!••.:“•  '  !  - 


$5? 


Kttt 


wj  f  i^*j  ' 

-IV 

-  ■-  'tvv:^V  '-  -t-v: 

„  .  ■ijsi'i, 

.  -  >  -•  S  «--  • '  . : .«'-  .  -  - 

•  V  .  •.  •'  r  •'  -.  VfJ  - 

:<W-  -'*.'■  ~v*»Tf  i.  •  '_. .  1  ■ 


-•-  ]%&•  \ «V$£,S 


few 


.;■’>>  V 


.  ass? 


'  Ve 


vSfe 


s'tfirfe 


a  I 


Etfc 


(a? 


m 


M 


■:4ftY 


M 


*•- V;S 

H 


.vy.vv 

c^fiS%x 

- JR* 

■ 

•  '  ■  .  -.•.&.  I  A  .  t 


It? 


i 


m 


-  Vv'^  .'.•i'-;*4'<-r 


;’,^- 


v  -t  -k  ,.t  ^  r*^ir  \i>^-  *  4c  •,  ■‘rf^  f '  T  rT'trV'r'*’ 

Imw 

. ..  >>  w  « f  »  f  •»  rt^/  4  r  *  f  -Vr  V  ?  ^  * 

wir  •  '  W'f  ^4  rr^ & /  4*  vi 

ffltffiStt&SftffiafiTtsjM 


m- 


Pi 


,  v.s.  v  >4  'rAt?.  •"- 


:y-': 


v-v" 


..v 


^HR'; 

Knmins 

rLse-s^;' 


55Ki 


mm 


■'•_*  •»  ■  «r=E-^;  >  --’j/  -*^ 

-  ••  •,.  £  ,r- >*.*&■'. 


k  .t,  »  -  »  •■  •  *  A*  t”?,  *■<*■». 6%  **  C-X 

,*V4^tr»^*r-V,v4rj5||.  '*!•-*.,  >  -  i  *  - 


WM 


■  V'.  £s~'z. <}^-; ^  't:  O. 't-  ''•'- 1  /•' v‘>c 

v'lri  ;  ‘  ‘  m  j'@f‘ 


ui»i  ,  >  «Vji > t  (  MfMrW  4  f  V'-*  rk  Vl 

Jrt-4  44  a  4  m-  r4?4n  r ^  ;*  v  *  t  *  ?  I  • 

,  ,L.V*wVM/R  •Vr-v?*'»i'f-4*W*  i-f- 

1  ‘ 

.  i .  * .  v J.  }  n  Mr  i 


V.:  •»•■  .-^  >i;:-' l  V-  vl*l.  '•--'  '  t  '  ‘  - 

igpll® 


life 


18 


•%.  .•<, 


■  v  ■  '>:• 


m. 


- 


??v 

m^mm 

■  V 


K' { 4/*  48  44 

.‘m-  ’  /*t4  ?'^c4  '^4 

- . . 


mm. 


tv^ 

;*4-  if-. 8-  -t;: 
:vK5V. '  ?- 


?%v 


as*® 


•.-r: 


»“l 


;>'sy 


JS5-V 


;■* 


k* 


li 


;;0-vY- 


fyf.  ■'• 


.ws 


?» -;t 


‘M  •/•S# 


V-ifiMk-v  ’ 


'  .  '  1+:.  'sl#v 


:tiK€ 


m 


&<  A**.'* 


Wm 


♦Iff  »m: 


*«  A.>l  •’  ’  - - 


. 

... 


w*'  • 


!gM  .  '  3p 

;.v«.S':!ffi%gs  •*»!■•  Jsv  .•  •'.  •-  i  :V  /- 


*  W  .  ■ 


4fv;v 


•-8t 


mkmm& 


b&k 


it  ft 

■*L~.  ^  Vy.r?VM^ 

yiftr  ■■■■  -'..■-,  ;.^ 

g8w 
. 

x  islli 

rV^v; 

.;  ..  .  'i  ■' 


8?” 


1 

•‘5«hW;-;^.-:. 


■  v?k  *!*  Y'  f.  _%Sti 


Vak 


■■m 


m. 


8‘-: 


oLca 


'  :  u 


f 

o 


* 


% 


4 


THE 

LONDON 

MEDICAL  AND  SURGICAL 

SPECTATOR  j 

< 

OR, 

MONTHLY  REGISTER  OF  MEDICINE 

IN  ITS  VARIOUS  BRANCHES : 

CONTAINING 

ORIGINAL  COMMUNICATIONS ; 
CASES  AND  REVIEWS 

IN 

MEDICINE,  SURGERY,  MIDWIFERY,  AND  PHARMACY, 

WITH  A  VARIETY  OF 

MISCELLANEOUS  MATTER, 

AND  OTHER  PROFESSIONAL  INTELLIGENCE. 

VOL.  II. 

January  to  April ,  1809, 


»■  ■  ■ '  Like  the  industrious  Bee, 
Culling  from  ev’ry  Flow’r. 


Hon&on:  ' 

PRINTED  FOR  S.  HIGHLEY,  No.  24,  FLEET-STREET. 

By  Mercier  and  Chervet, 

No,  32,  Little  Bartholomew  Close* 

<%**/** 

1809, 


t  4 


t 


PREFACE. 

*  t 


The  Editors  of  the  present  Work  have  now  con¬ 
cluded  their  Second  V olume,  and  beg  to  return  their 
acknowledgments  to  their  numerous  and  respectable 
Correspondents  who  have  favoured  them  with  their 
contributions,  which,  in  point  of  practical  informa¬ 
tion,  they  flatter  themselves  will  be  found  equal  to 
any  other  publication  of  the  kind. 


•  •  , 


V  4M 


H  *  "  Y 


s  ••  •£ 

-* - - 


m  .e  •  '•  ;•  *  f  •'  . 

*  l  :>  -i-  **■  *'■&  '2  'S  >■ 

.  /.  •.  £  :  -  *  * 

r-  *  ••  '  .  ' 

_  .  y ,  .'\  i  :  .  7.  *  y 

If  .  v  ..  .  T>  -r  v  ■ 

l*  .  '  .  ••' 

Sjt  L  ‘  '  -  —•  '  •-V  '  - 

*  ‘ 

-  v  r-r  .«■•?>'  '  Vi  »' 

5  •  r  -  -  *  '  v-'-  ■*•*_'.* 

r>  r,  ;  -  "•/  ■  'f  •  i  "•••'•>  ,* 

v  c.  i-  •  -*•->»  y  ■•  -  •  y  ”  y 

•  *  .  •  -r-  *■  ^  ■  *  , 

<  *,  *  ■  '  .  •  «  ’  "  • 
v_  -'-W  -  V,  •  -  ' 

'  T 

.. .  :  ,v  .  <  -  • 

^  *.  ,  .  .  ^  « 

7  r  :  •'  .  ;</v> 

/ 

...  r.  .  yiyf  -  f-r.  .  '  -  =  '  vr. 

a-  *•  ■  * 

..  -  -  '  *  '  * 

v { •  ii  ?'>r  Hi  t 

-’-■>* -.i fjr  } 

.  t  r  ">  i 

•  -  V.. 

i 

.  T  «  .  «• 

:  .  ;  :7  '-y  -  ■• : 

-  .  ,  ,  i-v  .  *  . 

•  •  '  -r  y  -  ■  ,  .  • .  :•  i 

■  '  -  '  ' 

-  -  .’  •  v  .  1 

.  .  -V  - 

if 

<»  *  T  %  1  .  . . .  •  f 

i  -  .•  .■  ;  \.  « 

t  ■  IsS  '  P, 


Vol,  li.]  January ,  1809. 


[No.  VI. 


THE  LONDON 

£petfical  anU  Surgical 

SPECTATOR. 


EMPIRICISM. 

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

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

VOL.  If.  v 


2 


Emp  i  ricisin .  |~  J  anu ary 

pure, ,  as  Velno’s  Syrup,  Brodum’s  Specific,  or  Soldihon’s 
Balm  of  Gilead,  is  taken  in  preference  to  a  forenoon  luncli 
before  going  to  take  a  ride ;  or  his  nerves  are  invigorated  by 
some  Cordial  of  the  same  class.  His  dinner  is  next  suc¬ 
ceeded  by  taking  an  Antibilious  Fill  to  as&isfc  digestion ; 
either  James’s,  Dixon's,  or  the  highly-famed  William  Bar¬ 
clay’s.  In  the  morning  his  teeth,  if  he  has  any,  are  well 
rubbed  with  some  of  the  dentifrice  powders,  or  washed  with 
a  tincture  of  the  same  description,  such  as  the  Chevalier 
Ruspini’s,  or  others  of  equally  fashionable  notoriety.  His 
hands  are  cleaned  and  perfumed  with  medicated  soaps,  and 
washing-cakes,  as  the  Bandana,  Sicilian  Bloom,  Rose  Soap, 
and  a  thousand  others ;  and,  lastly,  his  face  owes  its  rosy 
tinge  and  delicate  hue  to  some  high-prized  cosmetic,  as  the 
Bloom  of  Venus.  Should  a  pimple  unfortunately  appear,  it 
must  be  immediately  removed  by  a  careful  use  of  Grow- 
land’s  Lotion,  as  a  death-blow  to  comeliness  and  fashionable 
appearance. 

When  these  circumstances  are  considered  as  attaching 
themselves  to  the  conduct  of  men,  of  what  is  termed  the 
superior  sex,  need  we  wonder  at  the  encouragement  given  to 
empiricism  by  those  who  are  understood  to  be  the  weaker 
part;  and  that  such  deceptions  should  have  still  greater  in¬ 
fluence  on  their  minds  ?  They  do  not  perhaps  take,  like  the 
men,  their  forenoon  alterative,  but  they  swallow  in  place  of  it 
their  nervous  cordial,  and  anti-hysteric  water,  such  as  Silby’s 
Solar  Tincture,  Rymer’s  Cardiac,  and  others.  Instead  of  the 
Antibilious,  they  prefer  also  perhaps  the  Female  Pill  of 
Hooper,  or  the  more  favourite  one  of  Widow  Welch  ;  and, 
as  they  are  sometimes  bad  sleepers,  they  close  the  day  with 
their  dose  of  some  celebrated  narcbtic,  as  the  long-used'  Pa¬ 
regoric  Elixir,  Dalby’s  Carminative,  &c.  &c. 

Thus,  while  the'  idea  of  health  ingrosses  the  chief  busi¬ 
ness  of  the  day  with  persons  of  fashion,  amusement,  and 
fortune,  the  very  means  employed  are  the  source  of  subvert- 


1809,  J  .  Empiricism.  3 

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

TOOTH  SPECIFICS. 

(Continued from  Vol.  I.  page  42  4. ) 

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

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

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

b  9 


4  Empiricism ,  [January, 

separ  fc  this  by  proper  instruments,  and  then  the  method  pro¬ 
posed  will  be  ( ffectualfor  preserving  them  in  a  healthy  state. 

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

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

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

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


5 


J  809.  ]  Empiricism . 

u  Tb  fender  the  above  experiment  still  more  conclusive, 
it  need  only  be  observed,  that  the  teeth  neyer  receive  any 
renewal  of  the  enamel,  when  worn  away.  That  it  incre  s^s 
only  in  growth  and  fineness  till  the  age  of  twenty  ;  but  tint 
after  that  period  it  receives  no  addition,  but  on  the  contrary 
gradually  decays,  so  that  by  the  age  of  thirty  it  will  fre¬ 
quently  be  entirely  gone.  Nay,  its  original  thickness,  even 
in  full  growth,  is  not  more  than  the  twenty-fourth  part  of 
an  inch,  how  soon  then  must  continued  friction  itself  against 
such  a  thin  structure  produce  an  abrasion. 

u  The  mischief  of  this  practice  many  have  attributed  less 
to  the  powder  than  to  the  brush  that  applies  if,  and  they 
have  therefore  substituted  a  cloth  in  place  of  the  latter. 
To  shew,  however,  that  this  idea  is  ill-founded,  the  same 
experiment  may  be  repeated  as  already  related,  employing 
a  cloth  instead  of  the  brush.  The  same  effect  will  be  found 
to  follow  it,  with  this  difference,  that  the  cloth,  by  not  en¬ 
tering  like  the  brush  into  the  interstices  of  the  teeth,  does 
not  render  the  polish  so  complete. 

ci  When  the  teeth  possess  a  thin  scale  of  tartar,  the  use  of 
prepared  charcoal  will  in  time  remove  it. 

u  After  a  thick  tartar  has  been  removed  by  instruments, 
it  will  prevent  its  re-accumulating. 

£C  The  teeth  that  are  not  regularly  clean,  should  be  more 
rubbed  with  it  than  the  others. 

u  Lotions  are  sold  under  the  name  of  tinctures,  and  the 
chief  part  of  their  composition  consists  always  in  a  certain 
proportion  of  mineral  acid.  Hence  they  turn  out,  when 
examined,  very  powerful  in  softening  and  destroying  the 
enamel. 

((  They  are  much  more  easily  applied  than  the  powder, 
are  very  quick  in  producing  their  eff  cf,  and  are  therefore 
too  often  preferred.  But  in  proportion  to  this  quickness  of 
their  operation  are  their  bad  effects  produced  ;  and  the  slower 


Empiricism.  [  January 

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

Ci  All  tinctures,  then,  for  the  teeth,  are  composed  of  mi¬ 
neral  acids,  diluted  and  concealed  under  various  artifices  ? 
and  that  this  is  the  case  is  clear, 

1st,  From  their  sour  astringent  taste,  conveying  to  the 
teeth  a  peculiar  rough  sensation. 

ce  2d,  From  their  effervescence  on  the  addition  of  an  al¬ 
kali  ;  and, 

<e  3d,  From  the  known  effects  of  mineral  acids  on  the 
teeth,  when  submitted  to  their  operation  by  way  of  expe¬ 
riment. 

Cc  From  experiments  made  on  this  subject,  it  appears, 
that  a  mineral  acid  is  the  only  menstruum  by  which  the  ena¬ 
mel  of  the  teeth  can  be  speedily  cleaned  ;  and  that,  though 
all  acids  are  powerful  solvents  of  the  teeth,  yet  that  the 
vitriolic  is  the  only  one  which  has  also  the  singular  effect 
of  whitening  them.  Hence  it  becomes  necessarily  a  prin¬ 
cipal  ingredient  in  all  such  compositions.  Nay,  it  may  be 
observed,  that  even  in  its  most  diluted  state  the  effects  of 
this  acid  on  the  enamel  are  the  same ;  and  though  several 
attempts  have  been  made  to  meliorate  its  hurtful  principle, 
and  yet  preserve  its  property  on  the  enamel,  it  appears  that 
those  properties  cannot  be  disjoined,  and  that  such  attempts 
are  merely  a  deception  of  their  authors  on  the  public. 

<c  Thus,  all  acids  seem  to  have  a  particular  tendency  to  de¬ 
stroy  the  structure  of  the  teeth,  and  that  in  proportion  to 
the  strength  of  the  acid  principle  they  possess. 

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


7 


1809.]  Empiricism. 

siderable  degree,  which  is  evident  from  the  effect  of  tartar, 
and  also  from  the  similar  known  effects  of  sugar,  sweet¬ 
meats,  See. 

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

((  To  these  bad  effects  of  mineral  substances  on  the  teeth 

themselves,  may  be  subjoined  that  of  others  which  act  upon 

the  gums,  and  thus,  in  an  indirect  manner,  have  the  same 

hurtful  tendenev.  The  chief  of  these  is  the  use  of  tooth- 

•/ 

picks.  The  gum  is  spread  closely  between  the  teeth,  and  it 
is  intended  by  this  closeness  that  the  teeth  should  support 
each  other  in  their  place.  Whatever  then  widens  the  in¬ 
terstices  between  the  teeth,  must  tend  to  destroy  the  inten¬ 
tion  of  nature ;  and  independent  of  this  also,  the  frequent 
use  of  the  tooth-pick  affords  a  more  convenient  lodgment  for 
the  food.  Instead  of  the  tooth-pick,  therefore,  a  small  hair 
brush,  like  a  pencil,  should  be  used,  which  will  answer  the 
purpose,  and  obviate  all  the  inconveniences  that  have  been 
mentioned.” 

CHEVALIER  RUSPINl’s  MEDICINES. 

Every  Dentist  acts  ns  an  empiric,  and  his  medicines  con¬ 
sist  generally  of  a  powder  and  tincture,  the  composition  of 
which  is  kept  as  a  secret,  and  they  are  vended  either  by 
himself,  or  go  into  the  Patent  Warehouse.  The  first  we 
shall  notice  of  this  class  is  the  Chevalier  Ruspini’s  Denti¬ 
frices,  being  operator  to  the  Prince  of  Wales,  and  of  course 
the  director  of  fashion  and  form  in  this  department. 

TOOTH  POWDER. 

Take  of  orris-root  in  powder— carmine,  or  rose  pink,  as 

b  4 


S  Empiricism .  [January*, 

much  as  will  colour  it — add  powder  of  scuttle-fish-bone, 
equal  parts. 

The  scuttle-fish-bone  is  a  species  of  carbonated  chalk  or 
whiting ;  so  that  the  whole  of  the  box-full  of  the  compo¬ 
sition  is  not  worth  above  one  penny. 

tincture. 

Take  red  rose  leaves,  infuse  in  warm  water,  and,  when 
strained,  add  to  the  infusion  one  half  or  a  third  of  common 
spirits. 

A  little  acid  would  have  made  this  the  infusion  of  the 
Dispensary.  Though  not  a  very  activ<  tincture,  we  consi¬ 
der  it  as  not  a  bad  composition  for  the  teeth. 

lardner’s  prepared  charcoal. 

Charcoal  Powder  has  been  long  highly  estimated  as  a 
dentifrice,  and  its  antiseptic  qualities  have  been  largely  ex¬ 
patiated  upon.  Mr.  Lardner’s  preparation,  however,  is  not 
pure;  it  contains  a  mixture  of  chalk,  or  other  testaceous 
powder,  and  the  proportion  of  charcoal  seems  to  serve  only 
for  the  colouring.  This  is  an  imposition  on  the  public.  We 
do  not  object  to  the  real  charcoal  as  a  dentifrice,  if  finely  le¬ 
vigated,  but  we  object  to  the  carbonate  of  lime  mixed 
with  it. 

CONCENTRATED  SOLUTION  OF  CHARCOAL. 

Mr.  Lardner  accompanies  his  Powder,  as  is  usual 
with  the  Dentists,  with  a  Tincture  for  the  same  purpose.  A 
concentrated  solution  is  nonsense  in  the  extreme ;  but,  in 
place  of  it,  Mr.  Lardner  has  given  this  appellation  to  an 
infusion  of  roses  impregnated  with  myrrh.  We  can  see  no 
harm  in  this  composition,  if  he  gave  it  its  real  title. 

AREKA,  OR  BETEL  NUT. 

The  charcoal  of  this  substance,  we  are  told,  is  the  great 
dentifrice  in  the  east;  but  we  doubt  this  fact.  We  cannot 
see  what  superior  quality  it  can  possess  over  other  charcoal ; 
and  we  suspect  the  latter  is  generally  used  under  this  exotic 
appellation. 


1S09.] 


Medicine . 


9 


REGULAR  PRACTICE. 


I.  MEDICINE. 

Medicine  is,  more  than  any  other,  the  science  of  speciu 
lation.  Induction,  though  introduced,  has  not  been  strictly 
adhered  to  in  the  deductions  from  facts,  nor  have  facts  been 
investigated  on  a  scale  sufficiently  extensive,  on  which  to 
form  a  basis  fit  to  rear  a  permanent  superstructure.  For  the 
truth  of  this,  we  need  not  resort  to  times  of  the  science  be¬ 
yond  the  present  period. 

VACCINATION. 

In  a  former  number  of  this  work  we  gave  the  Report  of 
the  Jennerian  Deputation  to  Cambridge  for  the  investigation 
of  the  supposed  failures  of  Cow-pox  in  that  town.  This 
Report,  the  production  of  Mr.  Blair  and  Mr.  Ring,  offered 
a  satisfactory  explanation  to  the  public  on  this  head.  But 
since  that  time  a  different  statement  has  been  presented  to  the 
Royal  College  of  Physicians  by  Sir  Isaac  Pennington,  Pro¬ 
fessor  at  Cambridge,  Containing  25  cases  of  failure  of  Cow- 
pox  as  a  preventive  of  Small-pox,  thus  leaving  the  Col¬ 
lege  to  exercise  their  judgment  upon  them;  but  proving  in 
a  strong  manner  the  certainty  of  the  fact. 

Sir  Isaac’s  letter  is  written  with  a  coolness  and  candour 
which  form  a  contrast  to  most  other  writers  on  the  subject, 
and  give  a  greater  interest  to  his  assertions.  We  hope  that 
on  this  evidence  an  opinion  will  be  delivered  by  the  College, 
which  the  importance  of  the  matter,  as  well  as  Sir  Isaac’s 
respectability,  equally  claim. 


The  introduction  of  Vaccination  into  China  has  been  at* 
tended  with  some  obstacles  which  have  not  occurred  else*? 
where,  arising  from  the  apathy  of  the  natives,  the  preju*. 
dice  of  their  medical  men,  and  the  matter  not  being  easily 


Medicine. 


JO 


[January, 


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

ABSTINENCE. 

The  remarkable  case  of  abstinence  noticed  in  our  last 
number  has  undergone  a  farther  examination  by  Dr.  Bourne, 
who,  after  relating  the  particulars  of  his  visit  to  the  patient, 
gives  the  following  history  of  it  from  her  own  recital. 

u  Sometime  prior  to  the  summer  of  1806,  she  was  troubled 

with  occasional  pains  of  her  sides  and  stomach,  especially 

\ 

after  eating,  but  her  food  was  not  then  rejected ;  and  she 
did  not  consider  herself  so  ill  as  to  pay  any  particular  re¬ 
gard  to  these  circumstances.  She  had  had,  for  a  long  time, 
the  care  of  a  boy  who  had  the  evil,  on  whose  body  were  a 
number  of  very  offensive  sores.  At  the  above  period  her 
appetite  began  to  decline,  and  what  little  food  she  took, 
her  stomach  nauseated,  but  did  not  reject;  and  she  fancied 
it  had  the  smell  and  taste  of  the  ulcers  of  the  scrpphu- 
lous  boy.  In  November  following  she  felt  herself  unable 
to  do  her  usual  work,  which  was  that  of  picking  or  beat¬ 
ing  cotton.  In  the  month  of  March  1807,  she  was  seized 
with  fits,  which  by  her  description  appear  to  have  been 
epileptic;  these  continued  about  a  fortnight,  and  were  suc¬ 
ceeded  by  cramps  at  the  stomach  and  vomitings.  She  has 
had  no  fits  since.  About  Easter  of  the  same  year,  finding 
&  total  want  of  appetite,  and  much  pain  after  swallowing, 
she  gave  up  the  attempt;  and  has  never  taken  any  thing 
solid  since  ;  nor  has  she  had  any  desire  for  food.  For  some 
time  she  continued  to  take  now  and  then  a  little  tea  and 
water,  as  mentioned  above  ;  but  having  now  no  thirst  at  any  * 
time,  s.lie  contents  herself  with  washing  her  mouth  only  two  ^ 


3809.]  Medicine.  11 

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

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

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

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


12  .  Medicine.  [January, 

in  time  destroy  the  body  ;  hence  those  unfortunate  persons, 
who  are  completely  deprived  of  the  means  of  gratifying  this 
appetite,  quickly  die.  How  then  has  life  been  sustained  in 
the  case  before  us?  If  we  examine  the  subject  philosophi¬ 
cally,  I  think  we  may  come  to  some  rational  conclusion. 
The  elementary  principles  of  the  human  body,  or  those  into 
which  it  may  be  reduced,  by  means  of  chemistry,  are  very 
few.  The  food,  whether  solid  or  liquid,  destined  for  its  nu¬ 
trition,  and  repair  of  the  changes  and  waste  it  undergoes 
during  life,  is  also  resolvable  into  the  same  elementary  prin¬ 
ciples.  And  these  principles  are  moreover  present  in  the 
atmosphere  which  we  breathe,  combined  as  it  always  is  with 
Watery  vapour,  &c.  And  it  is  only  by  the  different  com¬ 
binations  and  modifications  of  these  few  elementary  prin¬ 
ciples  that  the  various  articles  of  food;  nav,  the  almost 
infinite  variety  in  the  products  of  nature,  present  themselves 
to  our  view;  that  one  thing  is  sweet,  one  is  sour,  and  ano^ 
ther  is  bitter ;  this  is  soft  and  that  is  hard  ;  one  proves  sa¬ 
lutary,  and  another  poisonous,  &c.  And  according  to  the 
relative  affinities  which  these  elements  have  with  each  o' h  r, 
one  is  more  readily  than  another  acted  upon  by  the  juices  of 
the  stomach,  intestines,  &c.  ;  or  in  familiar  words,  one  rs 
of  more  easy  digestion  than  another.  The  universal  recep¬ 
tacle  for  food,  in  mankind  at  least,  is  the  stomach ;  but  if 
the  body  be  supplied  through  this  medium  with  nutrirtient, 
containing  only  those  principles  which  exist  in  the  atmo¬ 
sphere  which  surrounds  us ;  and  if,  by  the  total  want  of 
appetite,  this  supply  be  precluded  by  the  usual  means ;  it 
is  reasonable,  or  it  is  not  unphilosophical  at  least,  to  sup¬ 
pose  that  life  may  be  sustained,  if  the  same  principles  can 
gain  admission  by  other  channels.  It  appears  that  the 
vigour  and  strength  of  the  body  cannot  be  maintained  in 
this  manner,  as  is  the  case  with  the  subject  under  consi¬ 
deration  ;  yet  life  itself  may  thus  be  preserved  for  an  inde¬ 
finite  period.  The  well-known  instances  of  hybernating 


Medicine. 


i  809..  ] 


animals  afford  proofs  of  its  continuance  for  months  by  re¬ 
spiration  alone. 

u  I  shall  conclude  with  a  few  observations  on  two  or  three 
of  the  particulars  noted  in  this  case.  In  the  first  place, 
the  nutrition  of  the  system  is  evidently  introduced  by  the 
lungs  ;  it  is  not  our  purpose  to  inquire  here  by  what  means 
it  is  afterwards  assimilated ;  she  lives  apparently  on  air 
alone  ;  to  use  her  own  expression  6(  she  loves  air,”  and  has 
the  chamber  window  constantly  open.  As  she  almost  conti¬ 
nually  lies  in  bed,  it  is  not  probable  that  much  is  furnish¬ 
ed  by  absorption  from  the  general  surface  of  the  body. 
But  it  seems  that  a  kind  of  digestive  process  is  carried 
on  in  the  intestinal  canal ;  and  that  a  species  of  chyle  is 
there  formed.  That  there  is  some  secretion  there,  which 
undergoes  a  decomposition  of  its  elementary  principles,  is 
apparent  from  the  presence  of  air  and  moisture,  which  we 
discovered  by  pressing  the  abdomen  with  the  hand  ;  hence 
arise  the  frequent  eructations  of  flatus,  &c.  ;  but  from  the 
tenuity  of  the  matter  imbibed,  there  are  no  gross  particles 
to  form  what  is  usually  evacuated  by  stool.  The  hardness 
of  pulse  and  dry  state  of  the  skin,  seem  to  indicate  that 
there  is  not  a  sufficiency  of  moisture  introduced  into  the 
system  to  answer  the  general  intentions  of  nature;  and  pro¬ 
bably  owing  to  this  defect,  life  will  be  gradually  exhausted. 
I  apprehend  that  a  thickening,  perhaps  an  ossification  of 
the  arterial  system,  has  thus  commenced,  and  will  keep  in¬ 
creasing;  having  begun  at  the  most  remote  points  from  the 
heart,  which  afford  the  greatest  resistance  to  the  action  of 
that  organ;  thence  ascending  to  the  greater  vessels  and  to  the 
heart  itself;  and  from  the  gradual  obliteration  of  these,  life  will 
become  extinct  in  like  maimer  to  the  burning  out  of  a  lamp. 
How  long  a  time  may  be  necessary  for  the  completion  of  this 
process  it  is  impossible  to  say  ;  but  from  present  appearances 
there  is  reason  to  belieye  she  may  continue  some  months 
longer.  It  is  probable  the  frequent  use  of  the  warm  bath,  if 
she  could  bear  it,  would  tend  to  defer  her  dissolution.” 


3  4 1  Medicine [  J  amrary ,■ 

.  HYDROPHOBIA 

Is  still  the  demon  of  the  day ;  but  it  is  kept  up  by  cohtro- 
versional  reasoning,  rather  than  elucidated  in  its  nature,  or 
ameliorated  in  its  treatment.  If  we  cannot  cure,  the  object 
should  certainly  be  to  prevent,  and,  whether  the  disease 
exists  or  not,  to  take  such  precautions  as  may  give  a  chance 
of  superseding  the  constitutional  attack.  Every  patient, 
therefore,  injured  by  the  bite  of  a  dog,  should  be  treated, 
whether  .rabid  or  not,  as  if  this  state  were  actually  to  be  ex¬ 
pected.  The  period  of  attack  being  so  uncertain,  as  from 
five  or  six  weeks  even  to  a  twelvemonth,  or  more,  no  relax¬ 
ation  should  take  place  in  any  efforts  directed  to  his  safety. 
One  great  point  seems  to  be  preventing  the  healing  of  the 
wound  ;  for  the  wound  healing  so  readily  as  it  generally 
does,  impresses  the  patient  too  much  with  the  idea  that  no 
poison  can  exist,  or  be  communicated  by  it. 

Though  hydrophobia  occasionally  occurs,  we  can  see 
no  reason  for  its  being  considered  epidemic ,  or  more  frequent 
in  its  appearance  now  than  at  any  preceding  period  of  me¬ 
dical  history.  The  leprosy,  it  is  true,  has  disappeared  in 
Europe ;  but  this  is  evidently  produced  by  the  change  of 
living  and  progress  of  civilisation.  On  the  disappearance 
of  Small-pox,  nothing  as  yet  for  a  series  of  years  can  be 
decisively  stated. 

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

SEQUEL  OF  DR.  POWI-L’s  CASE  IN  REGARD  TO  ANN  CHAND¬ 
LER'S  CHILD. 

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


( 


1809.]  Medicine.  15 

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

The  statementof  this  case  of  Ann  Chandler’s  child  we  shall 
here  give,  as  detailed  by  Mr.  Hodgson.  The  child  died  when 
three  months  old ;  and  Mr.  Hodgson  prefaces  the  case  by 
observing  that  u  it  is  not  yet  ascertained,  whether  the  hu¬ 
man  subject  can  communicate  the  venom  which  produces 
hydrophobia,  still  less  whether  such  communication  can 
affect  a  child  sucking  at  the  breast  of  its  mother  whilst  under 
the  disease. 

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

f 

Ci  SYMPTOMS. 

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

u  I  saw  it  on  Thursday  the  1 1th  with  Mr.  Tuck  well ;  it  had 
screamed  in  ,the  night,  there  was  much  excitement,  a  quick 
pulse,  and  heat,  but  no  marked  appearance  of  the  disorder 
in  his  opinion.  The  bowels  remained  better. 

“  Friday,  the  symptoms  increased,  and  the  bowels  were 
again  unwell.  I  had  recourse  to  the  same  medicines,  which 
relieved  her,  but  in  the  evening  she  was  seized  with  (as  de¬ 
scribed  by  the  nurse)  staring  and  fixed  eyes,  difficulty  of 
swallowing,  with  a  vomiting  and  a  frothy  appearance  from 
the  mouth,.  -  : 


16  Medicine .  [January, 

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

cc  Sunday  morning,  it  screamed;  the  other  symptoms 
much  the  same. 

6C  Monday,  the  symptoms  of  the  head  were  much  in¬ 
creased,  and  the  whole  body  put  on  an  appearance  which 
prognosticated  dissolution. 

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

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

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

<c  APPEARANCES  ON  DISSECTION. 

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

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

6(  In  this  case,  we  find  a  child  in  perfect  health,  until 
she  is  taken  from  the  mother,  who  has  suffered  deatli  from 
the  bite  of  a  mad  cat,  which  death  is  not  produced  till 
thirty  days  after  she  is  bitten. 

T  he  strabismus,  a  diagnostic  sign  of  hydrocephalus, 
appears  on  the  ninth  day,  but  the  increased  actions  on  the 
fourth. 

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


Medicine . 


17 


1809.] 


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

Ci  The  difficulty  of  swallowing  on  Friday,  and  the  vomit¬ 
ing  which  followed,  together  with  the  observation  of  Mr. 
Clark  and  myself,  on  giving  water  to  the  last  day,  are  cir¬ 
cumstances  by  no  means  unimportant.” 


SYMPATHY  BETWEEN  THE  BRAIN  AND  STOMACH  IN  CASES 

OF  DISEASE. 

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

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

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


YELLOW  FEVER. 

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

VOL.  II. 


c 


IS  Medicine »  [January, 

formidable  disease,  our  preference  has  been  decidedly  given 
to  the  mercurial  practice,  or  the  mode  of  raising  and  sup? 
porting  healthy  inflammatory  action  in  such  a  manner  as 
may  counteract  the  state  of  asthenic  debility  produced  by 
the  Qperation  of  the  morbid  cause.  The  superiority  of  this 
practice,  the  offspring  of  tropical  observation,  is  attested  by 
all  the  most  modern  writers  who  have  seen  the  disease ;  and 
the  decided  sanction  it  has  received  in  Jamaica  in  particular, 
the  subjoined  testimony  of  the  united  medical  experience 
of  that  island  will  confirm  to  the  satisfaction  of  the  most  seep? 
tical,  as  the  only  certain  mode  of  affording  relief,  and  saving 
the  victims  of  this  deplorable  malady.  This  testimony  has 
been  brought  forward  inconsequence  of  a  literary  controversy 
betwixt  Dr.  Grant  and  Dr.  Dancer  of  Jamaica. 

On  subjects  of  medicine  we  consider  the  disputes  of  pro¬ 
fessional  characters  as  favourable  to  the  cause  of  science. 
Collision  of  opinion  ever  leads  to  improvement.  Like  the 
flint  struck  against  the  steel,  it  gives  brilliancy  and  acuteness 
to  the  id' as  of  the  disputants.  If  personalities,  which  is  un¬ 
fortunately  too  often  the  case,  intervene,  it  is  easy  for  the 
spectator  to  separate  the  gold  from  the  alloy.  That  there  is 
too  much  personality  in  the  controversy  of  these  gentlemen, 
we  admit.  Dr.  Grant,  wedded  to  the  old  practice,  con¬ 
tends  for  bleeding  and  hark ;  while  Dr.  Dancer  is  an  enthu¬ 
siast  in  favour  of  the  new  dqctrine,  in  which  he  is  joined  by 
the  whole  medical  science  of  the  island,  with  one  or  two  ex¬ 
ceptions.  Dr,  Dancer’s  opinion  he  states  to  the  public  in 
the  following  words  : 

There  being  at  present  but  hardly  one  opinion  amongst 
the  Medical  Practitioners  of  this  island,  concerning  the  best 
known  mode  of  treatment  in  Yellow  Fever,  it  is  matter  of 
regret  that  anything  should  have  appeared  so  entirely  out  of 
date,  to  provoke  fresh  discussion  on  the  subject.— The  public 
are  unhapi  iiy  too  well  convinced,  bj'  experience,  of  the  fa¬ 
tality  attending  the  practice  of  large  bleedings  and  giving 


Medicine . 


19 


1809;] 

the  bark  in  Yellow  Fever,  to  be  either  imposed  on  by  the 
bold  assertions  of  an  individual  (Dr.  Grant),  or  to  be  influ¬ 
enced  by  the  opinion  of  Reviewers  in  Europe,  who,  with 
all  their  competency  for  general  criticism,  cannot  be  sup¬ 
posed  qualified  to  decide  on  a  question  of  this  nature,  which 
can  only  be  determined  by  actual  observation  and  experi¬ 
ence;  and  not  by  cx  parte  documents. — There  is  not  a  mer¬ 
chant  or  head  of  a  family  in  this,  or  any  of  the  sea- port 
towns,  who  is  not,  by  the  frequent  and  melancholy  opportu¬ 
nities  he  has  had  of  seeing*  cases  of  Yellow  Fever,  better 
qualified,,  in  some  respects.,  to  give  an  opinion  concerning 
the  disease,  than  the  whole  College  of  Physicians. -^-Physi¬ 
cians  will  judge  always  from  what  comes  under  their  own  ob¬ 
servation — and,  with  respect  to  Yellow  Fever,  the  Medical 
men  in  Europe  know  nothing  ;  except  those  who  have  been 
in  the  West  Indies,  and  have  practised  there,  who  are  al¬ 
most  unanimous  in  their  opinion  concerning  the  danger  of 
bleeding ,  the  mischief  of  giving  bqrk9  and  the  utility  of 
giving  mercury  . 

u  It  would  be  superfluous  to  quote  authors ;  but  if  there 
be  not  ten,  or  at  least  five,  to  one,  in  favour  of  the  use  of 
mercurial  treatment  in  Yellow  Fever,  let  the  contrary  be 
shewn.” 

In  confirmation  of  the  propriety  of  this  opinion  of  Dr. 
Dancer,  the  following  farther  testimony  has  appeared  by 
the  different  medical  characters  practising  in  Jamaica: 

<c  We  the  undersigned  practitioners  of  physic  in  the  city 
of  Kingston  and  island  aforesaid,  conceiving  that  we  are 
called  on  by  the  duty  we  owe  the  public,  and  in  justifica¬ 
tion  of  ourselves  against  the  charge  of  mal-practice,  to  state 
our  opinion  concerning  the  best  known  mode  of  treatment  in 
Yellow  Fever  ;  do,  on  the  fullest  conviction,  after  longex- 
perience,  solemnly  declare,  that  in  our  judgment,  the  prac- 
<ice  of  giving  calomel  and  employing  mercurial  frictions,  so 
m  to  induce  a  slight  salivation,  is  the  safest  and  most  success? 

$  2 


20  Medicine .  [January, 

ful;  other  means  are,  due  evacuations  by  stool ;  affusion  of 
cold  water,  &c9  &c.  not  being  neglected.  But  we  are  firmly 
of  opinion  that  blood-letting,  except  in  the  moment  of  the 
attack,  is  highly  detrimental,  and,  even  at  this  crisis,  the  adr 
missibility  of  it  may  in  most  cases  be  justly  questioned. 

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

u  Lastly,  we  beg  leave  to  mention,  that  so  far  as  we  are 
acquainted  with  the  sentiments  of  other  practitioners  in  dif¬ 
ferent  parts  of  this  island,  and  of  the  other  islands  of  the 
West  Indies;  and  of  the  surgeons  of  the  navy  and  army5 
they  entirely  coincide  with  those  we  have  expressed. 

fc  To  the  testimony  of  the  undersigned  might  be  adder} 
that  of  several  eminent  and  respectable  practitioners  now 
no  more,  or  who  have  left  the  country.” 

NEW  PRACTICE  IN  DIABETES,  AND  CERTAIN  NERVOUS 

DISEASES. 

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


1809.] 


Medicine . 


n 

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

MONTHLY  REPORTS  OF  DISEASES. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator * 

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

I  am,  Gentlemen, 

Your  obedient  Servant, 

fj)ndonj  December  14,  1808.  •  W.  NISBET 

c  3 


Medicine . 


[January 


n. 

Communication  of  Dr,  Nisbett ,  on  an  improved  Plan  of 
Monthly  Reports  of  Diseases ,  addressed  to  the  Phy¬ 
sicians  of  the  Hospitals  and  Dispensaries  of  the  Metro¬ 
polis, 

Gentlemen — The  first  object  of  every  professional  charac¬ 
ter  ought  to  be  the  improvement  of  that  science,  to  which 
he  has  devoted  his  attention.  It  is  one  paramount  to  every 
other  in  its  interest  with  mankind,  and  it  is  one,  therefore, 
to  which  mankind  must  ever  look  up  with  veneration  and 
gratitude,  as  imparting  the  means  of  suspending  and  remove 
ing  those  sufferings  which  unfortunately  u flesh  is  heir  to .” 

The  knowledge  of  this  science  is  only  acquired  by  expe¬ 
rience  and  observation ;  and  on  no  part  of  it  can  these  be 
more  usefully  employed  than  in  forming  accurate  reports 
of  diseases,  and  from  such  reports  drawing  the  proper  in¬ 
ductions  that  establish  our  opinion  of  their  nature — of  the 
frequency  of  their  attack,  of  the  constitutions  most  subject  to 
particular  diseases,  and  in  the  end  of  their  comparative 
fatality. 

No  situation  offers  such  an  extensive  field  for  this  purpose 
as  the  great  medical  charities  of  the  metropolis ;  and  to 
you,  Gentlemen,  I  beg  leave  to  offer  a  few  suggestions  on 
the  importance  of  this  point,  as  one  connected  with  the 
performance  of  your  public  functions  in  your  several  charges, 
as  one  from  which  society  in  general,  as  well  as  every  branch 
of  the  profession i  must  reap  the  most  solid  advantages,  and 
ns  one  necessary  to  the  intelligence  of  the  legislature  itself, 
in  forming  statements  of  the  population  and  strength  of  the 
country,  which  can  only  be  judged  of  by  ascertaining  the 
extent  of  the  ravages  from  disease. 

From  these  considerations,  I  can  have  no  doubt  of  your 
zeal  and  philanthropy  to  assist  in  making  such  arrangements 
as  may  convey  the  necessary  information  that  the  execution 
such  a  plan  requires. 


1809*]  Medicine .  §5 

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

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

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

c  4 


24  Medicine.  [January* 

consumption,  gout,  rheumatism,  &c.  which  all  afford  an 
ample  field  for  distinct  lines  of  practice. 

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

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

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


1809.]  Medicine.  25 

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

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

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


26  Medicine .  [January^ 

has  visited  the  patient,  should  send  a  note  on  the  death  of 
the  person,  stating  the  disease  of  which  he  died  to  the  pa¬ 
rish  clerk,  to  be  inserted  in  the  register,  from  which  the 
annual  bills  of  mortality  are  made  up.  This  would  make 
the  general  issue  of  all  diseases  clear,  and  faithfully  establish 
the  proportion  of  their  fatality  to  each  other. 

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

In  the  mean  time,  I  remain,  Gentlemen, 

"Your  obedient  Servant, 

London,  Dec.  1 5th.  WM.  NISBET. 

% 


1809.]  Medicine .  27 

REPLY  TO  DR.  W.  Y.’s  CRITICISM  ON  DR.  POWEL’s  CASE  OF 

HYDROPHOBIA. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator \ 

Gentlemen— “Having  in  a  former  number  written  in  de« 
fence  of  the  plan  adopted  by  Dr.  Powel,  I  should  eon* 
ceive  it  a  desertion  of  my  principles,  did  I  not  reply  to  the 
animadversions  of  Dr.  Y. ;  and  as  the  case  is  one  of  public 
importance,  if  I  offer  nothing  new,  I  shall  at  least  excite  a 
desire  for  investigation. 

In  the  unadorned  narration  of  Dr.  Powel,  I  can  discover 
no  leading  fact  so  overstrained  as  to  induce  any  one  to 
preconceive  any  partial  theory.  The  case  is  a  decisive  proof 
of  the  existence  of  a  species  of  tetanus,  that  has  acquired 
the  name  of  hydrophobia,  rather  in  compliance  to  general 
adoption,  than  to  propriety  of  expression ;  but  as  the  term 
of  hydrophobia  is  properly  understood,  a  misnomen  is 
here  of  little  importance;  for,  by  the  general  acceptation  of 
hydrophobia,  is  meant  a  disease  that  arises  from  the  saliva 
of  a  rabid  animal ;  and  as  such  a  disease  really  exists,  by 
whatever  name  we  may  counter-distinguish  it,  from  other 
species  of  tetanus  ;  hence,  whether  I  proceed  to  consider  hy¬ 
drophobia  as  arising  from  a  specific  virus,  secreted  by  the 
saliva  of  rabid  animals,  or  a  deviation  from  the  general  va¬ 
riety  of  tetanus  produced  by  a  lacerated  wound,  or  injured 
nerve,  can  be  here  of  little  moment,  since  the  treatment  will 
not  be  influenced  by  tbe  proximate  cause  of  the  disease,  so 
much  as  by  the  symptoms,  as  they  concur  and  arise :  and 
I  am  supported  in  this  argument  by  corresponding  facts  ; 
for,  in  most  species  of  tetanus,  the  constitutional  disease  is 
healed  before  any  spasmodic  affection  comes  oir. 

Dr.  Powel  has  distinctly  stated  that  his  unfortunate  patient, 
Ann  Chandler,  was  wounded  by  a  cat  supposed  to  be  mad ; 
two  cats  were  fighting,  and  in  this  moment  of  high  irritation 
she  interposes  to  separate  these  furious  combatants  ;  in  the 


28  Medicine.  [January, 

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


Medicine . 


29 


lj80@.j 


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


so 


Medicine « 


[  January , 


but  these  analogies  certainly  favour  the  existence  of  a  dis¬ 
ease,  communicated  to  man  by  animals,  if  a  rational  doubt 
could  be  entertained  on  the  subject :  and  this  doctrine  com¬ 
pletely  militates  against  the  idea,  that  Anri  Chandler’s  mind 
was  too  much  absorbed  by  the  nature  of  her  malady,  to  ad* 
tnit  of  a  fair  inference.  If  a  patient  perusal  of  the  case  is 
allowed,  I  think  it  will  be  found,  in  the  early  part,  her 
mind  appears  not  to  be  so  materially  affected  by  the 
event,  and  subsequently,  not  absolute  prepossession  of  the 
nature  of  the  disease  virtually  takes  place,  till  it  as¬ 
sumes  too  decided  a  character  to  admit  of  hesitation. 
Then  indeed  we  see  a  calamitous  train  of  events  arise  ; 
but  those,  it  is  evident,  arise  more  from  the  effect  of  the 
contagion,  than  the  prepossession  of  her  mind  respect¬ 
ing  her  disease:  the  mind,  amid  the  mighty  and 
harassing  conflict,  appears  to  have  combated  long  against 
its  enemy  ;  but  its  energies,  weakened  by  constant  exertion, 
at  length  yield  to  its  baneful  foe,  and  finally  we  see  the 
patient  fall  a  victim  to  rabid  contagion  in  all  its  horrors. 

Next,  the  want  of  the  pathognomic  symptom,  an  increased 
secretion  of  saliva,  is  also  noticed  ;  but  this  surely  admits, 
in  an  overflow  of  more  accurate  symptoms,  of  no  peculiar  in¬ 
ference,  but  can  alone  be  regarded  as  an  irregularity  of  the 
disease,  and  does  not  at  all  invalidate  the  opinion  of  Dr. 
Fowel :  the  attempt  to  bite  is  common  to  hysteric  affections, 
it  is  true,  blit  it  does  not  follow  we  are  to  exclude  it  from  hyr 
drophobia;  respecting  the  effects  of  sound,  nothing  new  is 
offered  to  justify  our  denial  of  the  existence  of  the  disease. 
In  every  simple  disease,  anomalous  symptoms  are  constantly 
arising ;  therefore,  in  a  disease  of  this  rare  occurrence,  wc  are 
iiot  warranted  to  dispute  its  existence,  because  some  irregular 
symptoms  may  not  appear  so  decided  as  might  be  wished. 
The  effect  of  sound  has  no  great  influence  in  common  cases 
of  tetanus,  nor  does  the  idea  of  water  produce  the  sensation 
in  other  species  of  tetanus  that  we  are  describing ;  far 
the  horror  of  solids  and  liquids  alone  belongs  to  this  class, 


Medicine * 


SI 


1809.] 


and  may  be  considered  as  a  distinguishing  character  of  the 
disease  :  therefore  I  have  no  hesitation  in  maintaining  the 
Correct  idea  Dr.  Powel  formed  of  this  case ;  an  idea  sup¬ 
ported  by  the  terminatioii  of  the  disease. 

We  next  come  to  the  considerations  of  the  mode  Dr.  Powel 
adopted  for  the  safety  of  his  patient ;  he  judiciously  chose  to 
try  the  argentum  nitratum,  a  medicine  of  very  high  import, 
and  one  not  uncertain  in  its  operation,  therefore  the  more  cor¬ 
rect  in  its  application  ;  and  though  by  this  mode  the  patient 
was  not  saved,  that  is  no  argument  against  itp  future  trial:  for 
I  am  well  convinced,  that  in  all  spasmodic  diseases  it  is  an 
useful  medicine,  and  conjoined  with  opium  may  be  rendered 
of  important  service ;  in  epilepsy  its  effects  are  known,  and  in 
the  ague  of  low  countries  it  acts  as  a  specific.  Thus  testimo¬ 
nies  are  not  wanting  of  its  efficacy,  and  justify  its  application 
in  this  instance.  In  extreme  debility,  too,  it  is  a  medicine  far 
better  than  the  sulphas  ferri,  sulphas  zinci,  or  any  tonic  of  that 
class.  Its  causticity  by  the  action  of  the  stomach  is  destroyed, 
for  becoming  saturated  by  a  combination  of  new  principles, 
peculiar  to  the  organ  of  the  stomach,  its  corrosive  action 
ceases,  and  its  medicinal  one  commences.  Thus,  Gentlemen,  I 
see  no  reason  for  condemning  its  practice  in  the  case  before  us. 
A  bold  and  decisive  practice  is  ever  preferable.  I  shall  take 
my  leave  of  you  for  the  present,  with  recommending  a  care¬ 
ful  perusal  of  Dr.  Powel’s  case  to  every  medical  practi¬ 
tioner.  In  the  interim,  I  remain, 

Your  obedient  Servant, 

london,  Dec.  6,  1808.  THOMAS  MOTT  CATON. 

HYDROPHOBIA. 

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

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — Ip  ridicule  were  a  certain  test  of  truth,  1 
should  find  little  inclination  to  interrupt  your  facetious  cor¬ 
respondent  Dr.  W.  Y. 


32 


Medicine . 


[  January , 


Dazzling  are  the  coruscations  of4  the  Doctor’s  wit,  and  he 
has  revelled  in  its  brilliancy,  even  to  the  total  discomfiture  of 
his  logic.  But  of  this  hereafter— 

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

It  is  unfortunate  for  Dr.  Y.  that  his  first  assertion,  one 
too  on  which  he  builds  so  much,  should  be  founded  in  error. 

I  never  heard  of  Dr.  Powel’s  case  until  a  fortnight  after  my 
patient  had  expired. 

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


ginning. 

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


Medicine . 


S3 


\ 

Dr.  W.  Y  .  asserts  that  the  absence  of  inflammatioi  in  the 
lymphatics  is  a  sufficient  proof  of  the  non-absorption  of 
any  morbid  poison — but  is  inflammation  a  necessary  conse¬ 
quence  of  absorption  ? 

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

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

I  have  before  observed  that  knowledge  is  best  obtained  by 
a  careful  notation  of  facts,  and  by  the  inferences  thence  de- 
ducible.  If  this  be  granted,  what  will  become  of  the  fol¬ 
lowing  position  of  Dr.  W.  Y.  ?  u  It  is  totally  unnecessary 
to  make  any  comments  on  the  particular  symptoms  which 
distinguish  the  progress  of  this  disease.”  Does  the  Doctor 
mean  that  it  is  useless  to  comment  on  the  disease  of  hydro¬ 
phobia  in  particular,  or  on  diseases  in  general?  But  to  quote 
farther,  u  whether  they  (the  symptoms)  were  produced  by  a 
splinter  of  wood,  or  the  teeth  of  a  dog  ;  whether  1  he  horror 
of  fluids  arose  from  a  particular  state  of  mind  incident  to 
the  malady,  or  merely  from  the  pain  and  difficulty  of  swal¬ 
lowing,  the  case  under  consideration  is  conclusive  that  hy¬ 
drophobia  is  not  a  contagious  disease,  which  is  capable  of 
being  communicated,  either  mediately  or  immediately,  from 
dog  to  man.”  What  can  the  Doctor  mean  ! ! ! 

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

VOL.  II. 


n 


Medicine. 


[January, 


reason  in  support  of  his  inference,  lie  concludes  from  the 
case  in  question,  that  hydrophobia  is  not  a  contagious 
disease. 

With  the  same  intuitive  glance  (for  he  admits  not  of  the 
vulgar  support  of  proofs)  by  which  the  above  discovery  was 
made,  does  he  in  the  next  sentence  proclaim  that  the  “  dog 
was  not  mad.”  But  if  in  this  instance  the  dog  was  not  mad, 
how  can  it  be  thereby  ascertained  that  hydrophobia  is  not  a 
contagious  disease?  May  not  the  Doctor’s  Irishisms  give 
support  to  a  certain  knight-errant,  who  in  his  u  righte 
merrie  and  conceifede  tpur,”  has  advanced,  that  the  only 
bull  he  heard  in  all  Ireland,  was  from  the  mouth  of  an  Eng¬ 
lishman  ? 

In  the  written  account  I  received  from  the  master  of  the 
dog,  he  states  that  she  was  carefully  confined  on  her  return 
home,  on  account  of  her  diseased  appearance,  and  from  her 
having  snapped  at  the  children,  (a  thing  quite  unusual  with 
her);  and  that,  instead  of  being  u  infirm  and  exhausted,”  she 
was  about  a  fortnight  before  she  died  as  liyely  and  playful 
as  ever. 

Another  circumstance  has  lately  come  to  my  knowledge, 
that  will  tend  much  to  prove  that  the  animal  was  diseased, 

A  day  or  too  previous  to  Mrs.  Sharpe’s  accident,  the  dog 
was  known  to  bite  another  in  the  neighbourhood,  which, 
about  a  month  afterwards,  exhibited  what  I  believe  to  be  the 
true  symptoms  of  rabies.  The  heavy  appearance  of  his 
eyes,  and  snapping  at  every  object  during  two  days,  first 
attracted  notice.  He  then  broke  out  from  his  master’s  yard, 
and  ran  wildly  about  the  country  for  several  hours.  On  his 
return  he  was  closely  confined,  and  died  in  five  days  from  the 
attack.  A  howling  of  a  very  unusual  kind  was  always  fol¬ 
lowed  by  furious  action,  which  continued  for  some  time, 
and  was  succeeded  by  sleep.  When  he  awoke  the  same  phe¬ 
nomena  were  again  exhibited.  On  the  fourth  day  the  howl 


Medicine . 


3  5 


SOD.  j 

became  gradually  weaker,  and  during  (lie  whole  of  the  last 
it  had  ceased  altogether — the  first  three  days  he  ate  as  usual, 
but  during  the  two  last  he  refused  every  thing. 

I  remain,  Gentlemen,  &c. 

HENRY  U.  THOMSON, 

Member  of  the  Royal  College  of  Surgeons,  London. 

, Kensington ,  Dec.  1 7  th,  1808. 


Medical  Reports  of  Cases  and  Experiments ,  with  Observa¬ 
tions,  chiefly  derived  from  Hospital  Practice ,  fyc. 
By  Samuel  Argent  Bardsley ,  M .  D.  M.M.  S.  Ed. 
and  M.  S.  London  s  Physician  to  the  Manchester  In¬ 
firmary. ,  £?.c.  S?c.  8vo.  pp.  336 . 

(Continued  from  Vol.  I.  page  4&5.) 

The  extracts  already  given  from  this  interesting  practical 
work  will  have  satisfied  our  readers  that  Dr.  Rardsley  has 
not  written  without  much  consideration  of  his  subject,  and 
an  attention  to  the  opinions  of. preceding  writers.  If  we 
do  not  always  coincide  with  him  in  opinion,  we  have  no 
reason  to  find  great  fault;  and  even  when  he  advances  nothing 
new  of  his  own,  he  renders,  by  his  remarks,  the  opinions  of 
others  more  perspicuous,  and  supports  them  by  additional 
facts. 

As  the  subject  of  Hydrophobia  at  present  fills  so  many 
of  our  pages,  and  excites  so  much  the  public  regard,  the 
following  addition  from  Dr.  Bardsley ’s  publication,  we 
should  conceive,  would  be  found  particularly  curious,  and 
properly  chosen  to  close  this  subject.  It  is  called  a  The 
history  of  a  case  of  Hydrophobia  occurring  12  years  after  the 
bite  of  a  supposed  Mad  Dog.3’  It  is  introduced  by  the  au» 
thor’s  remarking  that the  folio  wing  case  has  a  peculiar 
claim  to  attention,  on  account  he  great  distance  of  time, 
from  the  bite  of  a  supposed  rabid  animal,  to  the  appearance 
of  the  disease.  It  is,  indeed,  a  difficult  task,  to  ascertain  a 

d  2 


36 


Medicine. 


[January 


fact  of  th  is  nature;  and  especially,  when  inquiries  are  to  be 
made  from  ignorant  and  prejudiced  persons.  As  it  is,  how¬ 
ever,  a  mailer  of  the  utmost  importance  to  be  established, 
no  pains  have  been  spared  to  gain  every  intelligence  which 
tjbe  patient  and  his  friends  were  capable  of  communicating. 
The  result  of  the  inquiry  is  in  favour  pf  the  patient’s  re¬ 
peated  assertion  :  c  That  he  had  never  suffered  the  least  in¬ 
jury  from  any  animal ;  except  the  bite,  inflicted  twelve 
years  since,  by  an  apparent  mad  dog,’ 

a  John  Lindsay,  weaver  at  Fearn  G ore  near  Bury,  in  the 
county  of  Lancaster,  aged  thirty-six,  of  middling  stature, 
and  spare  habit  of  body,  and  pf  a  temperament  inclined  to 
the  melancholic,  was  brought  into  the  Manchester  Lunatic 
Hospital,  on  Friday  May  the  sixteenth,  1794,  about  three 
o’clock  in  the  afternoon.  He  was  immediately  visited  by 
Dr.  Le  Sassier,  who  obligingly  communicated  to  me  the  fol¬ 
lowing  particulars:  The  patient  expressed  feelingly  his 
sense  of  danger,  from  the  persuasion  that  his  disorder  pro¬ 
ceeded  from  the  bite  of  a  mad  dog.  He  was  desired  to  drink 
a  little  cold  water,  which  on  being  presented  to  him  he  re¬ 
jected,  with  every  appearance  of  disgust  and  horror.  Being 
again  strongly  urged  to  drink,  he  made  the  attempt,  and 
with  great  exertion  got  down  a  small  quantity  of  the  liquid. 
He  was  perfectly  rational,  but  appeared  apprehensive  of 
danger  from  the  least  noise,  or  approach  of  any  person  to¬ 
wards  him.  lie  expressed  a  desire  to  make  water,  and  was 
quitting  the  room  for  that  purpose ;  but  no  sooner  had  lie 
approached  the  door,  than  he  suddenly  retreated,  complain¬ 
ing  of  an  unpleasant  sensation  he  felt  from  the  cold  air,  and 
particularly  that  it  produced  a  convulsive  twitching  about 
his  throat.  To  screen  him  from  the  effects  of  the  air,  when 
conveyed  from  the  examining-room  into  the  Hospital,  an 
umbrella  w^as  held  over  his  head,  and  his  body  muffled  up  in 
a  wrapping  cloak.  As  soon  as  he  had  got  into  his  apartment, 
he  ate  some  bread  and  cheese,  but  with  difficulty  :  and  re** 


Medicine. 


37 


*809.] 

quested  to  be  allowed  to  drink  some  butter-milk.  He  at¬ 
tempted  to  swallow  this  liquid,  and  in  part  succeeded  ;  but 
not  without  the  most  violent  struggling  efforts,  attended  with 
distortions  of  his  countenance,  which  remained  slightly  con¬ 
vulsed  for  some  time  afterwards. 

A  consultation  of  the  physicians  of  the  Hospital  being 
called  by  Dr.  LeSassier,  and  the  assistance  of  Dr.  Percival, 
physician  extraordinary  to  the  charity,  requested  ;  the  latter 
Gentleman,  in  concurrence  with  Dr.  Le  Sassier,  (the  rest  of 
the  faculty  being  out  of  the  way,)  entertained  not  the  least 
doubt  of  this  patient  being  afflicted  with  genuine  Hydro¬ 
phobia*  As  the  disorder  was  far  advanced,  and  might,  in¬ 
deed,  be  considered  as  nearly  terminating,  being  the  third 
day  from  the  appearance  of  the  symptom  of  Hydrophobia, 
little  or  no  advantage  could  be  expected  from  medicine.  He 
was  ordered,  however,  about  four  o’clock  the  same  afternoon, 
to  take  a  bolus  composed  of  twelve  grains  of  musk,  two 
grains  of  opium,  and  six  grains  of  camphor.  Two  drachms 
of  strong  mercurial  ointment  were  also  directed  to  be  rubbed 
in,  upon  the  throat  and  breast.  I  saw  the  patient,  in  com¬ 
pany  with  the  other  physicians,  about  six  o’clock  the  same 
evening ;  and  we  found  him  very  willing,  and  sufficiently 
composed,  to  give  a  distinct  account  of  the  circumstances 
preceding  the  disease,  and  to  describe  his  sufferings  since  its 
attack.  The  following  particulars  were  collected  :  He  has 
been  industrious,  sober,  and  regular  in  his  mode  of  living  ; 
but  subject  to  low  spirits  from  the  difficulty  he  found,  at 
times,  of  maintaining  a  wife  and  six  young  children.  His 
exertions,  however,  were  in  general  proportionate  to  his 
difficulties.  But  of  late,  from  the  depreciation  of  labour,  he 
found  that  the  most  rigid  oeconomy  and  indefatigable  indus  ¬ 
try  were  not  sufficient  to  ward  off,  from  himself  and  family, 
the  calamities  of  hunger,  debt,  and  most  abject  poverty. 
The  anxiety  of  his  mind  now  became  almost  insupportable. 
As  the  last  refuge  for  his  distress,  he  applied,  a  few  days 


38  Medicine .  [January, 

previous  to  the  attack  of  his  complaint,  to  the  Overseers  of 
his  Parish  for  their  assistance  to  pay  his  rent,  and  thereby 
prevent  the  seizure  of  his  goods;  but  obtained  no  relief* 
Overwhelmed  with  grief  and  disappointment,  he  yielded 
to  despair,  resigning  himself  and  family  to  their  wretched 
fate.  He  was  soon  roused  from  this  state  of  fancied  apathy, 
by  the  piercing  cries  of  his  children  demanding  bread.  In 
a  paroxysm  of  rage  and  tenderness,  he  sat  down  to  his  loom 
on  the  Monday  morning,  and  worked  night  and  day,  seldom 
quitting  his  seat,  till  early  on  the  ensuing  Wednesday  morn¬ 
ing.  During  this  period  of  bodily  fatigue  and  mental  anx¬ 
iety,  he  was  entirely  supported  by  hasty  draughts  of  cold 
butter-milk,  sparingly  taken.  Nor  did  he  quit  the  loom, 
until  his  strength  was  completely  exhausted.  He  then  threw 
himself  upon  his  bed,  and  slept  a  few  hours.  On  waking, 
he  complained  of  giddiness  and  confusion  in  his  head,  and  a 
general  sense  of  weariness  over  his  body.  He  walked  five 
miles  that  morning,  in  order  to  receive  his  wages,  for  the 
completion  of  his  work  ;  and  on  his  return,  felt  much  fa¬ 
tigued,  and  troubled  with  a  pain  in  his  head.  During  the 
night,  his  sleep  was  interrupted  by  involuntary  and  deep 
sighs— slight  twitch ings  in  the  arms — and  a  sense  of  weight 
and  constriction  at  the  breast.  He  complained  of  much 
uneasiness  at  the  light  of  a  candle,  that  was  burning  in  the 
room.  On  evacuating  his  urine,  he  was  obliged  to  turn 
aside  his  head  from  the  vessel,  as  he  could  not  bear  the  sight 
of  the  fluid  without  great  uneasiness.  Being  rather  thirsty,, 
he  wished  for  balm-tea  to  drink  ;  but  was  unable  to  swallow 
it  from  a  sense  of  pain  and  tightness,  which  he  experienced 
about  the  throat,  when  the  liquid  was  presented  to  him.  He 
suddenly,  exclaimed,  on  perceiving  this  last  symptom, 
(  Good  God  !  It  is  all  over  with  me!1  and  immediately  re¬ 
called  to  his  wife’s  recollection,  the  circumstance  of  his 
having  been  bitten,  twelve  years  ago,  by  a  large  dog  ap¬ 
parently  mad  ;  which  was  flying  from  the  pursuit  of  a  num- 


Medicine. 


1809.] 


her  of  people,  on  the  high  road  between  Warrington  and 
Manchester. 

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

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

i)  4 


40  Medicine..  ["January 

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


» 


1809.]  Medicine ,  41 

ia  t lie  gallery,  he  begged  in  the  most  pitious  accents  to  be 
protected  froqi  harm.  He  had  never  offered  the  least  violence 
to  any  one,  since  the  commencement  of  the  disease  ;  and  even 
now,  when  the  increased  secretion  of  saliva  occasioned  him 
to  spit  out  very  frequently,  he  apologised  to  thebye-standers, 
and  al  ways  .desired  them  to*  move  out  of  the  way.  I  ob¬ 
served,  he  frequently  fixed'  his  eyes,  with  horror  and  af¬ 
fright,  on  some  ideal  object ;  and  then,  with  a  sudden  and 
violent  motion,  buried  his  head  underneath  the  bed-cloaths. 
The  last  time  I  saw  him  repeat  this  action,  1  was  induced  to 
inquire  into  the  cause  of  his  terror. — He  eagerly  asked,  if  I 
had  not  heard  bowlings  and  scratchings  ?  On  being  an¬ 
swered  in  the  negative,  he  suddenly  threw  himself  upon  his 
knees,  extending  his  arms  in  a  defensive  posture,  and  forci¬ 
bly  throwing  back  his  head  and  body.  The  muscles  of  the 
face  were  agitated  by  various  spasmodic  contortions ; — his 
eye  balls  glared,  and  seemed  ready  to  start  from  their  sock¬ 
ets  and  at  that  moment,  when  crying  out  in  an  agonising 
tone — £  Do  you  not  see  that  black  dog?’  his  countenance 
and  attitude  exhibited  the  most  dreadful  picture  of  compli¬ 
cated  horror,  distress,  and  rage,  that  words  can  describe,  or 
imagination  paint  ! — The  irritability  of  the  whole  system 
was  now  become  excessive.  He  discovered  the  highest  de¬ 
gree  of  impatience  on  the  least  motion  of  the  air.  Every 
action  was  accompanied  with  that  hurry  and  inquietude, 
which  marks  an  apprehension  of  danger  from  surrounding 
objects.  The  oppression  of  the  prmcordia  was  evidently  en- 
creased  ;  and,  when  he  gasped  for  breath,  the  whole  body 
was  writhed  with  convulsions.  His  speech  was  interrupted 
by  convulsive  sobs.  The  pulse  was  tremulous  and  inter¬ 
mitting;  and,  at  sometimes,  so  hurried  as  not  to  be  counted. 
He  had  frequent  retchings,  and  brought  up  occasionally 
small  quantities  of  a  yellow  liquid.  Solids  were  now  swal¬ 
lowed  with  excessive  difficulty ;  and  the  attempt  always  pro¬ 
duced  strong  spasms  about  the  neck  and  breast.  At  tern 


42  Medicine.  [January, 

o’clock  (the  same  morning)  we  met  in  consultation  ;  when 
the  medicines  were  ordered  to  be  repeated  every  two  hours, 
with  an  increase  of  the  dose  of  opium,  from  two  to  three 
grains.  Half  an  ounce  of  strong  mercurial  ointment  was 
ordered  to  be  rubbed  in  over  the  surface  of  the  body,  and 
a  sponge  dipped  in  vinegar  to  be  constantly  held  to  the 
mouth  and  nostrils.  At  four  o’clock  the  same  day,  the  con¬ 
sultation  was  renewed.  We  found  the  patient  had  been  able 
to  swallow  his  boluses  without  much  difficulty,  and  had 
drank  several  times  with  infinitely  more  ease  than  usual  ;  but 
the  fluid  had  been  immediately  rejected  by  the  stomach, 
and  had  come  up,  deeply  tinged  with  yellow.  His  counte¬ 
nance  exhibited  a  cadaverous  aspect.  His  voice  was  hoarse, 
indistinct,  and  faultering.  He  complained  of  a  fi^ed  pain  at 
the  region  of  the  stomach  ;  which  lie  had  felt,  more  or  less, 
during  the  disease.  The  pulse  was  feeble,  and  scarcely  per¬ 
ceptible.  He  swallowed  some  tea  with  less  difficulty  than 
had  been  observed  since  his  entrance  into  the  Hospital. 
His  dissolution  was  apparently  drawing  near  ;  yet  it  was 
deemed  advisable  to  order  his  body  to  be  rubbed  with  warm 
oil ;  and  one  ounce  of  that  fluid  to  be  taken  every  half  hour, 
or  as  often  as  the  stomach  would  bear  it.  His  mental  facul¬ 
ties  at  this  period  suffered  very  little  derangement ;  for  al¬ 
though,  when  not  attending  to  external  objects,  he  would 
utter  some  incoherent  sentences ;  yet,  the  moment  he  was 
spoken  to,  he  was  perfectly  collected,  and  returned  rational 
answers.  At  half  past  four  o’clock,  he  submitted  willingly 
to  have  his  body  rubbed  with  the  oil,  and  for  that  purpose 
sat  dovrn  upon  the  side  of  the  bed  ;  when  he  was  seized  with 
an  instantaneous  convulsion,  threw  himself  backward — and 
expired  without  a  groan  1  An  immediate  inspection  of  the 
body  would  have  been  a  desirable  circumstance  :  but  we 
were  obliged,  (however  reluctantly,)  from  unavoidable  impe¬ 
diments,  to  defer  the  dissection  till  the  following  morning. 
Accordingly,  on  Sunday  morning,  about  ten  o’clock,  the 


Medicine. 


43 


1809.] 


body  was  opened  in  the  presence  of  one  of  the  physicians, 
myself,  and  twro  of  the  surgeons  belonging  to  the  charity. 
I  have  to  regret  that  the  examination  did  not  extend  to  the 
brain;  and  indeed,  that  a  more  minute  investigation  of  the 
morbid  appearances,  accompanying  this  fatal  malady,  did 
not  take  place.  But,  such  was  the  peculiar  horror  inspired 
by  a  view  of  the  progress  and  catastrophe  of  the  disease, 
that  the  accustomary  dread  of  danger  arising  from  any  ex¬ 
amination  of  an  hydrophobic  subject  was  increased,  by  tlm 
instance,  to  a  tenfold  degree.  Besides,  the  well-known  pre¬ 
judices  entertained  by  the  country  people,  against  the  open¬ 
ing  of  dead  bodies,  rendered  us  anxious  to  finish  the  inspec¬ 
tion  before  the  arrival  of  the  patient’s  friends,  who  were  hourly 
expected.  In  the  cavity  of  the  thorax  no  unusual  appear¬ 
ances  were  discovered  ;  except,  that  the  surface  of  the  lungs 
appeared  of  a  darker  hue,  and  more  distended  with  blood  than 
usual.  No  inflammation  appeared  on  an  inspection  of  the 
fauces ;  nor  were  the  muscles  of  the  larynx  or  pharynx  in 
the  least  discoloured.  The  stomach  and  oesophagus  were 
removed  from  the  body,  and  subjected  to  particular  inspec¬ 
tion.  A  longitudinal  incision  was  made  through  the  whole 
cavity  of  the  oesophagus,  but  not  the  least  marks  of  disease 
were  discovered.  Upon  opening  the  stomach,  evident  traces 
of  inflammation  were  observed,  it  commenced  at  the  supe¬ 
rior  orifice,  and  was  there  confined  to  small  and  irregular 
spots  of  a  dark  red  colour ;  and  might  also  be  traced  in  a  linear 
form,  and  of  a  brighter  red,  along  the  curvature  of  the  sto¬ 
mach,  terminating  at  the  pylorus  in  large  and  irregular  spots 
of  a  gangrenous  appearance.  The  contents  of  the  stomach 
did  not  exceed  three  ounces;  and  consisted,  chiefly,  of  the 
medicines  that  had  been  swallowed,  mixed  with  a  dark  co¬ 
loured  fluid.  All  the  other  viscera  of  the  abdomen  exhibited 
no  marks  of  disease.” 

This  case  is  followed  by  a  number  of  scientific  observations 
on  the  disease,  which  shew  much  noting  on  the  part  of  the 


44  Medicine.  [January* 

author,  and  are  detailed  with  judgment  and  apposite  elu¬ 
cidations. 

Modern  Medicine:  containing  a  brief  Exposition  of  the 
Principal  Discoveries  and  Doctrines  that  have  occasioned 
the  recent  Advancement  of  Medical  Philosophy ,  with 
Strictures  on  the  present  State  of  Medical  Practice ,  and 
an  Inquiry  how  far  the  Principles  of  the  Healing  Art 
may  become  the  Subjects  of  unprofessional  Research . 
By  David  Uwins ,  M .  D.  Member  of  the  Royal  College 
of  Physicians ,  London ;  and  Author  of  the  Medical 
Articles  in  Dr.  Gregory's  Encyclopcedia.  London ,  Svo. 

pp.  200. 

The  title-page  of  this  work  promises  somewhat  more  than 
it  will  be  found*  on  perusal,  the  author  performs.  The  model 
of  his  medical  style  seems  to  be  tiie  same  as  that  employed 
by  Dr.  Reid  in  his  Reports,  and  which  we  by  no  means 
consider  as  constituting  the  chief  part  of  his  merit* 

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

a  In  remarking  on  Brown’s  doctrines,”  says  our  author* 
w  it  may  be  observed  in  the  first  place,  that  should  we  con¬ 
cede  to  his  position,  that  fibrous  excitement  is  a  necessary 


1809.]  Medicine .  45 

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

u  A  second  error,  which  our  author’s  generalizing  dispo¬ 
sition  led  him  to  embrace,  respects  the  universality  of  ex¬ 
citability,  or  the  equal  distribution  of  this  principle, 
throughout  the  living  system,  for  it  is  a  fact  that  one  organ 
can  be  excited  while  another  is  depressed,  and  that  too  by 
the  same  means  ;  thus  we  find  it  admitted  by  those  even  who 
are  reluctant  to  question  the  authority  of  Brown,  that  fox¬ 
glove,  while  it  reduces  the  actions  and  power  of  the  arterial, 
excites  and  invigorates  the  absorbent  vessels. 

Thirdly,  our  theorist,  in  denying  the  direct  agency  of 
external  powers  upon  the  fluids,  and,  but  through  the  in¬ 
tervention  of  excitability,  the  solids  of  the  system,  was 
either  ignorant  of,  or  overlooked  several  facts  in  the  oeco- 
nomy  of  animated  nature,  to  which  we  shall  afterwards  refer. 
It  will  be  seen  that  some  substances,  which  may  not  have 
any  sensible  or  immediate  agency  upon  the  excitability, 
shall  become  by  a  species  of  chemical  attraction,  component 
parts  of  the  living  frame;  this,  however,  by  no  means  in 
that  mode  nor  to  that  extent  which  was  formerly  imagined, 
and  is  by  some  speculates  at  present  conceived.” 


46 


Surgery,  [January, 

In  his  explanation  of  the  chemical  theory  of  medicine, 
"we  apprehend  defects  exist  in  his  account  of  heat.  But  still, 
on  the  whole,  we  are  inclined  to  give  it  commendation.  His 
observations  on  digestion,  drawn  from  Mr.  Abernethy,  are 
also  worthy  of  perusal  ; — the  remaining  parts  of  the  work 
we  shall  reserve  for  our  next  number. 


II.  SURGERY. 

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

TUMOURS. 

From  its  numerous  species,  one  of  the  most  complicated 
forms  of  disease  to  which  surgical  aid  is  applied  is  the  class 
of  Tumours  ;  and  of  these,  some  of  the  chronic  kind  are  the 
most  difficult  in  their  management.  A  remarkable  chronic 
tumour,  which  he  terms  pendulous,  is  thus  described  by  Mr. 
Carwardine,  of  Thaxted  : 

u  Abraham  Perry,  aet.  73,”  he  observes,  u  about  forty- 
two  years  ago,  first  perceived  a  small  tumour,  situated,  ac¬ 
cording  to  his  description,  upon  the  outer  edge  of  the  pec¬ 
toral  muscle,  where  it  forms  the  margin  of  the  axilla.  It 
was  like  a  little  hard  gland,  without  any  pain  in  its  sub¬ 
stance;  but  his  attention  was  excited  to  it  by  a  constant  and 
very  troublesome  itching  over  its  surface.  This  tumour  in¬ 
creased  slowly  for  about  twenty  years,  and  had  then  acquir¬ 
ed  the  size  of  a  small  orange,  when  it  appeared  to  quit  its 
base,  or  rather  to  be  elongated  from  it  by  a  slender  peduncle, 
and  gradually  became  pendulous ;  in  this  state  it  augmented 


1S09.J  \  Surgery,  47 

with  increased  rapidity  ;  the  itching  subsided,  or  was  only 
occasional,  and  less  in  degree.  He  never  experienced  any 
thing  Like  acute  pain,  but  a  sort  of  dull  aching  sensation, 
which  might  be  supposed  to  arise  from  the  pendulous  weight 
of  so  large  a  mass  ;  yet  this  sensation  was  rather  augmented 
than  lessened  when  the  tumour  was  suspended  by  a  broad 
band  slung  round  the  neck.  However,  the  pain  or  incon¬ 
venience  of  any  kind  which  he  experienced  was  so  slight, . 
that  he  usually  worked  as  a  husbandman  till  within  a  few 
months  of  his  decease,  though  at  no  advanced  age. 

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

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


i 


48 


Surgery.  [January, 

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

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

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


1S09.]  Surgery.  ’  49 

white  tendinous  bands,  most  accurately  resembling  a  large 
plexus  of  nerves,  except  that  they  were  not  separable  into 
distinct  fasicula  of  fibres  like  nerve.  Nothing  of  this  ten¬ 
dinous  substance  was  observed  about  the  peduncle,  but  the 
chief  great  plexus  was  situated  in  the  middle  of  the  tumour, 
,and  sent  oft'  a  branch,  or  branches,  to  each  lobe.  A. few  of 
the  branches,  as  they  approached  the  lobes,  became  ossified, 
and  in  that  state  entered  the  body  of  the  lobes,  and  were  ac¬ 
companied  by  some  very  trifling  vessels;  indeed  one  small 
artery,  arising  from  the  subclavian,  was  all  that  supplied 
the  whole  tumour.  Some  of  the  lobes  were  still  in  an  adi¬ 
pose  state,  like  the  neck  of  the  tumour;  others  were  of  a 
glandular  structure,  with  numerous  small  cells,  containing 
an  oily  fluid,  which  escaped  as  soon  as  they  were  cut  into  ; 
others  had  formed  a  thin  shell  or  case  of  hard  bone,  which 
contained  an  unctuous  kind  of  earth.,  exactly  resembling, 
pi  colour  and  consistence,  fuller’s  earth ;  and  in  these 
the  tendinous  bands  above  described  were  ossified  before  they 
entered  the  lobe.  The  largest  of  these  masses  of  earth,  sur¬ 
rounded  by  its  bony  case,  I  have  preserved  ;  and  sent  to  Mr. 
Abernethy ;  it  weighs  about  a  pound  and  three-quarters. 
All  the  lobes  were  surrounded  by  more  or  less  of  the  original 
fatty  matter  of  the  tumour ;  the  whole  mass  might  weigli 
perhaps  nine  or  ten  pounds. 

tc  What  appears  to  me  most  worthy  of  remark  in  the  fore¬ 
going  case,  is  the  late  deposition  of  bone,  &c..  A  tumour 
is  formed  like  most  adipose  tumours,  in  the  common  adipose 
substance  of  the  body,  having  a  very  small  supply  of  blood¬ 
vessels,  and  these  vessels,  as  far  as  can  be  judged  from  the 
history  and  appearance  of  the  disease,  took  upon  them  the 
office  of  secreting  fat ;  but?  after  a  great  length  of  time,  they 
assume  a  new  action,  and  deposit  bone  and  other  earthy 
matter  of  an  anomalous  character. 

•  .  •  -  v 

There  appeared  nothing  of  a  malignant  nature  in  eithef 
of  the  tumours;  they  neither  communicated  their  actions  to 

VOL.  II.  E 


(p 


/ 


50  Surgery .  *  [January 

the  neighbouring  parts,  nor  insinuated  disease  through  th$ 
medium  of  the  absorbents. 

BURNS. 

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

6(  I  have  not  been  under  one  single  instance  of  embarrass¬ 
ment,  but  on  the  contrary,  have  been  uniformly  charmed 
with  the  immediate  ease  produced  ;  and  several  of  my  pa¬ 
tients,  who  have  had  opportunities  of  trying  both  methods, 
voluntarily  give  it  in  favour  of  the  new  one,  and  that  in 
terms  of  the  highest  eulogy.  It  is  surely  unnecessary  to  add 
more;  what  I  have  stated  are  facts.  Cessation  from  pain  is 
almost  instantly  produced  by  the  terebinthinate  application  ; 
but  by  the  cooling  treatment,  it  is  necessary  often  to  have  a 
constant  renewal  of  cold,  for  hours,  before  similar  effects 
take  place.  I  have  been  in  the  habit  of  using  the  ol.  tere¬ 
binth.  cold,  mixed  with  ol.  lini,  in  the  proportion  of  two 
parts  of  the  former  to  one  of  the  latter;  and  from  my  ex¬ 
perience,  applying  it  cold,  has  been  attended  with  more 
beneficial  effects  than  hot,  although  I  can  readily  perceive 
that  in  bad  cases  of  burns  from  metallic  substances,  where 
deep  eschars  are  formed,  that  heating  the  oil  might  be  at¬ 
tended  with  more  advantage,  but  I  have  not  yet  had  oppor¬ 
tunities  enough  in  my  own  practice  to  establish  the  fact,” 


1809.] 


Surgery, 


51 


BLEEDING. 

However  easy  and  trifling  the  practice  of  Bleeding,  as 
commonly  practised,  appears,  yet  in  many  instances  it  is 
known  to  be  succeeded  by  the  most  serious  consequences — even 
death  itself.  These  consequences  are  happily  very  rare,  and 
physiologists  have  been  puzzled  in  such  cases  to  ascertain  on 
what  particular  organic  lesion  induced  by  the  operation  these 
vsymptoms  so  alarming  could  depend.  The  opinions  on  this 
subject  may  be  reduced  to  four  heads,  each  having  its  par¬ 
ticular  favourers,  who  support  it  by  a  variety  of  arguments. 
These  are,  1st,  the  pricking  of  a  tendon  ;  2dly,  of  a  nerve; 
Sdly,  a  bad  constitution  ;  or,  4tbly,  peculiar  inflammation. 

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

The  pricking  of  a  nerve,  therefore,  may  be  most  readily 
suspected,  and  it  explains  the  symptoms  of  this  affection 
more  easily  than  by  any  other  supposition.  The  first  symp¬ 
tom  felt  in  this  case  is  a  smarting  at  the  orifice  made,  which 
is  succeeded  by  a  tingling  pain  shooting  from  the  orifice  to 
the  hand,  and  in  the  other  direction  also  to  the  shoulder. 
These  symptoms  increase,  affecting  all  the  connecting  muscles 
of  the  arm, v  An  erisipelatous  inflammation,  or  efflorescence, 
also  generally  appears  in  different  parts  about  the  orifice, 
which  comes  to  discharge  an  ichorous  matter.  Convulsive 
eatchings  of  thg  member  at  last  succeed,  and  even  a  tendency 
to  tetanus  has  been  known  to  take  place ;  death  at  last 
puts  an  end  to  the  sufferings  of  the  patient.  From  this  his¬ 
tory,  then,  it  seems  evidently  a  nervous  affection,  for  the 

e  2 


52  Surgery*  [January^ 

nervous  symptoms  are  prior  to  those  of  the  inflammation ; 
and  what  puts  it  beyond  doubt  is,  that  even  where  the  symp¬ 
toms  have  already  gained  their  utmost  height,  the  enlarging 
the  wound,  so  as  entirely  to  divide  the  laesed  nerve,  has  im¬ 
mediately  relieved  the  patient,  and  soon  effected  a  cure. 

*  The  third  opinion,  or  its  arising  from  a  bad  constitution, 
cannot  be  admitted,  as  not  accounting  for  the  quick  progress 
of  the  symptoms,  for  the  effects  of  a  bad  habit  are  slow  in 
their  operation.  Besides,  the  same  person  has  been  after¬ 
wards  bled  repeatedly  without  any  such  accident  occurring. 

The  last  opinion,  or  its  depending  on  a  peculiar  inflam- 

> 

mation  of  the  vein,  is  very  ingeniously  supported  by  Mr. 
John  Hunter.  To  this  he  was  led  by  a  similar  accident  oc¬ 
curring  to  horses  after  bleeding,  the  neck,  the  part  where 
they  are  commonly  bled  in,  swelling,  and  occasioning  at  last 
death.  On  tracing  the  effect  of  this  accident  by  dissection 
in  these  animals,  he  observed  that  the  cavity  of  the  vein  was 
inflamed,  and  that  the  inflammation  had  spread  along  its 
internal  surface  to  the  chest — sometimes  to  the  heart  itself. 
From  observations,  also,  on  the  human  body,  he  finds  that 
such  inflammations  of  the  cavities  of  veins  frequently  occur, 
and  he  is  induced,  therefore,  to  consider  these  as  the  cause 
of  the  various  symptoms  that  arise. — But  were  this  the  case, 
the  symptoms  of  inflammation  we  should  expect  to  find  much 
more  diffused  than  what  they  commonly  appear.  Nay,  the 
Symptoms  of  the  disease  are  often  uncommonly  severe,  while 
those  of  the  inflammation  are  slight ;  and  if  Mr.  Hunter’s  rea¬ 
sonings  were  true,  they  should  bear  always  a  proportion  to 
the  state  of  the  inflammation.  Besides,  the  enlargement  of  the 
orifice  should,  in  this  case,  also  be  of  no  service  ;  it  should 
Exasperate  the  symptoms,  and  increase  the  inflammation  :  but 
tlie  patient  is  found  often  immediately  relieved  after  its  per¬ 
formance.  Mr.  Hunter’s  alleging  that  the  nerves  wounded  are 
Small  and  unimportant,  is  going  too  far.  It  is  in  this  case  not 
talking  like  himself.  Who  is  so  ready  to  attribute  great  efFects 


1S09.J  Surgery,  '58 

to  slight  causes  as  he.  Small,  indeed,  they  may  be  ;  but  as  to 
their  being  unimportant,  that  does  not  so  readily  follow  ;  for 
every  person  who  has  paid  proper  attention  to  the  phenomena 
of  the  nervous  system,  must  know  that  the  smallest  fibre  of  a 
nerve,  when  injured  under  certain  circumstances,  will  com¬ 
municate  irritation  from  one  branch  to  another  in  a  most  ex¬ 
traordinary  manner.  That  nerves  are  divided  in  many  of 
the  common  operations  of  surgery,  is  certain,  but  as  to 
their  being  merely  pricked  is  doubtful.  It  is  the  partial 
division  of  a  nerve  which  we  contend  is  attended  with  these 
alarming  effects. 

Though  the  enlargement  of  the  orifice  admits  of  a  ready 
cure,  it  would  be  of  importance  if  we  could,  without  cut¬ 
ting,  find  any  application  equally  successful,  and  which* 
by  inducing  a  paralytic  state  of  the  nerve,  might  remove  the 
symptoms.  We  know  that,  in  the  celebrated  case  of  Charles 
the  ninth  of  France,  treated  by  Ambrose  Pare,  warm,  sti¬ 
mulating  applications  effected  a  cure.  We  know,  also,  that 
oil  of  turpentine  is  very  efficacious  in  the  puncture  of  a  ten¬ 
don  ;  and  we  know  still  further,  that  volat.  alkali  dropped 
on  the  sciatic  nerve  of  a  frog  will  render  it  paralytic.  From 
these  facts,  then,  some  experiments  may  be  tried  to  super¬ 
sede  the  necessity  of  an  operation. 


COMMUNICATION  ON  WHITE  SWELLING  OF  THE  JOINTS,  ANR 

ON  THE  TREATMENT  OF  CATARACT,  BY  R.  REECE,  M.  D. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — There  is  no  disease  which  is  more  to  be  la¬ 
mented,  and  to  which  the  aid  of  surgery  is  applied  with  less 
success,  than  the  affection  of  the  joints  known  by  the  name 
of  white  swelling.  This  disease  has  been  commented  on  by 
lecturers  and  authors,  as  existing  under  two  species,  dis* 
tinguished  by  the  appellation  of  scrofulous  and  rheumatic. 
The  propriety  of  this  division  I  am  much  inclined  to  call  in 
question.  Rheumatism,  I  admit,  in  a  scrofulous  habit, 

je3 


[January* 


54  Surgery, 

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

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

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

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

Admiral  Hhnry  having  a  cataract  in  each  eye  consulted 
Mr.  Ware,  who  recommended  their  extraction.  The  ad¬ 
miral  agreed  to  give  the  operation  a  trial  on  the  left  eye,  and 
if  it  succeeded,  lie  promised  he  should  shortly  after  operate  on 
the  other  :  unfortunately,  such  a  degree  of  inflammation  and 
thickening  of  the  cornea  succeeded,  as  entirely  to  destroy 


1609. J  Surgery.  55 

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

RICHARD  REECE 


56 


|  January 


Surgery* 

COMMUNICATION  ON  TINEA  CAPITIS. 

7b  the  Editors  of  The  Medical  and  Surgical  Spectator, 
Gentlemen- — 1 There  are  many  diseases,  apparently  sim* 
pie,  which  much  perplex  a  surgeon  in  his  treatment  of 
them.  I  know  of  none  more  so  than  Tinea  Capitis,  or  Scald 
Head.  In  obstinate  cases,  I  have  found  it  resist  every  local 
application  of  the  most  powerful  kind,  whether  in  the  form 
of  lotion  or  liniment ;  and  it  has  only  yielded  at  last  to  the 
radical  cure  of  extracting  most  of  the  hairs  by  the  roots* 
From  this  obstinacy  of  the  disease,  I  have  long  suspected  its 
being  rather  a  constitutional  than  local  affection  ;  and  that 
in  all  cases  this  circumstance  should  be  held  in  recollection. 
Small  doses  of  calomel  do  not  succeed  here  in  the  worst 
eases;  a  proof  that  it  is  not  (if  sometimes)  always  connected 
with  a  specific  cause ;  and  I  would  rather  attribute  it  to  a  scro¬ 
fulous  origin,  and  keep  the  indications  employed  for  the  treat* 
ment  of  this  last  disease  in  view.  Since  I  proceeded  on  this 
plan,  and  administered  steel  internallyin  liberal  doses  along; 
with  the  usual  local  remedies  of  the  stimulant  and  gently  es* 
charotic  kind,  I  have  never  failed  in  a  single  instance.  It  is 
clearly  a  disease  of  debility ;  and  whether  this  debility  is  of 
a  peculiar  species,  or  not,  strengthening  the  habit  by  the 
use  of  powerful  tonics  will  tend  to  remove  the  cause,  and 
allow  the  local  remedies  to  have  their  full  influence.  If  this 
suggestion  should  lead  any  of  your  correspondents  to  take 
up  the  subject,  and  point  out  a  preferable  plan  from  their 
own  experience,  they  will  do  a  service  to  most  practitioners^ 
and  to  none  more  than  to, 

Gentlemen,  your  obedient  Servant, 
Cambridge ,  Dec.  5,  1808.  A  CONSTANT  READER. 

P.  S.  Tinea  often  occurs  in  adults.  Where  it  does,  it-  is 
generally  connected  with  a  siphylitic  taint,  and  yields  rea¬ 
dily  to  small  doses  of  calomel  internally,  and  the  following 
liniment,  vh. — Equal  parts  of  the  tar  ointment,  the  citrine 
(nitrated  mercurial)  ointment  and  the  sulphur  ointment  re¬ 
gularly  employed.  *  *■ 


57 


1809.]  "  .  Surgery . 

Practical  Observations  on  the  Nature  and  Cure  of  Strictures 
in  the  Urethra.  By  William  Wadd9  Member  of  the  Royal 
College  of  Surgeons  in  London .  8vo.  pp.  88.  3s. 

This  subject  is  one,  which,  from  its  frequent  occurrence, 
and  from  being  one  of  the  most  profitable  kind  to  the  practi¬ 
tioner,  has  engaged  the  attention  of  a  great  number  of 
surgeons,  and  even  formed  a  separate  line  of  practice. 
Daran  endeavoured  to  secure  it  by  his  idea  of  a  medicated 
bougie  ;  and  Home  and  others  by  the  application  of  caustic,. 
Lesser  authors  have  followed  the  steps  of  these  two  in  their 
different  methods,  and  the  present  work  is  a  humble  imitation 
of  his  predecessors  in  favour  of  the  bougie  over  the  caustic. 
In  the  present  work  we  accordingly  find  nothing  very  new 
©r  striking.  It  is  a  pamphlet  written  as  an  advertisement, 
and  can  claim  no  higher  merit.  But  we  shall  enable  our 
readers  to  judge  for  themselves  by  a  few  extracts  from  the 
most  interesting  parts  of  this  dissertation. 

One  effect  of  the  application  of  caustic  is  often  to  produce 
a  troublesome  and  dangerous  haemorrhage,  and  the  observa¬ 
tions  of  the  author  on  this  subject  are  thus  introduced  : 

u  It  has  been  said  that  the  haemorrhage,  which  sometimes 
ensues  after  the  application  of  caustic,  is  more  alarming  than 
really  dangerous.  For  the  extent,  however,  to  which  it 
continues,  I  need  only  refer  to  Mr.  Home’s  treatise,  and  the 
common  experience  of  every  surgeon  who  has  used  the 
caustic.  In  the  perusal  of  Mr.  Home’s  works — 'CC  the  parts 
bled  freely  — -£C  it  continued  for  hours;” — u  the  quantity 
lost  we  supposed  to  be  several  pounds ;” — are  expressions  to 
he  met  with  in  several  pages  ;  and  in  one  case  it  is  observed, 
u  the  bleeding  and  pain  continued  several  days.”  These  are 
circumstances  that  are  not  regarded  as  objections  to  the 
practice;  and  the  indifference  with  which  they  are  viewed, 
is  considered  by  Dr.  Andrews,  as  the  result  u  of  cool  and 
steady  conduct.”  He  admits,  however,  <£  that  if  it  (has- 


58  Surgery.  [January* 

morrhage)  was,  in  a  great  proportion  of  cases  *  to  terminate? 
fatally,  it  would  then  be  a  strong  objection  to  the  practice?; 
but  this  (in  a  great  proportion  of  cases)  wre  do  not  find  by 
any  means  to  be  true.”  This  would,  indeed,  be  a  very 
strong  argument  against  the  practice;  but  admitting,  as 
may  be  fairly  inferred  even  from  this  account,  that  sdme  in¬ 
stances  have  terminated  fatally,  surely*  it  is  at  least  a  strong 
objection,  and  enough  to  justify  Mr.  Whately  in  com¬ 
plaining  of  the  levity  with  which  these  objections  are- 
treated,  as  well  as  expressing  his  astonishment,  at  the  cool¬ 
ness  with  which  a  surgeon  views  a  chamber-pot  full  of 
blood,  and  the  ease  with  which  he  calls  for  another.  Mr* 
Carlisle  speaks  of  it  as  one  of  the  most  dangerous  cOnse* 
quences  following  the  application  of  lunar  caustic,  and  men¬ 
tions  a  case  in  which  the  haemorrhage  continued  seven  days; 
in  the  two  first  the  patient  lost  four  pounds  of  blood,  and 
nearly  as  much  afterwards. 

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


59 


809.]  Surgery. 

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

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

u  It  is  by  patiently  persevering  in  gentle  means,  that  suc¬ 
cess  is  to  be  secured  or  expected.  The  bougie  should  be 
increased  in  size  according  to  the  facility  with  which 
the  stricture  dilates,  and  the  ease  with  which  the  patient 
bears  the  dilatation.  If  the  parts  are  very  firm,  or  very 
irritable,  the  increase  of  the  size  of  the  bougie  should  be 
slow,  gradually  stealing  upon  the  parts,  and  allowing 
them  to  adapt  their  structure  to  the  increased  size.  This 
is  well  expressed  by  a  French  writer,  who  describes  this  gra¬ 
dual  stealing  upon  the  parts,  as  effected  by  “  little  and 
little.”  C£  La  medicare  methode  est  d’introduire  dans  la 


60 


SttYgkry*  [January^ 

verge  des  bougies  qui  par  Ieur  volume  et  leur  fermete  puis- 
sent  ecarter  a  peu  les  parois  de  l’uretbre^  et  en  meme  terns  ra- 
molliret  relacher  ses  fibres. ” 

a  With  respect  to  the  time  a  bougie  ought  to  remain  in  the 
passage,  that  must  be  determined  by  the  feelings  of  the  pa¬ 
tient;  nor  should  it  be  laid  aside  for  some  months  after  it 
passes  with  facility :  cc  quoiqu’on  urine  a  plain  canal,  il  ne 
faut  pas  laisscr  de  continuer  f usage  des  bougies  tons  les 
jours  pendent  quelques  heures,  ensuite  toutes  les  semaines,  et 
enfin  tous  les  mois.” 

u  The  good  effect  of  stretching  a  constricted  part  is  fre¬ 
quently  witnessed  in  contractions  of  the  oesophagus  and  rec¬ 
tum.  A  woman  applied  to  rue  on  account  of  an  obstruction 
in  her  throat,  producing  a  total  inability  of  swallowing  any 
solid  substance ;  of  which  complaint  her  father  some  years 
before  had  died.  With  a  view  of  knowing  in  what  part  of 
the  oesophagus  the  stricture  was,  a  probang  was  introduced. 
When  it  arrived  at  the  obstacle,  the  woman  was  very  de¬ 
sirous  it  should  be  pushed  through  by  force.  Several  at¬ 
tempts  were,  however,  made  in  vain  :  at  last  the  woman 
declared  she  felt  the  part  give  way,  when  she  applied  her 
hands  to  the  probe,  and  forced  it  through.  She  was  afterwards 
furnished  with  a  proper  bougie,  by  the  daily  and  frequent  use 
of  which  iu  a  few  months  she  became  quite  well.  1  have  seen 
several  cases,  of  a  similar  nature,  considerably  relieved  by 
these  means.  Mr.  Home  records  one  case  of  a  lady,  nine¬ 
teen  years  of  age,  who  was  perfectly  cured  by  it.  Mr. 
Samuel  Sharp  was  of  opinion,  with  many  others  of  equal 
character,  that  the  mere  stretching  of  a  constricted  part  was 
not  only  equal  to  procure  an  abatement  of  symptoms,  but 
to  effect  a  cure.  Speaking  of  obstructions  of  the  urethra, 
he  observes,  a  that  it  is  very  remarkable,  in  regard  to  many 
of  these  strictures,  that  the  symptoms  arising  from  them  shall 
be  extenuated  by  acting  against  the  stricture,  that  is  to  say, 


1809.]  Surgery.  61 

by  introducing  a  bougie  big  enough  to  distend  the  urethra, 
the  painfulness  of  the  stricture  shall  cease  and  the  strangury 
shall  abate,  so  that  a  man  who  is  accustomed  to  make  water 
every  hour,  shall,  by  wearing  a  bougie,  retain  it  three  or 
four  hours.”  But,  perhaps,  the  most  unexceptionable  au¬ 
thority  is  Mr.  Hunter;  every  advocate  of  the  caustic  prac¬ 
tice  must  pay  deference  to  his  opinion,  and  more  decided 
language  need  not  be  sought.  He  expressly"  states,  tc  that 
if  the  case  is  such  as  to  admit  the  end  of  a  small  bougie  to 
pass ,  let  it  be  ever  so  small ,  the  cure  is  then  in  our  power  ” 

Having  endeavoured,  by  all  the  usual  arguments,  to  con¬ 
firm  the  superiority  of  the  treatment  of  strictures  by  the 
bougie,  the  pamphlet  is  wound  up  with  the  following  con¬ 
clusions  ;  and  then  the  finale  takes  place  by  the  relation  of 
a  certain  number  of  cases  ; 

££  From  the  complex  nature  of  strictures,  it  must  surely  be 
admitted  by  every  unprejudiced  mind,  that  even  presuming 
the  situation  of  a  stricture  to  be  precisely  ascertained,  each 
different  form  of  this  disease  presents  difficulties  that  must, 
with  every  improvement,  render  the  direction  of  the  caustic 
to  the  exact  spot,  a  matter  of  great  uncertainty.  If  then  this 
end  is  still  unaccomplished,  the  observations  of  Mr.  Sharp 
remain  in  full  force :  u  The  objections,”  says  he,  u  to  the 
use  of  caustics,  were  the  difficulty  and  almost  impossibility 
of  directing  them,  so  as  to  eat  through  all  the  diseased  parts  of 
the  urethra,  without  destroying  the  sound  part ;  the  imprac¬ 
ticability  of  preventing  the  urethra  from  contracting  when 
it  healed ,  as  much ,  if  not  more}  than  it  was  at  the  time  of 
employing  the  escharotic ;  and  lastly,  the  pain  was  so  ex¬ 
cruciating,  and  perhaps  the  application  so  poisonous,  that 
immediate  mortification  of  the  scrotum,  penis,  and  bladder, 
were  sometimes  well  known  to  ensue  :  upon  these  accounts, 
the  use  of  escharotics  seems  to  have  been  entirely  rejected.” 
There  are  few,  I  believe,  who  will  not  think  this  was  sufficient 
ground  for  abandoning  them ;  and  viewing  the  fairest  repre¬ 
sentations  of  all  the  improvements,  suggested  in  the  applica- 


62  .  Surgery.  [January, 

tion  of  escliarotics  to  the  diseases  of  the  urethra,  must  we 
not  still  agree,  that  <£  ces  remedies  enflamrnoient,  rongeoient 
et  ulceroient  ce  conduit — et  bien  loin  de  procurer  du  soulage- 
ment,  apres,  la  cicatrice,  le  conduit  de  T urine  se  trouvoit 
encore  pluf  etroit.”  That  there  are  circumstances  in  which 
the  application  of  the  caustic  may  be  attempted  as  an  expe¬ 
riment,  and  under  certain  modifications,  I  am  ready  to  ad¬ 
mit;  but  I  believe  those  cases  to  be  very  few,  and  the  pro¬ 
spect  of  success,  as  far  as  regards  the  cure  of  stricture,  to  be 
very  precarious.  Here,  as  in  many  other  situations,  where 
there  is  doubt  as  to  the  probability  of  success,  and  where  the 
mode  of  cure  proposed  is  both  painful  and  hazardous,  the 
patient  only  ought  to  decide.  It  is  for  him  to  make  Ills 
election,  whether  he  will  go  through  the  new  rough  road, 
instead  of  the  smooth  old  one.  Every  young  practitioner 
will  do  wisely  to  act  on  this  principle;  for  one  unsuccessful 
operation  may  be  more  painful  to  his  feelings,  and  do  more 
injury  to  his  fame  and  fortune,  than  an  hundred  successful 
cases  can  repair. 

“  Thus  far  I  have  endeavoured  to  shew,  that  the  use  of 
the  common  bougie  should  be  considered  as  a  leading  prin¬ 
ciple  in  the  cure  of  every  description  of  stricture  in  the 
urethra.  u  It  requires  patience,  coolness,  and  persever¬ 
ance.  If  the  surgeon  can  make  any  progress,  though 
slowly,  he  must  be  contented.  If,  after  the  exertions  of 
many  days,  he  once  gets  through,  he  will  be  compensated  by 
seeing  the  ease  and  comfort  of  the  patient,  and  the  pleas¬ 
ing  prospect  of  being  soon  at  the  end  of  his  labour.” 
I  will  conclude  with  applying  here,  an  observation  used  by 
Mr.  Whatcly  on  another  occasion.  “  If,  therefore,  by  this 
easy,  safe,  and  mild  method  of  treatment,  relief  can  oc¬ 
casionally  be  given  to  the  close  of  life,  without  the  patients 
suffering  much  inconvenience  or  pain  from  the  disorder,  it  is 
certainly  more  advisable  to  pursue  this  plan  of  treatment, 
than  to  make  use  of  a  remedy,  which  has  in  some  instances 
produced  even  fatal  consequences.” 


1809,]  Midwifery .  63 

In  all  this  there  is  nothing  more  than  what  we  knew  before. 
It  is,  in  fact,  only  an  old  song  set  to  a  new  tune.  But 
with  respect  to  this  disposition  of  stricture  to  recur,  we  may 
remark,  that  it  may  be  considered  often  as  a  constitutional 
disease,  to  which  every  passage  or  outlet  of  the  body  lined 
with  a  secreting  membrane  is  more  or  less  subject.  This 
disposition  to  stricture  is  equally  conspicuous  in  certain 
persons,  as  the  tendency  to  warts  and  other  excrescences  of 
the  skin.  Hence  it  occurs  in  the  passage  to  the  stomach, 
in  the  intestines,  and  even  in  the  passage  to  the  lungs.  It 
is  this  constitutional  nature  of  stricture  which  at  all  times 
gives  it  a  tendency  to  return,  and  which  accordingly  recom¬ 
mends  the  means  of  cure  employed  to  remove  it  to  be  oc¬ 
casionally  used  to  prevent  a  relapse.  In  every  constitution, 
stricture,  we  conceive,  may  be  produced  by  the  excitement 
of  general  irritation,  if  the  original  symptoms  are  in  that 
degree  to  produce  a  deposition  of  coagulable  lymph  into  the 
cellular  membrane,  which  is  not  afterwards  absorbed.  But 
where  stricture  arises,  without  any  previous  venereal  excite¬ 
ment,  the  constitutional  disposition  or  tendency  to  it  must 
be  strong ;  and  here,  though  a  cure  is  effected,  a  relapse  is 
always  endangered. 


III.  MIDWIFERY. 

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


64 


[January, 


to  direct  tlie  use  of  your  instruments,  in  midwifery  you  must 
trust  entirely  to  the  feel,  so  that  the  difficulty  of  operating 
as  increased.  This  difficulty  ©f  operating  has  led,  at 
different  periods,  to  the  invention  and  rejection  of  a  variety 
of  instruments.  But  in  midwifery,  the  time  of  operating 
is  perhaps  of  more  consequence  than  the  form  of  the  instru¬ 
ment.  Hence,  as  this  point  has  been  more  completely  under¬ 
stood,  the  use  of  instruments  has  been  lessened,  and  apparent 
difficulties  trusted  to  the  management  of  nature.  That  mid- 
wifery  was  originally  practised  by  the  illiterate,  who  were 
only  acquainted  with  the  operation  of  labour,  is  clear,  when 
we  find,  in  all  the  authors  of  a  prior  period,  that,  under 
particular  circumstances,  the  calling  in  of  a  physician  is 
always  advised.  On  the  contrary,  at  present  the  physician 
is  more  apt  to  take  the  advice  of  the  accoucheur,  than  to 
trust  to  his  own  opinion  on  female  diseases. 


PUERPERAL  CONVULSIONS. 

Of  the  diseases  which  perplex  the  obstetrical  physician, 
none  is  more  perplexing,  embarrassing,  and  uncertain  in  its 
issue,  than  Puerperal  Convulsion ;  and  the  following  cases 
by  a  Derby  practitioner,  which  have  lately  appeared,  will 
confirm  our  opinion  on  this  head  . 

u  In  the  vast  and  gloomy  catalogue  of  diseases/'  it  is 
observed,  u  to  which  the  human  frame  is  liable,  there  is 
none  so  replete  with  terrors,  so  inconceivably  dreadful,  as 
this  affection ;  and  none  that  requires  nicer  management  and 
skill,  and  more  boldness  and  promptitude  in  practice.  I 
allude  to  those  cases  of  it  which  occur  after  delivery^,  or 
during  the  time  of  actual  labour.” 

“  That  this  disease  depends  upon  pressure  of  the  brain 
from  extravasation,  or  from  over-distention  of  its  vessels, 
producing  inflammation,  and  not  from  nerwus  irritation ,  is, 
I  believe,  a  truth,  that  requires  more  generally  to  be  under¬ 
stood.”  4 

u  It  is  no  difficult  matter  to  distinguish  a  disease  from  Us 


1809.  ]  Midwifery.  65 

symptoms  when  it  exists,  but  it  is  a  knowledge  of  the  causes 
that  must  dictate  a  proper  and  effectual  mode  of  treatment. 
•Epilepsy  is  a  disease  ire  arealkof  us  familiar  with,  but  we 
know  nothing  of  its  causes,  and,  consequently,  as  little  of  its 
cure.  This,  certainty,  then,  Can  be  an  object  of  ho  small 
moment,  as  it  may  frequently,  if  not  always,  enable  us,  by 
timely  care  and  proper  management,  to  arrest  a  disease  in 
its  progress,  which,  when  it  occurs,  is  so  fatal  in  its  conse¬ 
quences. 

“  The  two  following  cases,  which  have  lately  come  under 
my  inspection,  may  serve  to  throw  some  light  upon  this  im¬ 
portant  subject. 

u  Case  I.— A  young  woman,  aged  19,  had  a  difficult 
though  natural  labour  of  her  first  child the  pains  were 
violent  and  protracted,  which  continued  for  eight  or  ten 
hours,  when  she  was  safely  delivered  by  a  respectable  mid¬ 
wife.  In  the  latter  stage  of  the  labour,  she 'complained  of 
pain  and  giddiness  in  the  head;  and  as  seen  as  the  placenta 
was  expelled,  she  sunk  into  a  comatose  state ;  and  in  ten 
minutes  was  seized  with  convulsions.  She  had  three  violent 
paroxysms,  succeeded  by  slight  intermissions ;  and  in  five 
minutes  after  the  last,  she  died  wi(h  every  symptom  of  apo¬ 
plexy.  In  this  <;ase,  nothing  was  done,  as  I  only  arrived  in 
time  to  see  her  expire  ;  which  was  in  about  half  an  hour  after 
she  was  delivered. 

cs  Case  ;II.— A  woman,  advanced  in  years,  was  safely 
delivered  of  her  second  child,  which  was  many  years  sub¬ 
sequent  to  her  former.  She  was  in  labour  for  twelve  hours, 
*he  latter  part  of  which  was  unusually  difficult.  She  ap¬ 
peared  tolerably  well?  but  complained  of  pain  in  the  head, 
which  gradually  increased,  and  she  became  delirious ;  in  which 
state  she  fcontinued  for  two  hours,  and  was  seized  with  con¬ 
vulsions.  Before  I  saw  her  she  had  had  thirteen  fits  in  rapid 
succession,  which  left  her  in  a  state  of  complete  torpor,  and 
-she  was  to  all  appearance  on  the  brink  of  dissolution.  Hear 

VOL.  II. 


F 


66  Midwifery,.  f  January  2 

pulse  was  scarcely  perceptible,  and  her  skin  was  of  a  dark  or 
purple  colour.  From  these  symptoms,  I  entertained  nq 
hopes  of  recovery,  but  ordered  her  a  stimulant  draught  with 
aether  and  laudanum,  &c.  which  seemed  to  revive  her,  and 
a  second  was  given ;  when  her  natural  colour  was  gradually 
restored,  and  the  convulsions  returned  with  the  same  violence 
as  before.  Her  pulse  now  became  strong  and  hard ;  and  a 
considerable  fullness  appearing  about  the  head,  I  took  away 
a  pint  of  blood  from  the  arm,  and  applied  four  leeches  tq 
each  temple:  after  which,  her  head  was  shaved,  and  a  blister 
applied  over  the  whole.  Her  bowels  being  in  a  costive 
state,  a  solution  of  soft  soap  was  ordered  as  a  glister,  and  an 
opening  mixture  with  neutral  salts  and  infus.  senna;.  The 
bleeding  having  reduced  her  almost  to  a  state  of  syncope? 
she  sunk  into  a  comatose  sleep,  in  which  she  continued  for 
six  hours,  when  she  awoke,  and  was  for  a  few  minutes  quite 
sensible,  but  again  became  delirious,  and  uttered  the  most 
incoherent  expressions.  As  her  pulse  did  not  warrant  q. 
second  bleeding,  and  the  convulsions  having  entirely  sub¬ 
sided,  she  took  draughts  every  three  hours  with  mixtur. 
cainph.  aq.  ammon.  acet.  et  vin.  antim.  which  produced  a 
most  copious  and  general  perspiration ;  in  which  treatment 
she  persisted  for  two  days  ;  during  which  time  she  gradually 
recovered  her  senses,  and  is  now  perfectly  recovered,” 

ON  THE  PROGNOSIS  IN  LABOUR. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — A  Correspondent,  in  one  of  your  former 
numbers,  endeavoured  to  controvert  the  opinion  delivered  by 
an  ingenious  Surgeoq  on  the  uncertainty  of  the  issue  of  la^ 
hour. 

Two  cases  lately  occurred  to  me,  which  confirmed  strongly 
what  that  Surgeon  asserted,  and  point  out  the  propriety  of  a 
close  attendance  on  the  patient  during  the  whole  progress  of 
delivery.  I  was  called  to  a  lady  whose  labour  was  only  com¬ 
mencing,  and  after  staying  some  time,  and  observing  its  pro- 


67 


1809.]  Midwifery. 

gress,  I  deemed  it  unnecessary  to  continue  longer  my  attend" 
ance  at  this  time,  returning  home  at  four  in  the  morning. 
About  eight  o’clock  I  was  again  sent  for  in  a  great  hur¬ 
ry,  and  found  the  child  born  before  I  arrived.  The  ac¬ 
count  I  then  received  of  my  patient  was  singular.  From 
the  time  I  left  her,  at  four  in  the  morning,  she  had  not  had 
the  return  of  a  single  pain,  nor  would  it  have  been  known 
that  she  was  delivered,  but  that  the  nurse  perceived  by  chance 
something  stir  under  the  bed-cloaths,  and,  on  raising  them, 
she  found  it  to  be  -the  child-.  The  patient  did  not  know 
of  it ;  she  felt  no  pain,  and  therefore  could  not  suppose 
herself  delivered. 

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

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

I  am.  Gentlemen, 

Your  obedient  servant, 

Bath,  Dec ,  10,  1808.  T.  S. 

OBSERVATIONS  ON  RUPTURE  OF  THE  P  ARTURIENT  UTERUS. 

*  • 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — Rupture  of  the  uterus  in  labour  is  an  acci¬ 
dent  which,  though  not  frequently  occurring,  every  accou¬ 
cheur  should  be  aware  of.  Permit  me,  then,  to  sta'e  what  re¬ 
gards  this  subject ;  for,  rare  as  it  is,  there  are  few  practition¬ 
ers  of  extensive  experience  who  have  not  met  with  it :  to  the 
lot  of  some  it  has  fallen  a  great  number  of  times. 

f  2 


68  Midwif c  ry.  [January  > 

The  occurrence  indeed  of  this  accident  we  shall  not  be 
surprised  at,  when  we  consider  the  manner  in  which  the  ac» 
tion  of  ihe  uterus  takes  place  in  labour.  By  its  contraction, 
every  part  of  its  cavity  is  straitened,  or  forms  a  resistance  to 
its  contents.  This  resistance,  however,  is  less  at  the  orifice 
than  in  any  other  part,  and  the  action  of  the  other  parts  is 
likewise  assisted  by  the  abdominal  muscles,  and  diaphragm, 
which  render  the  effect  of  their  contraction  more  powerful 
on  the  orifice.— If  then  the  orifice  is  uncommonly  rigid,  or 
praeternaturally  contracted,  so  as  to  possess  an  equal  resist¬ 
ance  with  the  action  of  the  other  parts,  the  labour  either  can-* 
not  proceed,  or  some  part  of  the  uterus  that  is  weaker  than 
the  orifice,  from  the  action  of  the  other  parts  bearing  against 
it,  will  give  way,  and  a  rupture  of  it  then  be  produced. 
The  place  of  the  uterus,  at  which  that  most  commonly  hap¬ 
pens,  is  the  neck, — for  the  fundus  is  protected  from  the  su* 
perior  resistance  it  acquires,  by  the  addition  of  the  abdomi¬ 
nal  muscles,  and  other  assistant  parts,  co-operating  with  it. 

The  causes  of  this  accident  are  all  unknown  to  us,  and  we 
shall  only  repeat  them  as  enumerated  by  authors. 

1 .  The  first  set  of  causes  is,  those  which  produce  difficult 
labour, — as  distortion  of  the  pelvis,  and  morbid  contraction 
of  the  external  parts. 

But  these  we  know  occur  in  a  thousand  cases,  without  rap¬ 
ture  of  the  uterus. 

2,  Violent  and  irregular  contraction  of  the  organ  itself,  as 
in  case  of  convulsions  ;  and  if  this  symptom  occur  along 
with  distortion,  so  as  to  prevent  the  termination  of  delivery, 
it  certainly  may  have  a  very  powerful  effect. 

3,  The  excessive  bulk  of  the  child’s  head  locked  in  the 
pelvis;  and, 

4.  Accidental  injury  of  the  uterus  itself,  from  strokes,  &c. 

These  causes  then  occurring  where  the  uterus  is  previous- 

ly  in  a  diseased  state,  may  occasion  this  accident  to  happen ; 
but  we  can  have  very  little  suspicion  of  it  till  it  take  place  ; 
and  even  admitting  we  have  suspicion  of  it,  we  are  notautho- 


1809.}  Midwifery*  69 

rised,  on  such  slight  grounds,  to  attempt  immediate  delivery, 
without  other  circumstances  in  the  case  indicate  the  propriety 
of  it.  Hence  it  is  of  more  consequence  to  be  able  to  ascer¬ 
tain  the  signs  of  this  accident,  when  it  has  really  happened, 
than  to  know  its  causes. 

The  signs  commonly  enumerated,  are— 

1.  The  sudden  disappearance  of  the  head,  or  present¬ 
ing  part,  formerly  easily  felt. 

Excessive  pain  of  the  abdomen,  fixed  particularly 
in  one  place. 

3.  Remission  of  the  throes  of  labour,  formerly  violent. 

4.  Reaching  and  flooding;  and, 

5.  Weak  intermitting  pulse,  with  tendency  to  deli- 
quium. 

It  is,  however,  the  sudden  disappearance  of  the  pre¬ 
senting  part,  if  once  certainly  felt,  and  the  state  of  the 
pulse,  we  are  more  to  trust  to  than  any  other ;  for  the  others 
may  all  occur  in  the  course  of  a  natural  labour,  independent 
of  this  accident. 

In  the  late  Dr.  Young’s  Lectures  of  Edinburgh,  there  are 
three  cases  mentioned  of  this  accident,  and  in  all  of  them  the 
labour  pains  were  uncommonly  trifling,  so  that  it  could  not  be 
referred  to  any  violent  action  of  the  organ,  but  was  evidently 
the  effect  of  disease. 

Where  this  accident  occurs  for  the  delivery  of  the 
child,  the  Caesarian  operation  has  been  proposed ;  but  some 
objections  may  be  urged  against  it,  from  the  state  of  the 
patient,  and  more  especially  as  the  child  does  not  descend 
completely,  for  the  most  part,  into  the  abdomen ;  so  that 
some  of  its  members  being  entangled  in  the  laceration,  will 
allow  the  introduction  of  your  hand  to  get  at  the  feet,  when 
the  delivery  may  be  more  properly  completed  in  this  way. 
Besides,  wounds  of  the  uterus  ate  mentioned  by  authors  as 
not  always  fatal,  and  a  greater  chance  therefore  is  given  to 
the  patient,  if  the  extraction  is  made  in  this  way,  than  by  & 

f  3 


70  Midwifery*  [January 

new  incision  through  the  abdomen.  The  delivery,  how¬ 
ever,  must  be  very  quickly  made,  as,  by  keeping  the  wound 
extended,  the  patient  will  sink  in  a  few  minutes  from  the 
internal  haemorrhage,  and  she  commonly  indeed;  dies  under 
your  hands.  Hence  it  has  been  proposed  by  some  authors, 
to  delay  any  attempts  at  delivery  till  the  death,  of  the  mother 
takes  place,  and  that  the  Cassarian  operation  should  then  be 
performed  as  quickly  as  possible.  But  however-  humane 
this  practice  may  be,  it  is  not  giving  her  any  chance  of  re¬ 
covery  ;  and  when  the  smallest  hopes  remain,  however  un¬ 
favourable  circumstances  may  appear,  it  is  certainly  the 
duty  of  the  practitioner  to  take  advantage  of  them,  and 
to  leave  nothing  undone  which  may  contribute  to  save  the 
patient. 

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

To  this  subject,  Mr.  Croatz  lias  paid  particular  atten¬ 
tion,  and  has  endeavoured  to  mark  those  previous  symp¬ 
toms  in  the  course  of  the  labour  that  point  out  this  accident 
as  going  to  happen.  He  remarks,  that  in  such  women,  the 
abdomen,  upon  examination,  feels  very  prominent,  and 
much  distended,  the  vagina  drawn  upwards,  and  the  orifice 
of  the  uterus  uncommonly  high.  The  pains  at  the  same 
time  are  extremely  violent,  without  any  intermission,,  and 
the  labour  is  very  inconsiderably  advanced  by  them.  But 


71 


X  • 

1809;]  Midwifery* 

all  these  symptoms  may  occur  in  the  course  of  labour,  with¬ 
out  any  such  accident  taking  place ;  and  therefore  the  enu¬ 
meration  of  such  symptoms  serves  only  to  frighten  a  practi¬ 
tioner  in  his  attendance,  and  more  especially  if  his  patient 
has  been  in  a  delicate  ailing  state. 

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

I  am,  Gentlemen, 

Your  obedient  Servant, 

F.  MELLTS. 

Upper  Thornhaugh  Street , 

Dec ,  10,  1808. 

The  London  Practice  of  Midwifery ;  to  which  are  added 
Instructions  for  the  Treatment  of  Lying-in  Women ,  and 
the  principal  Diseases  of  Children ,  chiefly  designed  for 
the  use  of  Students  and  early  Practitioners ,  2d  Edit, 
12mo.  pp.  300. 

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

f  4 


72  Midwifery ..  [January 

acquirements.  From  the  book  now  before  us,  such  a  person 
will  learn,  that  in  case  of  spurious  pregnancy,  €C  we  must 
not  tell  the  patient  the  truth,  but  throw  a  shade  over:  each 
symptom. .  We  may  say,  No  doubt  but  she  is  with  child ^ 
but  we  have  some  doubt  with  regard  to  her* reckoning  on  her 
confinement.  We  may  ask,.  If  she  has  been  sick  in  the 
morning,  all  the  time  from  that  she  first  reckoned  ?  She  wil^ 
say,  u  No,  certainly  ;  but  do  you  doubt  my  being,  with 
child  ?” — u  O  no,  there  is  little  doubt  of  that;  but  stomach 
complaints  will  at  times  arise  in  a  very  strange  way.  You 
have  felt  the  motion  of  the  child,  I  suppose  ?”— O  yes,, 
very  often.” — 

u  But  have  you  ever  felt*  a  limb  coming  up,  or  a  knee 
pressing,  as  if  it  would  come  through  your  side  ?”—<c  Why 
no,  not  so  plain  as  that,  certainly ;  but  I  have  felt  it  move 
so  often,  that  there  can  be  no  doubt.” — <c  Aye,  but  are  you? 
sure  it  might  not  be  wind  ?” — “  Why,  dear  me,  Sir,  you 
never  doubted  it  before  ?”—■**  Oh,  I  do  not  doubt  it  now ; 
but  wind  will  do  this,  and  feel  a  good  deal  like  a  child.. 
Pray  are  you  always  sick  in  the  morning?  Because  I  once 
knew  a  young  lady  who  was  mistaken  on  this  point,  and  she 
had  seven  children  afterwards.!’ 

In  case  of  spurious  pains  we  are  told  that  u  when  a  prac¬ 
titioner  is  sent  for  without  occasion,  he  should  particularly 
avoid  showing  that  he  is  out  of  humour;  it  can  do  no  good, 
and  is  often  productive  of  harm.  A  gentleman  being  sent 
for  on  one  of  these  fruitless  errands,  began  abusing  the  nurse 
most  unmercifully ;  the  consequence  was,  that  the  lady  sent 
to  another  gentleman  when  really  in  labour.  The  great 
object  is  to  remove  the  cause;  to  do  which  we  should  empty 
the  bowels,  and  afterwards  give  an  opiate  draught.” 

The  advice  on  the  accoucheur’s  first  going  into  the  room 
is  equally  instructive : 

(e  It  is  very  difficult  for  a  man  at  first  to  find  his  way,  where 
it  happens  he  was  not  known  to  the  patient  before ;  for  the 


2f809.j  Midwifery l  73s 

sight  of  him  will  at  times,  indeed  generally,  cause  a  sort 
of  sensation  which  frightens  away  the  pain  for  a  length  of 
time.  In  the  early  part  of  labour  this  is  of  great  conse¬ 
quence;  a  practitioner’s  time  may  be  consumed,  when  it 
may  be  the  woman  only  fancies  herself  in  labour  ;  how  then 
is  this  to  be  discovered  ?  There  is  no  other  mode  than  by 
doing  away  the  first  impression,  which,  as  a  stranger,  lie 
lias  made.  With  this  view  it  is  very  easy  to  remark  on  her 
family,  that  Richard  is  the  picture  of  his  papa,  and 
that  little  Miss  Sally  has  the  countenance  of  her  mama, 
observing  that  the  girls  are  the  handsomest,  and  how  na¬ 
tural  it  is  to  expect  that  they  should  be  so ;  that  it  rained 
yesterday,  but  has  a  fairer  prospect  to-day;  that  the  wind 
was  yesterday  in  the  north,  but  to-day  to  the  east ;  that  the 
weather  is  very  odd!  for  the  time  of  year,  but  there  is  reason* 
to  expect  it  will  soon  change  for  the  better.  In  the  midst  of 
this  she  will  get  a  pain,  which  will  bring  the  conversation* 
Very  naturally  round  to  pain;  then  we  may  inquire  the 
number  of  pains,  the  length,  violence,  and  interval  of  them,, 
&c.  till  she  gets  a  second,  which  it  is  right  always  to  insist 
upon  as  being  a  very  bad  one,,  just  for  the  sake  of  urging 
an  examination,  the  necessity  for  which  should  be  explained 
on  account  of  giving  her  satisfaction,  which  is  necessary. 
She  will  say  perhaps,  “  But  I  have  not  had  a  show  yet.” — 
*c<  Have  you  not,  indeed!”  may  be  the  answer:  If  that 

is  true,  it  is  very  necessary  I  should  examine  if  the  child 
lies  right.”  If  she  says  she  has  had  a  show,  we  can  stiff 
make  it  an  argument  in  favour  of  examining.  If  the 
waters  are  broken,  or  not  broken,  if  she  is  strong  or  weak,, 
we  may  easily  make  some  reason  or  other  in  favour  of  our 
examining,  for  we  cannot  know  with  accuracy  how  a  woman 
is  going  on,  till  we  have  examined  her,  after  which,  we  may 
make  up  our  mind  as  to  the  probable  duration  of  the  labour ; 
but  in  the  early  stages  of  labour  we  should  never  allow  that 
they  are  in  labour,  but  say,  that  we  think  they  are  going  on 


I 


74  Midwifery.  [Janifaryy 

ver y  far  towards  being  in  labour,  and  this  more  especially 
where  we  know  it  is  a  first  labour.  If  we  tell  them  they  are 
in  labour,  the  woman  will  then  go  on  fatiguing  herself  and 
get  no  repose,  while,  by  another  mode  of  conduct,  we 
obtain  for  her  a  good  night’s  rest.  We  should  never  allow 
of  their  getting  us  to  form  a  prognostic  as  to  the  duration  of 
the  labour ;  we  may  generally  prevent  them,  by  telling  them 
that  we  have  ascertained  the  child  lies  well,  and  it  will  be  an 
easy  labour,  or  some  such  thing  ;  adding,  that,  as  to  the  time 
it  may  last,  we  are  not  able  to  say  exactly ;  or  if  we  do  hazard 
an  opinion,  it  is  never  till  we  have  the  child's  head  in  our 
hand,  and  even  then  we  are  very  cautious,  having  been  often 
deceived  ;  we  may  then  perhaps  say,  the  child  may  be  born 
in  a  pain  and  a  half,  or  a  pain  and  three  quarters.” 

On  early  evacuation  of  the  waters,  as  a  cause  of  difficult 
labour,  it  is  observed  ; 

cc  A  patient  in  this  situation  requires  a  little  management ; 
it  is  not  just  to  stay  with  her  all  the  time  ;  and  yet  it  is  neces¬ 
sary,  if  we  leave  her,  to  leave  her  in  confidence  ;  therefore  we 
may  give  her  the  idea  of  making  provision  for  whatever  may 
happen  in  our  absence  :  we  may  pass  our  finger  up  the  va¬ 
gina  y  and  make  a  moderate  degree  of  pressure  for  a  few 
seconds  on  any  part  of  it,  so  that  she  may  just  feel  it;  after 
which  we  may  say  to  her,  cc  There,  Ma’am,  I  have  done 
something  that  will  be  of  great  use  to  you  in  your  labour.” 
This  she  trusts  to  ;  and  if,  when  she  sends  for  us,  we  get 
there  in  time,  it  is  all  well ;  if  later  than  we  should  be*  we 
easily  satisfy  her  :  u  Yes,  you  know  I  told  you  I  did  some¬ 
thing  which  would  be  of  great  service  to  you  in  labour.” 
If  the  placenta  is  not  yet  come  away;  u  Ah,  1  am  quit** 
in  time  for  the  after-birth,  and  that  you  know  is  of  the 
greatest  consequence  in  labour.”  And  if  the  whole  is  come 
away,  We  are  glad  the  after-birth  is  all  come  away,  in 
consequence  of  wluit  we  did  before  we  last  left  the  patient, 
and  the  labour  terminated  just  as  we  intended  it  should.” 


1809.] 


Midwifery .  ,r  75 

The  management  of  twins  is  thus  detailed  : 

i 

u  As  it  is  necessary  to  wait  before  delivery  the  second  time,, 
we  must  be  prepared  for  it,  and  amuse  the  patient  with  con¬ 
versation  :  she  may  inquire,  cs  Dear  me,  Sir,  why  does  the 
after-birth  stay  so  long  this  time?” — u  Oh,  they  will  some¬ 
times  be  very  tedious.”  She  will  say,  “  But  the  last  time  I 
lay  in,  it  came  away  in  ten  minutes.” — 66  Did  it.  Ma’am?,  aye, 
I  have  attended  so  many  since  I  attended  you  last,  that  I 
don’t  recollect  exactly  the  time  it  took  in  coming,  though  I 
recollect  all  the  material  circumstances  clearly.”  We 
should,  therefore,  let  her  have  an  hour  to  cool  and  to  nourish; 
and  if,  when  she  begins  to  feel  herself  strong,  she  should  be 
again  uneasy  about  the  after-birth,  we  may  alarm  her  a 
little,  so  that,  after  playing  this  piece  of  artifice,  she  will  be 
quiet  enough.  Tlius  we  may  begin  by  explaining  to  her 
that  the  after-birth  is  like  a  sort  of  sponge,  which  ought  to 
contract,  and  will  not,  in  some  cases,  till  after  a  considerable 
time ;  when  it  does  so,  it  will  get  free ;  but  if  she  is  very 
anxious,  that  we  wrill  get  every  thing  ready  to  go  up  and 
perform  the  operation  of  separating  this  spongy  mass  ;  that 
we  will  not  give  her  any  more  pain  than  we  can  help,  though 
it  is  a  very  painful  operation  without  a  doubt.  Before  we 
have  said  so  much  as  this,  she  will  feel  herself  less  inclined  to 
it,  than  she  was,  and  tell  os  that  she  feels  herself  easier,  and* 
if  we  please,  she  will  wait  a  little.  We  may  then  urge  it, 
for  we  may  be  sure  she  will  be  against  it.  The  time,,  how¬ 
ever,  comes  when  we  really  see  it  necessary  to  turn  and 
deliver,  or  at  least  to  deliver.  We  have  now  to  undo  what 
we  have  been  doing.  This  we  do  by  representing  that  the 
sponge  is  separated  and  is  kept  by  the  uterus ,  which  it  is 
easy  to  set  right  without  much  pain.  Thus  we  must  amuse 
the  patient  by  talking  of  the  after-birth  till  the  second  child, 
is  delivered.  When  the  last  child  is  delivered,  we  may  pull 
gently  at  the  cords  of  all  the  after-births  at  once,  in  order  to 
prevent  a  partial  separation,  which  might  bring  on  flooding: 


T6  Midwifery .  January, 

pulling  at  one  cord  separates  one  placenta;  this  brings  on 
bleeding,  and  the  woman  dies  ;  therefore  they  must  all  be 
considered  as  one,  and  treated,  in  giving  assistance,  as  a 
single  placenta. 

6C  It  is  necessary  for  a  youngman  to  be  prepared  for  a  ques¬ 
tion  that  may  be  asked  :  one  of  the  women  may  perhaps  say, 
ee  Pray,  Sir,  did  you  ever  see  a  case  of  twins  ?”  If  he  was 
off  his  guard,  he  would  be  apt  to  speak  the  truth,  and  say, 
no,  he  never  did;  now  if  he  says  no,  he  does  an  injury  to  the 
woman  and  himself  too.  She  will  reason  thus  :  £c  Oh  deaf 
me,  I  hope  I  have  not  got  twins,  for  he  won’t  be  able  to  de¬ 
liver  me,  as  lie  owns  he  never  saw  a  case  in  his  life.”  Her 
pains  will  gradually  go  off  from  the  alarm.  The  way  is  to 
give  an  equivocal  answer,  as,  ££  It  would  be  very  odd  if  I  had 
not  seen  a  case  of  twins  in  so  large  a  town  as  London,  in  the 
midst  of  which  there  are  so  many  advantages,  such  a  number 
of  large  hospitals,  that  I  declare  a  person  has  an  opportunity 
of  seeing  much  more  in  London  than  he  would  have  any 
where  dse.” 

From  the  above  extracts  it  will  appear  that  what  the 
book  wants  in  science  is  made  up  in  policy.  It  is  the  system 
of  Machiavellian  deception  to  be  practised  on  the  poor 
woman  solely  for  their  own  good ,  and  to  enhance  the 
character  of  the  profession.  So  that  if  the  young  man  who 
peruses  it  is  not  made  an  accoucheur  by  its  lessons,  he  w  ill 
at  least  be  made  a  cunning  fellow. 

If  this  work  is  compiled  from  Dr.  C.’s  Lectures,  which 
\ve  doubt,  he  may  be  considered  the  Machiavel  of  Midwifery? 
fit  to  preside  over  every  gossipping  chamber  of  the  metro¬ 
polis  ;  and,  in  the  language  of  French  official  coutume,  he 
may  be  styled  Intendant  General  of  the  Department  of  the 
Sex. 


1809.] 


Pharmacy. 


77 


IV.  PHARMACY,  &c. 

The  great  improvement  of  modern  pharmacy  is  the  sim¬ 
plification  of  the  art  of  prescription.  This  simplification 
has,  perhaps,  been  carried  too  far,  and  the  activity  of  opera¬ 
tion  is  often  lost  by  studying  clearness  of  induction.  This 
may  be  instanced  in  many  preparations  :  the  elixir  parego- 
ricum,  or  camphorated  tincture  of  opium,  as  originally  made, 
is  a  more  successful  preparation  than  the  modern  improve¬ 
ment  of  it.  This  subject  has  been  very  ably  descanted  on 
by  the  late  Dr.  George  Fordyce  in  the  case  of  several  pur¬ 
gative  compositions,  shewing  that  the  combined  action  of 
certain  medicines  is  very  different  from  their  powers  in  their 
simple  state,  as  in  rhubarb,  senna,  aloes,  &e.  ;  and  that  it  is 
only  from  facts  and  experience,  not  from  reasoning  a  prion , 
on  the  particular  properties  of  separate  articles,  that  can 
enable  us  to  judge  of  the  real  qualities  and  powers  of  such 
compositions.  In  the  use  of  metallic  remedies,  such  com¬ 
bination  is  of  less  consequence,  from  the  natural  activity 
of  their  operation  .  The  only  point  is  to  exhibit  them  in 
their  most  active  chemical  state  ;  and  since  tc  Philosophers, ” 
as  Mr.  Dunn  observes,  u  have  asserted,  and  on  the  testimony 
of  experiment,  that  the  action  or  activity  of  metals  depends 
on  the  proportion  of  oxygen  with  which  they  are  united, 
to  this  principle  we  may  attribute  the  more  immediate  influ¬ 
ence  of  the  muriat  of  mercury  to  the  submuriat.” 

•  ■  ARSENIC  ACID. 

This  acid  is  introduced  into  practice  by  Mr.  Dunn,  of 
Wells  in  Norfolk  : 

ct  Having,”  he  remarks,  cc  about  six  weeks  back,  had 
cases  of  obstinate  inter mittents,  which  resisted  the  usual 
means  employed,  as  the  bark,  canella  albe,  Fowler’s  mi¬ 
neral  solution,  emetics,  &c.  I  resolved  upon  the  trial  of 
the  aneuic  acid.  The  acid  was  made,  according  to  Bu^ 


78  Pharmacy .  [January, 

cholz’s  process,  by  first  mixing  in  a  retort,  one  part  of  mu¬ 
riatic  acid,  four  parts  of  the  white  oxide  of  arsenic  or  arse- 
incus,  and  twelve  parts  of  nitric  acid ;  then  boiling  the 
mixture  till  nitrous  gas  ceases  to  be  engaged.  After  the 
mass  was  evaporated  to  dryness,  by  exposing  fit  for  a  few 
minutes  to  a  lowered  heat,  I  dissolved  it,  being  about  32grs. 
in  8  oz.  of  boiling  water.  Of  this  solution  I  gave  three 
drops  every  two  hours,  combined  with  either  an  equal  quan¬ 
tity  of  tincture  of  opium,  or  cascarilla  bark.  The  result 
was  particularly  successful.  The  following  are  facts  which 
at  once  prove  the  fallacy  of  its  being  injurious,  (at  least 
when  given  in  small  doses,)  and  at  the  same  time  its  decided 
and  remarkable  efficacy. 

<c  Robert  Curie,  a  boy  about  14  or  15  years  of  age,  who 
had  lately  enjoyed  exceeding  good  health,  was  attacked  in 
the  commencement  of  September  with  general  rigour,  great 
prostration  of  strength,  and  a  vomiting  of  green  bilous 
matter;  these  symptoms  were  gradually  superseded  by  the 
hot  stage  of  fever;  the  pyrexia  was  considerable,  tongue 
parched,  and  skin  excessively  hot  and  dry  ;  he  took  during 
this  stage,  a  draught  with  nitre,  which  was  immediately  re¬ 
jected.  He  then  attempted  to  swallow  a  beverage  he  called 
for,  made  with  apple-juice  and  water,  but  the  irritability  of 
Ins  stomach  continued  so  great  as  to  refuse  every  tiling  taken. 
During  the  remission  of  the  paroxysm,  he  took  an  emetic, 
which  operated  perfectly  well ;  and  after  his  stomach  was 
easier  lie  began  with  three  drops  of  Fowler’s  solution,  which 
were  repeated  every  two  hours.  The  second  day  following, 
he  was  attacked  as  usual,  and  the  hot  fit,  if  any  thing,  was 
more  violent.  His  medicine  was  continued  with  the  addition 
of  one,  and  afterwards  two  drops  at  a  dose.  Notwithstand¬ 
ing,  the  paroxysms  came  on  every  other  day  equally  severe 
for  nearly  a  fortnight,  when  they  remitted  for  about  three 
clays.  A  relapse  ensued  ;  the  type,  however,  was  more  re¬ 
gular.  He  then  began  with  three  drops  of  the  arsenic  acid. 


1809.]  Pharmacy.  79 

which  was  afterwards  increased  to  four.  This  dose  was 
taken  every  two  hours.  The  next  day  he  was  again  at- 
tacked,  but  with  much  less  severity.  Since  this  time,  the 
fever  returned  no  more,  and  he  is  now  as  hearty  and  free 
from  disease  as  ever. 

“  Encouraged  by  this  success,  T  next  gave  it  a  trial  in  a 
case  of  Rheumatism*  The  subject’s  name  was  Ely,  of  the 
parish  of  Wighton.  On  her  first  application,  she  com¬ 
plained  of  considerable  pain  and  rigidity  of  her  arm.  The 
tendons  at  the  elbow-joint  were  very  much  enlarged,  and 
the  muscles  of  her  arm  were  so  contracted,  that  she  could 
scarcely  move  it.  A  strong  volatile  liniment  was  ordered, 
frequent  friction  with  flannel,  and  the  topical  application  of 
the  warm  bath. 

u  On  the  7  th  of  September,  which  was  about  three  days 
after,  she  was  much  worse;  her  arm  the  same ;  much  pain 
and  inflammation  about  the  ancles ;  pulse  quick ;  tongue 
white,  and  indeed  she  had  now  every  symptom  of  acute 
rheumatism.  Leeches  were  applied  to  her  ancles ;  the  in¬ 
flamed  parts  were  ordered  to  be  kept  constantly  wet  with  a 
lotion  composed  of  spt.  terebinth  et  aqua.  The  sudorific 
regimen  was  enjoined. 

•4 

“  R.  P.  ipecac,  comp,  six  grains — Pulv.  quaq.  quart,  hor. 
sumend. — P.  ipecac. Jc.  eight  grains— --Calomel  three  quarters 
of  a  grain — G.  a.  q.  s.  ft.  bol.  li.  s.  sumend. 

6 4  As  her  bowels  had  been  rather  relaxed,  no  aperient  was 
deemed  requisite.  In  a  few  days  the  inflammatory  symp¬ 
toms  abated,  but  the  pain  and  tension  still  continued,  and 
every  joint  was  alternately  affected. 

Cc  R.  Solut.  Fowler  miner. — Tinct.  opii-  aa.  two  ounces, 
sumat.  gtt.  viij.  secund.  hor. 

c£  September  10.  Continues  much  the  same  as  to  pain  and 
rigidity  of  the  joints.  Rep.  gutta  also. 

a  R.  P.  cort.  fl.  half  an  ounce — P.  canell.  alb.  gr.  v. — 
M,  Pulv.  sumat.  ter  in  die. 


'SO  Pharmacy.  [January, 

a  17  th.  Little  amendment,  very  weak,  still  much  irri- 
lability  and  contraction  of  the  muscles. 

ii  R.  Solut.  arsenic  acid  gtt.  iij.  quoq.  bihor.1 

19th.  Better.  Rep.  gutta. 

u  21st.  The  arm  is  reduced  to  its  natural  size;  her  ancles*, 
though  painful,  are  considerably  better. 

(C  24th.  Feels  so  much  recovered,  that  she  complains  now 
only  of  weakness,  which,  perhaps,  was  aggravated  by  her 
taking,  from  some  serious  mistake,  a  quantity  of  white  vi¬ 
triol  to  the  amount  of  a  scruple. 

<c  R.  Yin.  ferri  six  ounces — Sumat.  cochl.  parv.  j.  ter 
an  die. 

16  The  last  words  which  I  heard  from  her  were,  that  she 
is  very  finely. 

“  On  the  16th  of  September,  George  Parker,  residing  in 
Wells,  complained,  u  his  poor  boy,  who  had  got  the  ill¬ 
ness  that  is  about,  wanted  some  medicine,  as  he  had  been 
sadly  with  it  off  and  on,”  as  he  expressed  himself,  u  for 
some  time.” 

u  R.  Antim.  tart.  gr.  j.  P.  ipecac,  gr.  v.  M.  pair.  Stat. 
sum.  Solul.  arsenic  acid.  Tinct*  opii.  aa.  1  ounce,  M. 
sumat.  gtt.  v.  quaq.  secund.  hor. 

u  The  next  day  he  was  again  attacked,  but  with  a  very 
^transient  paroxysm.  Though  transient,  it  was  his  last,  and 
he  is  now  quite  well. 

u  A  few  days  after,  Geo.  P.  himself  came,  and  with  the 
same  complaint  as  his  son’s  was.  The  type  of  his  intermit- 

f 

tent  was  a  regular  quotidian.  His  head  suffered  excruciat¬ 
ing  pains,  and  when  I  saw  him,  his  skin  was  almost  scorched 
with  heat ;  pulse  quick ;  frequent  nausea ;  dry  tongue ; 
and  bowels  very  irregular.  I  gave  him  an  emetic  with  a 
scruple  of  ipecacuanha,  and  afterwards  ordered  eight  drops 
of  the  compound  solution,  of  equal  parts  of  arsenic  acid  and 
tinct.  of  opium,  to  be  taken  every  two  hours.  The  day  lie 
applied  was  the  26th  of  September. 


81 


Pharmacy . 


ci  On  the  29 ill,  I  found  lie  had  entirely  lost  his  fever. 
Being  rather  of  a  phthisical  habit,  and  at  that  time  labouring 
under  a  troublesome  cough,  the  following  pills  were  pre¬ 


scribed. 

R.  Fer.  vit. 
opii  three  grains, 


two  scrunles— Pil.  scillae  two  ounces — F. 

A 

M.  et  divid.  in  pilula  il — Capiet  iij.  ter 


in  die. 


<c  His  health  is  now  perfectly  re-established. 
u  On  the  18th  of  October,  a  man  by  the  name  of  Lake, 
of  the  parish  of  HolLham,  who  had  been  labouring  under  a 
tertian  intermittent  for  a  considerable  time,  applied  for  me¬ 
dical  assistance.  He  had  been  previously  attended  by  a 
Mr.  It.  and  taken  about  thirty-two  bark  powders,  but  with¬ 
out  deriving  the  least  benefit.  On  the  first  day  of  his  ap¬ 
plication,  he  began  with  the  arsenic  solution  without  any 
emetic,  ut  infra  praescripfa. 

‘  u  R.  Solut.  arsenic  acid — Tinct,  cascariike  re  three  ounces 
— M.  sumat  gtt.  vj.  quaq.  dua  hor. 

a  Onthe22d,  the  drops  were  repeated,  but  he  informed 
me  the  fever  had  attacked  him  only  once  since  he  took  the 
medicine.  I  saw  him  again  on  the  26th,  and  with  ineffable 
joy  in  his  countenance,  he  told  me  that  he  has  suffered  no¬ 
thing  from  his  complaint  since  the  time  above-mentioned. 
My  appetite,  says  he,  is  improved,  and  my  strength  so  much 
recruited,  that  I  feel  quite  another  man.  To  these  might 
be  added  no  less  than  twenty  other  instances  where  I  have 
given  it  without  the  least  injury,  but  with  the  most  decided 
advantage.  One  patient,  however,  took  it  to  ilic  extent  of 
nine  drops,  which  brought  ou  a  great  degree  of  vertigo;  but 
another,  (like  the  first)  imagining  the  larger  the  dose  the  sooner 
the  cure,  took  at  least  sixteen  drops  at  once,  and  without 
any  bad  consequence.  To  avoid  these  errors  in  future,  the 
drops  were  given  in  a  mixture;  and  though  the  latter,  a 
Mrs.  Norman,  had  taken  that  extraordinary  dose  without 


* 


VOL.  II. 


Q 


82 


Pharmacy . 


[  January f 


any  sensible  effect,  I  found  in  three  days  after,-  the  diminish¬ 
ed  dose  of  four  drops  every  two  hours  effected  a  cure* — Such 
are  the  results  of  an  acid,  which,  I  believe,  has  never  till 
now  been  ventured  internally  ;  if  I  am  wrong  in  this  con¬ 
clusion,  I  hope  to  be  forgiven.  To  calculate  on  the  su¬ 
perior  advantages  of  this  solution  is  useless;  what  has  been 
said  of  the  white  oxide  may  be  said  of  this  acid,  only  that 
the  latter  is  a  more  active  preparation*  The  value  of  a  medi¬ 
cine  is  generally  in  proportion  to  the  simplicity  of  its  form. 
Though  the  bark  may  cure,  when  taken  in  sufficient  quantity, 
any  intermittent ;  yet,  the  disgust  which  it  creates,  the  nausea 
which  it  excites,  and  .the  neglect  of  it  which  consequently 
ensues  :  two-thirds  of  the  sick,  rather  than  take  it,  will  leave 
themselves  a  prey  to  their  disorder,  trusting  to  the  chanees 
of  fortune,  or  the  auspices  of  their  Creator.’7 


OPIUM. 

During  the  late  high  price  and  scarcity  of  this  valuabl# 
article,  the  East  India  opium  has  been  much  used ;  it  lias 
not,  however,  been  found  so  efficacious  as  the  Turkey,  ex¬ 
cept  when  used  in  nearly  double  the  quantity.  Opium, 
though  not  in  any  considerable  quantity,  has  also,  during; 
the  late  scarcity,  been  imported  from  Madeira,  the  produce.; 
of  one  of  that  cluster  of  islands  of  Porto  Santo.  It  is  said  to 
be  more  aromatic,  and  more  freb  from  impurities,  than  either 
the  East  India  or  the  Turkey  opium  :  it  is  said  also  to  be  the 
natural  juice  of  a  species  of  poppy  growing  there,  and 
yielded  by  cxcission.  It  is,  in  point  of  efficacy,  found  equal 
to  the  Turkey,  and  superior  to  the  East  India.  The  price 
of  Turkey  opium  is,  however,  from  the  very  large  importa-* 
tion  lately  made,  now  reduced  from  six  guineas  per  pound  to 
thirty  or  thirty-four  shillings;  but  it  cannot  remain  long  at 
this  reduced  price,  as  it  is  known  to  sell  for  more  at  this  pre¬ 
sent  time  in  Turkey. 


Pharmacy . 


83 


) 


1509.] 


COMMUNICATION  ON  FISH-POISON,  BY  MR.  KIERNAN, 

MEMBER  OF  THE  ROYAL  COLLEGE  OP  SURGEONS,  LON- 

DON. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen— Some  observations  were  introduced  into  a 
former  number  of  your  valuable  work,  or  the  subject  of 
Fish-poison.  This  deleterious  quality,  it  was  observed, 
was  confined  to  the  fish  of  the  tropical  climates ;  and  though 
the  fact  is  in  general  well-founded,  yet  an  exception  to  it  in 
this  country  has  come  within  the  sphere  of  my  own  know¬ 
ledge  in  the  following  case. 

Mr.  Helton,  of  George  Street,  Cavendish  Square,  dined 
on  a  very  fine  Barbel r,  as  also  his  wife  and  child.  In  the 
course  of  three  hours  after  eating  it,  they  were  all  seized 
with  excessive  vomiting  and  purging ,  and  these  symptoms 
continued  the  whole  night,  till  the  morning  when  I  saw 
them.  On  makiug  the  most  minute  inquiry  into  the  source 
of  their  malady,  I  could  find  no  other  cause  to  which  it 
could  be  attributed,  than  to  thfe  eating  of  the  fish.  I  there¬ 
fore  conceive  this  circumstance  may  arise  in  any  climate  to 
give  the  deleterious  quality  slated  in  your  work  to  this  spe¬ 
cies  of  food.  This  quality  has  been  particularly  noticed  as 
attending  the  use  of  Mussels,  and  therefore  caution  is  ob¬ 
served  by  most  people  in  eating  them  ;  but  the  same  circum¬ 
spection  has  not  been  thought  necessary  with  White  Fish  of 
any  kind,  nor  should  I  have  conceived  it  till  I  met  with  the 
above  case.  When  I  was  called  to  the  patients,  I  found, 
from  their  history  of  the  symptoms,  that  no  farther  evacua¬ 
tion  was  necessary,  and  I  immediately  had  recourse  to  quieting 
medicines,  which  were  attended  with  the  desired  effect,,  and 
the  symptoms  were  soon  removed.  In  the  child  they  were, 

g  2 


84  Pharmacy.  [January, 

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

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

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

I  am,  Gentlemen, 

Your  obedient  Servant, 

F.  KIERNAN. 

Charlotte-street ,  i Bed  ford-square^ 

Dec.  15,  1808.  ' 

COMMUNICATION  ON  ELECTRICITY,  IN  CASES  OF  SUPPRES¬ 
SION  OF  URINE,  BY  F.  LOWNDES,  MEDICAL  ELECTRI¬ 
CIAN. 

V 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

i 

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


1809c]  Pharmacy.  85 

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

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

e  3 


80 


[January* 


Pharmacy . 

As  the  present  communication  was  entirely  suggested  by 
the  slowness  of  cure  in  the  case  of  suppression  of  urine,  de¬ 
tailed  by  Mr.  C  alder  wood,  in  order  to  prove  the  justice  of  my 
remark,  I  shall,  in  the  next  number,  offer  the  particulars  of 
some  instances  of  obstinate  suppression  of  urine,  which  had 
resisted  all  the  usual  remedies,  yielding  to  the  application  of 
Electricity  at  once,  and  in  so  complete  a  manner,  that  the 
water  was  discharged  in  a  full  and  powerful  stream  before 
the  patient/had  finished  his  first  attendance  on  me. 

I  am, 

Gentlemen, 

Your  obedient  Servant, 

F.  LOWNDES, 

*  >  ?  '  .  •  I  <  fr 

St.  Paul’s  Church-yard , 

Dec.  20  1808. 


LETTER  ON  THE  OXID  OF  BISMUTH. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — No  disease  is  more  obstinate  than  the  com¬ 
mon  one,  known  by  the  name  of  stomach  complaints,  and 
we  are  in  want  of  a  remedy  which  may  be  termed  specific 
against  this  train  of  disorders.  In  fact,  irregularities  in 
diet  are  too  often  the  great  source  of  this  affection,  and  a 
life  of  temperance,  sobriety,  and  water-drinking,  which  is 
the  great  step  towards  a  cure,  can  hardly  be  submitted  to  by 
most  patients.  Of  late,  a  remedy  against  these  disorders 
has  been  prepared  by  Dr.  MarCet,  riz.  the  Oxid  of  Bis¬ 
muth  ;  and  I  give  him  credit  for  its  introduction.  I  have 
repeatedly  tried  this  remedy  in  affections  of  the  stomach, 
attended  with  indigestion,  pain,  and  spasm,  and  found  it 
answer  every  intention  which  has  been  described.  In  some 
cases  the  relief  was  very  rapid ,  in  others  the  cure  went  on 


Pharmacy . 


3? 


1809.] 


Tnore  gradually  ;  but  from  ray  own  experience,  I  can  vouch 
it  to  be  a  medicine  of  very  active  powers.  It  is  highly 
necessary,  however,  that  this  Oxid  be  in  a  pure  state,  and 
well  prepared.  In  confirmation  of  this  opinion,  I  have 
also  the  authority  of  Dr.  Bardsley,  as  well  as  Dr.  Marcet, 
in  its  favour-  It  is  said  to  have  alleviated  even  the  ex¬ 
cruciating  pains  of  a  cancerous  Pylorus  by  Dr.  Odier. 
The  particular  affection  in  which  it  seems  to  excite  its  pow¬ 
ers,  as  it  were  specifically,  is  in  the  Pyrosis ,  o^  Water 
Brash .  It  should  be  assisted  in  its  operation  by  a  proper 
use  of  aperients,  and  it  is  perhaps  one  of  the  safest  metallic 
preparations  that  can  be  introduced  intothe  system.  These 
circumstances  I  state  with  the  view  to  attract  the  attention 
of  the  profession,  whose  experience  will  confirm  my  as¬ 
sertions  or  detect  my  error,  if  I  have  carried  my  zeal  for 

novelty  and  improvement  too  far. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

A  CHEMICAL  PHYSICIAN. 


Liverpool ,  Deg.  10,  1808. 

■i«gi 


ON  TAXED  MEDICINES. 

To  the  Editors  o  f  The  Medical  and  Surgical  Spectator . 

Gentlemen— l  submit  to  you  the  propriety  of  inserting  in 
your  useful  publication,  a  thought  which  struck  me  a  few 
days  ago,  on  buying  a  few  bottles  of  Soda  Water,  which  I 
was  advised  to  take  to  restore  my  health  : — When  a  tax  is 
laid  on  a  medicine,  quack  or  not  quack ,  for  no  difference  it 
seems  has  been  made,  it  is  not  on  the  vender  it  falls,  but  the 

buyer :  he  unfortunately  must  buy,  or  die  and  be  d - d,  if 

lie  cannot  dp  so  :  while  the  vender,  who  frequently  makes  no 

G  4 


88  Pharmacy.  [January, 

less  than  two  hundred  per  cent,  by  the  sale,  cannot,  io  be  sure, 
afford  to  sink  the  tax  out  of  his  profits.  Hence  it  becomes 
a  tax  actually  laid  on  by  Quacks  and  Medicine  Tenders  ; 
who,  if  reports  speak  truly  of  them,  make  a  rare  living  by  the 
misfortunes  and  credulity  of  mankind. 

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

I  maybe  wrong  ;  but  1  do  not  see  why  the  price  of  medi¬ 
cines,  I  mean  such  as  are  essential  and  valuable  for  the  cure 
of  certain  diseases  to  which  mankind  are  liable,  should  not 
be  fixed  by  proper  persons  appointed  for  the  purpose,  in  the 
same  manner  that  certain  necessary  articles  of  consumption 
are, — such  as  bread,  sugar,  &c.  Arc  not  useful  medicines 
as  essential  to  the  welfare  of  mankind  as  the  former  ? 
Then,  if  Ministers  thought  proper  to  lay  a  tax  on  these,  they 
might  always  be  able  to  do  so,  with  justice  to  all  parties,  by 
laying  it  on  such  medicines  as  circumstances  rendered  best 
able  to  bear  the  impost,  such  ns  a  fall  in  the  price  of  the  in= 


|809.  j  Pharmacy.  89 

gradients  with  which  they  ara  manufactured.  The  public, 
by  these  means,  so  far  from  suffering  by  such  a  tax,  would 
be  benefitted  in  proportion  to  the  sum  produced  by  it. 
Instead  of  which,  as  the  taxes  are  now  laid  on  these  articles, 
they  are  very  often  grievously  felt,  by  the  poor  sick  man, 
who  is  not  oiffy  in  want  of  the  medicine  but  often  money  to 
buy  it, 

I  might  enter  more  fully  on  the  benefit  likely  to  arise  from 
the  adoption  of  my  plan,  and  its  practicability,  but  I  fear  to 
intrude  too  much  on  your  room. 

I  remain,  Gentlemen, 

Your  obedient  Servant, 

London,  A  SICK  MAN, 

Dec.  20,  And  formerly  a  Patient  at  Guy’s, 

The  complaint  of  (he  above  correspondent  is  just :  lie 
speaks  a  language  which  every  man  who  has  felt  sickness  will 
approve.  The  preparation  of  mineral  waters  is  certainly 
rendered  now  both  a  simple  and  cheap  process.  Their  pow¬ 
ers  as  medicines  are  held  in  high,  estimation  by  the  Faculty  at 
large,  but  the  fact  stated  by  our  correspondent  is  true,  they 
are  only  to  be  got  at  a  high  price ,  which  the  pocket  of  the 
poor  man  cannot  command.  He  is  thus  excluded  from  their 

t 

benefit — for  they  are  not  remedies  prepared  in  the  public  hos¬ 
pitals,  nor  have  they  yd,  however  necessary  they  may  be, 
entered  the  list  of  the  College  Pharmacopoeia.  In  a  former 
communication  by  a  correspondent  to  this  work,  the  subject 
was  treated  in  a  letter  to  Dr.  Babington,  advising;  an  aften- 
tion  on  the  part  of  the  College  to  this,  and  we  hope  these 
hints  have  not  been  thrown  away.  We  conceive  that  the 
mineral  waters  being  prepared  at  all  the  public  hospitals  and 
dispensaries,  both  a  cheaper  and  more  successful  plan  of 
medicine  might  be  adopted,  and  the  complaint  of  our  poor 
^ick  correspondent  done  away . 


90 


3/edical  Intelligence. 


[January* 


MEDICAL  INTELLIGENCE. 


TO  THE  ARMY  MEDICAL  BOARD. 

AN  ingenious  Correspondent  has  desired  us  to  offer  the  following'  sug¬ 
gestion  to  the  consideration  of  the  Array  Medical  Board.  In  the  present 
arduous  service  in  which  our  brave  troops  are  engaged  iu  Spain  and 'Portu¬ 
gal,  it  must  occur  that  the  soldiers  dress  of  this  climate  must  be  a  great 
impediment  to  their  exertions.  The  chief  inconvenience  suffered  by  men 
in  these  countries  is  from  the  rainy  season  setting  in,  by  which  they  are 
kept  constantly  drenched  with  wet.  The  moisture  soon  soaks  through  their 
heavy  great  coats,  and  other  parts  of  their  dress  intended  to  guard  them 
against  it,  so  that  these  parts  of  their  dress  thus  add  to  their  inconve¬ 
nience  by  their  weight  as  well  as  moisture,  instead  of  being  a  protection  or 
comfort.  For  the  service  on  the  Continent  it  would  be  fitter,  as  heat  is 
not  so  much  wanted  as  dryness,  that  a  light  wax  covering,  perfectly  waters 
proof,  could  be  made,  which,  on  the  approach  of  rain,  could  be  thrown 
over  the  rest  of  their  dress,  and  completely  defend  them  from  the  incle¬ 
mency  of  the  weather.  It  could  be  easily  carried  in  their  knapsack,  and 
might  he  so  formed  as  to  make  no  more  than  two  pounds  of  additional 
weight.  When  we  consider  that  moisture  is  the  great  predisposing  cause 
to  all  Army  diseases,  the  above  observations  merit  the  serious  attention  of 
the  Medical  Board,  and  all  the  Military  Departments. 

THE  ESSEX  REPORT  OF  VACCINATION. 

If  we  take  our  own  experience. as  the  test  of  Vaccination,  we  are  its 
decided  friends,  and  shall  always  feel  happy  in  the  removal  of  doubts  on 
this  very  interesting  point :  we  are  of  opinion  the  following  candid  statement 
will  materially  contribute  to  its  success,  and  under  a  firm  conviction  that 
every  friend  to  humanity  ought  to  facilitate  this  national  object,  we  have 
given  it  at  length,  as  it  affords  irrefragable  evidence  of  the  security  of  vac¬ 
cination,  attested  by  the  first  medical  characters  in  the  County  of  Essex  : 

At  the  Anniversary  Meeting  of  the  Colchester  Medical  Society,  holden 
this  da;y,  August  23,  1808,  the  following  Resolutions  were  entered  on  their 
Journals,  in  consequence  of  a  motion  made  at  their  last  Meeting,  June  21st, 


Medical  Intelligence . 


91 


1809.] 


by  Dr.  Newell,  requesting  the  Members  of  the  Society,  at  their  next 
Meeting,  to  Report  their  Observations  on  the  Security  of  Vaccination  as  a 
Protection  from  Small  Pox,  and  the  consequent  Effects  of  it  upon  the  Con¬ 
stitution, 

“  Resolved,  That  the  Members  of  this  Society,  from  a  steady,  candid  and 
impartial  attention  to  the  effects  of  Vaccination,  during  a  period  of  eight 
years,  in  which  time  several  thousand  persons  have  been  vaccinated  by  them, 
think  it  their  duty  to  give  this  public  testimony  of  its  perfect  safety  and  se¬ 
curity  as  a  preventive  of  Small-Pox;  and  further,  that  under  the  fullest  con¬ 
viction  of  the  practice,  they  have  not  only  recommended  it  to  their  patients, 
but  introduced  and  practised  it  in  their  own  families,  amongst  their  nearest 
and  dearest  relatives.  That  they  have  at  different  times  exposed  many  of 
their  patients,  long  afterwards,  to  the  contagion  of  the  Small -Pox  in  every 
way  they  could  devise,  with  perfect  safety  from  its  infection,  and  that  they 
have  never  been  able  to  trace  any  subsequent  diseases,  as  excited  by  Vacci¬ 
nation  in  the  constitution. 

“  They  feel  it  the  more  incumbent  upon  them,  at  this  time,  to  make  so 
public  an  avowal  of  their  sentiments,  as  the  Small-Pox  has  lately  been  so 
extremely  prevalent,  and  fatal  in  this  town  and  its  vicinity,  and  because  the 
prejudices  against  vaccination,  particularly  among  the  lower  order  of  the 
people,  have  been  kept  up  by  false  and  infamous  reports,  some  of  which 
have  been  artfully  introduced  into  publications  of  notoriety  and  extensive 
circulation. 

“  They  are  fully  convinced,  that  it  is  only  by  the  unbiassed  declarations 
of  experienced  and  respectable  practitioners  in  different  districts,  the  public 
mind  can  be  satisfied,  and  this  most  valuable  discovery  and  piactice  univer¬ 
sally  adopted. 

“  Resolved,  That  this  Society  views  with  abhorrence  the  subtle,  artful, 
and  designing  conduct  of  some  practitioners,  who  continue  indiscriminately  to 
recommend  Inoculation  for  the  Small-pox  or  Cow-pox,  as  best  suits  their 
purposes,  and  by  that  means  frequently,  when  the  former  is  adopted,  diffuse 
and  spread  that  most  dreadful  and  destructive  pestilence  through  whole  vil¬ 
lages  or  populous  districts,  regardless  what  misery  and  distress  they  entail 
upon  others ;  of  such  shocking  conduct  the  Members  of  this  Society  have 
lately  had  the  many  proofs,  and  they  earnestly  hope  that  proper  and  effi- 


m 


Medical  Intelligence.  [January* 


dent  steps  will  ere  long  be  taken  by  the  Legislature  to  stop  this  horrid 
traffic. 

“  Resolved,  That  Copies  of  these  Resolutions  be  transmitted  to  the 
different  Medical  Journals  now  in  circulation,  and  a  sufficient  number  pf 
them  printed  and  circulated  in  this  town  and  its  vicinity. 


S.  R.  Meweix,  Colchester. 
Ph.  Gretton,  dittos 

John  Godfrey,  Coggeshall. 

T.  C.  Uarrold,  Nayland. 

' 

Henry  Nunn,  Manningtree. 
Wm.  Travis,  East  Bergholt. 
G.  Rogers,  Manningtree. 
Wm.  Silke,  ditto. 


Benj.  Smith,  Wivenhoe. 

Natii.  Sauter,  Boxford. 
Maurice  Mason,  St.  Osvth. 

R.  Nunn,  Colchester. 

F.  Eagle,  Coggeshall. 

G.  Kemball,  Tolleshunt  Barcey. 
T.  Osmund,  Thorp. 


The  Medical  Board,  we  are  informed,  was  to  expire  on  the  24th  of  this 
month.  We  have  not  heard  what  new  arrangements  have  taken  place,  and 
what  medical  regulations  are  of  course  to  follow.  When  these  are  made 
public,  we  shall  be  attentive  to  lay  them  before  our  readers.  We  hope  they 
jvill  make  a  material  improvement  on  the  old  system,  and  that  we  shall  have 
only  to  present  them  with  commendation  and  satisfaction,  as  applying  to  all 
the  wants  of  the  service. 


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


We  understand  the  Secretary  of  State  for  the  Home  Department  has  di¬ 
rected  the  Royal  College  of  Physicians  to  inquire  into  the  cause  of  the  re<- 
cent  frequent  occurrence  of  cases  of  Hydrophobia,  and  to  consider  of  the 
means  of  preventing  the  increase  of  this  alarming  disorder.  We  look  for¬ 
ward  to  this  report  with  considerable  anxiety,  and  have  no  doubt  this  learn¬ 
ed  body  will  give  every  attention  to  this  interesting  subject ;  it  could  not 


1809. J 


Medical  Intelligence. 


95 


have  been  committed  to  better  hands,  and  we  have  no  donbt  considerable 
elucidation  will  be  the  result  of  their  labour  ;  the  well  drawn  case  ©f  Dr. 
Powell,  and  the  recent  effects  that  case  had  upon  the  infant  of  Ann  Chandler, 
we  should  conceive  would  lead  to  much  important  information  on  a  subject  in 
which  the  interests  of  mankind  in  general  are  at  issue.  That  case  in  our 
opinion  cannot  be  too  widely  diffused,  and  may  justly  be  considered  as  the 
land-mark  to  future  practitioners  :  we  lament  that  men  eminent  for 
science  and  liberality,  should  in  this  instance  deviate  so  widely  from  the 
point  :•  we  trust  the  intended  report  will  finally  settle  the  controversy,  to  the 
advantage  of  the  civilized  world. 

A  meeting  of  the  Collego  of  Physicians  has  since  been  held  on  the 
subject ;  and  we  hope,  from  their  united  consultation,  that  some  means 
may  he  devised  to  ameliorate  the  treat-  meat  in  this  most  dreadful  of  all 
maladies. 

St.  Andrew’s  day  Royal  Society. — Dr.  William  Henry  this  year,  re- 
leived  the  gold -medal  for  his  varions  communications.  (Sir  Godfrey  Cross- 
ey’s.)  Dr.  W.  H.  Wollaston  was  the  same  day  elected  one  of  the  Secre¬ 
taries,  and  a  Member  of  the  Old  Council  i  Dr.  C.  Ash  was  also  elected  of 
the  New  Council. 

The  Election  of  a  Physician  of  the  Surrey  Dispensary,  in  the  room  of 
the  late  Dr.  Hawes,  has  been  attended  with  much  opposition,  and  has  ex¬ 
cited  general  interest.  It  is  not  the  business  of  this  work  to  enter  into  the 
controversy  to  which  this  opposition  has  given  rise.  In  the  appointments  to 
all  public  charities,  our  opinion  is  “  detur  digniori.  If  the  merits  of  the  two 
candidates  are  weighed  by  their  profesaional  experience,  respectability,  and 
uniform  attention  to  the  interests  of  the  charity,  the  Governors  can  have  no 
hesitation  in  their  choice;  but  the  interests  of  the  charity  are  not  always- 
the  bias  on  these  occasions. 

Dr.  Tatersall,  we  just  learn,  has  been  voted  in  Physician  to  the  Surrey 
Dispensary  by  a  majority  of  new  names  about  to  be  scrutinised', 

Anthony  Carlisle  Esq.  of  Soho  Square,  Surgeon,  F.  IF.  S.  h  chosen  pro¬ 
fessor  of  Anatomy  to  the  Royal  Academy. 

We  are  sorry  to  learn  the  Small  Pox  rages  with  great  violence  at  Wellington, 


94 


[January, 


Medical  Intelligence . 

Retley,  See.  in  Staffordshire.  In  each  county,  the  erection  cf  a  central  vac- 
cine  station  would  be  of  great  service  :  it  is  with  pleasure  we  announce  such 
a  scheme  is  in  agitation. 


A  letter  from  Savannah,  dated  Oct.  6,  says—  “  Accounts  from  St, 
Mary’s  by  the  last  mails,  represent  that  place  as  very  unhealthy.  Letters 
Trom  thence  state  the  prevalence  of  a  disease  attended  with  every  symptotn 
of  yellow  fever.— -Though  the  faculty  did  not  consider  it  contagious,  mos* 
of  the  inhabitants,  we  understand,  had  deserted  the  town,  and  fled  into  the 
country.  The  following  is  extracted  from  a  letter  leceived  by  last  mail* 
dated  on  Friday  : 

4‘  The  fever  has  raged  here  more  violently  than  I  ever  knew  it  in  Geor¬ 
gia.  Although  it  was  at  firt  conceived  to  he  very  partial,  it  has  extended 
to  at  least  one  third  of  the  inhabitants.  There  are  now  said  to  be  forty- 
eight  cases,  of  which  nineteen  are  black  ;  and  fourteen  exclusive  of  thrs 
number  have  been  interred.  The  town  is  nearly  deserted. 

A  General  Bill  of  all  the  Christenings  and  Burials  within  the  Bills  of 
Mortality,  from  December  15,  1807,  to  December  13,  ISOS. — 

Christened  in  the  97  parishes  within  the  Walls  1088. — Buried  1372. 

Christened  in  the  17  Parishes  without  the  walls  4503. — Buried  3969* 

Christened  in  the  23  Out-Parishes  in  Middlesex  and  Surrey  10,105. — - 
Buried  9737. 

Christened  in  the  10  Parishes  in  the  City  and  Liberties  of  Westminster 


4210.— Buried  4876. 


Christened 


Males  . 
Females 


•  •  • 


1 0, 1 89 
9,717 


|  in  all  19,90,6 


# 


Buried 


Whereof  have  died  — 
Under  two  years  of  age 
Between  two  and  five 
Five  and  ten 
Ten  and  Twenty 
Twenty  and  thirty 
Thirty  and  forty 
Forty  and  fifty 


age  6,075  Fifty  and  Sixty 


2,466  Sixty  and  Seventy 
8  4/7  Seventy  and  eiirhfv 


1,690 

1,499 

1,200 

305 


l 


Increased  in  the  burials  this  year  1,63© 


1809.]  Medical  Intelligence . 


Never  did  the  great  cause  of  humanity  suffer  more  severely  by  the 
death  of  any,  than  by  that  of  Dr.  William  Hawes ;  a  man  venerat¬ 
ed  by  humanity  and  revered  by  science ;  the  wild  Arab,  the  unpolished 
Indian,  and  the  civilized  citizen,  each,  in  their  turn,  may  owe  to  him  a  se¬ 
cond  life;  the  achievements  of  the  warrior  and  statesman  will  perish  in  revolv¬ 
ing  time,  but  the  name  of  Hawes  will  triumph  over  death,  and  the  unclouded 
energy  of  his  beneficence  animate  posterity.  Were  we  to  fondly  indulge 
in  enthusiastic  sorrow,  it  would  be  incompatible  with  the  solemnity  of  the 
occasion,  and  be  completely  opposite  to  that  fascinating  simplicity  that 
Sheds  so  bright  a  lustre  on  every  act  of  his  well  spent  life  :  the  removal  of 
such  a  character  from  the  theatre  of  his  beneficence,  we  must  deplore  as  a 
national  calamity,  and  in  the  plenitude  of  our  sorrow,  we  naturally  wish  his 
residence  had  for  ever  been  prolonged  among  us.  In  the  erection  of  the 
Humane  Society,  the  people  of  this  country  have  received  a  legacy  from 
which  ages  to  come  may  derive  happiness ;  the  improvement  of  this  legacy 
has  been  deposited  to  the  care  of  the  British  Nation.  Generous  guardians, 
continue  to  improve  this  dowry,  and  let  the  vivid  effusion  of  sensibility  me¬ 
liorate  humane  misery. 


LONDON  HOSPITAL. 

Dr.  Buxton’s  Lectures  on  the  Theory  and  Practice  of  Medicine,  and  o* 
Materia  Medica  will  be  commenced  about  the  20th  of  January.  For  par¬ 
ticulars  apply  to  Mr.  Price,  Apothecary  at  the  Hospital,  or  to  Dr.  Buxton 
Fenchurch  Street.  / 


MEDICAL  AND  CHEMICAL  LECTURES. 

Dr.  Clutterbuck  will  begin  his  Spring  Course  of  Lectures  on  the  Theory 
and  Practice  of  Physic,  Materia  Medica,  and  Pharmaceutic  Chemistry,  early 
in  January,  at  nine  in  the  morning.  Particulars  may  be  known  on  application 
at  No.  ],  Crescent,  New  Bridge-Street. 


Dr.  Reid  will  commence  his  Course  of  Lectures  on  the  Theory  and  Prac¬ 
tice  of  Medicine,  at  his  house,  No.  6,  Grenville  Street,  Brunswick  Square,  on 
Monday,  January  23d,  at  nine  o’clock  in  the  morning. 


Mr.  Taunton  will  commence  his  Spring  Course  of  Lectures  on  Anatomy, 
Physiology,  Pathology  and  Surgery,  at  his  Theatre  of  Anatomy,  on  Satur¬ 
day,  January  the  21st,  at  eight  o’clock  in  the  evening. 


$6  'i  Medical  Intelligence.  [January, 

i 

Dr.  Squire  will,  on  Monday,  January  2d,  1809,  begin  a  Course  of  Lec¬ 
tures  on  the  Theory  and  Practice  of  Midwifery,  and  the  Diseases  of  Women 
and  Children. 


NEW  MEDICAL  PUBLICATIONS. 

An  inquiry  into  the  symptoms  and  treatment  of  Carditis,  or  the  inflam¬ 
mation  pf  the  Heart ;  illustrated  by  cases  and  dissections.  By  John  Ford 
Davis,  M.  D.  12mo.  6s.  boards. 

Suggestions  for  the  prevention  of  that  insidious  and  destructive  foe  to  the 
British  Troops  in  the  West  Indies,  commonly  termed  the  Yellow  Fever,  &c. 
By  Stewart  Henderson,  M.  1).  8vo.  5s. 

Observations  on  madness  and  raela&cboly  ;  including  practical  remarks  on 
those  diseases;  together  with  cases  :  and  an  account  of  the  morbid  appear¬ 
ances  on  dissection.  By  John  Has  lam.  Member  of  the  Royal  College  of 
Surgeons,  8vo.  9s.  boards. 

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

Identities  ascertained,  or  an  illustration  of  Mr.  Ware’s  opinion  respecting 
the  sameness  of  infection  in  Venereal  Gonorrhea,  and  the  Ophthalmia  of  Egypt, 
Svo.  2s.  6d. 

IN  THE  PRESS. 

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


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


Tie  have  received  the  prospectus,  addressed  to  us.  of  an 
intended  periodical  publication 3  to  be  called  THE  DETEC¬ 
TOR;  but  as  it  is  irrelevant  to  the  plan  of  The  Medical 
and  Surgical  Spectator  to  enter  into  the  merits  or  demerits 
of  controversial  disputes ,  zee  shall  be  silent  on  the  nature  of 
its  intended  contents. 


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

THE  LONDON 

Metrical  anss  Surgical 

SPECTATOR. 


EMPIRICISM, 


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


98 


[February, 


Empiricism . 

that  none  of  them  are  ever  submitted  to  the  opinion  of  pro¬ 
fessional  characters.  If  they  were,  they  would  find  all  the 
compositions  of  those  ignorant  pretenders  erroneous  in  the 
principles  of  their  prescription,  or  else  no  other  than  common 
forms  of  the  Pharmacopoeia,  intended  for  a  special  purpose, 
converted  by  imposition  to  the  exalted  state  of  an  universal 
remedy. 

The  degraded  rank  of  patent  privileges,  as  a  passport  to 
public  confidence  and  reputation  on  the  head  of  medicine, 
cannot  be  better  instanced  than  by  the  opinion  entertained  of 
them  on  the  continent.  When  the  Yellow  Fever  remedy  was 
introduced  into  Spain,  the  Prince  of  Peace  expelled  it  by 
Royal  Edict,  as  dangerous  to  the  lives  of  the  community  ;  so 
that  one  sovereign  reprobated  what  another  had  given  royal 
authority  to  use.  In  Russia,  British  Patent  Medicines  are 
not  even  allowed  to  be  imported. 

Of  empirical  medicines,  those  have  been  experienced  the 
most  successful  to  their  owners  which  have  been  employed 
against  incurable  diseases.  This  we  cannot  instance  more 
strongly  than  by  noticing  some  of  the  specifics  for  Pulmonary 
Consumption. 


ANTI  PHTHISICAL  SPECIFICS. 

The  first  we  shall  introduce  is  the  famous  remedy  of  Mr. 
Crodbold,  termed  his  Vegetable  Balsam. 

GOD  Bonn’s  VEGETABLE  BALSAM. 

This  medicine  is  no  more  than  the  simple  oxymel  of  the 
shops,  consequently  a  composition  of  vinegar  and  honey. 
Such  a  simple  remedy,  therefore,  as  its  inventor  well  observes, 
u  if  it  does  no  good,  can  certainly  do  no  harm.”  In  slight 
colds  or  catarrhs,  trifling  remedies  of  this  kind  may  be  used. ; 
they  at  least  amuse  the  patient ;  but  where  they  are  employed 
in  diseases  of  a  formidable  nature,  and  under  the  impression 
thatthey  are  more  than  useful,  nay  infallible,  to  the  prejudice 
of  proper  means  being  resorted  to,  the  use  of  such  remedies 


99 


1809.J  Empiricism . 

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

CRAMOIl’s  BALSAM  OF  ICELAND  LIVERWORT. 

A  more  modern  antiphthisical  specific  is  the  Iceland  Li- 
verwort.  This  is  a  deception,  being  nothing  more  than  the 
oxymel  of  squills  flavoured  with  the  essential  oil  of  anise  and 
carraway.  It  is  introduced  to  notice  by  a  long  dissertation 
on  the  subject,  in  which  the  virtues  of  the  Liverwort  are 
amply  detailed,  though  not  a  particle  of  it  enters  the  present 
composition  ;  and  the  mode  of  preparation  is  carefully  con¬ 
cealed  by  the  author. 

u  Fearful  that  the  invaluable  properties  of  the  Iceland  Li¬ 
verwort  might  be  much  impaired ,  or  totally  destroyed,  I 
have  thought  proper,”  says  the  proprietor,  u  to  conceal  its 
process  and  combination,  upon  the  very  careful  preparation 
ȣ  which  depends  its  efficacy,  its  consequent  reputation,  and 

u  9 


100  Empiricism .  [February 

my  veracity ;  but  when  such  regulations  take  place  in  the 
profession  that  the  different  departments  be  strictly  observed, 
I  shall  with  pleasure  divulge  it.” 

REGNAULt’s  SYRUP  AND  LOZENGES  OF  ICELAND  LIVER¬ 
WORT. 

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

Allen’s  PECTORAL  BALSAM  OF  LIQUORICE. 

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


101 


1809.]  Empiricism . 

cc  Most  of  the  nostrums  advertised/1  he  observes,  Ci  as  cough 
drops,  &c.  are  preparations  of  opium,  similar  to  the  paregoric 
elixir  of  the  shops,  but  disguised  and  rendered  more  deleteri¬ 
ous  by  the  addition  of  aromatic  and  healing  gums  ;  the  injury 
which  may  be  occasioned  by  the  indiscriminate  employment 
of  such  medicines  in  this  disease  may  be  very  considerable,  as 
is  well  known  by  every  person  possessing  even  the  smallest 
share  of  medical  knowledge.’5 

perrin’s  balsam  of  lungwort. 

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

To  prepare  the  lungwort,  and  give  it  such  concentration, 
is  impossible.  It  is  merely  a  mucilaginous  vegetable,  and 
Mr.  Perrin  has  taken  an  active  preparation  well  know  n,  which 
he  has  newly  christened  with  this  name.  This  is  nothing 
more  than  the  Paregoric  Elixir  in  its  usual  form.  On  the  % 
use  of  such  opiates  we  have  said  enough  in  the  former  ar¬ 
ticle. 

pectoral  balsam  of  honey. 

This  is  the  production  of  the  celebrated  Sir  John  Ilill, 


102 


[February* 


Empiricism. 

who,  with  considerable  abilities,  ingenuity,  and  learning,  de¬ 
scended  at  last  to  the  character  of  a  Quack.  The  balsamic 
qualities  of  honey,  he  knew,  was  a  favourite  popular  idea  ; 
and  though  such  a  preparation,  it  is  well  known,  is  impos¬ 
sible,  a  substitute  in  the  fragrant  smell  and  appearance,  h© 
knew,  could  be  had  in  the  tincture  of  Tolu  and  Benzoin.  This 
is  therefore  the  true  advertised  Balsam  of  Honey  ;  and,  like 
all  the  other  balsams  which  are  of  a  heating  and  stimulant  na¬ 
ture,  instead  of  alleviating  the  symptoms  of  consumption, 
they  tend,  by  increasing  the  quantity  of  pus,  to  aggravate  the 
disease. 

The  medicine  is  introduced  by  the  following  eulogium  on 
Sir  John  Hill,  and  a  long  detail  of  the  merits  of  the  prepat 
ration : 

u  The  Linnasus  of  Britain  (for  such  was  Sir  John  Hill  em¬ 
phatically  called)  recommends  this  excellent  preparation,  as 
the  most  salutary  and  effectual  remedy  for  recent  colds,  obsti- 
nate  coughs,  sore  throats,  difficulty  of  breaching,  asthmas, 
catarrhs,  and  all  disorders  of  the  breast  and  lungs.  Congeal¬ 
ed  phlegm,  acrimony  in  the  fluids  and  obstructions  in  the 
glands,  are  gently  and  safely  discharged  by  easy  expectora- 
tion,  wheezings,  and  uneasiness  in  breathing  are  speedily 
removed  by  a  few  doses.  It  takes  off  the  irritation,  opens  the 
thoracic  duct,  and  heals  the  soreness  cf  the  breast  and  lun«fs. 
Thirty  years  experience  has  confirmed  the  recommendation 
in  the  immediate  relief  and  gradual  cure  of  coughs,  colds, 
asthmas  and  consumptions,  it  is  the  greatest  preserver  of  the 
lungs  ever  discovered,  and  contains  all  the  healing,  softening 
and  soothing  qualities  of  that  salubrious  extract  of  flowers, 
called  honey,  and  the  richest  balsams  of  the  eastern  world  ; 
it  is  as  restorative  as  asses’  milk,  and  never  disagrees  with  the 
stomach  ;  a  common  cold  yields  to  its  benign  influence  in  a 
few  hours  ;  and  when  resorted  to,  before  the  complaint  is  far 
advanced,  all  danger  of  consumption  is  certainly  prevented. 

&c  Obstinate  coughs,  confirmed  asthmas,  and  consumptive 


303 


1809.]  Empiricism 

complaints,  yield  to  the  influence  of  this  great  medicine ;  in 
tact,  it  needs  only  a  trial  to  convince  the  most  incredulous  of 
its  unrivalled  properties.  Such  are  the  faint  outlines  of  the 
merits  of  Sir  John  Hill’s  Balsam  of  Honey,  the  result  of  long 
researches  into  nature  by  that  great  botanist,  who  dedicated 
his  life  to  the  discovery  of  the  true  means  of  health  in  the 
vegetable  kingdom.” 

The  example  thus  set  by  Sir  John  Hill  has  been  univer¬ 
sally  practised;  and  there  is  almost  no  vender  who  does  not 
deal  in  the  Pectoral  Balsam  of  Honey  drawn  from  this  source. 
One  person,  of  the  name  of  Cundell,  has  even  pretended  to 
improve  it;  but  where  the  improvement  lies  we  cannot  dis¬ 
cover. 

HOPE’S  HECTIC,  OR  RATHER  ANTI-HECTIC,  PILES. 

This  is  a  medicine  said  to  be  brought  forward  by  the 
author  on  philanthropic  principles ;  and,  in  the  idea  of  its 
inventor,  is  a  discovery  of  equal  importance  with  vaccination. 
It  is  a  discovery  of  old  times,  the  recipe  being  so  antient  that 
the  writing  was  rendered  yellow  by  age.  On  examination, 
it  appears  to  be  nothing  more  than  the  Pectoral  Horse  Balls  of 
the  Farrier.  It  is  more  common  to  apply  regular  medicine 
to  the  veterinary  art,  than  to  transfer  veterinary  practice  to 
the  human  body.  It  has  indeed  been  done  externally  in  the 
Black  Oil  of  Barnet  Guest ;  but  it  has  not  been  ventured  on 
before  internally,  especially  in  a  disease  of  such  a  dangerous 
nature  as  pulmonary  consumption.  As  we  have  not  heard 
much  of  late  of  Mr.  Hope’s  specific,  in  spite  of  his  boasts,  and 
even  challenge  held  out,  we  suppose  it  has  returned  to  the 
senility  from  which  his  anile  understanding  and  ignorance  first 
drew  it. 

PNEUMATIC  PULMONARY  PRACTICE 

To  be  introduced  in  our  next  number, 


104 


Medicine . 


[February  g 


REGULAR  PRACTICE. 


I.  MEDICINE. 

The  important  subjects  which  have  for  some  time  so  much 
occupied  public  atlpntion,  still  continue  to  proceed. 

HYDROPHOBIA. 

Tins  first  of  these,  Hydrophobia,  has  now  engaged  the 
interference  of  the  legislature,  who,  by  a  letter  to  the  Col¬ 
lege,  noticed  in  our  last,  has  directed  a  Report  to  be  made, 
and  every  information  to  be  promulgated  on  the  subject.  The 
College,  with  a  becoming  zeal,  have  requested  information 
from  the  Profession  gt  large ;  and  we  have  no  doubt,  that 
much  valuable  knowledge  will  be  brought  forward  by  these 
means.  At  present,  any  report  by  the  College,  as  far  as  we 
can  judge  by  those  members  of  it  who  are  Physicians  to 
the  Public  Hospitals,  could  only  be  a  recital  of  unsuccessful 
practice,  and  fruitless  precautions.  We  would  wish  parti¬ 
cularly  to  direct  the  attention  of  the  College  to  procure  in¬ 
formation  from  those  concerned  in  veterinary  medicine,  and 
in  the  cure  and  diseases  of  the  animals.  This  information  can 
be  afterwards  regulated  by  proper  views  of  science.  Hydro¬ 
phobia  is  a  subject  bn  which  we  cannot  reason,  because  we 
have  no  facts  on  which  to  build.  We  want  here  a  specific , 
if  such  can  be  procured,  and  the  College  should  here  pro¬ 
ceed  on  the  saying  of  the  noted  Paracelsus,  £C  that  he  would 
take  a  remedy  from  any  quarter,  even  from  the  Devil  him¬ 
self.”  The  importance  of  this  subject  has  brought  a  detail 
of  some  farther  cases  since  our  last  before  the  public.  The 
first  of  these  is  given  by  Mr.  Hardwick,  of  Wenslow,  in  or¬ 
der  to  shew  the  inefficacy  of  the  local  application  of  caustic 
at  the  distance  of  26  hours  after  the  accident. 

u  A  boy,  10  years  old,  was  bitten  in  the  lip  by  a  dog,  with 
which  he  was  accustomed  to  play.  This  happened  in  the 
^yening.  The  boy  was  brought  to  me  the  next  night,  but. 


Medicine. 


m 


JS09.] 

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


10(5 


Medicine. 


[February, 


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

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

CASE  OP  HYDROPHOBIA,  BY  DR.  PINCKARD. 

66  William  Waters,  of  Chipping  Barnet,  Herts,  a  sawyer, 
aged  25  years,  a  strong  healthy  man,  married,  arid  father  of 
one  child,  was  bitten  on  the  J  4th  day  of  September  last,  close 
above  the  upper  joint  of  the  little  finger  of  the  left  hand,  by  a 
strange  dog,  which  he  met  running  upon  the  public  road 
between  Barnet  and  Whetstone.  The  wound  was  deep,  and 
thelaceration  extensive.  He  applied  to  Mr.  Lloyd,  a  surgeon 
at  Barnet;  and,  no  suspicion  of  madness  being  entertained, 
the  common  treatment,  as  in  other  recent  wounds,  was  employ¬ 
ed.  The  cure  proceeded  without  any  circumstance  worthy 
of  particular  remark,  leaving  an  eschar  about  an  inch  in 
length.  No  provocation  was  given  to  the  dog  ;  nor  has  any 
opportunity  occurred  of  ascertaining  whether  or  not  he  was 
affected  with  rabies. 

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


Medicine . 


10T 


1809.] 


when  lie  still  complained  of  the  pain  it  the  shoulder,  add¬ 
ing,  that  he  was  distressed  likewise  with  <{  the  wind.” — 
Another  of  the  boluses  was  administered,  w  hich  he  swallow¬ 
ed  with  difficulty,  and  he  was  advised  to  take  some  warm 
wine  and  water  ;  but  he  put  it  away,  saying  that  he  could  not 
drink  it,  Mr.  Lloyd  felt  less  satisfied  respecting  the  nature 
of  the  disease  than  when  he  saw  him  in  the  evening,  but  no 
suspicion  yet  arose  that  it  might  be  hydrophobia. 

“  During  the  night  he  remained  extremely  restless,  and 
groaned  so  as  to  disturb  the  family  in  the  adjoining  house; 
but  the  pain  of  the  shoulder  subsided,  leaving,  as  he  expressed 
it,  ct  a  tightness  and  ehoaking  about  the  throat,”  which  inr 
creased  to  an  alarming  degree.  Between  seven  and  eight 
o’clock  the  following  morning  Mr.  Lloyd  repeated  his  visit, 
when  he  found  him  in  a  state  of  extreme  agitation,  with  a 
sense  of  constriction  about  the  throat,  and  great  uneasiness 
and  oppression  at  the  epigastricregion.  His  respiration  was 
irregular  and  convulsive,  and  he  had  frequent  eructations  of 
fiatus.  In  order  to  obtain  relief  from  the  difficulty  of  breath¬ 
ing  and  sense  of  suffocation,  he  had  placed  himself  upon  his 
knees  and  elbows  in  bed.  Some  water  being  offered  him  to 
drink,  he  suddenly  started  with  terror  and  alarm,  was  thrown 
into  violent  convulsive  distortions,  looked  offended,  and  said 
he  could  not  take  it. 

<c  The  nature  of  the  disease  being  no  longer  doubtful,  Mr. 
Lloyd  had  immediate  recourse  to  mercurial  friction.  About 
three  ounces  of  the  unguentum  hydrargyri  fortius,  mixed  with 
camphire,  were  rubbed  in  by  three  persons  upon  the  extensive 
surface  of  the  neck  and  thorax,  the  patient  himself  assisting. 
This  process  was  continued  until  lie  felt  greatly  exhausted. 
He  then  begged  to  be  ldft  quiet,  saying  that  he  was  better. 
His  pulse  was  at  this  time  languid  and  feeble.  After  he  was 
a  little  rested,  about  two  ounces  more  of  the  ointment,  mixed 
wjfh  opium,  w  ere  rubbed  into  the  legs  and  thighs ;  the  frip? 


103  Medicine *  [February* 

lion  being  continued  until  it  was  interrupted  by  excessive 
agitation,  and  general  convulsions. 

<c  The  violent  symptoms  of  this  most  dreadful  of  all  hu«» 
man  calamities  now  increased  rapidly.  Any  liquid  was  an 
object  of  perfect  horror  to  him  ;  the  moving  of  it  in  a  ba¬ 
sin,  pouring  if  from  one  vessel  into  another,  splashing  it 
about  the  room,  placing  it  before  his  eyes,  or  even  speaking 
of  it,  produced  inconceivable  agitation,  accompanied  with 
a  pecular  expression  of  terror,  and  a  dreadful  distortion  of 
the  whole  frame.  Some  water  being  presented  to  him,  he  wag 
instantly  seized  with  convulsions,  sprung  up  suddenly,  and 
leaped  out  of  bed,  throwing  himself  from  the  very  sight  of 
the  basin.  At  this  period  of  the  disease,  the  convulsions  re¬ 
curred  in  rapid  succession  ;  a  considerable  quantity  of  frothy 
saliva  issued  from  his  mouth,  he  uttered  hideous  and  inde¬ 
scribable  groans,  looked  trembling  and  terrified,  and"  a  mark¬ 
ed  expression  of  horror  settled  upon  his  countenance.  Soon 
afterwards  it  was  observed,  that  his  urine  passed  involunta¬ 
rily;  he  complained  more  and  more  of  the  <c  wind  and 
choaking  ;”  the  general  agitation  and  restlessness  increased  : 
the  convulsions  grew  stronger  and  stronger,  and  the  groans 
and  screams  louder,  and  more  frightfully  distressing. 

cc  Between  ten  and  eleven  o’clock  he  was  quite  outrage¬ 
ous  ;  and  the  convulsions  being  so  powerful  that  four  people 
were  unable  to  hold  him  in  bed,  it  was  deemed  expedient 
to  have  recourse  to  a  straight  waistcoat.  During  the  vio¬ 
lence  of  the  convulsions,  one  of  the  persons,  who  was  hold¬ 
ing  him,  said  that  he  attempted  to  bite  him ;  but  lie  imme¬ 
diately  apologised,  observing,  that  he  did  not  mean  to  hurt 
him;  and  Mr.  Lloyd,  who  witnessed  this  circumstance,  be¬ 
lieved  it  to  be  accidental  rather  than  intentional. 

u  The  cicatrix  produced  by  the  wound  upon  the  hand 
was  examined,  and  the  nature  of  the  malady  was  openly 
talked  of  by  the  crow  d  of  persons  who  came  into  the  roon> ; 


Medicine. 


209 


1809,] 

but,  instead  of  feeling  any  apprehension  upon  the  subject, 
he  would  not  admit  that  the  disease  was  in  any  way  con¬ 
nected  with  the  bite  he  had  received.  He  persisted  in  calling 
it  u  the  wind,”  but  expressed  himself  conscious  that  he  could 
u  never  recover.”  No  change  could  be  perceived  in  the  part 
which  had  been  bitten,  except  that  the  scar  appeared  slight¬ 
ly  livid,  as  if  it  were  from  cold.  It  was  neither  swelled  nor 
inflamed  ;  nor  was  there  any  tumour,  inflammation,  or  sore¬ 
ness  in  the  glands  of  the  axilla:  but,  on  being  questioned  par¬ 
ticularly  respecting  the  state  of  the  limb,  he  remarked  that  he 
had  felt  a  sense  of  cold  or  numbness  in  the  hand  and  arm,  for 
two  or  three  days  previous  to  his  being  unwell ;  and  that  he 
had  covered  the  bitten  part  again  with  a  66  thumb  stall,” 
which  he  had  used  for  some  time  after  the  wound  had  healed. 

u  The  restlessness,  terror,  extreme  agitation,  and  strong 
convulsions  continued  until  noon;  the  convulsions  recurring- 

y 

with  excessive  violence  at  intervals  of  only  two  or  three 
minutes,  and  from  the  slightest  irritation ;  mostly  from  the 
sight,  the  sound,  or  only  hearing  the  name  of  water.  About 
one  o’clock  he  became  more  calm,  and  it  was  perceived  that 
'the  horror  and  aversion  to  liquids  were  in  some  degree  dimi¬ 
nished.  Soon  after,  he  wras  prevailed  upon  to  swallow  two 
drachms  of  the  tincture  of  opium. 

Ci  It  was  between  seven  and  eight  o’clock  in  the  evening  of 
the  27th  of  November  when  I  first  saw  him.  Messrs.  Lloyd, 
Rumbold,  Booth,  and  Morrison,  medical  practitioners  at 
Barnet,  were  present.  He  was  then  lying  in  a  straight  waist¬ 
coat,  extended  upon  his  back,  with  his  hands  and  feet  fastened 
to  the  bedstead.  He  was  tranquil  and  composed  ;  his  coun¬ 
tenance  was  natural,  and  his  intellects  undisturbed.  To  the 
questions  which  were  asked  him,  he  replied  in  a  collected  and 
rational  manner ;  and  lie  w  as  sensible  of  all  that  passed  in  the 
room.  His  skin  was  of  natural  warmth,  and  covered  w  ith  a 
moderate  perspiration.  The  pulse  did  not  exceed  90  in  a 
minute:  it  was  obtuse  and  undulating.  On  pressing  his 


no 


Medicine . 


[February 

wrist  with  the  fingers,  the  artery  was  perceived  to  be  slightly 
tremulous.  The  tongue  was  moist,  and,  although  whitish* 
nearly  of  a  natural  appearance ;  the  eye  looked  rather  flat  and 
clouded.  The  convulsions  had  ceased  ;  the  dread  of  liquids 
was  removed,  and  he  frequently  called  for  water  to  drink  i 
but  he  had  still  a  great  source  of  terror  and  agitation  from  a 
peculiar  sensibility  to  currents  of  air  falling  upon  his  skin  $ 
and  to  the  impresion  of  odours  upon  the  olfactory  organs. 
The  senses  of  feeling  and  smelling  seemed  to  bepreternaturally 
increased.  He  had  no  pain,  but  was  extremely  distressed 
with  flatulency.  His  respiration  very  much  resembled  that 
of  a  female  in  a  paroxysm  of  hysteria.  It  was  accompanied 
with  frequent  irregular  sighing,  and  almost  constant  eructa¬ 
tions  of  wind.  On  my  asking  him  to  describe  his  feelings, 
he  said,  <c  I  am  better,  much  better ;  I  have  no  complaint  but 
the  wind  and  choaking;”  and  upon  my  loosening  one  of  his 
hands,  in  order  that  he  might  accurately  describe  the  parts 
most  affected  by  constriction,  he  pointed  distinctly  to  the 
throat  and  epigastrium. 

u  It  was  distressing  to  observe  the  anxiety  and  the  fre* 
quency  with  which  he  now  called  for  water  ;  yet  I  observed 
that  he  never  took  it  by  deliberate  drinking,  so  as  to  bring  the 
organs  of  deglutition  into  any  number  of  successive  actions. 
Each  time  it  was  given  to  him,  he  seized  the  cup  eagerly,  both 
with  his  lips  and  his  hand,  made  one  convulsive  swallow,  then 
hastily  pushed  away  the  vessel,  saying,  if  the  person  who  held 
it  chanced  to  press  it  longer  to  his  lips,  that  he  gave  him  u  tod 
much,”  and  would  u  choak”  him.  Several  loud  eructations 
of  air  usually  followed  the  swallowing  of  the  water,  and  he 
remarked,  that  he  drank  it  because  it  u  broke  the  wind,  and 
eased”  him.  For  a  short  time  after  obtaining  this  relief  his 
breathing  was  less  disturbed,  and  he  conversed  with  all  the 
calmness  of  a  person  in  sound  health  ;  but  soon  the  spasmodic 
feeling  about  the  throat  and  stomach  increased,  the  respiration 
was  oppressed,  and  he  again  called  anxiously  for  u  drink  to 


Medicine . 


Ill 


1809.] 


move  the  wind,”  as  he  expressed  it.  On  my  giving  him 
some  wine  in  the  water,  lie  said  it  relieved  him  more  than  the 
water  alone  ;  but  he  begged  that  it  might  not  be  made  strong ; 
observing  that  if  it  were  lie  could  not  swallow  it. 

“  Next  to  his  anxiety  for  frequent  drinking,  the  greatest 
distress  that  he  suffered  proceeded  from  the  opening  and 
shutting  of  the  chamber  door  :  which,  indeed,  was  the  most 
characteristic  symptom  at  this  stage  of  the  disease.  He  was 
more  watchful,  regarding  the  door,  than  concerning  any 
other  object.  "Whenever  it  was  moved,  he  started  in  great 
agitation,  looked  terrified,  and  impatiently  called  out  u  the 
door,  the  door  and  although  lie  neither  saw  nor  heard  it 
opened,  so  acutely  sensible  was  he  of  the  slightest  current 
of  air,  that  he  instantly  knew  from  his  own  sensations, 
when  any  person  entered  or  left  the  room.  The  slightest 
current  of  the  breath  falling  upon  his  face  from  any  person 
who  was  speaking  to  him ;  air  blown  from  the  lips  upon 
bis  breast,  and  the  fanning  of  a  hat  across  his  chest  or  throat 
produced  great  agitation,  together  with  convulsive  breath¬ 
ing,  and  a  sense  of  suffocation :  but  the  same  effect  was  not 
observed  from  waving  a  hat  across  his  feet  and  legs  ;  nor 
from  suddenly  sprinkling  a  few  drops  of  cold  water  upon 
his  face  or  thorax.  A  candle  was  held  near  to  his  eyes, 
but  he  expressed  no  uneasiness  from  the  light  of  it.  He 
had  a  dread  of  any  person  standing  near  his  face  ;  also  of 
any  substance  being  put  in  motion  near  his  mouth  ;  and  of 
any  thing  strong  or  volatile  being  applied  to  his  hose.  He 
seemed  likewise  to  have  a  terror  respecting  the  moving,  or  in 
any  way  disturbing  his  person.  He  expressed  himself  satis¬ 
fied  to  lie  fastened  in  the  wraistcoat ;  and  when  his  hand  was 
released,  said  that  it  gave  him  no  relief.  He  swallowed  the 
water,  lying  upon  his  back,  with  the  head  Iowr;  and  refused 
to  be  raised,  when  it  was  proposed  to  lift  him  up  to  drink  it; 
he  complained  of  the  wind  produced  by  a  handkerchief, 
which  was  used  to  w  ipe  the  saliva  from  his  lips ;  and  he  was 


1 12 


Medicine ;  [February, 

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

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

“  At  midnight,  upon  observing  a  person  in  the  room  eating 
roasted  apples,  he  requested  to  have  some,  and  ate  nearly  tw  o 
of  them,  with  seeming  gratification.  He  then  said  that  his 
stomach  was  66  restored,”  and,  feeling  as  if  he  could  eat  some¬ 
thing  more,  desired  to  have  a cc  beef-steakfor  supper.”  This 
was  accordingly  prepared,  and  he  chewed  two  or  three  mor¬ 
sels,  but  did  not  swallow  them. 

“  About  one  o’clock  in  the  morning  of  November  28tlr, 
the  high  susceptibility,  and  the  dread  of  currents  of  air  left 
him,  and  he  desired  to  have  the  door  and  window  set  open. 
He  now  remarked  that  he  was  much  worse  ;  requested  to  be 
released  from  the  confinement  of  the  waistcoat :  and  said, 
impressively,  that  he  should  c<  soon  be  gone.”  His  eager¬ 
ness  for  water  became  quite  insatiable,  and  although  his  sto¬ 
mach  now  began  to  reject  it  by  vomiting,  he  called  for  it 
incessantly.  On  one  of  the  by-standers  asking  him  if  he  were 
not  afraid  that  so  much  water  might  do  him  harm,  be  replied 


M cdicine . 


113 


2809.] 


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

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

<c  APPEARANCES  ON  DISSECTION. 

<c  On  opening  the  head,  the  dura  mater  adhered  so  strongly 
to  the  cranium,  that  great  force  was  required  to  separate  them. 
The  whole  surface  of  this  membrane  appeared  in  a  state  of 
unusual  dryness,  and  was  more  free  than  is  common  from 
small  red  points,  or  exudations  of  blood.  The  vessels  of  the 
piair.ater  were  not  overcharged  with  blood. 

<c  The  brain  was  remarkably  close  and  firm  in  its  texture. 
A  peculiar  dryness  was  observed  throughout  the  whole  of  its 
substance.  The  cerebrum  appeared  beautifully  white,  and 
had  not  those  numerous  red  points  which  are  usually  observ¬ 
ed.  When  cuttingthecorticai  and  medullary  portions,  they 
both  opposed  a  strong  resistance  to  the  knife  ;  they  also  pre¬ 
served  their  form  under  considerable  pressure  from  the  finger. 
A  small  quantity  of  colourless  fluid  was  contained  in  the  ven-* 
tricles. 

tc  On  cutting  through  the  integuments  and  muscles  of  th« 
thorax,  to  turn  them  back,  for  the  purpose  of  exposing  the 

VOL.  II.  i 


/ 


* 


1 14  Medicine .  [February, 

ribs  and  sternum,  the  whole  fleshy  substance  was  observed  to 
be  in  a  state  of  unusual  dryness. 

u  The  Viscera  of  the  thorax  had  a  healthy  appearance. 
The  lungs  were  fully  distended  with  air.  There  was  a  gene¬ 
ral  dryness  upon  the  surface  of  the  pleura.  The  pericardium 
contained  about  half  an  ounce  of  fluid. 

(c  The  posterior  part  of  the  tongue,  the  outer  surface  of  the 
epiglottis,  and  the  whole  of  the  pharynx,  exhibited  strong 
marks  of  inflammation  :  some  degree  of  redness  was  also  ob¬ 
servable,  although  not  so  conspicuous  within  the  larynx,  and 
upon  the  surface  of  the  trachea  and  oesophagus.  At  the 
lower  part  of  the  oesophagus,  about  half  an  inch  from  the 
cardiac  orifice  of  the  stomach,  was  an  eroded  spot,  nearly  the 
size  of  a  shilling,  assuming  an  appearance  as  if  the  inner  coat 
had  been  separated  and  shrivelled  Up  by  scorching. 

“  The  stomach  and  intestines  were  much  distended  with 
flatus.  Their  exterior  coats,  also  the  peritonaeum  covering 
the  other  parts  of  the  cavity  of  the  abdomen,  and  likewise  the 
diaphragm,  were  in  a  state  of  dryness  similar  to  the  pleura. 
The  rugae  of  the  inner  coat  of  the  stomach  were  numerous, 
large,  and  very  distinct.  A  few  inches  below  the  cardia  Was 
a  fulness  of  the  vessels  of  the  villous  coat,  which  caused  a 
spotted  and  circumscribed  redness  about  three  or  four  inches 
in  diameter. 

(i  The  liver  and  spleen  were  of  a  light  or  ash-coloured  hue ; 
in  other  respects  of  a  healthy  appearance. 

<c  The  general  dryness  which  prevailed  in  the  fibres  of  the 
muscles,  within  the  substance  of  the  brain,  and  upon  the 
membranous  surfaces,  extended  likewise  to  the  omentum, 
which,  when  pressed  in  the  hand,  felt  like  a  loose  net  of  pack¬ 
thread. 

(C  It  is  proper  to  remark,  that  the  stomach,  the  oesophagus, 
and  the  trachea,  were  not  only  carefully  inspected  by  Mr. 
Lloyd,  Mr.  Booth,  and  myself  upon  the  spot,  but  that  they 
were  taken  from  the  body  and  brought  to  London,  where 


115 


180,9 .  j  Medicine. 

they  were  farther  examined  by  Mr,  Blair  and  Mr,  Dixon, 
who  are  much  in  the  habit  of  inspecting  bodies  by  dissection ; 
and  that  both  these  gentlemen*  without  any  communication 
with  each  other  upon  the  subject*  favoured  me  with  a  written 
statement  of  the  appearances  they  observed,  previous  to  their 
receiving  any  intimation  that  the  parts  were  taken  from  a  per¬ 
son  who  had  died  of  hydrophobia, 

*4  These  parts  were  also  examined  several  successive  days, 
after  being  immersed  in  water.  The  redness  of  the  pharynx 
was  darker  and  stronger,  and  assumed  a  livid  hue,  as  the 
membrane  became  corrugated;  but  the  redness  of  the  mem¬ 
branes  lining  the  trachea  and  oesophagus,  went  off  soon  after 
the  parts  were  put  into  water.  There  was  not  the  slightest  4 
appearance  of  coagulum,  exudation*  or  adventitious  mem¬ 
brane,  in  any  part  of  the  pharynx  or  larynx ;  nor  throughout 
the  whole  extent  of  the  oesophagus  or  trachea. 

44  The  body  was  examined  twenty-nine  hours  after  death. 

44  The  disease  continued  about  thirty-eight  hours  from  thy 
time  when  the  man  first  became  sensible  of  indisposition, 

44  Observing  the  progress  of  the  symptoms,  as  they  occur¬ 
red  in, this  case,  the  disease  might  be  divided,  with  tolerable 
accuracy,  into  several  distinct  periods,  or  stages,  viz. 

44  1.  A  sensation  of  cold  and  numbness  about  the  wound, 
and  throughout  the  hand  and  arm— during  two  or  three 
days. 

44  2.  A^evere  pain  of  the  shoulder,  with  undefined  general 
disposition — about  ten  hours. 

44  3.  Horror  of  liquids,  with  violent  convulsions  and  dis¬ 
tortions;— fourteen  or  fifteen  hours. 

44  4.  Comparative  tranquillity,  with  a  desire  for  water,  and 
a  dread  of  currents  of  air — nearly  twelve  hours. 

44  5.  Au  insatiable  craviug  for  air  and  water— between  two 
and  three  hours.  G,  PINCKARD* 

44  Bloomsbury  Square ,  Nov.  30,  1808, 75 


116 


Medicine . 


[February, 


■VACCINATION 

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

PURPURA.’ 

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

CRETINISM. 

Cretinism,  or  that  species  of  bodily  deformity  and  ment¬ 
al  imbecility,  which  marks  the  lower  orders  in  certain  dis¬ 
tricts  of  Switzerland,  more  than  elsewhere,  lias  received 
some  elucidation  from  the  late  experience  of  Dr.  Reeve,  of 


Medicine . 


1809.] 


Norwich  ;  and  he  has  endeavoured  to  point  out  a  connection 
between  this  afflict ing  malady  and  rickets. 

44  The  enlargement.,”  he  observes,  44  of  the  thyroid  gland 
called  goitre,  is  the  most  striking  feature  in  the  unsightly 
aspect  of  a  cretin  ;  but  this  is  not  a  constant  attendant.  His 
head  also  is  deformed,  his  stature  diminutive,  his  complexion 
sickly,  his  countenance  vacant  and  destitute  of  meaning,  his 
lips  and  eye-lids  coarse  and  prominent,  his  skin  wrinkled 
and  pendulous,  his  muscles  loose  and  flabby.  The  quali¬ 
ties  of  his  mind  correspond  to  the  deranged  state  of  the  body 
which  it  inhabits  ;  and  cretinism  prevails  in  all  the  interme¬ 
diate  degrees,  from  excessive  stupidity  to  complete  fatu¬ 
ity-” 

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

44  It  is  probable,”  he  remarks,  44  the  one  has  been  assum¬ 
ed  as  the  cause  of  the  other,  from  the  enlargement  of  the  thy¬ 
roid  gland  being  a  frequent  occurrence  in  cretins  ;  and  as  it 
forcibly  strikes  the  observer  from  the  deformity  it  occasions, 
this  strong  impression  may  have  converted  an  accidental, 
though  frequent  occurrence,  into  a  general  and  necessary 
cause.  Cretinism  is  frequently  observed  without  any  affec¬ 
tion  of  the  thyroid  gland,  and  that  gland  is  often  very  much 
enlarged  without  any  affection  of  the  intellectual  faculties. 
There  seems  to  be  some  similarity  between  cretinism  and 
rickets,  as  they  both  take  place  in  infancy,  are  both  charac¬ 
terized  by  feebleness  of  body,  and  sooner  or  later  by  feebleness 
of  mind,  and  they  both  affect  males  and  females  equally;  but 
there  is  no  sort  of  connection  between  persons  afflicted  with 
bronchocele  in  England,  and  with  rickets.  For  although  it 
might  be  granted,  that  there  is  some  delicacy  of  frame  in  fe¬ 
males  about  the  period  of  pubescence,  when  bronchocele 
usually  occurs,  yet  neither  irrcgqlar  formation  of  the  bones,  nor 

i  3 


i 


118  Medicine .  [February, 

weakness  of  the  intellectual  powers,  are  common  symptoms 
attending  bronchocele  in  Britain. 

u  The  production  of  cretinism,  by  the  bad  quality  of  the 
air  and  the  food,  the  neglect  of  moral  education,  and  other 
evils  attendant  upon  poverty ,  is  supported  by  facts  so  pointed, 
that  the  greater  number  of  cases  in  mountainous  districts 
where  snow  water  abounds,  may  safely  be  ascribed  to  these 
general  causes.  The  notion  of  snow-water  being  the  Cause  of 
goitre,  and  consequently  of  cretinism,  seems  to  have  been  de* 
rived  from  Pliny  (Lib.  II.  cap.  37),  and  copied  by  almost 
every  succeeding  writer,  because  it  coincided  with  their  hy¬ 
potheses  of  cold  and  crude  matters,  although  directly  contra* 
dieted  by  facts.  In  the  first  place,  persons  born  in  places 
contiguous  to  the  glaciers,  who  drink  no  other  water  than 
what  flows  from  the  melting  of  ice  and  stiow,  are  not  subject 
to  this  disorder;  and,  secondly,  the  disorder  is  observed  in 
places  where  snow  is  unknown. 

u  The  causes  of  cretinism  begin  to  OpetateUpofi  the  System 
soon  after,  perhaps  even  before  birth  ;  the  want  of  energy  in 
the  parent  is  communicated  to  the  offspring ;  the  children 
become  deformed  and  cachetic  very  early  in  life,  the  growth 
and  developement  of  the  body  are  impeded,  the  abdomen  be¬ 
comes  enlarged ,  arid  the  glands  swelled  in  various  degrees; 
and  the  powers  of  the  mind  remain  dormant,  Or  become 
entirely  obliterated,  partly  from  want  of  proper  organiza¬ 
tion,  and  partly  from  the  total  neglect  of  every  thing  like 
education . 

<c  It  might  be  expected,  that  the  dissection  of  cretins 
would  throw  some  light  upon  the  series  of  phenomena  associ¬ 
ated  together  in  the  origin  and  progress  of  this  singular  affec¬ 
tion  ;  but  the  people  are  so  superstitious,  that  it  is  very  diffi¬ 
cult  to  procure  bodies  for  anatomical  examination .  However, 
some  dissections  have  been  made,  and  the  appearances  in  the 
cranium  are  very  cutiofis,  From  the  description  of  a  cretin’s 


Medicine . 


119 


1809.] 

skull  by  Ackermann,  it  appears  that  the  cavity  for  the  recep¬ 
tion  of  the  pons  varolii  and  medulla  oblongata  was  completely 
obliterated,  and  that,  in  which  the  cerebellum  is  lodged,  so 
much  diminished,  that  it  scarcely  exceeded  one  third  of  its 
natural  capacity.  The  return  of  the  venous  blood  must  have 
been  considerably  impeded  by  the  mal- conformation  of  the 
foramina. 

<c  There  is  no  fact  in  the  natural  history  of  man,  that 
affords  an  argument  so  direct  and  so  impressive,  in  proof  of 
the  influence  of  physical  causes  on  the  mind,  as  cretinism.  It 
shews  moreover,  that  the  growth  of  every  part  is  essentially 
connected  with  the  conditions  in  which  it  is  fit  to  exercise  its 
peculiar  functions:  and  in  this  respect,  it  fares  with  the 
intellectual  as  with  the  bodily  powers. 

“  The  most  decisive  argument  in  proof  of  this  opinion  is, 
that  cretinism  may  be  prevented  by  removing  children  from 
the  confined  and  dirty  places  where  it  prevails,  and  nursing 
and  educating  them  in  the  higher  parts  of  the  mountains. 
Within  these  last  ten  years,  the  number  of  cretins  has  dimi¬ 
nished,  the  condition  of  the  lowest  class  of  society  is  some¬ 
what  bettered,  and  more  attention  is  paid  towards  that  diseased 
constitution  which  is  the  forerunner  of  mental  imbecility.  I 
did  not  find  that  the  poor  creatures  took  any  pride  in  having 
any  of  their  children  idiots  or  Men  heurenx ,  as  some  authors 
assert ;  on  the  contrary,  the  parents  were  very  much  ashamed 
of  acknowledging  that  any  cretins  belonged  to  their  families  ; 
and  it  was  after  repeated  attempts,  only  by  declaring  myself 
to  be  a  physician,  that  1  could  get  access  into  their  houses  to 
examine  any  of  these  wretched  beings  in  the  human  form. 
The  burnt  sponge  is  known  as  a  remedy  for  the  goitre  among 
the  people  where  it  is  most  prevalent ;  but  it  is  seldom  admi¬ 
nistered,  because  the  disease  is  so  common,  that  it  does  not 
attract  notice,  nor  affect,,  in  general,  the  ordinary  fund  ions  of 
life.  And  as  to  cretinism,  that  seems  to  be  looked  upon  as  be¬ 
longing  to  indigence  and  poverty ;  for  in  every  plac#  where  I 

I  4 


120  Medicine.  f  February  s 

saw  cretins,  many  well-looking  persons  of  both  sexes  resided, 
and  these  were,  without' exception,  persons  of  a  higher  class  in 
society,  who  lived  in  better  houses,  and  could  supply  both 
their  moral  and  physical  necessities. 

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

ANIMAL  HEAT. 

The  subject  of  animal  heat  is  one  of  principal  importance 
m  all  inquiries  into  the  nature  of  the  animal  oeconomy.  Some 
experiments  have  been  lately  made  by  Dr.  J.  A.  Paris,  to 
prove  that  the  quantity  of  it  present  in  the  secrefed  fluids 
is  less  than  in  the  blood,  and  that  the  secreted  fluids  being 
mere  chemical  compounds,  formed  by  the  glands  from  the 
principles  of  the  blood,  in  proportion  as  the  capacity  of  the 
fluids  is  less  for  caloric,  a  considerable  source  is  created  for 
the  production  of  aiymal  beat,  and  consequently  that  the  se¬ 
creting  process  is  a  great  instrument  in  its  production. 

*£  The  sums  of  the  secretions,”  it  is  observed,  ££  is  com¬ 
monly  the  same ;  for  if  any  single  secretion  suffers  a  change 
in  quantity,  we  shall  find  the  others  varying  so  as  to  pre¬ 
serve  the  same  general  effect :  thus,  for  instance,  if  the  urine 
flows  with  greater  abundance,  the  saliva  or  perspirable  mat¬ 
ter  is  secreted  less  copiously  ;  if,  however,  a  universal  cause 
affects  the  body,  so  as  to  diminish  all  its  secretions,  we  find 
the  animal  temperature  sinks,  as  is  exemplified  by  sleep,  or 
fhe  influence  of  the  depressing  pasjsions,” 


Medicine . 


121 


1809.] 


The  experiments  on  which  this  opinion  is  founded,  ar# 
thus  detailed — 


U  EXPERIMENT  I. 


Temperature  of  the  Laboratory  4 6Q  Fah. 

Of  urine  1  pint  was  heated  to  65Q  £  Arithmetic  mean 


Of  water  ------  113  S  89. 

Temperature  that  resulted  -  90 

Escaped  during  the  experiment  2 

True  temperature  -  -  -  -  92 


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

7  :  9  ;  :  x  :  1 . 000 
9  x  s=  7. 

:  x  ~  i- *7777  ; 

whereas  the  capacity  of  arterial  blood  is  1.003.” 

IMPROVEMENT  OF  DISPENSARIES. 

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


Medicine • 


[February, 


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

INCREASE  OF  MORTALITY. 

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

(i  From  these  documents  it  appears  that  two  conclusions 
may  be  drawn :  1st,  that  the  number  of  deaths  from  con¬ 
sumption  towards  the  end  was  greater  than  at  the  beginning 
of  the  last  eentury;  and  2d,  that  of  the  whole  number  who 


Medicine . 


1M] 


died  during  the  eentitry,  those  from  consumption  bore  a  larger 
proportion  at  the  end  than  at  the  beginning.  In  other  words 
the  absolute  and  relative  mortality  of  consumption  seems  to 
have  increased.  In  viewing  these  conslusions  however,  we 
must  not  overlook  two  possible  sources  of  error.  In  the  first 
place,  according  to  the  returns  of  Mr.  Addington’s  Act  to 
ascertain  the  population  of  this  kingdom,  it  appeared,  that 
during  the  whole  of  last  century  the  number  of  inhabitants 
Was  continually  augmenting,  and  was  therefore  much  greater 
at  the  end  than  at  the  beginning  of  the  century.  The  increas¬ 
ed  number  of  deaths  from  consumption,  therefore,  might  de¬ 
pend  on  the  increased  number  of  inhabitants,  and  not  upon 
any  increase  in  its  frequency  and  fatality,  in  the  same  mass  of 
population  :  cousumption  might  devour  more  victims  merely 
because  there  were  more  to  be  devoured.  In  the  second  place, 
we  may  err,  if  we  suppose  that  consumption  is  on  the  in¬ 
crease,  because,  of  the  w  hole  number  of  deaths,  those  from  this 
disease  form  a  larger  proportion  at  the  end  than  at  the  begin¬ 
ning  of  the  century;  for  the  various  modern  improvements 
in  the  prevention  and  cure  of  diseases,  have  most  probably 
diminished  the  frequency  and  fatality  of  some  diseases,  and 
the  proportion  of  deaths  from  consumption  may  seem  to  have 
increased.  ” 

To  remove  any  objections  to  these  facts  from  a  better  treat¬ 
ment,  and  lessened  mortality  from  other  diseases,  rendering  it 
from  consumption  more  prominent,  also  to  obviate  any  argu¬ 
ments  from  an  increased  population,  Dr.  Woollcombe  thus 
proceeds  : 

If,  for  example,  the  inhabitants  of  this  country  had,  in 
the  year  1700,  been  six  millions,  the  proportion  of  morta¬ 
lity  one  in  forty,  and  the  proportion  of  consumptive  morta¬ 
lity  One  to  six,  the  total  deaths  would  have  been  150,000, 
and  those  from  the  disease  under  consideration  25,000.  If 
in  the  year  1800,  the  inhabitants  had  been  tire  same  in  num¬ 
bers  and  the  deaths  from  consumption  had  been  known  to 


124 


Medicine.  [February, 

have  increased  relatively  one-third,  or  to  be  in  the  ratio  of 
one  to  four,  still  might  there  have  been  no  increase  in  theab- 
s  flute  fatality  of  consumption  ;  but  a  reduction  of  the  gene¬ 
ral  mortality  might  have  taken  place  in' the  same  proportion, 
so  as  to  have  become  as  one  to  sixty  ;  in  which  case  the  total 
mortality  would  be  100.000,  and  the  consumptive  mortality 
still  25,000.  This  objection  is  therefore  not  without  weight, 
and  shews  that  in  order  to  establish  a  relative  increase  of  mor¬ 
tality  from  any  disease  to  be  a  just  measure  of  its  absolute 
augmentation,  we  must  ascertain  the  proportion  of  deaths  to 
the  inhabitants  ofthe  country  at  the  particular  periods  between, 
which  a  comparison  is  instituted.  As  this  proportion  is  not, 
and  cannot  be  ascertained  with  precision,  we  must  be  satisfied 
with  such  an  approximation  to  the  truth  as  can  be  derived 
from  the  imperfect  evidence  found  in  those  authors,  who  have 
treated  of  that  branch  of  political  economy  w  ith  which  this 
question  is  connected. 

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


Medicine. 


m 


1809.] 

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

An  Inquiry  into  the  Symptoms  and  Treatment  of  Carditis  ; 
or  the  Inflammation  of  the  Heart ;  Illustrated  by  Cases 
and  Dissections.  By  John  Ford  Davis,  M.D.  Member 
of  the  College  of  Physicians ,  London  ;  of  the  Royal  Me¬ 
dical  Society ,  Edinburgh ;  and  of  other  Medical  and 
Philosophical  Societies.  Small  Svo.  pp.  190. 

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


126  Medicine*  [February* 

•we  conceive  would  be  the  case*  by  the  purchase  of  his 
Treatise.  Those  who  wish  to  diffuse  general  knowledge 
should  not  cramp  their^ertions  by  fixing  too  great  a  vain* 
on  their  labours  :  this  is  a  species  of  empiricism,  which  we 
hold  to  public  derision  and  general  execration,  as  being  in~ 
compatible  with  the  noble  principle  of  humanity,  and  the 
best  interests  of  society. 

Our  author  begins  with  informing  us,  Carditis  is  one  of  the 
most  obscure  diseases  known,  and  that  it  occurs  oftener  than 
is  suspected.  After  a  long  train  of  quotations,  in  which  La¬ 
tin,  Greek,  and  French,  swell  the  page,  he  brings  us  to  a 
point  already  in  the  possession  of  every  boy  that  has  at¬ 
tended  the  lecture-room,  viz. 

<c  That  an  inflammation  of  the  lungs  may,  from  contiguity 
of  parts,  spread  to  the  pericardium  and  heart,  and  vice  versa  ; 
and  thus,  according  to  the  particular  parts  affected,  will  be 
the  difficulty  of  breathing,  cough,  &c.” 

Lie  then  proceeds  to  consider  what  the  inflammation  of  the 
heart  is : 

cc  It  seems  proper  to  consider  the  inflammation  of  the 
heart  and  pericardium  as  only  one  disease ;  notwithstanding 
some  authors  have  made  them  distinct  affections.  Sauvages, 
whose  definition  of  Carditis  has  been  already  noticed,  ranks 
the  inflammation  of  the  pericardium  ,  as  a  species  of  Pleuritis, 
mnder  the  name  of  Pleuritis  Pericardii.  Selle  preserves  the 
distinction  without  any  reference  to  the  pleura.  His  defini¬ 
tion  of  the  inflammation  of  the  pericardium  is,  <£  Dolor  punc- 
torius  ac  gra vitus  in  pectoris  parte  profnndiore  :  anxietas  : 
palpitatio  cordis :  perpetua  ad  tussiendum  procli  vitas.” 
He  adds,  ce  Haud  raro  accidit  ut  plurium  partium  inflamma- 
tkmes  simnl  coexistunt,  pro  cujus  complicationis  diversitate 
alia  atque  alia  phenomena  ad  parent,  quorum  determinatio  sat 
difficilis  est.”  According  to  him,  the  inflammation  of  the 
heart  is  . distinguished  from  that  of  the  'pericardium yi  by  the 


Medicine ; 


127 


1809.] 

absence  of  the  disposition  to  cough  in  the  former,  the  defini¬ 
tion  of  which  is,  “  Dolor  punctorius  sub  sterno :  palpitatio 
cordis  et  anxietates  continue :  pulstis  parvus  inaequalis : 
calor  exiguus.” 

“  Whether  these  different  affections  can  ever  be  distinguished 
in  practice  seems  very  doubtful ;  their  separate  existence 
must,  however,  be  admitted,  of  which  one  of  the  cates  to  be 
related  presently  afFords  proof,  if  that  were  wanting.  Dr. 
Baillie  also  has  seen  the  substance  of  the  heart  inflamed,  with¬ 
out  any  inflammation  of  the  pericardium ;  and  although  he 
says,  u  whenever  the  inflammation  of  the  pericardium  is 
violent,  the  muscular  substance  of  the  heart  is  inflamed  to 
some  depth,”  he  does  not  deny  that  in  slighter  inflammation, 
of  this  membrane  the  heart  may  escape.  According  to  him, 
the  symptoms  which  have  been  observed,  are,  “  the  general 
affection  of  the  system  known  by  the  name  of  fever ;  pain  in 
the  region  of  the  heart,  which  is  often,  but  not  always,  attend¬ 
ed  with  palpitations,  and  with  an  irregular  pulse ;  cough  ; 
difficulty  of  breathing;  and  sometimes  syncope.”  Notwith¬ 
standing  the  high  authority  from  which  this  description  pro¬ 
ceeds,  it  must  be  allowed  to  be  very  unsatisfactory.  Nearly 
all  the  symptoms,  supposed  to  be  present  in  every  case,  are 
common  to  peripneumony ;  so  that  there  is  scarcely  one  by 
which  the  inflammation  of  the  heart  can  be  distinguished. 
At  the  same  time  it  cannot  be  denied,  that  this  arises  more 
from  the  difficulty  of  the  subject,  than  from  any  neglect  or 
inability  of  that  excellent  pathologist. 

iC  Since  then  Carditis  is  so  often  connected  with  peripneumo- 
ny,  and  since  the  symptoms  which  more  immediately  arise 
from  inflammation  of  the  heart,  as  palpitation,  syncope,  &c6 
are  not  always  present ;  it  will,  perhaps,  be  impossible  to 
establish  a  diagnosis  upon  solid  principles.  But  let  not  the 
obscurity,  in  which  the  subject  is  involved,  deter  us  from  at¬ 
tempting  its  elucidation.  Let  it  rather  call  forth  our  greatest 
exertions ;  and  if  we  recollect  that  there  was  a  time,  when 


128 


Medicine . 


[February, 


that  formidable  disease,  denominated  Croup,  was  as  imper¬ 
fectly  known,  and  as  little  under  our  control,  as  Carditis  is  at 
present,  we  shall  not  want  encouragement  to  proceed. 

a  case  1. 

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

u  He  has  taken  thirteen  grains  of  James’s  Powder  in  three 
doses,  and  a  grain  of  Emetic  Tartar  in  four  doses,  without 
vomiting.” 

“  Capiat  Pulv.  Antim.  Jac.  gr.v.  horis  2dis,  ter,  cum 
Mist,  camph.  efferv. 

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

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

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

u  Capiat  haustum  ex  Sp.  Minder.  Syr.  Aurant.  a  a  two 
drachms,  Yin.  Antim.  gtt.  xx.  4tis  horis. 

u  Jan.  25.  P.  156.  Pain  of  the  head,  epigastrium,  left 
side  of  the  chest,  and  leg.  Five  stools  from  the  same  cathar¬ 
tic,  and  four  ounces  more  of  blood  have  been  drawn. 

“  Fiat  V.  S.  terlia  ad  seven  ounces  (antea  ad  seven 
ounces  et  four  ounces)  Capiat  Nitri  gr.  x.  horis  Stiis. 
Vesicatorium  Fpigastrio. 

u  Jan.  26.  There  is  a  very  thick  and  hard  crust  on  the 


Medicine . 


m 


1809.] 

blood  in  both  cups#  Slept  quietly  several  times  in  the  course 
of  the  night.  P.  1 36.  Delirium  in  the  evening,  after  he 
awoke  ;  none  in  the  morning, 

“  Repr.  Mist,  cathart.  Y.  S.  et  deih  Nitri  gr.  x.  horis 
Stiis. 

a  7.  p.  m.  Six  ounces  of  blood  were  drawn*  which  near¬ 
ly  occasioned  syncope.  The  blood  has  a  crust  one  fourth  of 
an  inch  thick.  The  symptoms  are  greatly  relieved,  but  the 
pulse  is  now  126.  Three  stools.  Sleeps  frequently  without 
any  delirium. 

“  Capiat  Nitri  gr.  x.  horis  Stiis.  Potus  imperial  is,  &c. 
copiose. 

u  Jan.  27,  h.  7ma.  a.  ra.  P.  90— 108.  Sleeps  much. 

u  Capiat  Haust.  efferv. 

(<  Jan.  28,  h.  6ta.  p.  m.  Acute  pain  in  the  left  mamma. 
Is  seldom  hot*  Sleeps  frequently,  and  moans  while  awake. 
Eats  sparingly.  Has  taken  the  cathartic  mixture  without 
effect. 

cc  Injr.  Enema.  Admoveantur  Hirudines  sex  loco  dolenti. 
Capt.  Nitri  gr.  x.  horis  Stiis. 

<c  Jan.  29.  Slept  well  during  the  night.  A  copious 
stool  from  the  clyster.  Pain  of  the  thorax  much  relieved. 
P.  120. 

<c  Si  dolor  fixus,  admoveantur  Hirudines ;  si  vagus,  des- 
cendat  in  Balneum.  Repr.  Mistr.  cathart.  et  post  dejectiones 
Capiat  Nitri  gr.  x.  horis  3tiis. 

u  Jan.  30.  P.  126.  Fingers  cold.  Wandering  pain  of 
the  head,  side,  abdomen,  hip,  and  leg.  Two  stools.  Moan- 
ing. 

u  Habeat  Jul.  camph.  two  and  a  half  drachms,  Sp.  Minder, 
one  and  a  half  drachms,  Yin.  Antim.  gtf.  xxv.  horis  4tis. 
Yesicatoria  pone  aures.  Balneum. 

u  Jan.  31.  Slept  often  during  the  night.  P.126.  Heat 
natural.  Moaning.  The  Bath  afforded  little  relief.  Wan¬ 
dering  pain  of  head,  abdomen,  and  leg.  Urine  tiirbid . 

T0L.  it.  K 


ISO  Medicine.  [February? 

u  Capiat  Infus.  Cort.  Per.  one  ounce,  horis  2dis.  et 
Rhei  gr.  v.  bis. 

44  Jan.  31,  h.  xi.  p.  m.  Took  five  ounces  of  the  Infusion, 
and  food  twice  or  three  times.  Belter  during  the  day,  but  is 
moaning  at  present.  P.126.  Feet  and  hands  cold.  Deliri¬ 
um.  Wandering  pain  of  the  head  and  abdomen. 

44  Injr.  Enema. 

<c  Feb.  lyh.  8va.  a.  m.  P.  126.  Heat  natural;  but,  not 
Ions'  a°;o,  the  extremities  were  nearly  cold.  Has  taken  the 
infusion  twice,  and  some  wine  and  water.  Delirium.  Moan¬ 
ed  and  was  quiet  alternately  during  the  night.  Face  pale. 
Swallows  with  difficulty.  Urine  deposits  a  copious  white 
sediment. 

44  Capiat  Infus.  Cort.  Per. 

44  Feb.  2.  A  very  restless  night,  but  slept  from  seven 
o'clock  this  morning  till  one  in  the  afternoon.  Symptoms 
relieved.  P.  124.  Has  taken  butter-milk,  bread,  and  wine 
and  water.  At  four  in  the  morning  he  took  a  draught  with 
twenty-five  drops  of  Antimonial  Wine  and  five  of  Laudanum, 
and  at  nine  o’clock  ten  drops  of  Laudanum. 

44  Feb.  2,  h.  4f  p.  m.  Died  quietly. 

*  #  i  .  i  V*  Sjj 

44  DISSECTION. 

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

44  The  arteries,  veins,  and  sinuses  of  the  dura  and  pia 
mater,  were  turgid  with  blood,  but  those  membranes  did  not 
appear  inflamed.  The  frontal  veins  and  arteries,  where  the 
pain  w  as  chiefly  seated,  w  ere  less  turgid  than  those  of  the  ver- 


r 


1809.]  Medicine.  131 

tex  and  occiput.  There  were  about  2  or  3  drachms  of  serum 
in  the  ventricles  of  the  brain.  There  was  no  other  morbid 
appearance  in  the  brain,  thorax,  or  abdomen. 

The  history  of  the  disorder  afforded  no  suspicion  that  the 
heart  or  pericardium  wereattacked till theTth  day  ofthe  fever.” 

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

U  RECAPITULATION. 

iC  It  may  not  be  improper  to  state  briefly  the  principal  in¬ 
ferences,  which  have  been  drawn  from  the  faefs  contained  in 
the  foregoing  pages. 

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

66  2.  Palpitation  happened  in  one  case,  and  then  only  in 
the  advanced  stage  of  the  complaint,  after  adhesion  may  be 
supposed  to  have  taken  place  between  the  heart  and  pericar¬ 
dium* 

“  3.  The  usual  marks  of  deep-seated  inflammation,  as 
rigor  and  flushing,  were  not  observed ;  nor  was  there  so  much 
fever  as  might  reasonably  have  been  expected. 

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

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

u  6.  Vomiting,  mentioned  by  Br7  Darwin  as  a  constant 
symptom  of  Carditis,  happened  in  one  case. 

7.  So  far  from  being  always  complicated  with  Pneumo- 

k  2 


132  Medicine .  [February, 

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

u  8.  Inflammation  may  take  place  within  the  ventricles, 
which  seems  not  to  have  been  observed  before. 

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

u  10.  From  the  relief  which  followed  bloodletting  in  two 
of  the  cases,  it  is  probable,  that,  if  it  were  employed  more 
freely  than  has  hitherto  been  done,  the  disease  might  be 
cured/’ 

W e  think  that  neither  science  or  humanity  will  be  benefit¬ 
ed  by  the  elucidation  of  this  author. 


Reports  on  the  Effects  of  a  Peculiar  Regimen  on  Scirrhous 
Tumours  and  Cancerous  Ulcers .  By  William  Lamhe , 
31. D .  Fellow  of  the  Royal  College  of  Physicians . — pp. 
190. 

To  the  researches  of  this  author,  society  and  the  profession 
are  much  indebted ;  indeed  wp  give  our  warm  applause  to  every 
attempt,  that  has  for  its  immediate  object  the  alleviation  of 
human  misery,  the  we  plus  ultra  of  medical  investigation. 
We  admire  the  perseverance  Dr.  Lambe  has  displayed  amid 
the  strong  prejudice  which  scientific  sceptics  have  insinuated 
against  his  judicious  practice. 

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


Medicine . 


1809..] 


m 


drawn  cases  elucidate  this  point,  particularly  the  first,  seventh 
and  eight  cases.  We  hope  further  trial  will  establish  the  repu¬ 
tation  of  this  remedy.  His  arguments  are  ingenious,  and 
many  of  his  ideas  novel :  he  looks  upon  man  to  have  been 
originally  an  herbivorous  animal.  And  when  we  recal  to  our 
recollection  the  wandering  Pelasgi  of  Thessaly,  who  shook  the 
oak  and  beach  for  their  daily  food,  we  must  confess  Natural 
History  establishes  the  doctrine.  We  recommend  the  adop¬ 
tion  of  Dr.  Lambe’s  mode  of  treatment  in  conjunction  with 
the  medicinal  one  of  Mr.  Carmichael.  The  Cancerous 
Ward  in  the  Middlesex  Hospital  is,  we  understand,  to 
be  open  for  this  purpose.  In  the  progress  of  animal  life 
the  body  becomes  less  vascular  :  the  vivid  bloom  of  youth 
moderates  into  the  hue  of  middle  life,  and  this  into  the  wrink¬ 
led  and  shrunk  appearance  ofold  age  :  corresponding  changes 
take  place  in  other  parts  :  in  short,  the  livid  hue  of  venous 
plethora  succeeds  to  the  vivid  tints  of  arterial :  while  the  body 
is  undergoing  these  material  revolutions,  a  mode  of  diet  that 
is  completely  opposite  from  general  routine,,  must  be  of  essen¬ 
tial  service,  even  where  no  previous  disease  existed ;  but  at 
the  period  when  menstruation  is  about  to  cease,  a  removal 
from  an  alealescent  to  an  acescent  diet,  we  considerof  the 
highest  import,  and  strongly  advise  its  universal  adoption, 
even  where  cancer  or  scirrhus  are  not  suspected ;  in  short  we 
recommend  this  treatise  to  the  attentive  perusal  of  the  pro¬ 
fession,  as  a  work  from  which  much  useful  information  is  to 
be  acquired :  for  though  the  same  plan  is  not  entirely  new, 
being  first  produced  largely  by  the  famous  Friar  of  Malta, 
and  the  same  mode  of  treatment  has  been  put  to  a  trial  in  this 
country,  by  Mr.  Pearson,  as  will  be  seen  in  his  treatise  on 
Cancer.  Dr.  Lambe  has  the  merit  of  carrying  it  a  step 
farther,  by  confining  the  fluid  diet  to  distilled  instead  of 
common  water. 

’  "  ,  ‘  ?  K  3 


134  -  Medicine .  [February 

The  following  conclusion  he  has  drawn:  that — 

<£  The  spreading  of  the  cancerous  disease  into  the  conti¬ 
guous  parts  is  completely  prevented  by  the  use  of  pure  dis¬ 
tilled  water  ;  cancerous  tumours  can  by  the  same  practice  be 
removed  by  absorption  ;  cancerous  ulceration  can  be  prevent¬ 
ed  ;  cancerous  ulceration  can  be  completely  closed  up  by  the 
basis  of  the  ulcer  becoming  covered  by  the  surrounding  sound 
skin ;  in  one  case,  which  proved  fatal,  a  part  of  the  ulcer  has 
been  brought  to  cicatrize,  but  the  cicatrization  was  not  perma¬ 
nent  ;  in  another,  of  which  the  event  was  similar,  all  the 
parts  surrounding  the  principal  ulcer  were  made  perfectly 
sound,  and  some  ulceration  firmly  cicatrized  ;  that  by  uniting 
the  use  of  distilled  water  to  a  vegetable  diet,  life  may  probably 
be  prolonged  to  an  indefinite  extent,  even  in  certain  cases  of 
ulcerated  Cancer  of  long  standing;  and  it  must  follow  as  a 
direct  consequence  of  these  facts,  that  if  the  disease  be  incipi¬ 
ent,  and  the  patient  in  good  health,  the  Cancer  may  be  pre¬ 
vented  from  ever  becoming  a  serious  disease  at  all. 

66  In  one  sense  I  am  inclined  to  believe  that  the  Cancer  will 
ever  prove  incurable.  If  it  affects  the  mammary  gland,  the 
diseased  part  will  ultimately  perish,  either  by  its  being  re¬ 
moved*  by  ulceration,  or  by  absorption.  The  facts  are  too 
few  to  assert  that  this  will  be  constant ;  but  the  powers  of 
regeneration  possessed  by  the  human  system  are  so  feeble, 
that  the  supposition  is  highly  probable.  Should  it  prove  to 
be  so,  this  circumstance  will  be  a  proper  criterion,  by  which 
to  determine,  whether  a  case  treated  in  an  early  stage  by  the 
method  here  proposed,  has  or  has  not  been  a  genuine  case  of 
cancer.” 

Speaking  of  the  strongest  characteristic  of  cancer  he  ob¬ 
serves  : 

“  This,  when  the  disease  has  become  active,  is  unceasing, 
and  gradually  involves  every  contiguous  part,  however  dissi- 


Medicine. 


135 


milar  in  their  nature,  and  excites  them  to  similar  action. 
The  skin  above,  the  muscle,  periosteum,  and  bone  beneath, 
besides  the  absorbent  glands,  all  become  eventually  a  carcino¬ 
matous  mass  ;  the  intercostal  muscles,  and  probably  even  the 
lungs  themselves,  eventually  suffer  from  the  contiguity  of  a 
cancerous  breast.  What  then  is  the  preventing  the  disease 
from  spreading,  but  direct  ocular  evidence,  that  the  genera¬ 
tion  of  new  Cancer  is  prevented.  It  is  an  inference  then  of 
common  sense,  that  whatever  is  proved  by  experience  to 
possess  this  salutary  influence,  should  be  adopted  as  soon, 
at  least,  as  the  nature  of  the  complaint  is  ascertained. 

6(  But  this  is  the  advice  of  friendly  exhortation,  not  ex¬ 
torted  from  the  disappointment  of  expectations  too  san¬ 
guine. 

Ci  If  there  be  any  doubt  that  the  spreading  of  the  disease  is 
truly  the  generation  of  new  pancer,  an  examination  of  the 
anatomical  structure  of  the  disease  must  put  it  beyond  ques¬ 
tion.  I  will  make  use  of  the  description  of  Mr.  Home,  whose 
access  to  the  preparations  of  the  Hunterian  Museum  makes 
his  authority  the  very  best  that  can  be  obtained  on  this  ques¬ 
tion. 

6i  Mr.  Home  has  described  anatomically  three  stages  of 
the  disease.  For  my  own  purpose  I  shall  transcribe  only  the 
first  and  third.”  u  When  a  section  is  made  (of  a  cancerous 
tumour)  in  its  early  stage,  it  puts  on  the  following  appear¬ 
ance  : — the  centre  is  more  compact,  harder  to  the  feel,  and  has 
a  more  uniform  texture  than  the  rest  of  the  tumour,  and  is 
nearly  of  the  consistence  of  cartilage.  This  middle  part  does 
not  exceed  the  size  of  a  silver  penny  ;  and  from  this,  in  every 
direction,  like  rays,  are  seen  ligamentous  bands,  of  a  white 
colour,  and  very  narrow,  looking,  in  the  section,  like  so  many 
irregular  lines,  passing  to  the  circumference  of  the  tumour, 
which  is  blended  with  the  substance  of  the  surrounding 
gland.”  Dr.  Baillie’s  description,  it  is  well  known,  of  the 
structure  of  Cancer  in  the  stomach  and  uterus  accords  precise¬ 
ly  4 


136 


Medicine . 


[February  % 


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

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


Medicine . 


1ST 


1809.] 

fill  the  cavity  of  the  mouth.  Mr.  Home  lias  recorded  a 
similar  circumstance  in  a  case  of  Cancer  of  the  penis,  where 
the  disease  in  the  gland  became  as  it  were  quiescent,  while 
the  ravages  committed  in  the  groin  were  violent  in  the  ex¬ 
treme.  But  in  all  the  cases  hitherto  related,  (except  the 
second,  where  the  subject  was  very  old)  and  in  those  still  to 
be  reported,  the  quiescent  state  extended  to  the  whole  dis¬ 
ease;  it  included  every  part  alike  ;  it  began  with  the  adop¬ 
tion  of  the  regimen,  and  continued  uniformly  and  steadily, 
as  long  as  it  was  continued, 

<c  I  have  said  enough,  I  think,  to  shew  the  utility  of  this 
regimen  in  cases,  even  where  it  cannot  effect  a  cure ;  it  limits 
the  disease;  it  soothes  the  pain;  and  it  palliates  several  of 
the  most  distressful  symptoms.  But  it  is  now  my  business  to 
turn  to  a  scene  still  more  pleasing  ;  and  to  shew,  by  the  infal¬ 
lible  test  of  experience,  that  both  the  cancerous  tumour  and 
the  cancerous  ulcer  are  really  curable.  The  former  may  be 
removed  from  the  system  by  spontaneous  absorption ;  and  the 
latter  may  be  healed  by  the  separation  of  the  diseased  parts, 
and  the  surrounding  skin  being  drawn  down,  and  completely 
closing  the  basis  of  the  ulcer.” 

(To  be  continued.) 


VACCINATION. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

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


Medicine . 


[February., 


this  discovery,  under  the  term  of  the  Psora  Bovilla  ?  What  is 
apparently  its  nature,  and  its  best  mode  of  treatment?  I  know 
some  strong  facts  have  occurred  in  Dr.  Willan’s  own  practice 
upon  this  point.  My  inquiry  is  one  neither  connected  with 
opposition,  nor  the  desire  of  singularity  ;  but  to  possess  a  con¬ 
viction,  from  the  judgment  and  experience  of  others,  of  what 
is  really  the  truth  respecting  this.  I  can  have  no  doubt  of 
Dr.  Willan’s  professional  correctness,  and  that  I  shall  be 
favoured  with  his  opinion  in  answer  to  the  above. 

I  am,  Gentlemen,  your  obedient  Servant, 
Henrietta  Street,  Jan .  20.  R.  REECE. 


VACCINATION. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen—In  may  be  expected  that  the  discussion  of 
Mr.  Rose’s  bill  in  the  present  session  of  parliament  will  ex¬ 
cite  the  activity  of  the  eternal  enemies  of  vaccine  inocula¬ 
tion  ;  and  I  hope  that  its  friends  too  will  be  equally  on  the 
alert  in  their  endeavours  to  refute  calumny  and  detect  misre¬ 
presentation. 

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

The  first  measure  I  would  propose  is,  that  the  deaths  from 
small-pox  should  be  divided  in  the  bills  into  two  heads ;  the 


) 


1809.]  Surgery.  139 

first  to  contain  those  who  perish  from  the  natural  contagion, 
and  the  second,  those  who  are  destroyed  by  inoculation.  Thus 
*we  should  have  annually  authentic  proofs  of  the  direct  and 
immediate  injury  of  the  old  practice;  and  might  compare 
it  with  the  alleged  mischiefs  of  vaccination.  I  believe  that 
the  numbers  thus  destroyed  are  much  greater  than  is  com¬ 
monly  imagined,  and  that  it  would  confirm  the  observation 
in  the  report  of  the  College,  that  ie  The  deaths  from  com¬ 
mon  inoculation  are  more  numerous  than  the  cases  of  im¬ 
puted  mischief  from  vaccination.” 

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

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

MEDICUS. 


II.  SURGERY. 

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

CATARACT. 

The  inconveniencies  that  attend  the  usual  mode  of  incision 


\ 


140 


Surgery .  ["'February, 

are  first  pointed  out,  shewing  that  the  incision  of  the  internal 
coats  is  not  equal  to  those  of  the  external.  After  enumerating 
very  clearly  all  thedisadvantagesof  theusual  mode,  Mr.  Ward- 
rop  observes,  they  appear  to  him  to  66  arise  chiefly  from  the 
want  of  a  sufficient  portion  of  the  cornea  being  left  at  the 
inferior  part  of  the  wound,  to  support  the  iris,  and  to  prevent 
the  pressure  of  the  parts  contained  within  the  eye-ball,  and 
the  occasional  action  of  the  muscles,  pushing  forward  the 
iris  toward  the  wound  of  the  cornea:  I  therefore  conceived, 
that  if  the  incision  could  be  made  in  such  a  manner,  that  a 
larger  portion  of  the  cornea  could  be  left  at  the  inferior  part 
of  the  wound,  and  that,  if,  at  the  same  time,  it  was  made  of 
such  a  form  as  to  allow  the  easy  extraction  of  the  lens,  a  con¬ 
siderable  improvement  would  be  made  in  the  operation. 
With  this  view,  1  made  the  incision  in  the  following  man¬ 
ner  : 

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


141 


1809.]  Surgery. 

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

Thus  conducted,  he  farther  proceeds  ; 
ic  The  incision  should  be  made  so  that  the  inferior  edge  of 
the  wound  is  half  way  between  the  circumference  of  the 
cornea  and  edge  of  the  pupil,  supposing  the  pupil  to  be  in  a 
moderate  state  of  dilatation .  If  it  be  made  nearer  to  the  sclerotic 

4 

coat,  then  the  advantage  to  be  expected  from  this  mode  of 
operating  will  be  lost;  and,  on  the  other  hand,  if  it  be  made 
at  too  great  a  distance  frpm  the  sclerotic  coat,  and,  conse¬ 
quently,  too  near  the  pupil,  the  iris  will  be  apt  to  fall  for¬ 
wards,  and  a  portion  of  it  to  pass  through  between  the  lips  of 
the  wound.  In  one  case,  in  which  this  accident  happened 
to  me,  the  wound  was  long  of  uniting,  and,  after  it  was  heal¬ 
ed,  the  pupil  remained  very  irregular  and  contracted. 

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


142  Surgery*  [February* 

of  the  knife,  and  presses  the  iris  from  its  edge,  by  gliding  the 
point  of  his  fore-finger  over  the  cornea,  the  incision  may  be 
completed  with  perfect  safety, 

u  I  should  not  omit  mentioning,  in  this  place,  the  great 
advantage  to  be  derived  by  having  the  eye-ball  properly 
fixed  before  attempting  to  introduce  the  knife.  I  suppose  the 
upper  eye-lid  firmly  secured  by  the  fingers  of  an  assistant,  or 
by  Peilier’s  speculum,  and  the  fore  and  middle  finger  of  the 
operator’s  left  hand  placed  within  the  eye-lid,  in  contact  with 
the  eye-ball,  pressing  firmly  in  the  corner  of  the  eye  the  mid» 
die  finger,  to  prevent  the  ball  rolling  inward.  When  first 
touched  with  the  point  of  the  knife,  the  eye  generally  starts  ; 
I  have,  therefore,  adopted  it  as  a  general  rule,  to  touch  the 
eye  gently,  or  give  it  little  strokes  with  the  back  of  the  knife, 
as  long  as  it  starts  or  remains  unsteady  ;  but  the  moment  it 
appears  fatigued  and  fixed,  I  draw  the  back  of  the  knife  with 
great  caution  along  the  surface  of  the  cornea,  till  the  point 
arrives  at  the  exact  place  where  it  is  intended  to  penetrate, 
and  then,  with  some  quickness  and  firmness,  it  ought  to  be 
pushed  into  the  anterior  chamber. 

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

C£  I  have  found  the  incision,  such  as  has  now  been  describ¬ 
ed,  to  fulfil  completely  my  expectations,  after  having  per¬ 
formed  it  in  up  wards  of  twenty  cases,  in  order  to  extract  the 
cataract,  and  also  in  other  operations,  where  it  was  necessary 
to  make  an  incision  into  the  anterior  chamber.  I  have  also 
observed,  in  some  persons  who  have  been  operated  on  by  the 
most  able  oculists,  that  the  incision  of  the  cornea  was  by  no 
means  of  the  regular  semicircular  form,  nor  was  it  so  near  to 
the  circumference  of  the  cornea  as  is  recommended  ;  notwith- 


ISO  9.]  Surgery,  14  % 

standing  the  lens  in  these  cases  was  readily  extracted,  and  the 
pupil  remained  perfectly  regular.  This  most  frequently 
happened  in  eyes  which  were  operated  on  with  the  left 
hand  :  I  therefore  did  not  consider  it  as  the  aim  of  the  opera¬ 
tor  to  make  the  incision  of  such  a  form,  but  rather  as  an  acci¬ 
dent  occasioned  by  the  difficulty,  which  most  people  find  in 
using  their  left  hand.” 

EGYPTIAN  OPHTHALMIA. 

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

ANEURISM. 

The  perfection  of  Surgery  is  now7  so  great,  that  the  opera¬ 
tion  for  Aneurism  has  been  performed  repeatedly  in  the  Hos¬ 
pitals  of  the  metropolis  on  large  arteries ;  and  these  cases  are 
the  following : 

u  A  fourth  operation  for  aneurism  of  the  carotid  artery  has 
recently  occurred.  It  was  performed  at  St.  Thomas’s  Hospi¬ 
tal  on  the  16th  instant,  upon  the  person  of  a  strong  middle 
aged  man,  by  Mr.  Cline.  The  tumour,  which  was  large,  had 
been  particularly  rapid  in  its  growth.  The  other  circum¬ 
stances  of  the  case  were  by  no  means  favourable.  Respiration 
and  deglutition  were  affected  by  the  pressure  of  the  tumour, 
which  had  pushed  the  larynx  from  its  straight  course.  The 


144  Surgerj/i  [February, 

patient  had  besides  a  very  frequent  and  troublesome  cough. 
The  pain  was  confined  to  the  tumour  and  corresponding  side 
of  the  face. 

u  All  these  symptoms  were  relieved  for  the  twelve  hours 
succeeding  the  operation.  They  then  recommenced  in  an 
increased  degree,  particularly  the  cough  and  difficulty  of 
swallowing,  accompanied  with  much  irritative  fever,  to 
remove  which  medicine  proved  inefficient*  The  man  died  on 
Monday  the  19th. 

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

u  The  subject  of  an  operation  (performed  about  the 
same  time  by  the  same  gentleman)  for  inguinal  aneurism, 
has  likewise  perfectly  recovered ;  he  walks  with  consi¬ 
derable  ease,  with  the  aid  of  a  stick,  and  has  accomplish* 
ed  a  walk  of  three  quarters  of  a  mile  at  One  time.  He 
m  \kes  no  complaint  of  coldness  in  the  limb.  The  event  of 


143 


I  BOB.]  Surgery. 

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

CALCULUS. 

No  disease  comes  oftener  under  the  care  of  the  surgeon 
than  Calculus.  Chemistry  lias  tended  much  of  late  years  to 
elucidate  its  nature,  and  some  observations  upon  it  have  been 
made  by  Mr.  Barlow,  of  Blackburn,  which  deserve  attention. 

<c  The  general  opinion,”  he  observes,  a  that  what  is  called 
hard-water,  when  taken  into  the  stomach  as  a  common  bever- 
age,  predisposes  persons  to  the  disease  of  stone  or  gravel,  by 
a  specific  mode  of  action  and  affinity  with  the  urine,  appears 
to  me  to  have  little  or  no  foundation  in  truth  ;  nor  will  calculous 
affections,  on  a  minute  inquiry,  be  more  frequently  discovered 
in  one  county  than  another. 

u  Were  it  possible  to  institute  a  ratio  of  the  comparative 
number  of  stone  patients  in  the  various  counties  in  this  king¬ 
dom,  according  to  the  aggregate  of  inhabitants  in  each,  it  is 
more  than  probable  that  the  difference  of  result  would  scarce¬ 
ly  be  noticed  :  this  conclusion,  then,  leads  me  to  believe  that 
water,  even  when  impregnated  with  sulphat  and  carbonat  of 
lime,  possesses  no  inherent  power  in  predisposing  persons  to 
this  disorder.  It  is  stated  by  the  querist  in  a  publication 
that  the  county  of  Norfolk  produces  more  instances  of  cal¬ 
culous  affections  than  that  of  Lancaster,  although  the  water 
in  each  is  equally  impregnated  with  earthy  matter.  Whence 
(says  lie)  the  origin  of  this  vulgar  error  ? 

u  The  popular  opinion  of  tills  complaint  being  endemic, 
may,  I  conceive,  arise  from  the  circumstance  of  some  resident 
surgeon  having  gained  celebrity  in  this  particular  branch  of 
chirurgery,  which  induces  those  who  are  afflicted  with  this 
malady  to  apply  for  relief,  when,  otherwise,  they  would,  in 

VOL.  IT,  i, 


146 


'  -4  -‘V  • 

i 

f 

Surgery*  [February 

all  human  probability,  haye  died  without  haying  the  stone 
extracted,  or  even  the  disease  discovered,  by  those  less  com¬ 
petent  to  undertake  the  operation . 

tc  I  am  not  acquainted  with  the  relative  frequency  of  calcu¬ 
lous  cases  which  any  particular  county  produces,  or  the 
average  number  of  stone  patients  admitted  into  the  different 
hospitals  in  this  kingdom,  nor  the  result  of  success  consequent 
to  the  operation  ;  nevertheless,  some  inference  may  be  drawn 
•  from  the  relative  number  of  cases  in  this  part  of  the  county, 
compared  with  other  districts,  when  it  is  known,  that  during 
the  period  of  the  last  seven  years  I  have  operated  for  the  stone 
thirteen  times  in  this  town  and  neighbourhood,  on  patients 
from  the  age  of  two  and  a  half  years  to  that  of  fifty,  and  in 
every  instance  (except  one)  with  success. 

66  In  allusion  to  the  popular  opinion  respecting  the  tenden¬ 
cy  that  water,  when  impregnated  with  earthy  matter,  has  in 
producing  stone  in  the  bladder ,t  1  will  refer  the  reader,  as  a 
proof  of  the  antiquity  of  this  prevailing  prejudice,  to  sect.  3d, 
page  68,  of  Hippocrates  de  acre  locis  et  aqua,  where  he 
says,  u  The  waters  of  rivers  or  lakes  into  which  different 
streams  fill,  or  of  other  places  into  which  they  have  at  times 
accumulated  themselves,  are  apt  to  produce  the  stone  ;  for, 
being  composed  of  many  different  sorts,  some  sweet,  others 
salt,  or  aluminous,  they  must  deposit  a  sandy  sediment. 
Persons  whose  bowels  and  bladders  are  in  a  soluble  state,  may 
escape  sabulous  collections;  but  those  of  a  /pore  fiery  habit, 
when  the  mouth  of  the  bladder  is  attacked  with  inflammation, 
cease  to  make  water  freely,  and  then  the  gross  sandy  parts  of 
these  waters  deposit  themselves,  whilst  the  more  fluid  particles 
are  let  out,”  &c.  &c.  In  another  part  of  the  same  author's 
works,  he  attributes  the  stone  in  children  to  the  impure  milk 
of  nurses 

<£  I  am  aware,  that  the  proximate  cause  of  the  production 
of  urinary  calculi  is  involved  in  much  obscurity;  yet  it  ap¬ 
pears  to  me,  that  the  disease  does  not  originate  so  much,  as 


147 


lew 

■ 

t 

r  • 

»  .  r*-  .  wjf#'  •  \  1  '. 

1 801).  J  '  Surgery. 

has  been  supposed,  in  the  uriniferous  vessels  of  secretion  in 
the  kidneys,  or  in  the  urine  secreted  therefrom,  as  in  the 
mucus  produced  from  the  inner  surface  of  the  bladder,  and 
sides  of  those  organs  and  cavities,  through  which  it  naturally 
passes  from  its  source  in  the  kidneys  to  the  termination  at  the 
prostate  gland* 

“  The  peculiar  construction  and  disposition  of  the  prostate 
gland  to  generate  calculi,  may  be  one  cause  why  men  are 
more  subject  to  the  disease  than  women,  seeing  they  aredesti- 
tute  of  that  organ ;  and  we  frequently  read  of  calculi  being 
found  in  this  appendage  to  the  bladder,  and  also  of  their 
existing  spontaneously  in  other  cavities  of  the  body ;  such, 
for  instance,  are  the  intestines,  uterus,  stomach,  gaii-i)  Mer, 
lungs,  and  cavities  of  the  joints  in  gouty  habits. — See  Baillie’s 
Morbid  Anatomy,  Morgagni’s  Epist.  Lieutaud,  Boerhaave’s 
Commentaries,  and  Memoirs  of  the  Royal  Academy  of  Sur- 
geryat  Paris. 

“  Th  ese  depositions  of  earthy  concretions,  I  conceive, 
abound  more  frequently  in  those  reservoirs  of  the  system 
•where  there  is  the  greatest  quantity  of  mucus  secreted,  and 
where  it  is  pent  up  in  certain  parts  of  the  body,  than  in  those 
cavities  from  which  there  is  a  greater  facility  for  the  fluid  to 
escape  from  the  part  where  it  was  deposited ;  lienee,  may  it 
not  be  reasonable  to  infer,  that  the  proximate  cause  of  urinary 
calculi  exists  in  an  over  degree  of  stimuli  affecting  the  urinary 
organs,  and  thereby  producing  an  excess  ofinspissated  mucus 
on  the  inner  surface  of  the  bladder,  and  a  morbid  state  of 
those  membranous  cavities,  so  essentially  necessary  for  the 
performance  of  their  healthy  functions.  These  superabund¬ 
ant  secretions  may  become  stagnant  in  the  excretory  ducts 
and  rugas  of  the  bladder,  and,  by  chemical  affinity  with  the 
urine,  calculi  may  probably  be  generated.  *  On  the  same 
principle,  any  foreign  substance  accidentally  lodged  in  the 
bladder,  may  excite  a  certain  degree  of  inflammation,  and 
coaguiable  lymph  or  mucus  be  thrown  out  in  the  cavity  of 

l  2 


148  Surgery .  [February, 

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

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

ENCYSTED  TUMOU11  ON  THE  CHEEK,  BY  A  MEMBER  OF  THE* 
ROYAL  COLLEGE  OF  SURGEONS. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

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

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

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


149 


1809.]  Surgery. 

sloughed,  jet  a  very  unsightly  cicatrice  would  form,  did 
the  patient  eyer  get  well. 

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

I  determined  nevertheless  to  trust  this  case  to  the  result 
of  the  original  opening,  and  with  that  view  i  satisfied  myself 
with  merely  introducing  as  much  lint  into  the  tumour,  as 
not  painfully  to  distend  the  sac. 

The  second  day,  part  of  this  dressing  came  away  easily  : 
on  the  fourth,  the  remainder  of  the  lint  dressing  separated 
itself  as  readily,  but  the  discharge  was  copious  and  greatly  of¬ 
fensive.  It  was  observable,  after  this  period,  that  the  exuber¬ 
ant  state  of  the  integuments  was  much  contracted ;  I 
then  conceived  it  possible,  that  the  sides  of  the  cyst  might 
approximate  and  unite  by  adhesive  inflammation,  and  thus 
prevent  a  renewal  of  a  fresh  secretion  in  the  cyst. 

The  integuments  of  the  tumour,  in  the  space  of  a  month’s 
treatment  on  this  plan,  collapsed  in  sucli  a  manner,  as  led  me 
not  to  regret  the  putting  into  practice  the  removal  of  the  seem¬ 
ingly  superfluous  integuments,  which  it  was  at  first  my  inten¬ 
tion  to  do,  and  certainly  from  the  appearance  of  the  very  pursy 
state  of  the  skin,  every  reader  will  think  with  me  it  might 
have  been  necessary. 

The  introduction  of  a  solution  of  the  argentum  nitratum 
in  the  proportion  of  one  drachm  to  one  ounce  of  water,  by 
the  means  of  lint  dipped  into  the  same,  has  certainly  pre¬ 
vented  a  renewal  of  the  steatomatous  secretion,  but  without 
effecting  an  obliteration  of  the  cyst.  The  bag  remains 
open,  and  although  two  years  have  elapsed,  no  collection  of 
any  kind  has  taken  place,  npr  docs  any  discharge  escape 
from  the  cavity  of  the  tumour.  I  shall  not  enlarge  on  this 


150 


Surgery.  [February, 

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

I  could  have  wished  to  have  made  the  recovery  of  this 
patient  complete,  by  removing  the  edges  of  the  opening,  arid 
thereby  procuring  by  the  first  intention  the  complete  healing 
of  the  wound. 


To  the  Editors  of  The  Medical  and  Surgical  Spectator, 

Gentlemen — In  your  last  number,  I  observed  a  letter  from  a 
correspondent,  dated  Cambridge,  containing  remarks  on  the 
nature  and  treatment  of  Tinea  Capitis  ;  I  conceive  it  there¬ 
fore  but  justice  to  myself  to  observe  that  the  same  prac¬ 
tice  detailed  in  that  letter  is  an  outline  of  what  has  been 
regularly  my  plan  of  treatment  for  the  last  three  years,  and 
as  surgeon  to  a  Public  Institution,  I  have  had  the  fullest 
opportunities  of  trying  its  success.  I  long  since  communi¬ 
cated  my  ideas  to  Dr.  Haighton,  my  worthy  colleague,  as 
well  as  to  my  friend  Mr.  Astley  Cooper,  both  of  whom  have 
had  opportunities  of  appreciating  its  merits,  and  to  both  of 
whom  I  intimated  my  intention  to  publish  a  short  detail  of 
those  cases,  in  which  this  plan  has  proved  successful.  I 
have  endeavoured  as  much  as  possible  to  disseminate  my 
ideas  on  the  subject  to  every  practitioner  whom  I  have  ever 
had  occasion  to  meet  on  this  disease,  which  occasions  have  not 
been  unfrequent,  and  1  am  therefore  glad  to  find,  that  the  same 
practice  has  been  adopted  by  others  as  well  as  myself. 

1  am,  Gentlemen,  your  obedient  servant,  * 

St.  Mary  Axe,  Jan.  IS,  1809.  THOS.  LUXMOGRE. 


1809.] 


m 


Surgery 

REMARKS  ON  SPHACELUS  OP  THE  TOES  AND  FEET,  BY  A 
MEMBER  OF  THE  ROYAL  COLLEGE  OF  SURGEONS. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

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

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

It  would  be  proper  to  premise  that  it  has  frequently  fallen 
to  my  lot  to  treat  mortifications  arising  from  cold,  inflamma¬ 
tion  or  accident ;  but  in  none  of  these  cases  did  the  quantity 
of  opium  required  to  allay  irritation  justify  me  in  con¬ 
sidering  it  as  possessing  any  thing  like  a  claim  to  the  charac¬ 
ter  of  being  a  specific  remedy,  as  intimated  by  that  writer.  In 
those  cases  of  mortification  analogous  to  the  instances  de*- 
scribed  by  Mr.  Pott,  I  have  not  succeeded  in  arresting  the 
progress  of  sphacelus,  and  in  some  cases  failed  of  procuring 
ease.  From  the  encomiums  given  to  this  drug  by  Mr.  Pott, 
had  I  not  attentively  perused  the  account  this  author  lias 
communicated  to  the  profession,  I  should  have  been  led  to 
conclude  that  we  had  been  treating  different  varieties  of  mor¬ 
tification. 

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

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

l  4 


152 


Su  rgery .  [F  ebruary , 

the  remedy  previous  to  the  existence  of  mortification,  having, 
upon  inquiry  of  every  patient,  found  that  they  had  for  days, 
in  some  instances  weeks,  experienced  excruciating  torture  in 
their  feet  before  the  part  manifested  any  change  of  colour 
or  appearance  of  disease. 

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

It  is  some  years  since  the  occurrence  of  this  case  ;  but  I  have 
succeeded  also  in  tvo  other  cases  by  this  practice  in  allevi¬ 
ating  and  removing  this  very  painful  affection  of  the  feet.  I 
most  perfectly  accord  with  Mr.  Pott  in  the  propriety  of 
adopting  the  mildest  external  applications  :  the  linseed  poul¬ 
tice  was  theexternal  means  I  used  in  those  cases  in  which  mor¬ 
tification  had  made  its  appearance  previous  to  my  being  con¬ 
sulted.  It  may  be  right  to  observe,  that  the  patients  always 
complained,  if  the  cataplasm  was  more  than  lukewarm,  of 


153 


1809.]  Surgery . 

their  sufferings  being  increased  by  it.  The  intelligent  reader 
will  determine  for  himself  what  degree  of  reputation  opium 
merits  as  a  probable  preventive  to  the  occurrence  of  spha¬ 
celus,  if  resorted  to  before  there  is  any  manifestation  of  dis¬ 
order  in  the  feet. 

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

ON  TIIE  FUNCTIONS  OF  THE  LIVER. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

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

Your  most  humble  Servant,  S, 

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


154 


Surgery.  [February, 

course  of  digestion,  a  deposit  of  pure  blood  is  laid  up  in  the 
cellular  substance  of  the  spleen  :  that  its  bulk  is  capable  of 
enlargement  and  diminution  is  acknowledged  by  most  anato¬ 
mists.  u  Monsieur  Lieutand  in  Hist,  de  Acad,  des  Scienc. 
Paris,  Ann.  17 33,  argued  for  the  spleen  being  larger  by  a 
greater  quantity  of  blood  in  it  when  the  stomach  is  empty, 
and  that  the  blood  is  pressed  out  when  the  stomach  is  full  to 
increase  the  secretion  of  bile.”  Cyclopaed.  But  that  the  liver  is- 
fully  competent  for  the  secretion  of  bile  without  the  help  of 
the  spleen  I  think  will  be  generally  allowed.  That  it  is  a 
magazine  from  which  the  system  is  occasionally  supplied,  I 
was  strengthened  in  my  opinion  from  two  of  the  experiments 
of  the  ingenious  Mr.  Home  upon  asses  that  had  been  kept 
four  days  without  water  and  two  days  without  solid  food. 
Upon  killing  those  animals,  the  spleen  in  each  was  found  di¬ 
minished  to  half  the  ordinary  size,  being  a  pretty  strongproof 
that  the  animals,  during  their  fasting,  were  partly  sustained  by 
nutriment  from  their  own  depots.  As  there  is  an  accumula¬ 
tion  of  adeps  in  its  proper  cells  when  the  animal  is  in  good 
health,  and  plentifully  supplied  with  nutritious  food,  which 
is  capable  of  being  again  taken  up  into  the  circulation  by 
means  of  the  absorbent  or  lymphatic  system,  so  in  like  man¬ 
ner  I  imagine  the  spleen  to  be  an  extra  store  of  pure  blood 
ready  to  supply  the  sanguiferous  system  when  needful.  Con¬ 
sidering  it  in  this  light,  how  useful  must  such  a  viscus  be  in 
the  animal  occonomy  :  how  often  do  we  find  the  stomach  in 
such  a  state  as  to  reject  food  for  many  days  together,  under 
which  the  animal’s  strength  would  sink  very  fast,  if  it  was  not 
for  this  wise  provision  of  nature  within  itself.  Hence  I  con¬ 
clude,  that,  besides  its  constant  duty  of  assisting  the  stomach 
in  promoting  digestion,  the  spleen,  from  its  proximity  to  the 
heart,  its  nervous  and  vascular  texture,  contains  a  kind  of 
extract  of  the  finer  particles  of  the  blood,  perhaps  chiefly 
red  globules,  highly  animalised,  and  abounding  with  living 
principle,  from  which  a  little  being  distributed  in  the  round 


1809.] 


155 


of  circulation,  the  animal  may  be  sustained  for  many  days, 
when  the  usual  supplies  of  nourishment  are  cut  off. 


Yours  very  respectfully 


SCRUTATOR. 


Jan.  IS,  1809. 


To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — I  have  conned  very  attentively  over  the  com¬ 
munication  from  Dr.  Reece,  in  your  publication  of  this  month, 
containing  the  case  of  Admiral  Henry ;  and  whether  it  be 
owing  to  my  impenetrable  dulness,  or  to  Dr.  Reece’s  style 
partakingtoo  much  of  that  which  Burke  would  call  a  portion 
of  the  sublime ,  I  cannot  tell,  but  so  it  is,  I  do  not  perfectly 
understand  him.  I  allude  to  the  following  passage  in  hi& 
letter  :  il  The  Admiral  having  cured  himself  of  many  ob* 
stinate  attacks  of  Rheumatism  and  Gout  by  severe  friction, 
and  pounding  the  part  affected  with  a  wooden  hammer  ;  re¬ 
solved  to  make  the  experiment  on  the  right  eye ;  and  after 
persevering  with  great  fortitude  for  about  a  month,  he  found 
that  he  could  discern  a  luminous  body,  and  continuing  the 
practice,  the  diseased  lens  was  gradually  diminished,  and 
the  gallant  Admiral  is  enabled  to  read  small  print.”  Now 
I  wish  to  be  informed  how  the  experiment  of  severe  friction 
and  pounding  (for  the  word  experiment  refers  to  both) 
was  performed  on  the  eye  of  the  gallant  Admiral  ■? 

We  are  told  again,  that  by  the  experiment  of  rubbing 
and  pounding  the  eye,  the  diseased  lens  was  diminished. 
There  appears  to  me  some  ambiguity  in  this  sentence  :  fronr 
the  manner  in  which  it  is  expressed,  we  must  suppose 
that  the  lens  itself  was  diminished ;  and  yet  I  cannot  help  think¬ 
ing  the  doctor  intended  to  have  said,  the  disease  of  the  lens 
was  diminished.  A  ray  of  his  information  in  your  next 
number  will  pierce  the  darkness  which  surrounds  me,  and 
my  mind  shall  be  no  more 


- —  like  a  clouded  lens, 

But  clear  and  bright  as  other  men’s. 


London ,  January.  23,  1 809. 


T  B, 


156 


Surgery. 


[February, 


Practical  Observations  on  the  Diseases  of  the  Joints ,  com¬ 
monly  called  While- swelling ;  with  Remarks  on  Caries , 
Necrosis ,  and  scrofulous  Abscess ,  in  which  a  new  and ' 
successful  method  of  treating  these  complaints  is  pointed 
out .  By  Bryan  Crowther ,  Member  of  the  Royal  Col¬ 
lege  of  Surgeons  in  London ,  and  Surgeon  to  Bridewell 
and  Beihlem  Hospitals. 

(Continued  from  Yol.  I.  page  64.) 

Society  is  certainly  under  the  greatest  obligations  to  those 
practitioners,  who,  by  their  assiduity  to  the  duties  of  their 
profession,  extend  our  knowledge  of  practical  science,  for 
one  practical  observation  is  wortli  ten  thousand  theories : 
theory  may  please,  but  fact  elucidates :  the  one  has  the  absur¬ 
dity  to  flatter  itself,  that  by  its  specious  garb  proselytes  will 
flock  to  it,  while  fact  establishes  itself  by  the  sober  simpli¬ 
city  of  its  manner,  and  solidity  of  its  argument.  Such  was 
the  state  of  information  respecting  caries,  when  Mr.  Crow¬ 
ther  opened  a  new  field  on  this  interesting  point,  and  called 
the  attention  of  the  medical  profession  to  some  new  facts, 
connected  with  a  subject  hitherto  involved  in  great  ob¬ 
scurity.  As  a  writer,  we  consider  Mr.  Crowther  as  neither 
wishing  or  anxious  for  literary  fame  ;  he  has  soared  still 
higher,  by  his  attempts  to  be  useful  to  the  public,  This 
writer  is  most  particularly  deserving  of  credit  to  his  asser¬ 
tions,  because  his  writings  contain  simply  a  narration  of  facts, 
unconnected  with  any  theoretical  opinions.  With  respect  to 
the  diseased  state  of  bones  consequent  on  white-swelling,  he 
has  stated  an  opinion  of  Mr.  Lawrence,  Anatomical  Demon¬ 
strator  of  St.  Bartholomew’s  Hospital ;  that  the  bones  in  (bis 
complaint  undergo  no  enlargement.  Mr.  Crowther  has,  with 
that  liberality  that  should  ever  attach  itself  to  a  professional 
character,  given  to  this  anatomical  surgeon  the  credit  of 
having  first  communicated  this  important  information ;  im¬ 
portant  it  is,  for  Mr.  Crowther  has  observed,  the  seemingly 


157 


1809.]  Surgery. 

enlargement  of  the  ends  of  the  bones  of  the  joint  has  induced 
many  surgeons  to  recommend  aryl  adopt  the  removal  of  the 
limb.  We  learn  from  this  author,  that  the  mere  distended 
state  of  the  joint  will  put  on  such  appearances  as  to  in¬ 
duce  the  most  experienced  surgeon  to  imagine  the  bones  to 
be  actually  expanded;  but  after  a  local  antiphlogistic  treat¬ 
ment,  derivation  of  purulent  discharge  from  the  integuments 
covering  a  diseased  joint,  this  seemingly  encrcased  size 
of  the  ends  of  the  bones  disappeared.” 

This  supposed  enlargement  has,  by  Cheston,  Kortum, 
and  other  practitioners,  been  confounded  with  rickets,  an  in¬ 
stance  of  which  we  give  in  Mr.  Crowther’s  own  words : 

<£  Kortum,  on  scrofulous  affections,  speaks  of  the  bones 
being  expanded ;  but,  it  is  very  extraordinary  that  he 
should  describe  the  complaint  as  proceeding  from  a  scro¬ 
fulous  or  rickety  source,  as  I  have  never  seen  a  case  of 
scrofulous  caries  arise  from  a  rickety  disposition.  A  mis¬ 
taken  opinion  was  several  years  ago  given  on  this  subject 
by  a  surgeon  of  eminence  :  when  a  little  boy  was  brought  to 
him,  with  a  disease  of  the  .knee,  he  told  the  friends  it  was 
only  the  rickets,  which  cold  bathing,  country  air,  and 
time,  would  remove.  In  this  boy’s  complaint  the  knee  was 
enlarged ;  there  was  no  fluctuation  in  the  joint,  and  little 
uneasiness  on  moving  it ;  and  it  was  one  of  those  cages  in 
which  the  condyles  of  the  femur  appeared  to  be  increased  in 
their  dimensions.  I  gave  my  opinion  accordingly,  and 
the  relations  were  satisfied  that  my  notions  respecting  the 
child  were  correct,  and  that  it  was  in  fact  a  white-swelling, 
and  not  the  rickets.  In  consequence  of  this  opinion  I  have 
since  been  induced  to  examine  particularly  many  children 
who  have  been  brought  to  me,  on  account  of  scrofulous  af¬ 
fection,  and  I  have  always  remarked  that  they  were  totally 
free  from  any  trace  of  rickets. 

iC  In  rickety  children  we  do  not  find  one  joint  only  affected, 
for  the  corresponding  limb  shews  marks  of  the  same  disease. 


158  Surgery.  [February, 

— Mr.  Cheston  says,  6  It  has  indeed  been  commonly  ad- 
6  yanced,  that  the  bones  are  almost  always  enlarged;  this  I 
4  never  observed,  unless  in  young  subjects,  where  it  might 
c  have  been  complicated  with  tbe  rickets,  though  I  have 
*  examined  a  great  number  of  them  when  injured  by  this 
4  complaint.  I  am  inclined  to  think  that  this  notion  either 
4  arose  from  the  deceitful  feel  through  the  diseased  in- 

O 

4  teguments,  &c.  or  its  being  confounded  with  spina  veil- 
4  tosa.’  I  have  seen  but  very  few  joints  dissected  after  am¬ 
putation,  but  in  those  affected  with  spina  ventosa,  or  scro¬ 
fulous  caries,  which  I  have  had  an  opportunity  of  inspecting, 
the  bones  had  not  undergone  any  increase  in  size,  although 
they  were  softened  in  their  texture,  and  excavated  from 
within  outwards.  In  those  cases  where  the  bones  are  in¬ 
jured  in  consequence  of  disease  occurring  first  within  the 
cavity  of  a  joint,  although  they  are  frequently  deprived  of 
their  cartilaginous  covering,  and  sometimes  even  suffer  loss 
of  substance,  yet  the  structure  of  the  bone  is  not  changed,  as 
happens  in  the  scrofulous  caries.” 

Mr.  Crowther  speaks  of  bones  being  affected  in  two  ways : 

44  The  bones,  in  this  complaint,  are  affected  in  two 
ways:  in  the  one,  they  are  affected  primarily  from  disease 
originating  in  their  interior  structure ;  in  the  other,  secon¬ 
darily,  by  their  articulating  surfaces  becoming  diseased,  in 
consequence  of  a  previous  affection  of  the  internal  surface 
of  the  joint. 

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


159 


1809]  Surgery, 

oils  practice,  such  as  the  making  use  of  the  knife,  caustics 
and  cauteries:  the  last  of  these  remedies  were  to  dry  up, 
what  was  termed  the  rottenness  of  the  hones,  and  to  destroy 
the  bypersarchosis,  or  the  exuberant  fungus,  with  which  the 
surgeons  of  those  days  were  frequently  troubled. ” 

From  our  knowledge  we  believe  his  statements  to  be 
very  just.  He  believes  when  bones  are  originally  affected, 
they  become  the  spina  ventosa  of  the  ancients,  or  a  scro¬ 
fulous  caries  of  the  modem  surgeon. 

We  are  of  opinion  with  this  author,  that  in  whatever  man¬ 
ner  tfte  bones  are  diseased,  the  treatment  must  be  the  same,  and 
confined  to  the  exterior  covering  of  the  articulation.  We 
cannot  notice,  in  a  publication  like  ours,  every  nice  distinc¬ 
tion  which  Mr.  Crowther  has  observed  in  his  practical 
book,  and  therefore  shall  content  ourselves  in  noting  some  im¬ 
portant  occurrences  marked  by  him  in  his  practice.  Speak¬ 
ing  of  fungi  he  thus  expresses  himself : 

tC  These  fungi,  by  a  probe,  will  be  found  to  lead  to  dis¬ 
eased  bone,  and  in  some  instances  into  the  cavity  of  the 
joint.  The  interspace  between  these  excrescences,  from  the 
inflated  appearance  of  the  integuments,  might  incline  the 
practitioner  to  believe,  that  he  felt  fluid  fluctuating  under¬ 
neath.  This  sensation  is  delusive;  but  1  would  recommend, 
particularly  in  this  state  of  the  complaint,  to  avoid  the 
use  of  the  knife,  as  diseased  parts  will  ill  bear  the  attack  of 
inflammation ;  and,  I  have  observed,  that  they  suffer  less 
by  openings,  which  the  disease  spontaneously  makes.” 

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

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


160  Surgery .  [February  , 

<c  In  cases  of  diseased  bones,  the  parts,  which  cover  them 
appear  affected,  and  they  afford  to  the  examiner  the  feel  of 
fluid  very  perceptibly  to  the  touch.  I  shall  give  such  part 
of  a  case  as  is  interesting,  and  applies  to  this  part  of  our  sub¬ 
ject. 

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

6C  As  we  are  on  the  subject  of  diseased  bones,  it  may  not 
be  improper  to  mention,  that  I  have,  in  cases  of  abscess, 
formed  in  the  course  of  the  tibia,  let  out  the  matter,  at  a 
distance  from  the  bone,  by  pressing  the  tumour  on  one  side, 
and  then  puncturing  it ;  on  the  introduction  of  the  probe, 
in  such  instances,  the  bone  has  been  found  rough  and  de¬ 
nuded.  Simple  dressings  were  applied,  and  over  them  a 
compress  of  linen  pressed  out  of  the  saturnine  lotion,  and  the 
cure  was  effected  without  exfoliation. 

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

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


151 


1809.]  Surgery . 

€(  In  a  compound  oblique  fracture  of  the  tibia,  the  lower 
portion  was  drawn  under  the  upper,  the  pointed  extremity 
of  which  projected;  a  fungus  arose,  which  covered  tl.o 
bone  and  the  space  of  an  inch  surrounding  it :  I  introduced 
a  layer  of  lint  between  it  and  the  integuments,  and  then 
covered  the  surface  with  the  same;  the  extremity  of  the 
bone  was  absorbed,  and  the  patient  was  cured  without  ex¬ 
foliation;  the  fungus  shrunk  up,  and  the  sore  healed  by 
bandage  and  simple  dressing.  I  regretted  at  first  not 
having  removed  the  end  of  the  bone  at  the  time  of  the  ac~ 
cident ;  but  from  the  pleasing  termination  of  this  case,  I  am 
happy  in  having  acted  otherwise. 

u  I  lately  amputated  above  the  knee,  under  circum¬ 
stances  little  desirable  ;  the  patient’s  health  was  hardly  such 
as  to  justify  the  operation ;  it  was  performed  at  his  own 
request ;  and  the  best  amends  for  the  anxiety  I  suffered  on 
his  account  are  that  he  recovered. 

Cc  On  my  first  dressing,  although  the  muscles  and  integu¬ 
ments  were  amply  saved,,  I  observed  the  parts  to  be  flabby, 
yet  still  in  contact:  they  yielded  abundant  serous  discharge, 
the  soft  parts  investing  the  bone,  I  anticipated  would  not 
keep  their  situation  ;  I  therefore  confined  them  by  more  slips 
of  adhesive  plaister,  and  directed  bark  and  wine  with  a 
more  nourishing  diet. 

<c  The  patient  was  afterwards  seized  w  ith  hysteria,  which 
prevented  him  from  taking  sufficient  food :  the  integuments 
and  muscles  retracted,  and  the  bone  protruded  about  an 
inch  and  a  half.  The  success  of  the  former  case  taught  me 
not  to  be  too  busy  with  the  exuberant  granulation,  which 
afterwards  covered  the  bone ;  but  the  circumstance  of  hav¬ 
ing  saved  the  integuments  sufficiently,  and  knowing  I  could 
recover  them  by  proper  attention,  and  the  use  ok  adhesive 
plaister,  afforded  me  a  little  comfort.  The  end  pf  the  bone 
was  absorbed,  at  least  it  never  exfoliated,  and  the  patient 
recovered  with  a  well-formed  stump.  I  am  persuaded,  that, 

VOL.  II. 


M 


1 62  Midw  ifery .  [  F  ebruary , 

if  the  fungus  had  been  destroyed  in  either  case,  exfoliation 
must  have  unavoidably  taken  place. 

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

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

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


III.  MIDWIFERY. 

Midwifery  forms  a  compound  of  the  other  departments 
of  the  profession.  In  the  diseases  of  pregnancy  and  child-bed 
it  claims  the  attention  of  the  physician.  This  was  pointed 
out  in  our  last  number  under  the  head  of  Puerperal  Convul¬ 
sions.  In  the  present  we  shew  its  connection  with  Surgery, 
by  stating  the  cure  of  one  of  the  most  formidable  local 
diseases  that  occurs  to  the  accoucheur  in  his  practice.  This 
is  Inversion  of  the  Uterus . 

INVERSION  OF  THE  UTERUS. 

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

“  Several  years  ago,”  he  observes,  u  my  friend  Dr. 
Searcs  and  myself  had  an  opportunity  of  rendering  the  most 
essential  service  to  ^  poor  woman,  in  whom  an  inversion  of 
the  uterus  had  occurred  :  with  your  permission,  I  will  lay 


163 


J  809.]  Midw  if  try. 

the  particulars  of  it  before  jour  readers,  as  an  additional 
proof  that  the  mischief  which  must  necessarily  result  from 
an  inversion  of  the  uterus  may,  by  prompt  assistance,  be 
prevented. 

<c  In  January,  1802,  Mrs.  Edwards,  residing  in  Brick 
Street,  Piccadilly,  was  delivered  of  her  first  child  by  Mrs. 

- ~,  a  midwife  of  considerable  practice  and  experience. 

The  labour  was  natural,  and  of  no  considerable  duration. 
Some  little  time  after  the  child  was  born,  Mrs. - en¬ 

deavoured  by  tightening  the  navel  string  to  exact  the 
placenta,  when  (though  she  asserts  that  no  force  was  used 
which  could  possibly  occasion  such  an  event)  a  very  vio¬ 
lent  pain  came  on,  and  the  uterus  was  completely  inverted, 
the  placenta  remaining  attached  to  it  ;  on  this  Mr.  Seares 
was  called  in,  who,  finding  things  in  this  state,  desired  that 
1  might  likewise  be  sent  for. 

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

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

m  2 


164 


Midwifery, 


[February 


without  a  single  bad  symptom.  She  has  since  borne  several 
children,  and  has  never  found  any  inconvenience  whatever 
from  this  alarming  and  dangerous  accident. 

<c  The  only  merit  which  can  be  claimed  in  this  case,  was 
for  doing  immediately  that  which  was  necessary  to  be  clone. 
Had  we  allowed  a  very  little  time  longer  to  elapse  before 
proceeding  to  reduce  the  inversion,  the  patient  would 
probably  have  sunk  beyond  recovery,  from  the  profuse 
haemorrhage;  or,  had  the  haemorrhage  been  stopped  by  the 
contraction  of  the  uterus,  that  very  contraction  would  have 
prevented  us  from  making  any  impression  on  the  fundus, 
and  the  os  uteri  v/ould  have  been  closely  shut  against  every 
attempt  which  we  could  make  to  relax  it. 

u  The  cases  which  have  come  to  our  knowledge,  of  women 
surviving  this  accident,  present  a  most  distressing  account 
of  mental  and  bodily  sufferings;  these  sufferings  can  be  pre¬ 
vented  by  one  method,  and  by  one  method  only ;  an  im¬ 
mediate  and  absolute  determination  to  re-invert  the  uterus. 
A  momentary  panic  in  the  mind  of  the  operator  may  occasion 
too  great  a  loss  of  time  to  allow  of  his  success  ;  for  unavailing 
have  proved  all  endeavours  at  restoring  the  parts  to  their 
original  site,  when  once  the  contraction  of  the  uterus  has 
completely  taken  place.” 

What  is  peculiar  in  this  accident  is  that  it  often  occurs 
after  the  easiest  labours,  and  where  the  placenta  has  come 
off'  in  the  most  complete  manner,  and  without  any  effort  on 
the  part  of  the  operator.  This  should  lead  a  practitioner  to 
be  cautious  of  blaming  those  that  have  had  the  direction  of 
the  labour.  Where  the  powers  of  the  fundus  uteri  arc 
strong,  and  it  is  possessed  of  much  irritability,  while  the 
neck  and  orifice  are  in  a  highly  atonic  and  relaxed  state, 
even  the  movements  of  the  female  herself  occasioning  a 
contraction  of the  fundus,  and  the  latter,  finding  no  resistance 
from  the  neck  and  orifice,  may  cause  it  to  be  forcibly  protrud¬ 
ed  in  an  almost  spontaneous  manner.  This  has  happened  in  a 


1809. 


Midwifery JS5 

variety  of  cases,  and  which  Mr.  Merriman  nrig-ht  have  taken 
notice  of  as  a  circumstance  which  should  be  always  in  the  re¬ 
collection  of  young  practitioners. 

SPINA  BIFIDA. 

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

<c  The  disease  termed  Spina  Bifida,”  he  remarks, Ci  may 
be  considered  as  the  effect,  and  that  the  Hydrops  Medullai 
Spinalis  appears,  ab  origine,  to  be  the  primary  and  proximate 
cause  of  this  morbid  affection. 

cc  About  three  months  since  I  was  requested  by  Mrs.  Dixon, 
of  this  town,  to  give  my  attendance  and  opinion,  relative  to  a 
swelling  occupying  the  lumbar  region  of  her  female  infant,  who 
was  then  three  days  old,  a  very  fine  and  healthy  looking  child. 

a  The  case  on  inspection  was  most  obviously  and  de¬ 
cidedly  a  deficiency  or  want  of  two  of  the  inferior  spinous 
processes  of  the  lumbar  vertebra.  Through  the  aperture 
projected  a  long  sac  or  tumour,  containing  a  diaphanous 
fluid,  and  which  appeared  to  be  an  elongation  of  the  dura 
mater.  On  making  a  gentle  pressure  with  the  hand  upon 
the  tumour,  there  was  evidently  a  free  .communication 
between  it  and  the  ventricles  of  the  brain,  constituting  the 
disease  called  Hydrocephalus  Intexnus.. 

u  The  head  was  large,  and  the  fantenelles  and  different 
sutures  of  the  cranium  were  preternaturally  divided.  The 
child  from  its  birth  had  strabismus  ;  and  it  did  not  appear 

m  3 


166  Midwifery,  February, 

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

u  Although  there  was  a  perpetual  exudation  of  a  perfectly 
colourless  fluid  from  the  tumour,  it  gradually  increased  in 
magnitude  till  within  a  few  days  of  its  death,  when  small 
incipient  ulcerations  took  place  upon  different  parts  of  the 
tumour,  accompanied  with  inflammation.  The  case  being 
a  hopeless  one,  1  advised  the  use  of  soft  emollient  cataplasms, 
which  appeared  to  be  the  best  and  easiest  kind  of  application. 
“dimensions  of  the  tumour. 

“  A  line  drawn  across  from  its  basis  in  a  horizontal  direc¬ 
tion  from  the  superior  part  of  the  sac  measured  nearly  4 
inches,  the  longitudinal  direction  measured  Scinches. 

£<  Before  the  child  was  buried  I  examined  the  part,  and 
found  the  integuments  were  become  corrugated  and  flat,  and 
the  contents  quite  evacuated.” 

CASE  OF  THREE  CHILDREN  AT  A  BIRTH,  BY  MR.  FRANCIS 
KIERNAN,  MEMBER  OF  THE  ROYAL  COLLEGE  OF  SURGEONS. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — A  plurality  of  children  in  the  human 
subject  seldom  exceeds  twins.  The  instances  beyond  this 
are  few,  and  where  they  do  occur,  deserve  to  be  recorded. 

About  a  month  ago  I  was  called  to  the  wife  of  Mr.  Bagster, 
of  Sommers  Town.  She  was,  according  to  her  own  calcula¬ 
tion,  in  her  eighth  month  ;  and  when  I  visited  her,  her 
labour  had  actually  commenced.  She  was  soon  delivered 
of  one  child,  which,  from  its  size,  and  the  apparent  state  of 
the  uterine  expansion,  I  was  sensible  could  not  be  the  only 
one  it  contained,  and  accordingly  I  found,  on  examination, 
another,  the  membranes  of  which  were  unbroken,  and  con¬ 
tinued  so  for  ten  minutes.  As  I  was  in  no  anxiety  to  hurry 
the  labour,  when  the  rupture  took  place,  the  child  was 
delivered  by  a  footling  presentation.  I  then  considered  my 


167 


1 809.]  M idwifen f . 

business  as  complete ;  and  on  attempting  to  extract  the 
placenta,  I  found  the  head  of  a  third  child  advancing, 
■which  came  off  with  the  same  ease  as  the  other  two.  Two 
of  the  children  were  born  alive.  The  whole  labour  did 
not  exceed  two  hours.  The  placentae  came  off  of  themselves 
without  any  interference  or  any  pain.  Two  of  them  were 
united  ;  the  other  was  single.  The  patient  said  there  was 
no  discharge  of  waters  with  the  first  child  ;  and  when  I 
examined,  I  found  the  membranes  ruptured.  She  is  only 
about  twenty  years  of  age.  It  was  a  first  case,  and  she 
promises  as  a  mother  even  beyond  what  the  wishes  of  the 
husband  may  find  convenient. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

F.  KIERNAN. 

Lower  Charlotte  Street ,  Bedford  Square , 

January  18,  1809. 

REMARKS.  '  • 

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

m  4 


168  Pharmacy.  [February, 

IV.  PHARMACY. 

In  this  department  of  the  profession,  scepticism  is  more 
necessary  than  any  other.  Mistatement  and  false  colouring 
are  natural  to  the  soil ;  and,  after  a  labour  of  so  many  ages, 
one  specific  only  has  been  found  in  mercury  to  reward  the  toil 
of  investigation  and  inquiry. 

CANTH  A  RIDES. 

This  powerful  medicine  is  still,  in  the  hands  of  Mr. 
Robcrton,  a  never-failing  remedy  in  those  diseases  of  the 
female  organs  connected  with  spasm,  debility,  and  deranged 
action  of  their  functions.  Those  diseases,  under  the  name 
of  habitual  Menorrhagia  Chlorosis,  whether  from  suppression 
or  retention,  leuconhasa  and  dy  sinenorrhasa,  he  considers 
little  in  appearance  different  from  each  other,  to  arise  from 
the  same  cause. 

In  stating  his  opinion  and  practice  in  these  cases,  Mr. 
Roberton  offers  his  objections  to  the  theory  of  menstruation 
advanced  by  Dr.  Cullen,  and  to  the  mode  of  practice  found¬ 
ed  on  that  principle.  Antispasraodics,  particularly  opiates, 
he  considers  as  giving  otdy  a  temporary  relief. 

“  The  same  diseased  state  of  the  parts, ”  he  observes, 
<£  still  continue,  and  the  only  service  derived  from  these 
substances  is,  perhaps,  relief  for  the  time ;  but  when  the 
next  menstrual  period  arrives,  all  the  former  symptoms, 
perhaps  in  an  aggravated  degree,  recur,  and  the  harassed 
and  enfeebled  patient  at  length  sinks  under  her  accumulated 
sufferings  by  the  supervention  of  dropsy  in  one  or  other 
form,  probably  by  consumption  of  the  lungs.  Practising 
with  the  remedies,  recommended  by  Cullen,  or  indeed  with 
any  remedies,  (if  they  be  suited  to  bis  general  mode  of 
reasoning  in  these  complaints,)  will,  I  venture  to  assert,  be 
in  every  case  unsuccessful,  except  in  very  recent  cases  where 
the  general  health  and  strength  have  been  unimpaired,  when 
the  disease  has  in  a  great  degree  deranged  the  general  health, 
Cullen  seems  to  think  it  incurable.  The  only  remedies  he 
then  recommends  are,  external  and  internal  astringents,  cold 


1809.]  Pharmacy.  169 

bathing,  and  chalybeates,  of  which,  with  similar  applica¬ 
tions,  I  have  repeatedly  given,  and  that  to  the  greatest 
extent,  without,  in  such  cases,  deriving  any  permanent  ad¬ 
vantage  from  them. 

■o 

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

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

44  If  one  or  more  of  these  complaints  be  brought  on  by 
long  continued,  though  slight,  leucorrhoea,  our  attention 


170  Pharmacy.  [February, 

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

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

u  It  is  by  the  reasoning  adopted  by  authors  respecting  the 
nature,  &c.  of  complaints,  that  the  treatment  in  them  must 
ffow ;  and  in  proportion  as  this  is  right  or  otherwise,  our 
cures,  except  by  some  accidental  occurence,  must  be  few 
or  numerous. 

u  Although  during  the  early  stages  of  menorrhagia,  if  it 
occur,  which  it  often  does,  in  stout  plethoric  persons, 
when  the  pulse  is  unabated  in  strength,  when  no  apparent 
debility  has  been  induced;  in  short,  when  all  the  other 
functions  of  the  body  seem  unimpaired,  and  even  when 
blood-letting  is  indicated  by  the  apparent  fulness  and  in- 


1809.]  Pharmacy.  171 

flammatory  action  of  the  sjstem,  the  greatest  caution, 
even  at  this  period,  ought  to  be  observed  in  adopting  ge¬ 
neral  blood-letting  for  its  removal.  Even  the  exhibition 
of  medicines  that  may  ultimately  induce  debility,  ought 
to  be  resorted  to 'with  nearly  equal  caution.  For  even  al¬ 
though  these  means  may,  in  almost  every  case,  remove 
the  morbid  discharge,  I  have  often  observed,  that,  after 
such  treatment,  it  was  long  before  the  patient  recovered 
her  usual  strength,  and  she  remained  often  for  years  sub¬ 
ject  to  returns  of  the  menorrhagia  from  the  very  slightest 
causes.  But  when  such  practice  has  been  adopted  in  weak¬ 
ly  and  debilitated  habits,  (for  it  is  too  often  indiscrimi¬ 
nately  applied,)  the  system  is  not  only  left  in  a  dreadfully 
debilitated  state,  liable  to  almost  continual  flooding,  but 
the  most  obstinate  and  troublesome  cases  of  leucorrhcea 
that  I  have  ever  met  with,  have  been  brought  on  after  the 
application  of  such  means.  The  remedies  then  which 
Cullen  recommends  are  either  hurtful,  inactive,  or  of  a 
trifling  nature,  and,  upon  the  whole,  by  no  means  suited  to 
the  removal  of  such  complaints.  He  forbids  the  use  of  all 
medicines  that  may  irritate  the  parts.  I  think,  however, 
that  what  I  have  to  state  will  completely  prove  that  such 
remedies  only  as  Cullen  thinks  would  irritate  the  uterus, 
are  calculated  permanently  to  remove  such  diseases ;  and 
that  the  chalybeates,  &c.  if  deemed  necessary  along  with 
such  medicines,  may  be  useful,  but  never  can,  except  in 
the  very  slightest  cases,  effect  a  cure. 

u  If,  during  these  complaints,  which  does  not  often  hap¬ 
pen,  the  pulse  indicates  inflammatory  action,  and  the  pa¬ 
tient  happens  to  be  of  a  full  plethoric  habit,  should  can- 
tharides  be  prescribed,  I  grant  that  it  would  require  no 
difficult  calculation  to  foretel  what  would  be  the  result. 
Benefit  must  be  evidently  sought  for  from  very  different 
treatment. 

“  In  all  these  complaints,  however,  I  believe  the  only  me- 


17  2  Ph  a  rm  acy.  £  February  , 

dicines  that  can  be  employed  with  decided  advanatge,  are 
those  of  a  stimulating  nature.  Food  and  drink,  as  well 
as  medicines,  ought  all  to  be  considered  in  this  way.  In 
these  affections,  the  uterine  vessels  are  in  a  great  state  of 
disease ;  but  it  appears  to  me  that  the  general  habit  of  body 
has  been  and  is  equally  deranged.  The  medicines  there¬ 
fore  to  be  employed  are  such  as  will  sufficiently  affect  the 
whole  system,  and  the  generative  organs  as  a  part  of  the 
whole. 

i(  It  is  of  importance  to  observe,  that  a  great  proportion 
of  women  have  been  taught  to  believe  that  leucorrhoea  is 
a  natural  discharge,  the  existence  of  which  is,  for  the  most 
part,  absolutely  necessary  to  the  preservation  of  their 
health  ;  and  even  if  their  health  be  already/  considerably 
impaired  by  it,  the  old  and  experienced  matrons  console 
themselves  and  others  in  the  supposition,  that  to  this  dis¬ 
charge  alone  they  owe  the  little  health  they  possess.  It  is 
not  therefore  to  be  w  ondered  at  that  women  often  so  stre¬ 
nuously  deri}'  being  affected  by  it.” 

MINERAL  POISONS. 

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

u  This  conclusion  appears  incontrovertible;  and  though 


1809.] 


17 


Pharmacy, 

some  analogous  facts  had  occasionally  been  noticed,  it  is  so 
different  from  the  generally  received  opinion  upon  the  sub¬ 
ject,  that  I  think  it  must  have  considerable  influence  on  all 
future  judicial  proceedings,  in  which  the  question  of  poi¬ 
soning  is  agitated.” 

But  though  no  particle  of  the  poison  may  be  discovered 
by  the  tests,  it  is  clear,  without  the  diseased  appearance  of 
the  part  or  organ  that  receives  it  corresponds  with  the 
usual  phenomena  known  to  occur  where  it  can  be  detected, 
these  inferences  are  certainly  to  be  considered  as  delusive, 
and  no  foundation  is  to  be  built  upon  them  in  spite  of  Dr. 
Bostock’s  assertion,  as  leading  to  the  most  dangerous  con¬ 
sequences  to  the  peace  and  happiness  of  society,  and  put¬ 
ting  into  the  hands  of  medical  men  an  authority  and  a  con¬ 
fidence  which  they  ought  not  to  be  entitled  to.  In  the 
case  of  Miss  Burns,  the  appearances,  on  opening  the 
stomach,  were  not  what  usually  attend  the  operation  of 
arsenic,  the  poison  alleged  to  have  been  given.  The  ap¬ 
pearances  from  arsenic,  Dr.  Baillie  describes  to  be  u  that 
the  stomach  is  affected  with  a  most  intense  degree  of  inflam¬ 
mation  ;  its  substance  becomes  thicker,  and  there  is  a  very 
great  degree  of  redness  in  the  inner  membrane,  arising  partly 
from  the  great  number  of  minute  vessels,  and  partly  from 
extra vasated  blood.  Portions  of  the  inner  membrane  are  - 
sometimes  destroyed  from  the  violent  action  that  has  taken 
place  in  consequence  of  the  immediate  application  of  the 
poison.  I  have  also  seen  a  thin  layer  of  coagulated  lymph, 
thrown  out  upon  a  portion  of  the  inner  surface  of  the  sto¬ 
mach.  Most  commonly  too,  some  part  of  the  arsenic  is  to 
be  seen  in  the  form  of  a  white  powder  lying  upon  different 
portions  of  tire  inner  membrane.” 

tc  According  to  this  statement,  it  is  obvious  that  a  very 
considerable  part  of  the  injury  which  had  been  sustained  by 
the  stomach  of  Miss  Burns,  was  not  what  is  commonly  pro¬ 
duced  by  the  application  of  mineral  poisons. 


174  Pharmacy .  [February* 

ee  On  raising1  up  the  stomach,  an  opening  through  its 
coats  was  found  in  the  anterior  and  inferior  part  of  its  great 
curvature:  The  natural  structure  of  the  coats  of  the  stomach, 
for  a  considerable  space  around  the  opening,  was  destroyed, 
and  they  were  so  soft,  pulpy,  and  tender,  that  they  tore  with 
the  slightest  touch.  Around  this  part  of  the  coats  of  the 
stomach  there  were  no  traces  of  inflammation. 

a  Now,  if  the  hole  and  the  surrounding  alteration  of  struc¬ 
ture  were  effects  of  arsenic,  we  do  not  see  how  they  could  be 
produced  in  the  way  contended  for  by  the  authors  of  this 
pamphlet. 

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

u  But  supposing  that  the  appearance  of  Miss  Burns’s  sto¬ 
mach  was  completely  similar  to  that  which  commonly  arises 
from  the  action  of  a  mineral  poison,  it  would  have  been  only 
the  appearance  produced  by  very  intense  inflammation ;  and 
how  did  the  writers  ascertain  the  cause  of  this  inflammation  ? 
No  poison  was  to  be  detected,  either  by  the  eye  or  by  the  best 
tests,  aided  by  the  experimental  dexterity  of  Dr.  Bostock. 
To  refer  this  inflammation  to  poison,  in  the  total  absence  of 
all  medical,  or  anatomical,  or  chemical  evidence,  the  only 
evidence  they  had  any  business  to  interfere  with  in  the  ca- 


1809.]  Pharmacy .  175 

pacity  in  which  they  were  employed,  was  surely  an  unwar¬ 
rantable  and  an  unconscientious  degree  of  boldness.” 

ARSENIC. 

Poisons  seem  to  claim,  at  the  present  period,  a  marked  at¬ 
tention  ;  and  Mr.  Hill  of  Chester  has  entered  into  the  use,  forms 
and  effects  of  this  powerful  medicine  with  much  elaborate 
investigation.  “  To  Dr,  Fowler,”  he  observes,  u  the  medical 
world  stands  much  indebted,  for  his  accurate  attention  to  the 
power  and  salutary  effects  of  arsenic  judiciously  administered ; 
and  all  those  practitioners,  whose  practice  has  been  most 
intermixed  with  cases  of  intermittent  fever,  treated  by  the 
tasteless  ague  drop,  will  doubtless  bear  testimony  to  the 
safety  with  which  this  Herculean  remedy  may  be  administer¬ 
ed.  But,  notwithstanding  intermittent  fever  in  its  most  for¬ 
midable  shape  has  been  cured  by  the  arsenical  solution,  yet 
there  have  not  been  wanting  alarmists  to  excite  the  fears  of  the 
timid,  that  the  medicine  created  more  mischief  than  it  had  re¬ 
moved,  in  various  shapes,  as  tendency  to  hepatic  obstructions, 
phthisis,  asthma,  &c.  Of  such  results,  I  confess  my  entire 
ignorance.  That  such  may  have  seemed  to  have  occurred,  I 
am  far  from  attempting  to  deny  ;  but  I  must  continue  to  dis¬ 
believe  they  have  happened  when  this  poison  has  been  admi¬ 
nistered  with  all  that  caution  its  great  powers  demand,  and 
which  has  so  diligently  and  successfully  been  employed,  in 
respect  to  others,  upon  proper  subjects.  I  adduce  intermit¬ 
tent  fever  in  its  most  hostile  form,  as  that  disease  which  must 
ever  be  highly  illustrative  of  the  tonic  effects  of  arsenic. 
Impartially  calculated,  who  will  fail  to  decide  on  the  positive 
value  of  that  medicine,  which  can  cure  such  a  disease  with 
speed,  safety,  and  in  the  form  of  a  few  drops,  after  it  has 
continued  for  weeks,  or  months,  in  defiance  of  disgusting 
quantities  of  cinchona,  and  all  the  minor  tribe  of  tonic  febri¬ 
fuge  remedies.  Still  1  conjure  my  readers  not  to  hastily 
conclude  I  am  aiming  at  the  establishment  of  a  more  extensive 

use  of  such  a  medicine,  as  arsenic  is  well  known  to  be,  when 

✓  7 


170  J Pharmacy.  February, 

others,  less  dangerous,  and  as  certainly  curative,  will  answer 
every  purpose  of  the  prescribe^,  and  his  patient,  this  being 
by  no  means  the  case.  I  merely  contend,  that  terrific  and 
mistaken  apprehensions  have  caused  it  to  be  neglected,  where 
its  administration  might  have  been  greaUyand  safely  benefi¬ 
cial.  In  some  degree  to  dissipate  these,  consists  my  present 
intention ;  but  never  to  bring  forward  a  virulent  poison  as  a 
healthful  remedy  to  the  exclusion  of  any  other,  not  of  this 
description,  and  which  is  equally  salutary.  To  hesitate 
about  preference  here,  would  perhaps  fall  little  short  of  cri¬ 
minality. 

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


1S09.J  •  Pharmacy.  1 77 

Others  of  this  class,  is  no  less  certain  ;  finally,  that  its  delete¬ 
rious  effects  are  as  much  under  subjection  as  those  of  mer¬ 
cury,  opium,  antimony  &c.  &c.  is  or  may  be  satisfactorily 
known. 

u  A  saturated  aqueous  solution  appears  to  be  the  most 
simple  formula,  and  that  which  comes  nearest  to  certainty  of 
uniform  strength  of  any  other.  Where  the  disease,  its  reme¬ 
dy,  and  the  subject  of  both,  can  be  judiciously  adapted  to 
each  other,  this  medicine,  from  its  great  power  in  small 
volume,  possesses  decided  and  incalculable  advantages.  The 
sanguine  wishes  ofyoung  practitioner  often  lead  them  to  attack 
violent  diseases  by  very  enormous  doses  of  medicine,  think¬ 
ing  to  mow  down,  as  it  were,  all  opposition  to  their  wishes,  by 
a  coup  de  main ;  but  the  mineral  solution  of  arsenic  is  a  wea¬ 
pon  that  will  not  admit  of  loose  and  inattentive  application, 
in  the  hands  of  careless  or  over-eager  practitioners,  with 
impunity.  It  is  almost  superfluous  to  observe,  its  admini¬ 
stration  must  commence  with  very  small  doses,  when  exhibit¬ 
ing  it  for  the  first  time,  and  that  its  effects  cannot  be  too  nar¬ 
rowly  watched  :  for  there  are  to  be  met  with  certain  habits, 
whose  idiosyncrasy  will  cause  it  to  be  rejected,  notwithstand¬ 
ing  every  precaution,  in  whatever  dose  given,  or  under 
whatever  form  ;  but  this,  it  is  well  known,  is  not  exclusively 
the  case  with  regard  to  arsenic,  the  fact  resulting  from  opium, 
digitalis,  mercury,  and  even  the  bark  itself.  I  lately  attend¬ 
ed  a  gentleman  whose  case  appeared  to  indicate  the  use  of  this 
last  mentioned  valuable  remedy ;  it  was  given  in  the  simple 
form  of  decoction  ;  a  dose  or  two  induced  such  feelings  as  are 
better  comprehended  from  sensation  than  learnt  from  des¬ 
cription.  He  soon  informed  me  what  he  had  been  taking, 
although  not  apprised  of  the  composition  of  his  draughts  ; 
the  medicine  was  then  tried  in  another  form,  but  was  instantly 
discovered.  C£  Sir,”  said  he,  emphatically*  6i  you  have  been 
giving  me  bark  again,  and  I  cannot  bear  it.”  Such  will  oc¬ 
casionally  be  the  case  with  arsenic.  It  is,  however  in  this 


VOL.  IT. 


N 


178  Pharmacy .  [February-, 

view  but  on  An  exact  footing  with  other  remedies  deemd 
sufficiently  mild  to  persons  in  general.  Symptoms  announc¬ 
ing  its  disagreement  are,  nausea,  pain,  with  a  sense  of  con¬ 
traction  of  the  stomach,  horripilatio,  thirst,  with  a  clammy 
tongue  and  fauces,  increased  by  drinking  any  fluids,  milky 
or  oily  ones  excepted  ;  strong  feelings  all  over  the  body,  such 
as  were  never  experienced  by  the  patient  before,  on  any  occa¬ 
sion,  and  which  he  is  at  a  great  loss  to  find  words  to  describe. 

In  children,  incapable  of  giving  any  description,  its  dis¬ 
agreement,  whether  from  idiosyncrasy,  or  over-dose,  may  be 
known  by  its  producing,  soon  after  being  taken,  nausea,  pale¬ 
ness  of  the  lips,  sleepiness,  clamminess  of  the  skin,  at  length 
vomiting,  or  purging,  with  great  restlessness  ;  but  justice  de¬ 
mands  (from  me  at  least)  the  acknowledgment  that  few  such 
instances  have  fallen  under  my  notice.  It  would  be  sacri¬ 
ficing  time  to  point  out  what  mischiefs  have  originated  from 
want  of  attention  to  these  circumstances,  consonant  to  the 
position  advanced,  and  in  direct  opposition  to  that  accurate 
care,  and  close  attention,  which  all  other  Herculean  medicines 
require,  and  have  indeed  generally  received. 

aThe  next  arsenical  remedy  which  deserves  notice  is  a  pilb 
the  formula  of  which  will  be  found  in  the  2nd  volume  of  the 
Asiatic  Researches.— c  4  Take  of  recent  white  arsenic  105 
grains,  black  pepper  630  grains,  beat  well,  in  an  iron  mortar, 
for  four  days,  at  intervals ;  when  reduced  to  an  impal¬ 
pable  powder,  remove  to  a  stone  mortar,  add  watei  by  degrees, 
so  as  to  form  a  mass  of  a  pilular  consistence  :  make  pills  of 
the  size  of  tares,  or  small  pulse  (about  800);  keep  them  in  a 
dry  and  shady  place ;  gi  ve  one  night  and  morning,  with  a 
little  cold  water  :  gentle  cathartics  precede  their  use  with 
considerable  effect.”  These  pills  are  most  conveniently  pre¬ 
served  for  use  in  a  stone-bottle,  originally  destined  to  convey 
quicksilver.  In  the  above  work,  arsenic  is  recommended  as 
very  useful  in  the  cure  of  paralysis  and  cutaneous  diseases  ; 
but  too  little  is  said  on  the  subject. 


/ 


1809,]  Pharmacy.  179 

u  I  think  no  mode  of  using  it  externally  is  mentioned ; 
hence,  the  same  errors  are  liable  to  operate,  as  have  too  often 
done,  from  its  internal  exhibition  :  for  example,  in  the 
1st  vol.  of  the  Medical  Journal,  p.  508,  the  case  of  a  young 
woman  is  related,  (by  a  Swiss  physician),  who  had  rubbed 
her  head  with  arsenic  pomatum  to  destroy  vermin  :  the  con¬ 
sequences,  in  six  days  time,  were  excruciating  pains  all 
over  body,  a  general  millet- seed-like  eruption,  covering  the 
whole  surface,  violent  swelling  of  the  head,  and  with  much 
difficulty  she  grew  better.  Now  from  this  narration,  what 
can  be  learned  ?  We  know  nothing  of  the  proportion  of  in¬ 
gredients  of  this  deleterious  unguent,  nor  the  quantity  ap¬ 
plied  in  the  time  specified  ;  but  judging  from  what  may  be 
every  day  seen  in  this  country,  when  ignorant  persons  are 
intrusted  with  active  remedies,  without  due  precautions,  it  is 
reasonable  to  conclude  the  young  woman  was  very  bounti¬ 
ful  in  the  use  of  what  was  to  free  her  from  Sier  troublesome 
company  ;  most  practitioners  having  cause  to  regret  how 
difficult  it  is  to  excite  and  procure  due  attention  to  the  pre¬ 
cise  dose,  and  exact  periods  of  administration  of  medicines, 
more  especially  those  which,  from  their  minuteness,  are  con¬ 
ceived,  by  ignorant  persons,  to  be  of  little  consequence. 
Arsenic,  then,  is  perhaps  that  very  remedy,  in  many  violent 
and  obstinate  diseases,  which  can  be  advantageously  exhi¬ 
bited  in  the  smallest  quantity,  and  with  loss  necessity  for 
augmentation  of  dose  than  any  other,  demanding  simply, 
what  every  active  medicine  demands,  attention,  to  render 
it  generally  and  highly  useful,  as  exemplified  in  the  removal 
of  the  whole  tribe  of  fevers  and  asthenic  diseases,  painful, 
local,  or  partial  affections,  and  many  tiresome  cutaneous  de¬ 
rangements  ;  when  acting  favourably  on  the  stomach,  pro¬ 
ducing  in  a  few  doses,  and  in  a  short  time,  a  greater  quantum 
of  increased  tone  of  the  system,  than  can  be  obtained  by  any 
other  known  agent.  All  circumstances  proving  favourable, 
the  solution  of  Dr.  Fowler,  the  simple  saturated  solution^ 

n  2 


ISO  Pharmacy »  [February, 

and  the  Asiatic  pills,,  have  been  found,  for  many  years,  ex¬ 
tremely  beneficial,  and  much  to  be  relied  upon  in  the  removal 
of  the  following  diseases.  Intermittent  fever,  typhus  oph¬ 
thalmia  and  palsy.  The  solution  is  the  best  form  for  the 
three  first  the  pill  for  the  last. 


ELECTRICITY. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator , 

Gentlemen.-^ ^According  to  my  promise  in  the  last  num° 
ber  of  your  valuable  publication,  I  now  beg  leave  to  trans¬ 
mit  you  for  insertion  a  few  cases  of  suppression  of  urine  cured 
by  Electricity,  which  will  confirm  the  observations  I  offered 
on  Mr.  Calderwood’s  communication,  and  shew  that  the  size 
of  the  machine  is  of  material  consequence  to  the  speedy 
accomplishment  of  such  cures.  By  such  a  machine,  permit 
me  to  state,  the  electric  fluid  can  be  conveyed  with  a  force* 
energy  and  effect  superior  to  what  can  be  conceived,  and  this 
effect  takes  place  in  that  mild  active  and  unlocked  for  manner 
that  pleases  every  patient,  and  renders  the  form  of  a  shock  in 
every  instance  unnecessary,  the  great  bar  as  I  formerly 
noticed,  with  patients  to  the  use  of  this  means  of  cure.  In 
many  diseases  the  superior  operation  of  this  machine  com¬ 
pared 'with  those  of  the  ordinary  standard  and  make,  makes 
it  seem  to  act  like  a  charm,  and  as  it  were  instantaneously,  but 
this  quick  effect  in  subduing  the  morbid  state  is  particularly 
remarkable  in  those  affections  connected  with  a  suspension  or 
impaired  state  of  the  nervous  influence,  and  it  is  easily  ac¬ 
counted  for,  if  we  once  admit  it,  as  contended  for  by  most 
writers,  that  the  nervous  fluid  and  the  electric  matter  are 
analoguotis.  In  this  case  it  is  alone  the  quantity  of  matter 
thrown  in  that  produces  the  cure  by  supplying  the  diffici- 
ency  of  secretion  in  the  nerves.  The  preference  therefore  of 
a  large  machine  in  giving  out  at  once  the ’quantity  required 
will  be  obvious  ;  were  it  for  the  excitement  merely  that  was- 


JS09.1  Pharmacy.  1 81 

wanted  then  the  force  or  shock  with  which  it  is  directed 
wouhTform  the  only  point  of  attention  ;  but  as  all  electricians 
must  allow  that  the  cure  of  diseases  is  seldoraer  effected  bv 
shocks  than  otherwise,  so  it  is  evident  that  the  mere  excite¬ 
ment  is  not  the  successful  principle  of  cure.  The  accumula¬ 
tion  of  electric  matter  in  the  pari  is  the  great  object, 
and  this  is  only  made  quickly  and  with  ease  by  an  instrument 
of  extensive  powers.  To  shew  this  in  a  striking  manner, 
and  confirm  the  sentiments  1  have  delivered,  1  shall  now  nar¬ 
rate  some  cases  of  diseases  winch  fall  under  the  denomination 
of  those  stated  as  depending  upon  a  suspension  or  im¬ 
paired  state  of  the  nervous  influence,  or  spasm  of  the 
organs. 

I.  DERANGED  SECRETION  OF  THE  KIDNEYS. 

Mr.  J.  a  gentleman  of  a  strong  robust  habit,  was 
brought  to  me  by  Dr.  Sequeira.  For  eleven  days  preceding 
he  had  laboured  under  a  total  stoppage  of  urine,  and  that 
there  was  no  water  in  the  bladder  from  the  commencement  of 
the  disease  was  evident,  by  th£  abdomen  retaining  its  natural 
size  and  figure.  In  the  progress  of  the  disease,  he  had  been 
immersed  no  less  than  eight  times  in  the  warm  bath  :  the  two 
first  immersions  gave  a  delusory  hope  of  cure,  by  his  being 
enabled,  while  in  the  bath,  to  evacuate  a  teacupful  of  urine 
each  time.  But  this  remedy,  which  as  well  as  every  other  Dr. 
Sequira’s  skill  and  experience  could  suggest,  was  found  at  last 
entirely  to  fail,  and  as  a  forlorn  hope  electricity  wras  proposed 
by  the  Doctor  to  his  patient.  I  had  accordingly  an  oppor¬ 
tunity  of  shewing  its  miraculous  effects  in  this  obstinate  case, 
for  no  sooner  was  the  electric  fluid  applied  by  vibrations  than 
in  less  than  half  an  hour  it  offered  relief :  at  the  end  of  that 
time  he  signified  (as  1  had  previously  informed  him  would 
be  the  case)  a  desire  to  pass  his  urine.  About  half  a  pint 
was  voided  with  perfect  ease  and  in  full  stream.  The  opera¬ 
tion  was  continued  about  half  an  hour  longer,  when  the  secre¬ 
tion  became  so  copious,  that  he  was  obliged  several  times  in 

n  3 


t 


182  Pharmacy.  [February 

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

That  a  suspended  secretion  of  urine  had  here  occurred  is 
evident,  from  the  period  of  the  complaint  and  the  patient 
having  passed  no  urine  for  such  a  number  of  days.  The 
instantaneous  effect  of  electricity  is  also  a  proof  that  its  cause 
depended  chiefly  on  the  state  of  the  secretory  nerves.  What 
is  to  be  remarked  in  the  mode  of  cure  is  the  superiority  of 
electricity  to  all  the  powers  of  medicine.  We  possess  no  par¬ 
ticular  medicine,  it  is  well  known,  wdiichacts  exclusively  on 
any  of  the  secretions.  It  is  only  therefore  by  a  general  action 
on  the  system  that  any  particular  secretion  can  be  influenced,, 
which  must  render  at  all  times  its  operation  uncertain. 
Independent  of  this,  all  internal  medicines,  by  acting  on  the 
stomach  and  bowels,  must  tend  to  injure  them,  though  they 
relieve  the  disease.  Hence  the  advantage  of  a  po\ycr  which 
coniines  its  operation  to  the  particular  secretory  organ  diseased, 
which  is  certain  quick  and  safe  in  its  operation,  and  which 
does  not  act  either  on  the  stomach  or  bowels  or  inlerupt  their 
offices. 

II.  SPASM  OF  THE  URINARY  ORGANS. 

Nor  is  Electricity  less  powerful  in  these  cases  of  spasm 
which  come  from  an  obstruction  of  the  urinary  organs,  in 
consequence  of  calculi  or  urinary  concretions  obstructing 
0  the  kidneys  or  their  outlets.  Of  this  kind,  I  shall  subjoin  the 
follow  ing  case : 

Miss  L- . applied  to  me  on  the  23d  of  September,  1796, 


80S.]  Pharmacy .  183 

for  a  violent  pain  in  her  loins,  which  extended  round  to  her 
left  groin  with  great  severity .  From  the  situation  and  violence 
of  the  symptoms,  I  judge  it  to  be  stone  obstructing  the 
the  mouth  of  the  left  ureter:  she  was  electrified  accordingly  : 
in  about  an  hour  after  the  third  operation,  passed  a  rag¬ 
ged  stone  of  considerable  bulk.  I  was  certain  from  the 
effect  produced  by  the  second,  that  the  obstruction  was 
nearly  removed,  she  having  immediately  after  voided  very 
high  coloured  water,  mixed  with  an  uncommon  quantity  of 
sand.  Her  health,  from  the  time  she  passed  the  concretion 
was  perfectly  re-established,  excepting  a  slight  degree  of 
numbness  in  her  lower  extremities,  which,  a  few  days  con¬ 
tinuance  ot  the  electric  vibrations,  was  entirely  removed. 

III.  ATONY  OF  THE  BLADDER. 

A  more  frequent  disease  than  the  former,  where  electricity 
succeeds  in  a  manner  almost  miraculous,  is  suppression  of 
urine  which  are  connected  with  an  atony  of  the  organ. 
These  suppressions  are  knoiVn  to  succeed  the  recovery  after 
many  acute  diseases,  as  continued  fevers  ;  and  the  same  is 
a  very  common  complaint  in  old  age.  In  these  cases  the 
powers  of  the  organ  are  so  weakened,  that  the  contraction  of 
the  bladder  cannot  overcome  the  resistance  of  the  sphincter. 
Of  this  complaint,  the  first  case  will  shew  how  quickly 
the  disease  was  removed,  and  the  healthy  action  of  the  bladder 
restored  before  the  patient  left  the  room. 

IIow  superior,  then,  is  the  application  of  electricity  here 
to  the  use  of  the  catheter ;  the  only  means  which  can  be 
depended  upon  for  giving  even  a  temporary  relief  to  the 
patient.  The  introduction  of  such  a  hard  body  through 
the  delicate  irritable  passage  of  the  urethra,  it  is  clear,  must 
do  infinite  injury.  By  forcing  the  sphincter  at  the  neck  of 
the  bladder,  it  will  still  more  weaken  those  parts  already 
in  a  weakened  state;  and  either  increase  the  disease,  or 

n  4 


IS4  Pharmacy.  [February, 

or  produce  what  is  worse,  incontinence  of  urine.  Electri¬ 
city  on  the  contrary,  by  rousing  and  invigorating  the  natural 
powers  and  action  of  the  organ,  enables  it  to  recover  its 
functions,  and  to  do  its  own  work. 

I  am,  Gentlemen,  your  obedient  Servant, 

F.  LOWNDES. 


ON  MEDICAL  ELECTRICITY. 

To  the  Editors  of  the  Medical  and  Surgical  Spectator. 

Gentlemen —I  perceive  in  vour  last  number  a  commu- 

4/ 

nicaiion  from  Mr.  Lowndes,  medical  electrician,  in  conse¬ 
quence,  as  he  says,  of  one  from  me  in  one  of  your  last 
numbers.  When  Mr.  Lowndes  understood  that  the  cure  by 
electricily,  (a  circumstance  which  1  am  convinced  neither  he 
nor  I  will  doubt)  wras  tedious,  I  fear  he  misconceived  some 
part  of  the  statement  of  the  case  in  question,  which  I  am 
sure  so  strenuous  an  advocate  for  electricity  as  he,  could 
not  have  done  intentionally.  The  truth  of  the  matter  is, 
that  though  the  cure  altogether  certainly  was  tedious,  yet 
Mr.  Lowndes,  if  he  resort  to  it,  will  find  that  it  was  soon  ac¬ 
complished,  after  recourse  was  had  to  his  favourite  remedy. 
This  circumstance  I  suspect  escaped  him  in  his  great  anxiety 
to  establish  a  transcendant  superiority  of  his  own  apparatus 
(tlie  largest  in  this  country)  over  those  employed  by  surgeons 
in  general. 

It  is  an  axiom,  I  believe,  pretty  well  established  in  our 
science  that  in  proportion  as  any  active  remedy  is  capable  of 
doing  good,  when  properly  applied,  that  it  is  also  capable 
in  the  same  proportion  of  doing  mischief,  if  it  should  un¬ 
fortunately  be  unnecessarily  or  altogether  misapplied.  And 
though  I  have  no  doubt,  Gentlemen,  of  the  perfect  inno¬ 
cence  of  a  machine  so  large  in  the  hands  of  a  person  of  so 
much  discretion,  discrimination  and  anatomical  skill  as  Mr. 
Lowndes,  yet  I  must  own  I  should  be  very  apprehensive  of 
the  consequences  of  letting  loose  such  an  element  as  elec- 


1800.  J  Pharmacy*  185 

tricity  indiscriminately  on  his  Majesty’s  liege  subjects  under 
the  direction  of  any  person  not  so  gifted  in  those  particular® 
as  Mr.  Lowndes  is  well  known  to  be.  For  my  own  part  I 
am  perfectly  satisfied  with  the  limited  powers  of  my  own 
portable  apparatus,  with  which  I  can,  at  any  time,  produce 
power  as  far  as,  and  considerably  beyond  what,  from  the 
relative  susceptibility  of  parts  with  vitality,  it  would  be 
prudent  to  call  forth.  For  in  the  application  of  a  stimulant 
such  as  electricity,  care  ought  always  to  be  had,  and  the 
idea  never  lost  sight  of,  that  the  susceptibility  of  the  part  to 
be  acted  upon,  should  not  be  so  so  far  exhausted  but  that 
should  this  peculiar  stimulus  eventually  fail,  other  stimuli 
may,  not  without  some  prospect  of  success,  be  had  recourse 
to.  The  case  then  alluded  to,  we  are  told,  would  have  been 
cured  by  one  application  from  the  powerful  machine  he  usesi 
I  have  said  no  greater  power  was  used  than  that  species  of 
shock  or  vibration  which  is  sent  by  the  tube  of  the  Leyden 
jar.  The  effect  of  this  is  to  produce  a  great  vibration  in  the 
muscular  fibres,  without  inducing  the  pungent  sensation  of 
the  shock,  by  passing  the  whole  charge  of  the  jar,  which 
the  patient  could  not  bear ;  nor  would  it  have  been  prudent 
in  me  to  have  done  it,  considering  the  diseased  state  of  the 
prostrate  gland  and  bladder.  The  machine  I  use  has  a  cy¬ 
linder  of  eight  inches  fitted  up  on  the  most  perfect  principle, 
with  a  power  sufficient  for  all  medical  purposes,  and  equal 
to  the  most  destructive.  The  first  case  which  attracted 
my  attention  to  electricity  was  a  sebirrous  inguinal  gland, 
the  size  of  an  egg,  which  resisted  every  means  used  by 
myself,  and  the  late  Mr.  Fearon,  and  an  hospital  surgeon  of 
eminence.  The  patient,  a  young  man,  returned  to  me  in  the 
same  state,  the  disease  baffling  the  skill  of  those  gentlemen. 
I  proposed  electricity  ;  he  very  readily  assented  to  any  treat¬ 
ment  that  promised  the  slightest  hope  of  benefit.  I  endea¬ 
voured  to  send  small  shocks  through  it,  but  they  in  general 
passed  oyer  it :  I  asked  him  if  he  had  resolution  to  permit 


IS  6 


Pharmacy .  [February, 

me  to  use  it  stronger: --‘he  agreed.  I  then  passed  the  full 
charge  of  the  medical  jar  completely  through  it.  The  next 
day  I  perceived  it  was  divided  into  two  distinct  portions  : 
a  few  more  shocks  in  different  directions  occasioned  a  great 
many  more  divisions:  in  this  state  he  left  me,  and  after  a 
few  months  the  whole  disappeared. 

This  is  a  proof  that  the  size  of  the  instrument  is  no  im¬ 
perfection,  for  although  the  patients  in  both  cases  declared 
they  could  not  bear  stronger  applications,  yet  had  it  been 
necessary,  more  powerful  vibrations  and  shocks  could  have 
been  used  by  a  larger  jar  or  combination  of  jars  or  battery 
even  to  destroy  life. 

I  do  not  then,  Gentlemen,  see  the  utility  of  possessing 
power  beyond  what  it  is  prudent  to  use,  unless  arrogating 
to  ourselves  the  power  of  the  deity  over  another  element, 
we  should  wish  to  controul  this  so  as  sometimes  to  be  able  to 
destroy  that  which  we  are  not  able  to  restore. 

Though  once  very  sanguine  as  to  my  hopes  that  the  pe¬ 
culiar  modification  of  electricity  denominated  galvanism 
might  be  made  subservient  to  the  best  of  purposes  in  the 
treatment  of  many  diseases,  yet  I  own  those  expectations 
are  fast  vanishing. 

I  am  now  of  opinion,  that  it  is  not  necessary  (as  an  ap¬ 
plication  to  parts  endowed  with  vitality)  to  concentrate  this 
active  agent  in  a  degree  beyond  what  we  are  able  to  do 
from  bur  knowledge  of  it,  previous  to  the  brilliant  discovery 
of  the  ingenious  Galvani. 

I  remain,  with  respect,  Gentlemen, 

Yours,  &c. 

B,  CALDEKWOOD 

Great  Surry  Street s 
Jan .  Ifi,  1809. 


1809.] 


Pharmacy . 


1BT 


■ .(  '  H.  •_  ,  >  •  f/  .>■;  ■  .  ■  A  ; 

COMMUNICATION  OF  MR.  THOMAS  HARDING,  OF  THE  SUR¬ 
REY  DISPENSARY,  ON  A  NEW  AND  SIMPLE  REMEDY  IN 
GOUT. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen . — If,  when  opportunity  suits,  you  will  give 
publicity  in  your  excellent  and  widely  circulating  Journal  to 
the  following,  you  may  do  much  good,  for  you  may  he 
the  means  of  preserving  many  valuable  characters  from  dis¬ 
solution,  many  happy  families  and  friends  from  the  sharpest 
distress,  and  many  perhaps  from  ruin. 

A  NEW  MODE  OF  SAVING  LIFE  WHEN  IT  IS  THREATENED. 

Gout. — This  most  singular  and  most  dangerous  complaint 
often  attacks  suddenly  the  stomach,  or  head,  or  both,  and  other 
vital  parts;  and  fixes  itself  so  firmly  as  to  baffle  every  endea¬ 
vour  for  removing  its  action  to  the  extremities,  and  every  effort 
for  relief.  The  strongests  stimulants  by  the  mouth,  with  or 
without  annodjmes,  rubefacients  to  the  extremities,  blisters 
to  them,  sinapisms,  the  flesh  brush,  heat,  however  used,  are 
of  no  avail :  excruciating  pains  continue,  and  the  unhappy 
patient  is  left  to  lamentations  and  wishes  only,  until  death 
arrives  and  terminates  his  sufferings. 

A  long  time  ago  it  occurred  to  Mr.  Hayton,  a  well  in¬ 
formed  practitioner,  late  of  America  Place,  Southwark,  at 
present  of  Great  Guildford  street,  whose  moderation  and 
modesty  has  not  nor  would  now  permit  him,  (fearing 
also  that  it  would  be  considered  a  species  of  quackery),  to 
give  the  suggestion  to  the  world  himself,  nor  scarcely  allow 
him  to  consent  for  his  name  to  be  mentioned  on  the  occasion 
by  any  other,  notwithstanding  the  simplicity  and  harmless¬ 
ness  as  well  as  value  and  importance  of  the  mode,  it  oc¬ 
curred  to  him,  when  thinking  on  these  things,  that  if  in  such 
cases,  a  blow  with  a  piece  of  board  was  given  on  the  bottom 


188  Pharmacy .  [February, 

of  the  foot,  so  as  to  occasion  a  sharp  and  sudden  shock  to  the 
whole  habit,  the  strong  diseased  action  in  the  vital  part 
might  be  almost  instantly  arrested,  a  gouty  one  set  up  in  the 
extremity,  and  relief  immediately  obtained;  which,  if  it  did 
not  prove  permanent,  might  afford  a  valuable  opportunity  for 
employing  other  remedies  with  effect,  both  locally  and 
generally. 

With  this  impression  strongly  on  his  mind,  he  resolved  to 
make  experiments  as  often  as  fair  opportunities  offered.  In 
the  mean  time,  it  may  be  well  to  make  it  known  for  general 
benefit,  and  that  trials  may  be  multiplied  to  assist  in  determin¬ 
ing  its  efficacy.  Cases  similar  to  those  intimated  above,  do 
not  frequently  occur  to  one  particular. 

But  it  is  not  only  in  cases  similar  to  those  intimated  above, 
at  the  latter  end  of  the  affection,  namely,  and  after  every 
other  method  had  failed,  that  Mr.  Hayton  recommends  the 
employment  of  this  mode,  but  at  the  beginning  also  as  well 
as  latter  end  of  the  malady,  before  as  well  as  after  other  re¬ 
medies,  and  indeed  in  every  state  and  stage  of  the  attack  and 
treatment.  That  it  lias  been  of  use  at  the  very  onset  the 
following  case  will  testify. 

But  first,  it  may  be  observed,  what  will  be  at  once  admitted 
and  affirmed  by  all  podagrics,  and  strongly  evince  the  pro¬ 
bability,  at  least,  of  benefit,  that  the  feet  are  always  in  a 
high  state  of  sensibility  at  these  times.  There  is  always  a 
peculiar  gouty  feeling  in  them,  moderate  perhaps,  but 
remarkably  and  strongly  connected,  some  how  or  other,  with 
the  severe  diseased  action  in  other  parts  of  the  habit. 

CASE. 

Mr.  Day,  of  Union  Hall,  aged  53,  of  a  corpulent  and  very 
gouty  habit,-  was  suddenly  affected  in  the  forenoon  of  yester¬ 
day  with  severe  pain  in  his  head,  attended  with  great  faint¬ 
ness,  prostration  of  strength,  and  loss  of  voluntary  motion. 
Mr.  Hayton  and  myself  saw  him  immediately,  (happening 


1809.] 


189 


Pharmacy, 

to  be  near  at  the  time,)  and  found  him  placed  in  a  chair 
with  a  countenance  pallid  and  even  ghastly ;  a  pulse  smalls 
contracted,  quick  and  tremulous,  and  incapable  of  articu¬ 
lating  distinctly.  In  some  minutes,  however,  lie  so  far  re¬ 
covered  as  to  be  able  to  mention  his  state,  when  he  said  he 
had  a  severe  pain  in  his  head,  principally  at  the  back  part ; 
that  lie  felt  extremely  faint,  and  that  he  could  not  see. 

Apoplexy  and  paralysis  were  somewhat  characterised,  but 
the  affection  seemed  to  be  the  consequence  of  gouty  action. 

Under  this  impression,  the  stocking  on  the  right  leg  was 
taken  off,  and  a  sharp  smack  given  on  the  bottom  of  the  foot 
with  the  back  part  of  a  shoe-brush  (being  nearest  at  hand) 
when  he  almost  instantly  exclaimed,  tc  I  am  better,  I  can 
see.” 

In  about  ten  minutes,  however,  he  began  lo  relapse ;  had 
how  also  a  pallid  ghastly  countenance,  and  was  soon  de¬ 
prived  of  all  sense  and  motion,  when  Mr.  Hayton,  who  re¬ 
mained  with  him,  thinking  the  one  stroke  before  given  not 
sufficient;  again  removed  the  stocking  and  gave  two  more 
sharper  than  the  first,  when  he  instantly  recovered,  and  the 
pain  left  his  head . 

It  is  surprising,  but  his  countenance  also  became  almost 
immediately  as  usual,  when  in  health. 

He  had  a  moderate  stimulant,  given  with  something  warm, 
was  put  to  bed,  his  foot  being  enveloped  in  flannel,  and  in 
less  than  half  an  hour  a  genial  warmth  was  diffused,  and  he 
became  comparatively  w'ell,  and  so  continues. 

A  bottle  of  hot  water  was  applied  to  the  foot,  in  which,  it 
should  have  been  observed,  gouty  pains  arose,  after  the 
third  stroke,  and  in  the  leg  also. 

Sometimes  the  manner  of  attack  renders  it  impossible  to 
exhibit  any  thing  by  the  mouth,  and  blisters,  rubefacients, 
See.  &c.  to  the  extremities  are  very  tardy  in  their  operation. 
The  patient  may  not  only  suffer  an  unnecessary  length  of 
time,  but  fee  actually  lost  before  benefit  can  be  derived  from 

*  V 


190  Pharmacy.  [February,, 

them.  This  mode  is  applicable  at  all  times  and  under  all 
circumstances,  and  though  simple,  yet  powerful ;  though 
innocent,  yet  active  and  efficacious. 

A  ferrula,  it  may  be  right  to  notice,  similar  in  form  to 
those  used  in  schools,  might  be  better  than  a  piece  of  plain 
board ;  and  it  should  be  made  so  as  to  smack  soundly,  but 
not  bruise.  Perhaps  about  four  inches  in  diameter,  and  half 
an  inch  thick.  This  might  be  kept  in  all  gouty  families,  and 
by  the  bedside  in  all  appearances  of  need. 

An  heir  loom,  ah ! 

The  smack  should  be  very  sharp  ;  as  unexpected  as  pos¬ 
sible,  and  as  much  ou  the  ball  of  the  foot  as  possible :  repeated 
too,  if  necessary,  and  on  both  feet  if  required. 

Mr.  Hayton  also  observes  that  a  similar  mode  of  proceed¬ 
ing  might  be  adopted  with  good  effect  perhaps  in  most 
other  sudden  and  severe  affections,  and  in  most  kind  of  fits. 
Apoplexy,  Epilepsy,  Paralysis,  Hysteria,  &c.  He  thinks  it 
may  be  of  use  when  Erysipelas  attacks  the  head  severely, 
which  is  sometimes  the  case. 

Perhaps  it  may  be  agreeable  to  you,  Gentlemen,  to  invite 
and  receive  accounts  (post  paid)  of  experiments  and  of  cases 
on  the  foregoing  subject,  and  to  insert  them  occasionally  in 
your  valuable  work.  But  if  receiving  will  be  too  much  trou¬ 
ble,  I  will  with  pleasure  transmit  them  to  you  without 
further  trouble  to  the  writer,  if  addressed  (post  paid)  as  un¬ 
der.  Public  benefit  is  the  great  object :  and  if  we  can 
save  but  one  good  person  from  death,  or  one  good 
family,  or  friend,  from  severe  distress,  we  shall  be  amply 
repaid  for  our  trouble,  in  the  satisfaction  it  will  afford. 

With  many  apologies,  for  the  length  of  this,  I  subscribe 
myself, 

Gentlemen,  your  very  obedient  Servant. 

THOMAS  HARDING. 

.18,  Union  Street,  Southwark,  January  19,  1809. 


1809.] 


Pharmacy * 


191 


To  the  Editors  of  The  Medical  and  Surgical  Spectator 6 

Gentlemen — I  have  just  perused  Dr.  Lambe’s  late  pub¬ 
lication  on  Cancers : — Such  another  book,  for  its  compre¬ 
hensive  and  important  information,  I  will  venture  to  affirm, 
has  not  made  its  appearance  for  these  many  years  I  except 
none.  I  trust  you  will  believe  my  enthusiastic  praises  of  it 
to  be  at  least  conscientious ,  when  I  have  assured  you  that  I 
not  only  never  was  acquainted  with  Dr.  Lambe,  but  that  I 
do  not  even  know  him  by  sight. 

Unfortunately  for  the  welfare  of  mankind,  our  great  folks 
are  too  busy,  just  now,  about  schemes  of  maniac  warfare ,  to 
bestow  one  serious  enquiry,  one  serious  thought  on  the  im¬ 
portant  truth  contained  in  that  little  yet  great  production. 

Yet  I  will  venture  to  assert  that  it  is  as  deserving  of  their 
notice  and  interference  as  any  discovery  that  ever  was  made— 
not  even  the  Jenerian  expediency  excepted.  ~ 

One  observation  I  have  however  to  make,  which  struck 
me  on  reading  this  book,  and  which  perhaps  has  been  over¬ 
looked  by  Dr.  Lambe  : — that  is,  that  if  distilled  water  be 
essential  to  our  perfect  state  of  health,  how  can  we  reconcile 
this  to  a  natural  state  of  existence  ?  For  if  divine  providence 
intended  us  to  drink  water  at  all,  it  would  follow  that  in  a 
state  of  nature,  we  should  have  to  drink  it  with  all  its  impuri¬ 
ties,  by  bending  ourselves  down  to  whatever  stream  we  met 
in  our  way,  as  animals  are  accustomed  to  do.  Hence  it 
would  appear  that  either  water  was  not  intended  for  our  be¬ 
verage,  or  that  if  it  was,  we  should  take  it  with  all  the  impu¬ 
rities  with  which  it  may  chance  to  be  impregnated. 

But  another  reason  may  perhaps  be  brought  to  aid  us  in 
solving  the  above  contrarities  to  Dr.  Lamb’s  system Is 
there  not  a  material  difference  between  taking  water  into  the 
stomach  as  we  would  naturally  take  it,  that  is  by  going  to 
the  stream  or  river,  and  bringing  our  mouths  in  immed  iatc  con¬ 
tact  with  the  water,  and  our  present  way  of  procuring  it  for 


192  Phunnmy.  [February  5 

consumption  ?  In  the  first  instance  we  would  take  it  with  all 
the  active  principles,  not  forgetting  the  living  animalcules 
with  which  water  more  or  less  abounds,  and  immediately 
convey  it  into  the  stomach.  So  taken  they  are  perhaps  cal¬ 
culated  to  render  the  beverage  rather  wholesome  than  other¬ 
wise.  But  in  the  last,  by  first  conveying  it  into  pipes,  then 
into  reservoirs,  and  again  into  confined  rooms,  &c.  do  we 
not  in  part  destroy  these  principles  long  before  it  is  conveyed 
into  the  stomach,  thereby  giving  them  time  to  evaporate,  and 
to  the  animalcules,  if  it  contains  any  quantity,  to  putrify, 
and  consequently  poison  the  water  which  in  its  original  state 
was  salubrious  ? 

This  opinion,  Gentlemen,  may  prove  on  further  enquiries 
erroneous,  but  I  submit  to  your  judgement  the  propriety  of  its 
insertion,  as  calculated  to  throw  some  light  on  an  important 
subject. 

I  remain,  Gentlemen, 

Your  obedient  Servant, 

Jan.  21,  1809.  M. 

COMMUNICATION  ON  THE  EXTENSIVE  USE  OF  MINERAL 
PREPARATIONS  IN  THE  PRACTICE  OF  MEDICINE. 

To  the  Editors  of  The  Medical  and  Surgical  pectator. 

Gentlemen. ~~ There  seems  to  be  a  fashion  in  medicine,  at, 
present  to  prefer  chemical  preparations,  in  the  treatment  of 
diseases,  rather  than  draw  our  resources  from  the  vegetable 
kingdom.  This,  perhaps,  may  be  accounted  for  from  our 
greater  prepossession  in  favour  of  chemistry  than  pharmacy, 
and  the  supposed  application  to  the  one  science  over  the 
other.  The  remedies  of  the  mineral  kingdom,  it  must  be  con¬ 
fessed,  are  not  of  that  assimilating  nature  as  the  vegetable 
productions  :  neither  do  we  conceive  that  their  combinations 
and  new  arrangements  in  the  system  can  be  easily  and  cer¬ 
tainly  established  before  hand  with  the  same  ease  as  veget- 


J809.J  Pharmacy .  193 

t  ' •'  7\  ‘  '  *  \  '  ’’  * 

able  productions.  The  principles  of  vegetables  are  well  un¬ 
derstood,  and  the  manner  in  which  they  act  somewhat 
clear  and  determined.  The  principles  of  minerals  are  in 
many  respects  conjectural  and  obscure,  and  dependent  on 
accidental  circumstances,  in  the  degree  and  extent  of  their 
action.  If  a  narcotic  is  given  in  a  certain  dose,  we  knew 
it  will  have  a  determined  effect ;  but  if  a  mineral  prepara¬ 
tion  is  exhibited,  its  operation  will  be  varied  by  the  present 
state  of  the  stomach,  and  the  new  combinations  which  it  is 
accordingly  ready  to  enter  into,  dependent  on  the  presence 
or  absence  of  certain  matters,  for  which  it  has  a  greater  or 
less  affinity. 

Antimony  and  mercury  are  the  great  minerals  which  have 
been  valued  in  practice,  and  the  former,  till  of  late  years,  cer¬ 
tainly  held  a  preference  over  the  other  as  a  general  remedy. 
Mercury  has,  however,  now  gained  the  ascendancy  ;  and, 
whatever  blame  may  be  attached  to  empirics  for  their  indis¬ 
criminate  use  of  it,  regular  practitioners  are  perhaps  running 
fast  into  the  same  error.  Many  very  able  physicians  of  the 
metropolis,  we  understand,  prescribe  little  else  than  calomel, 
and  such  is  the  rage  for  this  preparation  in  every  state,  that 
even  patent  calomel  has  been  prepared  and  advertised.  I  am 
much  of  opinion  that  this  remedy  should  not  be  used  in  such 
an  extensive  manner  as  it  is  done  in  the  period  of  infancy. 
Calomel  is  the  great  catholicon  for  the  complaints  of  chil¬ 
dren.  It  is  used  to  cure  every  indisposition  to  which  they  are 
subject,  from  the  most  trifling  ailment  to  the  most  alarming- 
malady.  However  proper  it  may  be  to  excite  large  evacua¬ 
tions  in  certain  circumstances,  it  cannot  be  good  to  do  it  at 
all  times  ;  and  mercurial  oxyds  given  frequently  are  danger¬ 
ous-  at  a  period  when  the  constitution  is  forming,  by  the  ab¬ 
straction  of  that  solid  matter  so  necessary  to  give  strength 
and  finishing  to  the  fabric.  Many  serious  consequences,  i 
know,  have  resulted  of  late  from  the  large  ad  in  mist  ration  of 
calomel  in  the  hands  of  a  certain  physician  oi  live  metropolis, 

yol.  it.  ~  o 


194  Medical  Intelligence.  [February^ 

Exfoliation  of  bones  lias  been  known  to  take  place  under  his 
practice — a  sufficient  proof  that  it  was  improperly  exhibited. 
Borrowing  our  ideas  of  treatment  from  the  practice  in  the 
warm  climates  is  to  be  condemned.  Circumstances  of  con¬ 
stitution,  as  well  as  the  nature  and  progress  of  the  diseases, 
materially  change  the  principles  of  cure.  A  constitution 
that  cannot  now  bear  bleeding  to  any  extent,  which  most 
practitioners  will  assent  is  the  state  of  habit  of  the  present 
day,  can  far  less  bear  the  large  use  of  such  a  Herculean 
remedy  as  mercury.  These  observations  are  called  for  by 
the  present  mode  of  practice ;  and  I  shall  be  glad  to  find 
my  opinion  confirmed  by  others. 

1  am.  Gentlemen,  Your  obedient  Servant, 

THE  GHOST  OF  SYDENHAM. 

Bath ,  Jan.} 5,  1809. 


MISCELLANEOUS. 

The  application  of  Poetry  to  Medicine  is  of  very  great 
antiquity.  The  rules  of  the  School  of  Salernum  are  all 
written  in  verse.  Fra  castor  has  used  its  imagery  with  beau¬ 
tiful  effect  in  describing  the  Venereal  Disease.  Armstrong’s 
Art  of  preserving  Health  is  in  the  hands  of  every  one  who 
has  taste  to  relish  elegance  of  language,  and  good  sense  t® 
appreciate  its  maxims.  Downman’s  Poem  on  Infancy  con¬ 
tains  all  the  necessary  instructions  of  which  that  delicate 
period  stands  in  need  by  those  who  have  the  charge  of  it. 

W e  are  much  obliged  to  our  classical  correspondent,  Mr. 
Oakes,  for  sending  us,  from  the  seat  of  the  Muses,  the  sub¬ 
joined  Latin  Veises  on  tbe  subject  of  Hydrophobia;  a  dis¬ 
ease  so  much  the  terror  of  the  day. 

To  the  Editors  o  f  The  Medical  and  Surgical  Spectator . 

Gentlemen — The  following  copy  of  verses  was  written  by  { 


Medical  Intelligence , 


195 


1809.] 


an  old  Physician  several  years  since ;  and  if  they  are  worthy 
of  your  publication,  they  are  at  your  service. 

I  am,  Gentlemen,  yours, 

Cambridge ,  Jan;  22,  1809.  T.  V.  O, 


IN’  RA8IEM  CANINAM. 


Torret  agros  radiis  nunc  Sol  altissimus  omnes 
Depositisq;  petunt  Sjl varum  falcibus  umbras 
Tam  Messatores,  ABstu  victi  atq;  labore. - 

Cur  Cam’s  haud  solito  quaerit  pro  more  magistrum, 

Et  cur  non  blandm  gannitu  vocis  adulat. 

Cur  jacet  abjectus  demissa  in  gramine  cauda, 

Cur  non  latratu,  sed  rauco  murmure  tantum 

Accipit  ignotos,  cur  frustula  grata  recusat ; 

Curq;  gravi  passu  passus  comitatur  heriles, 

Nec  ludens  campos  late  velut  ante  vagatur, 

Miratur  Corydon,  comitis  miratur  ocellos 

Non  fervescentes,  non  ulla  luce  micantes. 

At  Canis  infectus  funestbtabe  veneni 

Sentit  iners  iutro  saevi  contagia  morbi 

Serpere,  prsenoscensq;  solet  miserabile  fatum; 

Vix  memor  ipsius  Domini,  sed  dente  maligno 

Irruit  in  cunctos,  spargitq;  miasmata  morbi, 

At  subito  saevit  virus,  carpitq;  Medullos  ; 

Turn  Canis  infelix,  Dommiq;  oblitus,  anhelans? 

Exserta  lingua,  per  devia  nescius  errat. 

* 

Nur.c  rapido  cursu,  nunc  lento ;  multa  per  ora 
Exbalans  spumosa,  febrisq;  ardore  perustus 
Qucerit  aquas,  horret  visu  tremefactus  aquarum, 
Quam  subitoq;  caput  retrain t  seu  saucius  ictu, 

Et  redit  ad  lymphos,  nec  fluctus  accipit  ore  | 

Nec  sentit  fatiq;  genus,  mortemq;  veneni 
Sed  putat  esse  sitim — sed  livida  lingua  ealorq; 
Intus  agens,  et  quae  circumfluit  albida  rictus 
Pestiferos  spuma,  et  quasi  pulvere  conspurcata 
|iUipjna,  inaequales  passus,  genus  omne  Caninuafj 


I 


196 


[February? 


Medical  Intelligence. 

Hunc  vitare  monent  dira  confage  gravatum. 

Tanta  diu  tolerare  nefas  mala ;  Mors  rapida  instat. 
*  Feles  atque  Canes  cur  non  teterrima  solos 
Festilitas  vexat,  tactus  contagibus  absque  pestis. 
Cur  solam  hanc  rabiem  vulnus  disseminat,  et  cur 
Noxia  fit  tantum  commisto  sanguine  pestis, 

Fertilis  in  mortes,  aut  quid  secreta  nocenti 
Miscuerit  natura  tui,  non  cura  laborq; 

Noster  scire  valet,  nisi  qnm  vulgata  per  orbem 
Fabula  pro  vera  decepit  saecula  caus&. 

(Febre  laborantes  Homines  aliquando  videmus 
Ilydrophobos  fieri,  nec  fatum  dente  minantes) 
Cmterum  dum  torquent  animalia  membra  labore 
Sudorem  videas  fundentia  corpore  toto. 

His  cutis  arctantur  dense  spiramina,  rodunt 
Sanguinis  inde  sales  cerebellum  mordicus ;  aut  quod 
Alba  subest  linguae  vermis,  se  sive  recondit 
In  sinubus  frontis;  vel  viscera  tenia  pungit 
Excruciatve  dolor  dentes,  aut  saevior  aures. 

Dentibus  exceptum  non  nunquam  virus  in  anno* 
Se  condit  tacite  latitans  in  corpore,  vana 
Spe  ludens  miseros  felicia  tempora  vitae 
Hucendi,  et  placido  claudendi  lumina  letho. 
Exerere  Hebd'omadis  paucis  plerumq;  suescit 

Pesteferas  vires,  et  ceita  morte  timendas - 

Yulnera  parva  lieet,  nullam  minitanfia  noxam 
Absque  dolore  omni,  paucisq;  imbuta  salivis 
Sanenturq;  cito,  &  vestigia  nulla  cicatrix 
Impressi  dentis  monstret ;  per  corpora  tota 
Insinuat  morsis  tamen  horrida  gutta  veneni. 

Mox  dolor  exoritur  puugens  ubi  vulnere  primo 
Infusum  virus  venis,  volat  impetu  miro 
Ignea  vis,  subitoq;  pererrat  singula  membra. 
Occupat  et  vertigo  caput,  fit  nausea,  sordes, 

Ecce  aerugineas  Stomachus  comitante  Screatu 

*  Genus  Canitium,  Lupos,  Vulpes, 

■  ■  ■  Felinum,  Tigridas,  Pardos  comprehendit. 


I 


1809.]  Medical  Intelligence . 

Evomit,  excruciant  Singultus,  Pectora  anhelant, 

Somnia  terrifieant,  gravitas  iu  corpore,  torpor, 

Signaq;  dejectae  mentis  suspiria  reddunt 
Sponte  sua  ejicitur  Semen,  genitaliaq;  aestu 
Tensa  dolent,  urget  mordax  stranguria,  fauces 
Viscidus  obturat  mucus,  sitis  ;  Horror  aquarum 
Visarum  savus,  Speculi  solidive  nitentis, 

Exagitat  nervos,  totos  tremor  occupat  artus, 

Latrantiq;  Cani  similis  nox  edita  terret 
Astan*es,  mens  mitis,  contans ;  aeger  amicos 
Admonet  ut.  fugiant  lethalia  vulnera  dentis. 

Extorquent  spasmi  vitam,  vel  lenia  somni 
Munera  deducunt  auimas  Acherontis  ad  oras. 

Nec  ratio  remedi  communis  cognita  certo; —  - 
Sunt  qui  confidunt  argenti  in  flumine  vivi, 

Aut  maris  immergunt  miserorum  corpora  in  undas, 

Nec  prius  inde  trahunt  quam  magno  extincta  Animiii 
Pars  sit;  vel  sasvi  candentis  viribus  Ignis 
Exurunt  partes,  cultrove  exscendere  acuto 
Audent,  ut  Tabo  viviscens  diffluat  ulcus. 

Antidotis  male  credendum  est  quae  Somnia  moustrant, 
Sitve  Cynorrhodon,  aut  rabidi  Canis  ipsius  Hepar. 

Pluraq;  multoties  quae  fabula  jactat  anilis  ; 

Morbus,  ni  sanet  Ferrum,  immedicabilis  angit; 

Solaq;  Spes  miseris,  nullam  sperare  Salutem. 


197 


MEDICAL  INTELLIGENCE. 

Joseph  Miller,  servant  to  Mr.  Bates,  of  Holmfirth,  near  Huddersfield, 
Yorkshire,  died  last  week  of  Hydrophobia,  occasioned  by  having  suffered, 
five  weeks  before,  a  dog,  which  afterwards  proved  to  be  mad,  to  lick  the 
wounds  on  his  hands  and  face.  This  proves  Dr.  Caton  to  be  correct,  who 
stated  in  his  last  communication,  that  it  was  only  necessary  that  the  saliva 
should  come  in  contact  with  some  animal  fluid  to  produce  the  disease. 


VACCINATION. 

In  pursuance  of  the  Resolution  of  parliament  passed  in  the  last  Session,  a 


m 


[February, 


Medical  Intelligence . 

National  Institution  for  promoting  Vaccination,  is  established  under  the 
management  of  a  Board,  which  consists  of  the  following  Members  — 

Sir  Lucas  Pepys,  Bart.  President  of  the  Royal  College  of  Physicians ; 
Dr.  Mayo,  Dr.  Heberden,  Dr.  Satterley,  and  Dr.  Bancroft,  Censors  of 
the  College;  George  Chandler,  Esq.  Master;  and  Robert  Keate,  Esq.  and 
Sir  Charles  Blicke,  Governors,  of  the  Royal  College  of  Surgeons. 

The  Board  have  appointed  the  following  Officers  : 

Director,  Dr.  Jenner;  Assistant  Director,  James  Moore,  Esq.;  Register, 
Dr.  Hervey ;  Principal  Vaccinator,  J.  C.  Carque,  Esq. ;  Vaccinators  at  the 
Stations,  Cnarles  Afkin,  Esq.  T.  Hale,  Esq.  Richard  Lane,  Esq.  Edward 
Leese,  Esq.  S.  Sawry,  Esq.  and  J.  Vincent,  Esq. — Secretary,  Charles 
Murray,  Esq. 

St.  Salvador,  (Brazil),  July  19,  1809. 

Art.  2.  The  vaccine  inoculation  was  first  practised  in  St.  Salvador  to¬ 
wards  the  end  of  the  year  1804,  and  from  thence  spread  through  all  the 
provinces  by  order  of  the  Prince  of  Brazil,  who  appointed  Dr.  J.  A.  Bar- 
boza  to  superintend  and  promote  the  new  practice,  and  so  beneficial  have 
been  its  effects,  that  the  small-pox,  which  was  very  destructive  here,  has 
almost  totally  disappeared. 


In  the  cancerous  ward  of  the  Middlesex  Hospital,  we  are  given  to  un¬ 
derstand  that  the  intelligent  Physicians  of  that  Hospital  are  going  to  give 
the  distilled  water  and  vegetable  diet  a  trial :  we  think  it  a  just  tribute  to 
humanity,  and  solicit  the  result  of  the  investigation. 


Dr.  Herdman  has  been  appointed  Physician  to  Ilis  Royal  Highness  the 
Duke  of  Sussex. 


Dy  the  death  of  Dr.  T.  Beddoes,  physic  has  lost  one  of  her  ablest 
practitioners,  and  philosophy  a  profound  disciple.  As  an  author  he  was 
admired,  as  a  man  loved.  Generation  will  succeed  generation  before  such 
bright  luminaries  as  a  Black,  or  a  Beddoes  will  adorn  the  lemisphere  of 
science ;  the  many  laws  of  the  physical  action  and  reaction  of  Chemistry 
by  his  well  directed  labours,  has  opened  an  ample  field  for  medical  iuquiry 
and  illustration,  the  just  attributes  of  practical  knowledge.  As  the  founder 
of  a  new  practice,  grounded  upon  the  intimate  knowledge  of  the  effects  of 
the  lungs,  and  the  agency  of  oxygen  in  the  system,  Dr.  Beddoes  met  with 
strong  opposition  ;  which  opposition,  fortunately  for  society,  called  forth 
the  exertions  of  Dr.  Darwin,  Percival  and  others,  who  hesitated  not  to  de¬ 
liver  their  unbiassed  testimony  in  his  favour. 


Medical  Intelligence . 


199 


1809. j 


The  Death  of  Dr.  Richard  Lubbock  deserves  also  to  be  mentioned.  He 
was  an  eminent  Physician  of  Norwich,  and  particularly  excelled  in  his  che¬ 
mical  knowledge.  His  practical  opinions  of  medicine  were  framed  on  the 
theory  of  Dr.  Brown,  but  applied  with  judgment  and  discretion.  He  was 
considered  in  practice  as  a  successful  physician,  and  enjoyed  a  very  high  de¬ 
gree  of  public  confidence  where  he  resided.  We  shall,  in  a  future  Number, 
extend  these  sketches  of  Biography  as  they  regard  Drt  Beddoes  and  Dr. 
Lubbock. 


Dr.  James  Hamilton,  of  Finsbury  Square,  has  been  unanimously  ap- 

/ 

pointed  Physician  to  the  London  Dispensary. 


t 


NEW  MEDICAL  PUBLICATIONS. 


Anatomia-Chirurgical  Views  of  the  Nose,  Mouth,  Larynx  and  Fauces, 
with  appropriate  explanations  and  references  to  the  Plate.  By  John 
James  Watt,  Surgeon,  Folio.  Plain,  11.  1  1  s.  Od.  Coloured,  21.  2s. 

The  London  Medical  Dictionary,  including,  under  distinct  heads,  every 
branch  of  Medicine,  viz.  Anatomy,  Physiology,  and  Pathology ;  the  Prac¬ 
tice  of  Physic  and  Surgery,  Therapeutics  and  Materia  Medica  ;  with  what¬ 
ever  relates  to  Medicine  in  Natural  Physiology,  Chemistry  and  Natural 
History;  illustrated  by  a  great  number  of  Plates  elegantly  engraved.  By 
Bartholemew  Parr,  M.  D.  &c.  2  vols.  4to.  4l.  16s.  boards. 

Reports  on  the  Effects  of  a  Peculiar  Regimen  on  Schirrous  Tumours  and 
Cancerous  Ulcers.  By  William  Lambe,  M.  D.  Fellow  of  the  Royal  Col¬ 
lege  of  Physicians,  8vo.  5s.  boards. 

Treatise  on  Scrofula.  By  James  Russell,  Fellow  of  the  Royal  College 
of  Surgeons,  and  Professor  of  Clinical  Surgery,  in  the  University  of  Edin¬ 
burgh,  8vo.  5s.  boards. 

IN  THE  PRESS. 

The  Practical  Materia  Medica,  in  which  the  various  articles  are  fuliv 
described  and  divided  into  classes  and  orders  according  to  their  effects,  their 
virtues,  doses,  and  the  diseases  in  which  they  are  proper  to  be  exhi¬ 
bited,  are  fully  pointed  out;  interspersed  with  some  Practical  Remarks, 
and  some  Select  Formulae;  intended  principally  for  the  use  of  Students 
and  Junior  Practitioners.  One  volume  duodecimo. 

Cooper’s  Dictionary  of  Practical  Surgery,  8vo. 

Hooper’s  Physician’s  Vade-mecum,  &e.  Svo. 

A  Treatise  on  Cheltenham  Waters  and  Bilious  Diseases;  the  second 
edition.  By  Thomas  Jameson,  M.  D. 


200 


Diseases  and  Casualties  in  London  in  the  Year  1808. 


Aged  - 
Ague  - 


Abortive  &  Stillborn  462 
Abscess  -  -  -  -  49 

-  -  1555 

-  5 

Apoplexy  &  Suddenly  229 
Asthma  and  Phthisic  586 
Bedridden  -  -  -  3 

Bleeding  -  -  -  -  28 
Bursten  and  Rupture  26 
Cancer  -  -  -  -  54 

Canker  -  -  -  -  2 

Chicken  Pox  -  -  -  3 

Childbed  -  -  -  172 

Colds  -----  1 1 
Colic,  Gripes,  &c.  -  19 
Consumption  -  -  5220 
Convulsions  -  -  4164 

Cough,  and  Hooping 


French  Pox  -  -  -  28 
Gout  -  -  -  -  -  33 
Gravel, Stone, &  Stran¬ 
gury  -  -  -  -  18 

Grief  -  -  -  -  -  5 

Headmouldshot,Horse- 
shoehead,  &  W  ater  in 


Spasm  15 

St.  Vitus’s  Dance  -  1 

Stoppage  in  the  Stom.  12 
j  Teeth  -  -  -  -  319 

Thrush  -  -  -  -  48 

Tumour  -  -  -  -  1 

Worms  -  3 


Cough  -  326 

Cow  Pox  -  -  -  -  1 

Croup  -  -  -  -76 

Diabetes  -  -  -  -  2 

Dropsy  -  -  -  -  870 

Evil  -  -  -  -  8 

Fevers  of  all  kinds  1168 
Fistula  -  -  -  -  1 

Flux  -----  10 

Christened  - 
Buried  r 


Under  Two  Years  of  Age 
Between  Two  and  Five 
Five  and  Ten 
Ten  and  Twenty 
Twenty  and  Thirty 
Thirty  and  Forty 


the  Head 
J  aundice 
Jaw  Locked  - 
Inflammation 
Lethargy  -  - 
Livergrown  - 
Lunatic  -  - 
Measles  - 
Miscarriage  - 
Mortification  ■ 
Palsy  - 
Piles  -  - 

Pleurisy  -  - 

Purples  -  - 

Quinsy  - 
Rheumatism  - 
Scurvy  - 
Small  Pox  - 
Sore  Throat  - 
Sores  and  Ulcers 


193 
.  39 

_  2 

765 

-  1 

-  14 
■  172 

1386 

-  2 

200 

98 

-  1 

-  17 

-  1 

-  3 

-  7 

-  2 
1169 

-  9 

-  5 


Bit  by  a  mad  Cat 
Bit  by  mad  Dogs 
Bruised  -  -  - 

Burnt  -  - 

Drowned  -  -  - 

Excessive  Drinking 
Found  Dead 
Fractured 
Frighted  -  -  - 

Frozen  - 
Killed  by  Falls  and  se¬ 
veral  other  Accidents  77 
Killed  themselves  -  36 

Poisoned  -  -  -  - 

Scalded  -  -  -  - 

Starved  -  -  -  - 

Suffocated  - 


1 

3 

1 

51 

123 

7 

17 

2 

1 

2 


Total  335 


I 

f 


Males  - 
Females 
Males  - 
Females 


10189 

9717 

10228 

9726 


In  all  19906 
In  all  19954 


Whereof  have  died, 


6075  Fifty  and  Sixty 

2466  Sixty  and  Seventy  - 

847  Seventy  and  Eighty 

6 43  Eighty  and  Ninety 

1200  Ninety  and  a  Hundred 

1792  A  Hundred 

1971  A  Hundred  and  Two 


Forty  and  Fifty 

Increased  in  the  Burials  this  Year  1620. 


1690 

1499 

1200 

504 

65 

i 

i 


Th  is  Register  exhibits  a  considerable  increase  in  the  proportion  of  deaths 
under  two  years  of  age,  the  whole  number  of  deaths  exceeding  the  preced¬ 
ing  year  only  1  6 20,  and  the  mortality  of  children  under  two  years  of  age 
greater  by  nearly  500  than  in  either  1800  or  1807.  This  may  be  ac¬ 
counted  for  by  the  g'reat  increase  of  measles,  which  exceeds  every  thing 
that  cad  be  produced  in  any  former  years.  It  is  also  well  known  that  in¬ 
flammatory  diseases  have  been  more  severe  and  frequent  than  usual.  The 
Yearly  Bills,  inaccurate  as  they  are,  confirm  this;  as  well  as  most  other 
facts  on  a  large  scale.  The  number  of  deaths  by  Croup  is  greater  than  in 
either  of  the  two  preceding  years;  and  under  the  general  term  of  Ci  inflam¬ 
mation,”  the  difference  is  not  less  remarkable.  The  deaths  by  Small  Pox 
are  128  less  than  last  year,  and  1 1  more  than  the  preceding  year. 


VoL.  II.] 


March,  1809.  [No.  VIII. 


THE  LONDON 

^eDical  anti  Surgical 

SPECTATOR. 


EMPIRICISM. 


The  functions  of  respiration,  and  the  changes  it  induces 
on  the  system,  have  opened  a  wide  field  for  what  we  may 
term  Scientific  Empiricism.  Chemistry  has  laid  the  found¬ 
ation  of  this,  and  her  pneumatic  discoveries  have  been  ap¬ 
plied  with  a  bold  speculation  to  arrest  the  progress  and  ef¬ 
fect  recovery  in  many  hitherto  incurable  diseases.  The  in- 

/ 

struments  thus  offered  were  first  seized  on  by  the  genius  of  a 
Beddoes,  and  made  to  acquire  for  a  time  some  reputation  in  his 
hands ;  but  though  moulded  with  some  judgment  by  him, 
and  capable  of  giving  even  to  his  failures  the  plausibility  of 
success,  they  were  but  clumsily  employed  by  the  talents  of  in¬ 
ferior  practitioners.  We  blame  not  a  Beddoes  for  the  at¬ 
tempt;  but  we  consider  the  present  perseverance  in  their  use 
as  a  species  of  Charlatanism  highly  to  be  condemned,  as  those 
means  of  cure  are  now7  to  be  considered,  when  regarded  as  me¬ 
dicines,  only  as  airy  nothings.  This  line  of  practice,  started 
by  regular  practitioners,  was  soon  taken  up  by  the  empirics, 
who,  if  they  could  not  imitate  the  principles  of  cure,  at  least 
gave  such  an  imposing  appellation  for  the  time  to  their  nos¬ 
trums,  as  the  Vital  Wine,  Vital  Pills,  Oxygen  Gas,  &c. 

But  we  shall  examine  the  principles  of  pneumatic  practice 
in  detail,  first  stating  the  airs  or  gases  which  have  been  em¬ 
ployed. 

vol.  ir. 


202  Empiricism .  [Marc 

Mr.  Watts’s  apparatus  is  the  only  mode  of  exhibiting 
them  yet  resorted  to.  This  apparatus  consists  of  an  alem¬ 
bic,  of  a  long  pipe,  conducting  to  the  refrigeratory,  of  a  re¬ 
frigeratory  of  considerable  size,  of  a  hydraulic  bellows,  into 
which  the  gas  is  conveyed  from  the  refrigeratory,  in  order 
that  it  may  be  farther  cooled,  and  of  an  air  holder,  into 
which  a  transfer  pipe  discharges  the  air  from  the  hydraulic 
bellows.  (Vide  Beddoes  on  Airs,  part  II.  p.  3.) 

Vital  Air.~— Vital  air  is  procured  by  exposing  simply 
black  ox  yd  of  manganese  to  a  red  heat,  or  by  mixing  it  with 
two  parts  and  a  half  of  sulphuric  acid,  adding  a  moderate 
heat,  when  a  large  quantity  of  this  air  is  separated.  When 
fresh  made,  it  is  rather  unfit  for  medical  use,  as  containing  in 
it  a  quantity  of  the  manganese  suspended,  and  some  caustic 
lime  should  therefore  be  well  mixed  in  the  water  of  the  re¬ 
frigeratory,  or  it  should  be  kept  12  hours  in  the  air  holder  be¬ 
fore  it  is  used.  In  using,  it  is  sometimes  employed,  in  ur¬ 
gent  cases,  undiluted,  but  more  commonly  it  is  mixed  with 
atmospheric  air,  from  20,  30,  to  50  quarts  of  atmospheric 
air  with  two  of  vital  air,  employed  once  a  day,  is  a  common 
course  in  chronic  diseases,  gradually  lessening  the  frequency 
of  its  application,  according  to  circumstances,  and  even  in¬ 
termitting  occasionally,  when  general  appearances  of  in 
fb.mmation,  as  a  white  tongue,  &c.  appear. 

The  effect  of  this  dose  is  to  diffuse  a  sense  of  warmth 
through  the  body,  and  to  occasion  a  suffusion  of  colour  over 
every  part,  and  to  render  the  pulse  slower  and  fuller. 

JDephlogisticated  Nitrous  Air  is  obtained  by  exposing 
nitrous  gas  to  wetted  iron  filings,  or  moist  sulphuret  of  alka¬ 
li.  It  may  be  inhaled  either  pure,  or  in  a  varied  propor¬ 
tion  with  atmospheric  air,  according  to  circumstances. 

Carbonic  Acid  Gas ,  or  Fixed  Air ,  is  obtained  in  its 
purest  state,  by  heating  chalk  or  calcareous  substances  red 
hot,  and  admitting  to  it  small  quantities-  of  water h  by  which 


m 


£09.]  Empiricism . 

the  fixed  air  will  be  disengaged  ;  or  it  may  be  procured  by 
pouring  dilute  sulphuric  acid  on  chalk,  and  allowing  the 
gas  to  pas  through  water,  and  be  inspired  through  a  tube  in 
that  state.  „ 

These  inhalations  may  take  place  for  20  minutes,  occa¬ 
sionally  breathing  an  inhalation  of  atmospheric  air,  and  they 
maybe  repeated  four  or  five  times  a  day,  unless  pain  of  chest, 
or  other  symptoms  arise,  that  occasion  it  to  be  desisted  from. 

Hydro  Carbonate  Air  is  a  modification  of  the  former, 
and  procured  by  heating  charcoal  to  redness,  and  dropping 
water  upon  it.  The  water  should  be  admitted  very  slowly, 
and  lime  should  be  mixed  in  the  water  of  the  refrigeratory,  to 
prevent  any  contamination  in  the  process,  and  this  air  is  best 
used  fresh  made.  From  the  great  powers  of  this  air  it  re¬ 
quires,  in  using  it,  that  the  dose  be  measured  out  with  great 
accuracy,  and  its  proportion  should  not  be  more  than  one 
part  to  15  of  atmospheric  air. 

The  utmost  care  should  be  taken  in  preparing  it  that  the 
charcoal  be  previously  well  calcined. 

To  facilitate  the  exhibition  of  this,  an  arrangement  of 
different  standards  or  changes  of  atmospheric  air  has  been 
proposed  by  Dr.  Beddoes  in  the  following  manner  : — 

Thus  28  parts  being  the  proportion  of  vital  air  usually 
present  in  the  atmosphere,  he  has  altered  it  by  the  addition  of 
successive  equal  parts  of  it  to  one  of  oxygen,  thus  : — 

TABLE  I0' 

Oxygen.  Azotic . 

1  part  of  atmospheric  to  1  of  oxygen  .  64  .  36 


1  of  atm. 

• 

.  to  do. 

.  52  . 

48 

3  do. 

• 

.  to  do. 

»  46  . 

54 

4  do. 

• 

.  to  do. 

.  42  . 

58 

5  do. 

« 

.  to  do. 

.  40  , 

60 

6  do. 

t 

* 

.  to  do. 

p  2 

.  38  . 

62 

m 


Empiricisms 


[March, 


Oxygen . 

Azotic. 

7  of  atm; 

.  .  to  1  of  oxygen  .  37  , 

63 

8  do. 

.  o  to  do.  • 

.  36  . 

64 

9  do. 

.  .  to  do. 

.  35  . 

65 

10  do. 

.  •  to  do. 

.  34f  . 

65| 

11  do. 

.  .  to  do. 

.  34  . 

66 

19  do. 

.  .  to  do. 

TABLE  11. 

.  30  f  - 

62§ 

The  standard  is  altered  in  the  following  manner,  by  ad- 


dition  of  successive 
spheric  air : 

equal  parts  of  oxygen  to  one 

Oxygen 

of  atmo- 

Azotic . 

2  oxygen 

to  1  atmospheric 

.  76 

.  24 

3  oxygen 

to  do. 

.  81 

.  19 

4  oxygen 

to  do. 

.  85 

.  15 

5  oxygen 

to  do. 

TABLE  III. 

00 

00 

♦ 

.  12 

Effect  of  the  addition  of  different  portions  of  atmospheric 
to  one  of  unrespirable  air. 

Oxygen .  Urtresp  i r . 

1  atmospheric 

.  to  I  unrespirable 

.  14  . 

86 

2  do. 

.  to  do. 

.  19  . 

81 

3  do. 

.  to  do. 

.  21  . 

79 

4  do. 

.  to  do. 

.  22  . 

78 

5  do. 

.  to  do. 

.  23  . 

77 

6  do. 

.  to  do. 

.  24  . 

76 

7  do.  , 

.  to  do. 

.  24  . 

76 

8  do* 

.  to  do. 

.  25  . 

75 

9  do. 

.  to  do. 

.  25  . 

75 

10  do.  . 

.  to  do. 

TABLE  IV. 

.  25|  • 

74| 

i 


Effect  of  the  addition  of  different  portions  of  unrespir- 

able  airs  to  one  of  atmospheric.  / 

Oxygen.  Unrespir. 

1  atmospheric  .  to  %  unrespirable  .9  .  91 


Empiricism . 


905 


1809.] 


Oxygen.  Unrespir. 

1  atmospheric  .  to  3  unrespirable  .  7  .  93 

1  (Jo.  .  .  to  4  do.  .  .  5§  .  94| 

1  do.  .  .  to  5  do.  .  .  5  95 


The  above  Tables,  though  ingenious,  and  on  that  ac« 
count  deserving  the  praise  of  chemical  knowledge  and  ar¬ 
rangement,  we  are  sorry  to  say,  are  no  way  applicable  to  the 
cure  of  diseases,  or  as  leading  to  any  successful  views  in  prac¬ 
tice.  All  the  gases  which  contain  a  greater  proportion  of 
oxygen  than  belongs  to  atmospheric  air,  in  the  same  propor¬ 
tion  are  apt  to  excite  inflammation;  and  all  those  again 
which  exceed  in  their  proportion  of  azote  beyond  the  due 
quantity  established  in  atmospheric  air,  are  liable  to  induce  in 
the  same  degree  symptoms  of  apoplexy,  accumulation  in  the 
brain,  and  atonic  state  of  the  nervous  system.  These  effects  of 
the  pneumatic  medicines  were  clearly  ascertained  by  the  French 
chemists,  particularly  Chaptal;  and  the  point  being  esta¬ 
blished,  the  matter  was  left  at  rest,  and  no  more  mischief  done 
by  the  experiments ;  but  in  this  country  it  has  been  different. 
The  introduction  of  the  airs  was  a  new  species  of  medical 
trade.  It  was  a  fine  speculation  to  amuse,  and  fill  the 
pockets ;  and  the  line  whicli  the  genius  of  Beddoeshad  chalk¬ 
ed  out,  when  abandoned  by  him,  was  prosecuted  by  inferior 
agents  without  success  ;  for  this  was  a  fact  which  every  che¬ 
mical  physician  must  have  been  convinced  of;  that  it  could 
not  be  applied  without  infinite  injury  to  those  who  were  un¬ 
fortunate  enough  to  put  themselves  under  their  care.  Even 
in  the  hands  of  a  Beddoes,  the  consumptive  patients  had 
their  lungs  inflamed  by  the  pneumatic  applications,  which 
were  then  obliged  to  be  suspended,  and  the  effects  of  the 
evil  counteracted  by  the  use  of  opiates.  The  progress  of  the 
disease  was  thus  accelerated,  and  the  slow  and  insidious 
steps  of  it  hurried  on  at  a  rapid  pace. 

In  other  cases,  patients  have  died  apoplectic,  been  seized 
with  giddiness  immediately  after  inhaling  the  supposed  salu- 

p  3 


206 


Medicine. 


tary  fumes,  and  dropped  down  to  the  confusion  of  the  pneu- 
matist,  and  to  the  unexpected  disappointmenf  of  their  friends. 
Hence  it  is  perfectly  clear,  that  nature  intended  that  for  the 
purposes  of  life,  the  gases  should  only  be  inhaled  in  a 
certain  proportion,  as  they  exist  in  atmospheric  air,  that  tilt 
the  function  of  inspiration  is  more  fully  understood,  no 
change  in  the  component  parts  of  this  fluid  can  take  place 
without  serious  injury  .  Nay,  in  almost  all  situations,  it  is 
found  that  the  quantity  of  oxygen  contained  in  atmosphe¬ 
ric  air,  is  much  the  same,  and  that  the  cure  of  diseases 
is  more  connected  with  its  degree  of  temperature,  than  with 
any  change  in  its  constitution.  Hence,  we  consider  pneuma¬ 
tic  medicine  as  a  dangerous  and  bold  innovation,  and  con¬ 
stituting  a  species  of  empiricism  of  a  more  injurious  tend¬ 
ency  than  any  of  the  nostrums  of  the  Patent  Warehouse, 
for  rapid  are  the  strides  from  its  use  to  e(  that  bourne  from 
whence  no  traveller  returns.” 


REGULAR  PRACTICE. 


I.  MEDICINE. 

GENERAL  PRINCIPLE  OF  PATHOLOGY. 

It  is  an  axiom  laid  down,  which  applies  very  generally, 
that  no  two  actions  can  take  place  in  the  same  constitution, 
and  in  the  same  part,  at  one  and  the  same  time.  The  ex¬ 
ceptions  to  this  rule  are  few,  and  on  this  principle  may  be 
said  to  proceed  the  cure  of  the  greater  number  of  diseases. 
The  great  point  is  to  find  out  the  proper  means  of  exciting 
that  action  which  is  to  suspend  or  overcome  the  diseased  one. 
Of  modern  remedies,  mercury  has  gained  a  decided  prefer¬ 
ence;  and  in  fevers  and  inflammations  of  a  chronic  nature, 
whic  «  affect  the  larger  organs,  as  well  as  in  a  variety  of  other 
complaints,  it  is  the  only  one  to  be  trusted  to  ;  but  the  use 


1809. 


Medicine. 


207 


of  this  remedy,  like  every  other  powerful  means,  may  be  car¬ 
ried  too  far.  The  adapting  the  means  to  the  end,  is  the  great 
criterion  of  judgment  in  the  practitioner,  and  the  use  and 
extent  of  any  remedy  is  to  be  regulated  by  this  rule  alone. 
Hence  failure  and  disappointment  will  accompany  the  same 
means  with  one,  which  will  be  attended  with  complete  suc¬ 
cess  in  the  hands  of  another.  The  practice  of  public  institu¬ 
tions  to  an  observer  demonstrates  this  every  day. 

On  the  same  principle  of  producing  a  new  action,  may  be 
explained  the  operation  of  cold  affusion  in  fevers,  by  counter¬ 
acting  the  morbid  one,  in  consequence  of  a  superior  sti¬ 
mulus.  and  also  of  emetics ,  which,  independent  of  the 
mere  evacuation,  exert  a  powerful  and  extensive  influence  on 
the  system;  suspending  the  morbid  action,  and  opening, 
particularly  from  this  extensive  influence,  the  excretion  by 
the  skin. 

The  effect  of  large  blood-letting  must  proceed  on  a  similar 
ground,  by  the  sudden  depletion  giving  a  suspension  to  the 
violence  of  the  morbid  excitement.  Hence  copious  bleed¬ 
ing,  and  suddenly  drawn  by  a  large  orifice,  are  the  points 
to  ensure  its  success  in  acute  diseases. 

VACCINATION. 

The  triumph  of  Vaccination  is  much  completed  since  our 
last  number  by  the  munificent  establishment  of  a  National 
Institution,  under  the  direction  of  the  two  Medical  Colleges 
of  the  Metropolis.  The  doubts  which  at  present  agitate 
the  public  mind,  it  is  to  be  hoped,  will  be  thus  entirely 
removed.  But  these  doubts,  which  preclude  the  general 
reception  of  this  discovery  in  Britain,  seem  not  to  have 
extended  their  influence  to  remoter  regions.  In  a  former 
number  we  stated  the  progress  of  vaccination  in  Ceylon,  in 
1802,  from  the  report  of  Mr.  Christie,  chief  medical  super- 
intendant  of  that  settlement.  A  report  is  now  published  by 
the  same  gentleman  for  1807,  in  the  official  Gazette  of  that 
government,  which  we  here  insert.  It  is  an  Abstract,”  he 

p  4 


SOS 


Medicine . 


[March, 


remarks,  u  of  the  number  of  persons  vaccinated  in  Ceylon  in 
1807 ;  which  will  shew  the  successful  progress  we  have 
made  in  disseminating  the  practice  of  vaccination,  through¬ 
out  the  island,  during  last  year. 

“The  number  inoculated  has  been  considerably  greater 
than  in  any  former  year,  particularly  amongst  the  Malabar 
inhabitants  of  the  Trlncomallie  and  Jatfna  districts*  who,  in 
the  first  instance,  seemed  less  disposed  to  adopt  the  prac¬ 
tice  than  the  Cingalese,  in  the  southwest  part  of  the 
island ;  but  a  conviction  of  the  perfect  innocence  of  vacci¬ 
nation,  and  its  preventive  influence  against  small-pox,  is  now 
very  general  amongst  all  ranks  throughout  the  British  pos¬ 
sessions  on  Ceylon,  though  from  the  unfrequent  occurrence 
of  small-pox,  the  natives,  in  many  places,  shew  more  indif¬ 
ference  and  apathy  about  shielding  themselves  from  that  ma¬ 
lady. 

<c  We  do  not,  however,  find  any  difficulty  in  keeping  up 
the  disease  at  the  respective  stations,  but  the  vaccinators  are 
now  frequently  obliged  to  visit  the  different  villages,  and  urge 
the  inhabitants  to  avail  themselves  of  the  benefits  of  inocula¬ 
tion;  whereas,  on  the  first  introduction  of  the  Cow-pox  in 
1802,  when  the  Small-pox  raged  at  Colombo,  the  natives  of 
their  own  accord  flocked  in  crowds  to  the  inoculators,  and 
expressed  the  greatest  anxiety  to  be  immediately  vaccinated* 

u  The  small-pox  was  prevalent  at  Trincomallie  in  January 
last,  and  from  thence  found  its  way  to  Jaffna,  but  has  since 
been  banished  from  both  places,  by  the  beneficial  influence 
of  Vaccination,  which  has  been  very  extensively  practised 
in  these  districts  during  the  last  year.  The  very  successful 
propagation  of  the  disease  at  these  places  may,  I  think,  be 
attributed  to  the  alarm  created  by  the  appearance  of  small¬ 
pox,  conjoined  with  the  beneficial  effects  of  a  Government 
Advertisement  on  the  subject,  circulated  in  the  Malabar  lan* 
guage,  to  which  must  be  added,  the  extreme  assiduity  of  the 
Collectors,  in  promoting  with  their  influence  a  diffusion  of 
the  practice,  and  the  very  meritorious  exertions  of  the  Medi- 


1809,]  Medicine .  209 

caiSuperintendants  and  Vaccinators  in  the  discharge  of  their 
duty. 

a  Previous  to  the  introduction  of  cow-pox  in  1802,  the 
small-pox  scarcely  ever  failed  to  visit  us  at  Colombo  during 
the  prevalence  of  the  southwest  monsoons,  when  the  port  was 
open,  and  generally  carried  off  a  great  proportion  of  the  in¬ 
habitants,  but  of  late  we  have  comparatively  suffered  very 
little  from  that  disease;  It  is  true,  that  since  May  1805,  we 
have  had  occasional  cases  of  small-pox  in  the  Pettah  of  this 
place,  which,  in  some  instances,  there  is  reason  to  believe, 
was  introduced  from  the  Candian  Country ;  but  the  conta- 
gion  never  spread  as  formerly,  and  is  at  present  extinct,  not 
only  in  the  Colombo  district,  but  throughout  the  whole  of 
the  British  possessions  on  Ceylon,  agreeably  to  the  most 
certain  information  I  have  been  enabled  to  procure,  from  the 
respective  Vaccinators,  who  are  directed  to  report  on  this 
subject. 

Ce  From  a  Review  of  the  Registers  of  Vaccination,  I  find 
that  the  total  number  of  patients  reported  to  me  as  having  re- 
gularly  passed  through  the  disease,  up  to  the  end  of  1806,— 
was  54,958,  which,  with  21,270,  included  in  the  Abstract 
for  last  year,  will  make  a  total  of  76,828  persons  ;  a  large 
proportion  of  the  limited  population  of  these  settlements. 

ce  It  would  be  absurd  to  expect  that  in  such  an  extended 
practice,  often  conducted  by  persons  not  regularly  educated 
to  the  profession  of  medicine,  some  failures  and  mistakes 
may  not  have  taken  place  ;  but  I  can  with  truth  affirm,  that 
in  the  neighbourhood  of  Colombo,  where  small- pox  has  most 
frequently  occurred,  I  have  been  at  great  pains  to  trace  to 
its  source,  any  report  prejudicial  to  vaccination,  and  to  in¬ 
vestigate  the  circumstances  of  every  case  of  supposed  fail¬ 
ure  ;  and  in  no  one  instance  have  I  found  that  a  person  who 
had  been  vaccinated,  and  declared  secure  by  the  Inoculator, 
ever  afterwards  had  small -pox. 

Cc  In  a  former  letter  I  had  occasion  to  mention,  for  the  in¬ 
formation  of  your  Medical  readers,  the  Vaccine  disease  hav- 


Medicine. 


510 


j 'March, 


ingbeen  communicated  to  a  boy  affected  with  leprosy  ;  and 
from  a  melancholy  instance  which  has  since  occurred,  it  is 
certain  that  persons  affected  with  that  disease,  in  the  most 
malignant  form,  are  not  exempt  from  the  contagion  of  small¬ 
pox. 

a  Clara  de  Silva,  a  woman,  aged  about  50  years,  who 
had  been  confined  in  the  Lepers  Hospital  since  May  1775, 
with  leprosy  in  the  worst  form,  having  been  exposed  to  vari¬ 
olous  contagion,  sickened  about  the  1st  of  August,  ISO  6,  and 
died  on  the  1 1th  of  that  month,  with  confluent  small-pox. — 
On  the  appearance  of  Small-pox  in  the  neighbourhood  of 
the  Lepers  Hospital  in  May,  1806,  vaccination  was  prac¬ 
tised  amongst  the  patients  of  that  Institution,  but  this  old  wo¬ 
man  declared,  she  had  had  the  small-pox  when  a  child,  and 
refused  to  be  inoculated. 


The  fact  may  be  useful,  by  shewing  that  no  disease  of 
the  skin,  however  virulent,  gives  perfect  security  against 
small-pox  ;  and  that  in  the  event  of  an  epidemic  contagion, 
no  consideration  of  that  nature  ought  to  prevent  us  from  at¬ 
tempting  to  shield  the  constitution  against  its  influence,  by 
vaccination. 


Abstract  of  the  Number  of  Patients  inoculated  in  the  dif¬ 
ferent  Districts  on  Ceylon ,  during  the  Year  1807. 
Superintendants. 


A.  High,  Esq. 


J.  A.  Stutzer,  Esq. 


J.  Bath,  Esq. 

J.  Adams,  Esq. 
and 

Reynolds,  Esq. 


Districts. 

Vaccinators,  a 

'No. 

(  Caltura 

F.W.  DeHoedt 

2684 

?  Col  umbo 

J  Negombo 
j  Chelaw 

H .  W.Sckimmelkettle 

1610 

M.  Mack 

1153 

J.  H.  Vansauden 

240 

I  Calpentio 
LPutlam 

B.  H.  Toussaint 

799 

J.  L.  Janzen 

860 

C  Manar 

H.  Mattheis 

1364 

<  Jaffna 

J.  C.  Keegel 

6083 

(  Mullativo 

J.  C.  De  lloedt 

247 

C  Trincomalie 

y  Batticaloe 

$  N.  Claasz,  & 

1  F.  Van  Sanden 

J.  W.  Seyp 

2016 

1070 

£  Hanbantotte 

C.  Hopman 

236 

y  Tangalle 

C.  Hersse 

1556 

j  Matura 

J.  W.  Pietersa 

1277 

(  Gallc 

J.  Scy brands 

675 

1809.] 


Medicine. 


211 


HYDROPHOBIA. 

Hydrophobia  still  continues  the  dreaded  subject  of  the 
day,  and  prevention  seems  very  properly  to  engage  medical 
investigation  as  much  as  its  actual  cure.  <c  As  a  means  of 
prevention,”  Dr.  Wood  of  Newcastle  observes,  <c  the  me" 
thod  of  dilution,  pointed  out  by  Dr.  Haygarth,  deserves  our 
first  attention ;  he  recommends  to  wipe  the  wound  with  a  dry 
cloth,  so  as  to  absorb  all  moisture,  then  abundantly,  and  with 
the  most  persevering  attention,  to  wash  the  part  with  water 
quite  cold  for  several  hours.  After  this,  warm  water  is  to  be 
used,  to  produce  a  flow  of  blood,  which  is  to  be  poured  from 

j * 

the  spout  of  a  tea-kettle  held  up  at  a  considerable  distance. 
The  ablution  should  be  accomplished  with  great  diligence* 
and  without  delay.  In  a  bad  wound  with  much  laceration, 
to  this  ablution,  cupping  and  syringing  are  to  be  added  ;  and 
in  addition  to  this,  it  has  been  proposed  that  the  wound 
should  be  enlarged,  and  even  excision  of  the  lacerated  parts, 
when  circumstances  will  admit  of  it.  Dr.  Percival  has  pro¬ 
posed,  as  a  farther  security,  jthat  the  parts  after  ablution  may 
be  washed  with  the  gastric  liquor  of  an  animal  recently  killed, 
or  with  the  juice  of  rennet ;  next  to  ablution,  the  beeping  up 
a  free  discharge  from  the  wound  for  a  great  length  of  time, 
seems  to  he  of  the  greatest  importance .  This  may  be  effect¬ 
ed  by  repeated  blistering,  or  by  escharotics.  It  may  here  be 
remarked,  that  all  trials  to  arrest  the  poison  by  means  of 
caustics,  gunpowder,  and  the  like,  have  invariably  failed ; 
but  after  ablution  their  use  to  keep  the  wound  open  may  be  of 
service.  Ligatures  above  and  below  the  wounded  part, 
where  they  can  be  applied,  have  been  recommended  during 
the  ablution,  by  Dr.  Percival.  Apparently,  simple  means 
produce  very  salutary  effects  ;  perhaps,  after  the  ablution 
recommended  by  Dr.  Haygarth,  the  pouring  of  warm  cow’s 
milk  from  a  tea-kettle  in  the  same  manner  upon  the  wound 
may  be  of  use ;  we  know  that  milk  has  the  power  of  counter¬ 
acting  the  effects  of  some  poisons  received  into  the  stomach. 


212 


Medicine . 


[March, 


Such  arc  the  means  of  prevention  most  likely  to  succeed :  we 
now  come  to  the  treatment  of  the  disease  when  such  have 
not  been  used,  or  shall  unfortunately  fail.  And  here  I  may 
observe,  that  I  was  of  late  more  immediately  led  to  the  consi¬ 
deration  of  the  cure  of  this  disease  by  seeing  Dr.  Arnold’s 
very  interesting  case  of  Hannah  Springthorpe,  which  was 
treated  by  stimulants  and  antispasmodics,  and  terminated 
favourably.  From  this  case  and  some  others,  it  appears  that 
our  reliance  ought  to  be  entirely  on  such  remedies,  when  the 
symptoms  of  the  disease  appear.  Opium,  musk,  cuprum 
ammoniacum,  calcined  zinc,  with  the  cold  bath,  have  been 
particularly  named  as  most  adapted  to  the  disease.  Doctor 
Percival  thinks  that  the  digitalis,  from  its  quick  action  and 
sedative  powers,  seems  to  promise  to  be  of  service  in  this  dis¬ 
ease.  Dr.  Shadwell’s  case  of  John  Cumbus,  a  drover,  seems 
to  shew,  that  the  internal  and  external  use  of  oil  is  of  consi¬ 
derable  service  in  allaying  the  irritability  and  spasms.  From 
our  knowledge  of  its  component  parts,  it  promises  to  be  useful 
to  answer  this  indication  ;  but  instead  of  frictions,  perhaps  a 
requent  immersion  of  the  whole  body  in  oil  of  a  temperature 
a  little  above  that  of  the  body,  might  be  more  efficacious. 
The  warm  bath  has  always  given  momentary  relief,  which  I 
attribute  to  the  stimulus  of  heat ;  but  the  effect  of  this  stimu¬ 
lus,  applied  through  the  medium  of  water,  may  not  be  so 
permanent  as  when  applied  through  the  medium  of  oil ;  be¬ 
sides  the  oil  itself  may  act  as  a  stimulant,  and  its  effects  may 
be  also  permanent*  The  internal  use  of  oil  should  also  be 
had  recourse  to  ;  and  when  its  use  in  this  way  is  prevented 
by  the  spasmodic  affection  of  the  muscles  of  deglutition, 
perhaps  it  may  be  conveyed  into  the  stomach  by  the  same 
means  as  have  been  recommended  for  throwing  food  into  the 
stomach  in  a  paralysis  of  those  muscles. 

The  benefit  experienced  from  the  use  of  the  spirit  of 
caustic  volatile  alkali,  in  preventing  the  bad  effects  of  the  bite 
of  a  species  of  viper,  induces  Dr.  Bardsley  to  think,  that  this 


Medicine. 


*13 


IS09.] 


medicine  may  be  of  use  in  this  disease.  We  cannot  have  too 
large  a  magazine  of  powerful  stimulants  to  resort  to  in  such  a 
stateof  the  body,  as  a  succession  is  required  in  a  rapid  manner 
to  produce  any  sensible  effect  in  so  short  a  period  as  commonly 
is  allowed  for  their  action;  perhaps  the  Peruvian  balsam 
may  be  no  trifling  vehicle  for  the  volatile  alkali .  Opium, 
that  anchor  of  all  our  hopes  in  many  diseases,  is  to  be  chiefly 
depended  on  in  this  disease.  The  late  Mr.  Hill  used  to  give 
it  with  his  medicine ;  but  as  a  preventive,  it  cannot  be  of  any 
use.  I  remember  that  Dr.  Black,  in  his  lectures,  always  men¬ 
tioned  his  suspicion  of  arsenic  forming  a  part  of  Mr.  H.’s  reme¬ 
dies.  Fromthe  powerful  tonic  effect  of  the  mineral  solution ,  it 
appears  adapted  to  every  indication  in  the  cure  of  convulsions ; 
I  have  stopped  long  established  epileptic  paroxysms  by  its 
powers.  It  has  not  been  mentioned  by  any  author  I  have 
read  on  this  disease. 

6C  To  all  the  means  of  cure  in  Hydrophobia  may  be  added 
topical  applications  to  the,  throat,  which  in  one  instance,  i* 
seems,  was  of  the  greatest  use.” 

This  case  occurred  to  the  late  Dr.  William  Turnbull,  phy¬ 
sician  to  the  Eastern  Dispensary ;  and  the  particulars  of  it  are 
w  orthy  of  narrating  here. 

iC  Robert  Dixon,  a  weaver,  of  Norham  Mains,  near  Ber¬ 
wick,  was  bitten  on  the  leg  by  a  mad  dog,  30th  July,  1761. 
The  symptoms  of  Hydrophobia  soon  appeared  ;  pain  gradu¬ 
ally  ascended  from  the  wound  to  the  knee,  thigh,  stomach, 
with  sickness  and  oppression  at  the  breast.  These  sensations 
daily  increased,  and  were  followed  by  convulsions  and  stric¬ 
tures  in  the  throat,  which  threatened  suffocation,  particularly 
when  water  was  presented  to  him.  To  the  wounded  part  a 
caustic  was  applied,  and  it  was  kept  open  by  blistering,  and 
stimulating  ointment,  from  thejirsty  until  some  time  after  all 
the  symptoms  were  entirely  gone.  The  leg  was  often  bathed 
with  warm  oil.  A  tea-spoonful  of  a  tonic  electuary  was 
given  four  times  a-day,  consisting  of  bark,  valerian,  musk. 


*14 


Medicine. 


[  March  $ 

and  camphor  ;  opium  was  also  given  in  large  doses,  to  assuage 
the  irritation  and  spasms.  To  the  throat  was  applied  a 
plaister,  consisting  of  opium,  frankincense,  camphor,  asafoe- 
tida,  and  gum  galbanum.  The  man,  after  his  recovery,  de¬ 
clared  that  he  felt  more  relief  from  the  plaister  than  any  other 
thing  :  he  said  that  it  gave  a  pleasant  warmth  to  his  throat, 
and  from  thence  its  effects  followed  in  the  same  direction  to 
the  wound  as  the  pain  had  ascended  from  it.” 

CUTANEOUS  DISEASES 

Are  a  numerous  and  obscure  class,  with  the  different  species 
and  varying  appearances  of  which  we  are  not  fully  acquainted. 
A  species  of  porrigo  affecting  the  scalp,  in  the  form  of  red 
circular  patches,  is  thus  described  by  Mr.  White  of  Bath. 

u  The  disorder  is  an  eruption  which  affects  the  heads  of 
children,  particularly  in  boarding-schools ;  and  from  its  cir~ 
cular  figure,  and  spreading  nature,  it  has  generally,  though 
not  with  strict  propriety,  obtained  the  name  of  ring- worm, 
since  that  disease  is  usually  vesicular,  appears  on  different 
parts  of  the  body,  and  is  not  contagious ;  but  the  disease  I 
mean  to  describe,  chiefly  affects  the  head,  arid  is  often  com¬ 
municated  to  the  hands  and  arms  of  parents,  or  other  person^ 
who  have  had  the  care  of  children  labouring  under  the  com¬ 
plaint. 

“  The  disease  commences  with  a  small,  red,  circular 
patch,  and  slight  elevation  of  the  cuticle,  on  different  parts 
of  the  head,  attended  with  itching.  As  the  patch  expands, 
the  centre  of  it  gradually  assumes  the  natural  colour  of  the 
skin,  still  however  remaining  scaly.  A  red  circular  line  at 
the  circumference  of  the  patch,  marks  the  termination  of  dis¬ 
eased  action ;  and  as  long  as  that  red  line  remains,  the  disorder 
, continues  to  spread,  and  the  hair  falls  off ;  which  circumstance 
commonly  leads  to  the  discovery  of  the  complaint.  Some¬ 
times  small  papulae,  or  very  minute  pustules  appear  in  the 
vicinity  of  the  patches.  This  species  of  scaly  eruption,  for 
the  most  part,  proves  very  obstinate,  sometimes  continuing 


Medicine. 


215 


1809.] 


several  months;  and  even  after  it  appears  checked  from 
spreading,  it  is  a  long  time  before  the  scaiiness  is  removed, 
and  the  cuticle  assumes  its  natural  appearance  again.  It  is 
not  attended  with  any  constitutional  affection,  but  sometimes 
children  are  observed  to  look  rather  paler  than  usual.  The 
disorder  is  evidently  contagious,  because  it  is  speedily  com¬ 
municated  to  children  who  happen  to  use  the  same  comb,  hat, 
&c.  belonging  to  those  who  are  affected  with  if.  Whether  it 
be  communicable  merely  from  sleeping  together,  I  cannot  as¬ 
certain  ;  but  from  the  inquiries  which  I  have  made  respecting 
it,  I  am  inclined  to  think  it  is  not. 

<c  Notwithstanding  the  disorder  is,  at  first,  somewhat  dif¬ 
ferent  from  the  porrigo,  yet  if  through  neglect  the  scales  be 
permitted  to  accumulate  to  a  considerable  thickness,  pus¬ 
tules  and  a  scab  will  at  length  be  formed.  I  have  at  present 
under  my  care,  a  case^of  porrigo,  accompanied  with  small 
circular  patches  of  scales  on  different  parts  of  the  body. 
These  entirely  disappeared  on  the  administration  of  the  mi¬ 
neral  solution ;  but  this  medicine  has  not  materially  benefited 
the  head,  for  though  the  scabs  are  removed,  the  cuticle  re¬ 
mains  red  and  scaly. 

a  Although  this  species  of  porrigo  above  described  may 
appear  of  a  trifling  nature,  yet  I  never  met  with  any  cutane¬ 
ous  complaint  more  perplexing,  and  which  proves  a  greater 
source  of  uneasiness  to  parents,  and  particularly  to  persons 
who  have  the  care  of  youth,  as  it  spreads  with  great  rapidity 
when  it  makes  its  appearance  in  schools,  and  is  very  difficult 
to  manage.  With  regard  to  the  mode  of  treatment,  a  variety  of 
applications  have  been  used,  and  frequently  to  very  little  pur¬ 
pose;  for,  however  carefully  the  scales  are  washed  off,  they 
very  soon  appeared  again.  Mercury  in  different  forms, 
nitric  acid,  solutions  of  zinc,  and  of  arsenic,  &c,  &c.  have 
been  alternately  tried.  In  some  cases,  I  have  known  an  alka¬ 
line  lotion,  in  the  form  of  the  lotio  saponacea  of  the  old  Edin¬ 
burgh  Dispensatory,  succeed  better  than  any  other  appli- 


916 


Medicine . 


[March, 


cation.  I  do  not  know  that  internal  medicines  are  of  any  ser¬ 
vice,  but  sometimes  I  have  given  small  doses  of  calomel  com¬ 
bined  with  iiatron.  Unless  the  disease  be  very  slight,  the 
head  is  always  shaved,  and  the  shaving  repeated  once  a  week 
as  long  as  it  appears  necessary.  In  order  to  prevent  its  spread¬ 
ing,  each  child  is  directed  to  have  a  separate  comb,  towel, 
£cc.  and  they  are  likewise  strictly  prohibited  from  wearing 
each  others  hats,  caps,  &c.  ” 


LETTER,  OF  DR.  J.  ARCHER,  TO  THE  HONOURABLE  SA¬ 
MUEL  MITCHELL  ON  VACCINATION  AS  A  REMEDY  IN 
HOOPING-COUGH . 

Harford  County ,  Maryland ,  Nov.  15, 1808. 
Dear  Sir — You  may  recollect  that  about  three  or  four 
years  ago,  I  mentioned  to  you  my  opinion,  that  vaccination 
would  cure  the  tujfis  conzulsiva  ;  that  I  had  made  one  expe¬ 
riment;  and  that  it  succeeded  fully  to  my  expectations.  I 
mentioned  the  case  to  several  physicians,  and  requested  the 
making  a  trial  of  its  effects  when  they  should  have  any  pa¬ 
tients  with  hooping  cough.  The  beneficial  effects  of  vacci¬ 
nation  above-mentioned  determined  me,  in  every  instancethat 
occurred  of  the  hooping-cough,  to  vaccinate.  I  therefore 
have  vaccinated  six  or  seven  patients  who  had  the  hooping- 
cough,  and  in  every  case,  it  has  succeeded  in  curing  this  most 
distressing  disease. 

The  hooping-cough  does  not  come  to  its  height  in  less 
than  six  w  eeks  from  its  commencement,  and  then,  when  a 
favourable  termination  is  expected,  the  declension  of  the  dis¬ 
ease  is  gradual;  and  does  not  terminate  in  less  than  six  weeks 
more.  To  arrest  this  afflicting  disorder  in  its  progress,  I 
would  recommend  vaccination  in  the  second  or  third  week  of 
the  hooping-cough ;  that  is,  when  the  symptoms  of  the 
hooping-cough  are  fully  ascertained,  then  to  vaccinate. 
Should  the  convulsive  cough  be  violent,  I  would  immediately 
vaccinate,  being  well  assured  that  the  distressing  symptoms 


Medicine . 


217 


1 809. 3 


of  the  hooping  cough  are  checked  by  the  vaccine  disease. 
The  termination  of  the  vaccine  disease  will  be  the  termination 
of  the  hooping  cough :  that  is,  as  soon  as  the  vaccinated 
part  loses  the  efflorescence,  and  the  scab  begins  to  dry,  and 
becomes  of  a  blackish  or  brownish  colour ,  there  will  then  be 
an  evident  change  in  the  hooping-cough  for  the  better,  and 
the  severe  symptoms  will  cease. 

iC  Thus  two  of  the  formidable  distempers,  to  which  the 
human  race  is  liable,  are  arrested,  the  small-pox  and  hoop¬ 
ing  cough ;  the  former  prevented  and  the  latter  cured. 

“  I  am,  with  respect  and  esteem, 

u  Your  fellow  citizen, 

“  JOHN  ARCHER.” 


CASE  OF  HYDROPHOBIA,  BY  DR.  NISBET,  AND  MR.  MORRIS, 

MEMBER  OF  THE  ROYAL  COLLEGE  OF  SURGEONS,  LONDON. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen— hs  a  disease  of  late  so  frequent  in  its  occur¬ 
rence,  and  so  ineffectual  in  its  treatment,  every  thing  that 
can  add  to  our  acquaintance  with  its  history  is  certainly 
worthy  of  attention ;  and  in  that  view  the  following  case  is 
requested  to  be  inserted  in  your  useful  work,  as  affording  a 
mite  to  the  histories  already  given  by  so  many  eminent  prac¬ 
titioners  on  tills  obscure  and  interestingsubject. 

Isidore  Le  Mercier,  a  Frenchman,  aged  25,  residing  in 
Bedfordbury,  was  by  accident,  in  the  month  of  August  last, 
attacked  furiously  by  a  dog  in  the  neighbourhood  of  Totten* 
ham-court-road.  The  animal  bit  the  forefinger  of  the  left 
hand,  and  likewise  the  wrist.  In  the  height  of  his  resent¬ 
ment,  and  to  prevent  the  enraged  animal  from  injuring  him 
farther,  he  grasped  the  dog  forcibly  by  the  throat,  till  he 
strangled  him.  The  wounds  he  had  received  were  super¬ 
ficial.  They  healed  up  in  a  day  or  two,  and  he  thought 
no  more  of  the  matter  ;  so  that  the  influence  or  impression 
on  the  mind  was  no  way  concerned  in  the  production 

VOL,  II.  Q 


218  Medicine .  [  March  , 

of  the  futii re  symptoms ;  a  circumstance  sq  much  dwelt 
upon  by  the  opposers  of  the  specific  nature  of  this  dis¬ 
ease.  In  the  month  of  January  last,  five  months  from  the 
time  of  the  accident,  he  was  seized  with  appearances  resem¬ 
bling  a  common  cold.  The  symptom  he  chiefly  complained 
of  was  an  inability  of  swallowing,  or  the  feeling  of  some¬ 
thing  as  if  choaking  him  when  he  attempted  to  get  any 
thing  down.  These  symptoms  continued,  for  two  days, 
before  they  assumed  the  last  and  aggravated  form  of  the  dis¬ 
ease.  On  Sunday  morning  about  four  o’clock,  slight  convul¬ 
sions  and  spasms  of  the  chest  first  attacked  him.  Their  fre¬ 
quent  repetition  alarmed  him,  and  about  eight  o’clock  the 
next  morning,  Dr.  Nisbet  was  desired  to  see  him  by  a 
friend,  who  seemed  rather  to  make  light  of  the  alarm  which 
the  unhappy  man  felt  for  his  situation.  On  seeing  him,  I 
was  particularly  struck,  though  I  had  never  witnessed  the  dis¬ 
ease  before,  with  the  peculiar  wild  anxious  look  which  the 
patient’s  countenance  depicted — it  was  an  expression  of  hor¬ 
ror  and  dread  of  his  situation,  which  I  can  faintly  describe, 
and  which,  I  immediately  decided,  could  not  be  connected 
■with  a  common  case  of  spasm.  The  fondness  for  life  was 
expressed  with  the  most  anxious  and  restless  solicitude  for 
his  recovery,  and  with  the  seeming  dread  observed  to  receive 
an  unfavourable  opinion.  Every  part  of  his  behaviour, 
which  was  most  restless  and  unsettled,  shewed  a  marked  and 
uncommon  suspicion  of  every  person  around  him.  The 
opening  of  the  chamber,  the  smallest  movement  in  the  room, 
gave  the  most  unspeakable  distress.  At  this  time  I  desired 
him  to  take  a  draught  which  stood  by  his  bed-side,  and  which 
Mr.  Morris  had  sent.  On  presenting  it  in  a  cup,  I  was  asto¬ 
nished  he  could  not  bear  it  to  come  near  him.  Somithinff,  he 
said,  choaked  him,  and  he  begged  I  would  take  it  away. 
My  opinion  of  the  case  was  now  settled  ;  and  as  soon  as  I  had 
an  opportunity  of  meeting  Mr.  Morris,  I  stated  my  conviction 
of  the  disease,  in  which  he  readily  acquiesced,  and  the  usual 


Medicine . 


219 


1809.] 


plan  of  opiates  in  liberal  closes,  as  a  mere  palliation  of  symp¬ 
toms,  was  resorted  to,  not  seeing,  indeed,  what  else  could  be 
done.  Particular  engagements  prevented  me  from  again 
visiting  the  patient  that  day,  and  next  morning,  about  eight 
o’clock,  I  was  sent  for  along  with  Mr.  Morris;  but  by  the 
time  we  had  arrived,  the  unhappy  patient  had  breathed  his 
last.  On  inquiring  into  the  subsequent  progress  of  the  dis¬ 
ease,  we  were  informed  that  the  whole  of  the  previous  night 
the  convulsions  had  been  most  violent,  and  repeated  almost 
every  five  minutes,  requiring  no  less  than  five  persons  to 
command  him,  that  the  patient  continued  sensible  during  the 
intervals,  and  lost  none  of  his  recollection  till  within  two 
hours  of  his  dissolution.  At  one  time  he  expressed  himself 
with  the  greatest  anxiety  for  life ;  at  other  times  he  seemed  to 
fall  into  a  state  of  despondency;  but  during  the  whole  of  hia 
illness  he  never  breathed  a  hint  of  the  cause  of  his  malady,  or 
that  he  had  been  accidentally  bitten.  It  was  only  from  the 
persons  in  the  house  that  wedearned,  after  his  death,  the 
particulars  of  it.  Permission  was  not  given  to  examine 
the  body,  which  is  to  be  regretted. 

I  had  never,  in  a  long  experience  of  medical  practice,  seen 
a  case  of  hydrophobia  before;  and  the  symptoms  therefore  in 
this  case  made  a  greater  impression  on  my  mind. 

After  the  very  accurate  histories  given  to  the  public  by 
Dr.  Powel,  Dr.  Pinckard,  and  others,  I  could  have  no  hesita¬ 
tion  in  deciding  what  it  was;  and  I  think  no  person,  who 
once  sees  such  a  case,  can  ever  be  mistaken  in  it. 

The  strong  pathognomic  symptoms  are  a  wild  anxiety 
depicted  iti  every  feature  of  the  countenance ;  a  perpetual 
increasing  restlessness  and  agitation ;  a  peculiar  suspicion 
and  dread  displayed  by  the  patient  respecting  every  thing 
about  him,  as  well  as  of  his  attendants. 

The  opening  or  shutting  of  the  door  alarms  him ; 
every  new  face  creates  distrust  and  dismay.  His  feelings 
^re  rankled  even  by  a  breath  of  air  blowing  upon  him ; 


m 


Medicine . 


[March, 


and  such  was  the  unhappy  state  of  the  patient  I  describe, 
that  he  caused  even  the  windows  of  the  room  to  be  closed  up 
lest  the  air  should  touch  him.  The  horror  of  liquids  is  there? 
fore  but  one  circumstance.  The  same  horror  pervades  every 
thing  that  makes  an  impression  in  this  state  of  general  and 
local  morbid  irritability,  and  especially  in  regard  to  those 
things  which  require  an  action  of  the  organs  of  deglutition. 
From  what  I  have  seen,  then,  I  am  ready  to  conclude  that  this 
disease  of  hydrophobia  not  only  exists,  but  is  peculiar  in  its 
character ,  specific  in  its  cause ,  and  requiring  on  this  account 
a  treatment  equally  specific,  if  we  can  once  acquire  a  know- 
ledge  of  it.  The  line  is  pointed  out  by  the  interference  of  the 
legislature,  and  it  is  to  be  hoped,  for  the  sake  of  suffering 
humanity,  it  may  be  an  opening  to  the  necessary  discoveries. 

If  the  above  can  lead  to  any  farther  information  on  the 
history  of  this  obscure  disease,  my  object  is  attained. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

London ,  Feb.  10,  1809.  WM.  NISBET. 

MEDICAL  REFORM,  EDINBURGH. 

From  a  correspondent  at  Edinburgh  we  learn  with  regret, 
some  dissentions  exist  among  the  Professors  and  the  Students ; 
in  consequence  of  the  former  having  doubled  the  graduation 
fees.  Respecting  the  propriety  of  this  measure,  it  does  not 
fall  to  our  province  to  applaud  or  censure  ;  but  as  we  are  on 
the  subject,  we  shall  with  due  deference  express  our  ideas  on 
the  points  at  issue.  As  friends  to  liberal  science,  we  confess, 
without  some  very  cogent  reasons  are  assigned  for  this  aug¬ 
mentation  of  fees,  we  are  inimical  to  the  measure  :  inasmuch 
as  we  conceive  these  superior  tribunals  are  not  erected  for  pri¬ 
vate  advantage  but  public  good  ;  and  where  an  individual  is 
found  worthy  of  the  academic  honours,  that  honour  wewould 
have  conferred  gratuitously  :  the  resident  student  most  assu¬ 
redly  should  not  be  too  much  oppressed  ;  in  his  favour  the 
fees  ought  to  be  moderate ;  as  one  of  the  children  of  the 


Medicine » 


1809,] 


221 


Alma-Mater,  some  distinction  ought  to  be  shewn  him,  other¬ 
wise  you  place  him  on  the  level  with  the  Empiric,  and  de¬ 
grade  the  medical  character  :  many  a  scientific  genius  will 
be  prevented  entering  the  medical  profession,  if  they  are  thus 
to  be  fettered  with  unnecessary  fees.  Zealous  as  we  are  for 
the  rights  of  corporated  bodies,  we  conceive  in  this  instance 
they  exercise  a  power  to  which  no  legitimate  claim  is  at¬ 
tached,  and  think  the  fair  principles  of  equity  somewhat 
distorted.  The  period  is  not  long  passed,  since  the  expenses 
of  a  Medical  Education  at  Edinburgh  were  by  no  means 
high  ;  three  guineas  a  session  to  each  professor  was  the  fee, 
three  guineas  to  the  infirmary,  and  three  more  to  the  clinical 
lectures.  That  universities  should  be  tenacious  of  their 
academic  honours  no  one  will  doubt,  and  it  is  with  pleasure 
we  announce  from  our  own  knowledge,  that  the  principals  of 
the  Scotch  college  have  come  to  a  resolution  not  to  grant 
diplomas  to  any  one  who  has  not  had  a  classical  medical 
education.  Sir  A.  Bannerman  in  this  has  particularly  distin¬ 
guished  himself,  and  merits  the  applause  of  the  medical 
world:  this  will  shut  the  door  upon  the  Empiric;  for  the 
privileges  of  a  diploma  once  granted,  are  unrestricted,  the 
exercise  of  the  right  of  that  diploma  being  secured  by  repeat¬ 
ed  acts  of  parliaments,  and  which  the  union  of  Scotland  and 
Ireland  secured  to  each  kingdom. 

We  now  give  our  correspondent’s  letter,  and  trust  their 
$chism  will  be  succeeded  by  a  perfect  harmony. 

<e  University  of  Edinburgh,  Feb.  12,  1809. 

6C  Gentlemen — 1  take  the  liberty  through  the  medium  of 
your  Spectator  of  making  a  few  observations  on  the  profess¬ 
ors  of  this  university,  more  particularly,  with  regard  to  a 
jaw  lately  passed  by  them  doubling  the  fee  for  graduation. 
I  will  not  at  present  take  up  your  time,  in  considering  the 
propriety  of  large  sums  being  given  to  the  professors  by 
students  who  have  already  paid  them  dearly  for  the  know¬ 
ledge  they  have  acquired,  in  order  to  obtain  this  teslimo* 

Q  3 


222 


M edicinc. 


\  Marc 

nial  of  their  abilities.  It  must  be  evident  to  every  one  that  no 
more  at  least  ought  to  be  given  than  will  compensate  for  their 
trouble,  and  for  this  the  former  fee,  even  by  the  professors 
themselves,  is  not  said  to  have  been  insufficient ;  indeed  it  is 
hardly  possible  to  conceive  that  men  receiving  1000  and 
1200  guineas  for  a  quarter’s  course  of  lectures  could  complain. 
Still,  however,  they  have  for  some  years  wished  that  their 
income  should  be  greater,  and  this  they  think  they  have 
accomplished  by  doubling  the  graduation  fee, 

(C  It  is  curious  to  observe  on  what  grounds  they  have  done 
this ;  they  are  ashamed  to  confess  their  avarice ;  they  know 
they  could  not  complain  of  insufficient  remuneration  for  their 
trouble,  but  they  wished  to  pass  it  off  on  the  plea  of  increas¬ 
ing  the  respectability  of  the  profession.  Let  us  see  then  the 
conduct  of  these  very  men  on  another  occasion; 

<e  In  February,  1807,  the  Royal  College  of  Physicians,  of 
which  the  professors  of  the  University  are  Editors,  Censors, 
&e.  &c.  relumed  an  answer  to  Dr.  Harrison’s  letter  con¬ 
cerning  the  Medical  Reform,  from  which  I  extract  the  fol¬ 
lowing — 

6  Whatever  regulation  be  enacted,  they  are  of  opinion, 
that  these  should  have  chiefly  in  view  the  benefit  of  the  com¬ 
munity  at  large  and  not  merely  the  emolument  or  respecta¬ 
bility  of  the  Medical  Profession. 

6  It  appears  to  them,  that  several  parts  of  the  proposed 
plan  may  tend  rather  to  diminish  the  number  of  those  who 
might  hereafter  engage  in  the  medical  profession,  than  to 
promote  the  welfare  of  the  public,  by  increasing  the  facility 
and  the  certainty  with  which  they  may  obtain  proper  advice 
and  assistance  in  sickness  or  in  bodily  injuries.’ 

(c  Again, 

6  Whatever  regulations  are  enacted,  it  would  be  unjust 
that  these  should  affect  practitioners  already  engaged 
in  business,  or  students  who  have  entered  on  an  education 
for  any  of  the  branches  of  the  Medical  profession.’ 


Medicine . 


1809.] 

u  Such  was  the  opinion  of  these  men  in  1807,  but  in  April 
1808,  they  pass  a  law,  having  in  view  merely  their  own 
emolument !  Their  speeches  concerning  the  tax  of  five 
shillings  on  each  student  can  now  be  perfectly  understood* 
If  the  law  were  intended  to  increase  the  respectability  of  a 
degree,  why  did  they  not  make  it  as  public  as  possible? 

cc  The  professors  will  not  however  long  enjoy  the  pecuniary 
advantages  arising  from  this  law,  for  although  several  will 
rather  pay  a  double  sum  than  at  the  end  of  their  studies  re¬ 
move  to  another  university,  that  will  not  long  be  the  case. 
Already  some  students  have  gone  to  a  neighbouring  univer¬ 
sity,  and  others  have  been  kept  merely  by  the  idea  that 
so  unjust  a  law  would  not  be  persevered  in. 

a  Let  the  magistrates  of  Edinburgh  also  consider  w  hether 
80,000/.  or  100,000/.  circulated  annually  in  their  chy  be 
such  a  trifle  as  to  be  endangered  by  the  private  emolument  of 
a  few  men.  In  my  next,  I  shall  give  some  farther  particu¬ 
lars  of  liberality  in  certain  of  the  professors  to  the  students. 
ec  I  am,  Gentlemen,  with  the  highest  respect, 

“  A  PUPIL  OF  THE  EDINBURGH  SCHOOL. 
e(  P .  A.  I  have  just  learned  that  the  associated  students 
intend  to  publish  the  whole  of  their  proceedings,  as  soon  as 
the  answer  has  been  returned  to  a  petition,  which  has  been 
for  about  two  months  before  the  magistrates,  the  patrons  of 
the  university.” 

To  the  Editors  of  The  Medical  and  Surgical  Spectator » 
Gentlemen — Whilst  I  cannot  but  be  gratified  by  the 
handsome  terms  in  which  your  correspondent  M.  has  noticed 
my  Reports  on  Cancer ,  in  the  last  number  of  your  Journal, 

I  think  he  might  have  observed,  that  I  have,  in  more  pas¬ 
sages  than  one,  sufficiently  declared  my  own  opinion,  how 
the  practice  which.  it  is  my  object  to  establish  is  to  be  recon¬ 
ciled  to  our  ideas  of  a  natural  and  healthy  state  of  existence. 

I  apprehend,  not  that  pure  water  is  necessary  to  a  perfect 

q  4 


524  Medicine •>  [March, 

state  of  health,  but  that,  under  a  diet,  strictly  conformable 
to  the  nature  of  man,  he  would  not  experience  a  necessity  for 
drinking:  in  a  word,  that,  naturally,  man  is  not  a  drinking 
animal.  In  p.  3  of  the  Reports ,  I  have  thus  expressed 
myself u  I  have  found  that  one  of  the  strongest  objections 
in  the  minds  of  many  sensible  and  well  informed  persons, 
against  my  proposal  of  introducing  the  use  of  pure  distilled 
water  in  the  treatment  of  chronic  diseases,  has  been  that  the 
practice  seems  wholly  unnatural.  If  they  can  once  bring 
themselves  to  suspect,  that  the  practice  of  all  drinking  what¬ 
ever  is  equally  unnatural,  a  strong  prejudice  will  be  re¬ 
moved,  and  they  will  more  readily  comprehend,  that  if  an 
unnatural  habit  be  at  all  indulged,  especial  care  should  be 
taken  to  prevent  it  from  being  likewise  a  nervous  one.” 
Some  other  passages  to  the  same  purport  might  be  produced; 
and  if  they  made  but  a  slight  impression  upon  your  corre¬ 
spondent,  it  is,  I  presume,  to  be  attributed  to  the  rapidity  of 
reading,  and  to  his  attention  being  fixed  on  more  prominent 
parts  of  the  argument. 

Nothing  can  be  more  striking  to  a  contemplative  mind,  than 
the  perfect  adaptation  of  the  organs  of  animals  to  their  habi¬ 
tudes  and  necessities.  Examples  of  this  are  so  obvious,  that  it  is 
almost  superfluous  to  cite  them.  We  may  remark  it  in  the 
gizzard  of  the  fowl,  in  the  webbed  foot  of  aquatic  birds,  or 
the  light  and  hollow  bones  of  those  that  fly.  Can  we  look 
at  the  formation  of  the  heron,  and  not  be  convinced  that 
nature  has  adapted  him  in  every  part  of  his  structure  to  his 
peculiar  occupation  of  wading  into  shallow  streams,  and 
catching  fish  ?  But  if  I  survey  in  the  most  superficial  manner 
the  structure  of  man,  I  perceive  that  drinking  is  an  action 
of  which  he  appears  naturally  to  be  hardly  capable.  Not  a  par¬ 
ticle  of  liquid  can  get  into  his  lips,  that  is  not  conveyed  thither 
by  some  artifice.  His  upright  form,  and  the  flatness  of  his 
mouth  are  in  direct  opposition  to  the  action  of  drinking. 
It  may  be  said  that  he  is  utterly  unprovided  by  nature  with 
any  organ  suited  for  this  purpose*  In  this  respect  man  is 


Medicine . 


225 


1809.] 

more  destitute  than  the  sheep,  who  can  drink  without  diffi¬ 
culty  ;  though  he  too  is  not  by  nature  a  drinking  animal ; 
he  never  drinks  when  he  can  procure  abundance  of  succulent 
food ;  and  almost  all  his  diseases  may  be  readily  traced  to 
the  operation  of  water.  It  is  true  that  a  man  can  drink  by 
stooping  down  to  the  stream  like  the  animals  ;  but  this  mode 
is  almost  as  much  a  constraint  upon  him  as  walking  upon  his 
head  instead  of  his  feet. 

It  may  be  thought  that  the  feeblest  exertion  of  intellect 
would  teach  him  to  surmount  this  difficulty.  But  slight  as 
it  is,  it  includes  a  process  of  reasoning,  of  which  animals  ap¬ 
pear  incapable;  and  all  the  accounts  of  children,  who  have 
been  discovered  in  the  forests,  living  wild  upon  what  they 
could  collect,  inform  us  that  the  human  animal  is  in  this 
condition  inferior  in  intelligence  to  the  quadruped.  It  is 
highly  probable  that  those  beings  really  did  not  drink  at  all. 
This  hypothesis  takes  away  all  the  difficulty  which  is  sup¬ 
posed  to  attach  to  the  idea,  that  the  streams  which  are  des¬ 
tined  to  the  service  both  of  man  and  brute  are  impregnated 
with  poisonous  matter ;  since  it  is  evident,  that  what  acts  as 
a  poison  upon  the  human  race,  may  have  no  such  effect  upon 
animals  which  are  formed  by  nature  for  drinking.  At  the 
same  time  I  must  say,  that,  it  appears  to  me  that  all  our 
domestic  animals  are  injured  by  drinking,  much  in  the  same 
way  that  mankind  is :  and  I  believe  that  if  they  had  always 
plenty  of  fresh  succulent  food,  they  would  rarely  drink  at 
all,  and  that  very  sparingly.  The  effect  of  common  water 
is  extremely  evident  upon  small  birds  in  a  cage.  The  wood¬ 
lark  is  a  bird  of  so  delicate  a  nature,  that  it  can  hardly  be 
bred  up  in  a  cage.  A  lady  of  my  acquaintance  had  often 
attempted  to  raise  them  without  success.  But  lately,  by  dis¬ 
tilling  her  bird’s  water,  she  has  succeeded  perfectly. 

I  am,  Gentlemen,  your  obedient  Servant, 

WM.  LAMBE. 

King’s  Road ,  Bedford  Row , 

February  20,  1809. 


Medicine . 


m 


[March* 


Reports  on  the  Effects  of  a  Peculiar  Regimen  on  Scirrhous 
Tumours  and  Cancerous  Ulcers .  By  William  Lambe, 

M.  D.  Fellow  of  the  Royal  College  of  Physicians,— pp„ 
190,  8vo.  5s.  boards. 

(Concluded  from  p.  3  37.) 

In  our  continuation  of  this  Review,  we  have  selected  this 
case  as  the  most  prominent  among  them  for  the  elucidation  of 
the  author’s  practice,  as  well  as  collecting  in  a  brief  point 
of  view,  all  the  fruit  of  his  as  yet  limited  experiment,  and 
with  it  we  close  our  account  of  this  well  written  book. 

“  Case  ix. — A  widow  lady,  aged  46,  had  perceived  for 
some  years  an  uneasiness  in  the  right  breast,  and  in  1802,  she 
applied  for  surgical  assistance  for  a  small  lump,  which  had 
appeared  just  above  the  nipple.  It  was  attended  with  some 
pain,  but  neither  at  this  time,  nor  since,  has  that  been  very 
severe.  The  tumour  was  treated  with  local  applications, 
(the  tincturaferri  ammoniac alis  mixed  with  spiritus  vinosus 
tenuior )  which  seemed  to  contract  or  flatten  the  tumour,  acting 
most  probably  on  the  parts  surrounding  the  substance  of  the 
tumour.  During  the  year  1805,  the  tumour  increased,  and 
in  February  1806,  a  small  hole  had  formed  in  the  skin, 
which  had  become  discoloured,  and  there  was  a  fetid  matter 
discharged  from  it.  At  this  time  the  regimen  I  have  so  often 
spoken  of,  was  recommended  to  her,  but  it  was  not  adopted ; 
and  I  know'  not  what  occurred  from  this  time  till  the  beginning 
of  June  1807,  except  that  the  ulcer  never  closed,  but  con¬ 
tinued  to  discharge  a  serous  fetid  matter;  once  the  whole 
inflamed,  and  a  number  of  oval  vesicles  came  out ;  afterwards 
there  was  a  discharge  of  a  cream-coloured  matter.  After 
this  the  ulcer  contracted  greatly  ;  it,  however,  never  closed, 
but  enlarged  by  the  gradual  destruction  of  its  margin. 

“  In  June  1807,  I  saw  the  case.  The  ulcer  was  still  no 
larger  than  a  half-crown  piece ;  there  was  some  scirrhous 
matter  around  it,  but  it  did  not  occupy  the  whole  gland ; 
there  wa^  a  sinus  of  some  depth  at  the  upper  part  of  the 


Medicine. 


m 


1800.] 


ulcer,  and  some  fungus  round  the  margin.  Though  the 
greater  part  of  the  breast  was  occupied  by  the  ulcer  and  sur¬ 
rounding  scirrhus,  yet  the  gland  being  naturally  small,  the 
whole  disease  was  also  proportionably  small.  The  general 
health  too  was  very  good ;  that  is  to  say,  for  a  person  with 
such  a  disease;  for  I  have  been  lately  informed,  that  her 
health  has  been  delicate  many  years.  However,  there  was 
neither  muscular  debility,  emaciation,  nor  any  other  ap¬ 
pearance,  threatening  a  speedy  termination  of  the  disease. 

u  Here  then,  at  length,  a  perfectly  fair  opportunity  (which  I 
Had  long  and  vainly  solicited  from  the  benevolence  of  sur¬ 
geons)  was  obtained  of  ascertaining  the  effects  of  this  regimen 
on  the  ulcerated  Cancer ;  for  the  lady  declared  her  readiness 
to  follow  my  advice ;  and  she  has  done  so  most  rigorously. 
The  result  has  been  such  as,  I  hope,  will  be  perfectly  satisfac¬ 
tory  to  the  most  scrupulous,  but  sincere  inquirer,  after  the 
truth.  It  may  be  described  in  a  very  few  words. 

4C  She  left  off  the  animal  food  gradually,  first  taking  a  little 
every  second  day,  and,  after  three  or  four  months,  using  it 
only  once  a- week :  at  present  she  uses  none ;  nor  has  she  per¬ 
ceived  any  inconvenience  from  the  change,  but  has  found 
herself  cooler  and  more  easy.  Her  strength  is  now  quite  as 
good  as  it  was  at  the  first. 

Ci  For  a  twelvemonth  there  was  littlechange  in  the  diseased 
part ;  no  fresh  thickening  took  place  as  long  as  the  scirrhus, 
which  had  been  formed,  remained  ;  but  once  in  the  course  of 
the  year,  the  same  train  of  circumstances  took  place,  as 
before  the  adoption  of  the  regimen  ;  viz.  the  part  inflamed, 
a  quantity  of  oblong  vesicles  sloughed  out,  and  afterwards 
a  cream-coloured  fluid  was  discharged.  The  ulcer  then 
contracted  a  good  deal,  but  it  still  continued  open ;  so  that 
at  the  end  of  the  year,  it  was  nearly  the  same  magnitude  as  it 
had  been  at  first.  When  all  the  scirrhous  matter  had  slouched, 
the  edges  all  around  again  thickened*  About  the  middle  of 
Tune  1808,  she  began  to  feel  more  pain  than  usual ;  some 


Medicine . 


228 


[March* 


haemr  hage  took  place ;  this  was  soon  followed  by  a  con¬ 
siderable  degree  of  inflammation,  attended  with  more  pain, 
and  a  much  greater  discharge  of  watery  matter ;  the  scirrhous 
edges  then  began  to  soften  and  come  gradually  away  in 
pieces  of  about  an  inch  long,  and  as  thick  as  a  quill.  In 
consequence  of  this,  the  cavity  of  the  ulcer  was  greatly  in¬ 
creased  in  magnitude ;  and  the  discharge  again  assumed  the 
colour  and  consistence  of  cream.  This  process  was  attended 
with  much  fetor.  The  discharge  gradually  abated,  the  ulcer 
contracted,  and  now  it  perfectly  and  completely  closed  up, 
the  surrounding  skin  being  brought  down  to  the  base  of  the 
ulcer,  and  covering  it  perfectly.  So  entirely  is  the  ulcer 
obliterated,  that,  except  for  some  relics  of  the  disease,  about 
to  be  related,  it  would  be  impossible  by  mere  inspection  to 
determine  the  precise  situation,  which  it  had  occupied. 

Ci  The  relics  of  the  disease  are  these;  a  small  quantity  of 
scirrhous  and  discoloured  substance  remains,  which  occupies 
the  upper  parts  of  the  original  seat  of  the  breast.  It  is  quite 
loose,  and  unconnected  with  the  parts  beneath.  This,  there 
being  no  ulcer,  must  be  regarded  to  be  small  occult  Cancer. 
Immediately  beneath  this,  is  a  ridge  of  an  inch,  perhaps,  in 
breadth,  and  half  as  high  at  its  summit,  running  downwards, 
and  rather  backwards,  with  a  small  curvature,  upon  the  side. 
Its  whole  length  is  between  three  and  four  inches :  it  is  firmly 
bound  to  the  side  at  its  top ;  at  its  lower  extremity  it  tapers, 
is  much  smaller  and  looser,  and  it  is  finally  lost  in  the  skin. 
Along  its  whole  length  runs  a  deep  oblique  furrow,  making 
it,  in  fact,  two  ridges  placed  close  along  side  each  other ;  the 
basis  of  the  furrow  has  no  cuticular  covering,  so  that  there 
is  from  it  as  much  discharge  as  may  moisten  a  piece  of  lint 
placed  in  it.  From  its  position,  I  conclude  that  the  upper 
part  of  this  ridge  was  an  adhesion  of  the  gland  to  the  side. 
It  swelled,  and  assumed  its  present  form  in  July,  either  when, 
or  immediately  after  that  the  remaining  part  of  the  gland 
had  sloughed  away.  The  lower  part  is,  of  course,  much 


Medicine, 


%2D 


1800.] 

below  the  situation  of  the  gland ,  and  shews,  in  a  very  curious 
manner,  what  was  the  whole  extent  of  the  contaminated  part. 
Besides  these  remains  of  the  disease  connected  immediately 
with  the  diseased  gland,  the  skin  is  a  little  rough,  and  tuber** 
ciliated  near  the  siennj.ni. 

-  This  adhesion  seems  to  have  been  formed  very  early  in 
the  disease.  As  far  back  as  1802,  when  first  examined  by  a 
surgeon,  the  gland  • 4  was  perfectly  moveable,  except  a  very 
slight  attachment  just  beneath  the  nipple,  and  by  this  the 
nipple  was  rather  drawn  a  little  obliquely  downwards.”  I 
use  the  words  of  her  surgeon,  in  the  country,  taken  from  his 
correspondence  on  her  case. 

u  Since  this  time,  the  disease  has  been  stationary  and  quite 
free  from  pain.  I  saw  it  in  October,  1808,  and  have  de* 
scribed  it  as  it  then  appeared.” 


A  Practical  Dictionary  of  Domestic  Medicine ;  comprising 
the  latest  Discoveries  relative  to  the  Causes ,  Treatment , 
and  Prevention  of  Diseases.  By  Richard  Reece ,  M.D . 
Member  of  the  Royal  College  of  Surgeons  in  London , 
$c.  fyc.  Royal  8vo. 

Popular  Medicine  has  for  some  years  past  become  the 
rage  of  the  day,  and  we  are  doubtful  whether  more  good  or 
injury  is  apt  to  arise  from  this  species  of  writing.  We  ad¬ 
mit  there  are  circumstances  in  which,  to  a  certain  extent, 
it  may  prove  beneficial  to  society.  These  circumstances  are 
in  cases  of  sudden  attacks  of  disease,  or  accidents,  where 
medical  aid  is  placed  at  a  distance.  A  person  on  the  spot, 
even  with  a  superficial  knowledge,  may,  in  these  particular 
instances,  apply  it  with  much  advantage  to  society.  But  the 
progress  of  science  induces  every  one  now  to  read,  and  has 
given  a  turn  for  investigation  on  subjects  which  do  not  belong 
to  them.  The  random  knowledge  thus  acquired  is  apt  to  be 
carried  too  far ;  and  on  a  subject  so  essential  to  the  interests 


230 


Medicine . 


[March, 

of  life,  may  lead  to  consequences  often  dangerous,  and  not 
unfrequently  fatal.  The  maxim  of  Pope  applies  here  with 
peculiar  energy : 

“  Brink  deep ,  or  taste  not  the  Pierian  spring ; — 

“  A  little  learning  is  a  dang’rous  thing/' 

At  the  same  time  it  must  be  allowed  that  those  will  be  more 
ready  to  attend  to  rules  of  living,  and  those  instructions  ne¬ 
cessary  to  the  preservation  of  health,  w  ho  have  traced  with  a 
careful  attention  the  injuries  arising  from  a  neglect  of  them, 
than  others  who  are  ignorant,  and  an  idea  of  remote  advice 
will  not  make  the  same  impression.  Many  of  the  diseases  that 
assail  human  nature  have  their  origin  more  in  the  follies  and 
vices  of  mankind  than  any  other  cause ;  and  to  point  out  the 
fatality  of  these  may  be  of  service  both  in  a  medical  and  moral 
point  of  view.  Such  works,  therefore,  as  consist  chiefly  of 
cautions,  and  treat  of  the  preventive  part  of  the  subject,  we 
consider  more  important  than  systems  of  practice.  The 
chief  fault  of  systems  of  practice  is,  that  their  readers  at¬ 
tempt  to  become  critics  on  the  regular  practitioner,  and  often 
form  a  judgment  of  his  conduct  and  professional  character  on 
very  lame  grounds,  suited  to  their  own  limited  acquaintance 
with  the  subject.  This  is  the  fault  of  Tissot  and  Buchan, 
and  of  many  other  writers  of  great  name.  The  present  work 
before  us  sets  out  on  a  different  principle.  Instead  of  being 
intended  merely  for  the  people  at  large,  it  is  directed  for  a 
class  of  the  community  who  stand  on  -a  different  footing. 
These  are  the  clergy,  and  practitioners  of  medicine,  who, 
perhaps,  have  not  had  all  the  benefits  of  an  extended  educa¬ 
tion.  The  first  being  men  of  science,  whose  minds  are  na¬ 
turally  turned  to  investigation  and  research,  will  certainly 
receive  more  benefit  from  such  works  than  any  other  persons. 
They  are  displayed  also  through  different  parts  of  the  country, 
where  medical  aid  is  often  difficult  to  be  obtained,  and  they 
possess  an  influence  on  the  community,  from  their  sphere  of 
life,  which  makes  their  sphere  of  life  be  attended  to  and  re- 


Medicine . 


ISO!).] 


§31 


spected.  A  knowledge  of  popular  medicine  to  such  persons 
is  of  value,  and  they  will  apply  it  with  a  d<  gree  of  judgment 
which  cannot  be  expected  in  other  sorts  of  readers.  Their 
liberality  also  will  lead  them  to  give  up  their  knowledge  to 
the  regular  profession  where  they  attend,  and  thus  they  will 
never  err  on  the  head  of  presumption.  Such  men  will  prove 
valuable  seconds  to  the  practitioner,  and  be  the  means  of  his 
precepts  being  more  strictly  enforced.  The  intention  of  the 
author,  in  directing  his  publication  to  this  body  in  parti¬ 
cular,  we  consider  as  highly  praiseworthy.  But  there  are 
subjects  in  this  work  which  do  not  fall  under  the  general  cen¬ 
sure  we  have  attached  to  popular  medicine.  These  are  what 
respect  medical  jurisprudence.  Questions  of  life  and  death 
are  the  too  frequent  subjects  of  investigation,  and  it  is  proper 
that  every  one  who  is  placed  in  the  delicate  situation  of  de¬ 
ciding  the  fate  of  his  fellow- creature  should  be  able,  from  his 
own  judgment,  to  form  some  opinion,  and  not  trust  entirely 
to  professional  evidence.  We  had  occasion  to  state  this 
lately  in  the  case  of  Miss  Burns,  and  whoever  peruses  the  de¬ 
tail  of  proceedings  in  that  trial,  will  agree  with  the  justice 
of  our  remark.  The  arrangement  of  this  work  into  the  form 
of  a  dictionary  we  deem  particularly  useful.  Each  separate 
article  contains  in  full  what  we  wish  to  know  on  the  particular 
points;  and  a  reference  is  easier  made  in  this  form  to  the, 
different  subjects  we  desire  to  be  acquainted  with  than  in  any 
other.  With  respect  to  the  execution  of  the  work  itself,  we 
observe  that  the  author’s  description  of  diseases  is  not  scien¬ 
tifically  intricate  nor  tediously  minute.  The  symptoms  and 
causes  of  disease  are  briefly  but  perspicuously  detailed,  as 
well  as  the  most  approved  plans  of  treatment.  We  remark 
that  much  attention  is  paid  to  give  the  pathognomic  or  dis¬ 
tinguishing  symptoms  of  each  malady,  which  is  the  most 
useful  method  that  could  be  adopted.  The  diseases  of  the 
mind  seem  not  to  have  been  omitted  more  than  those  of  the 
body.  This  is  a  point  on  which  medical  works  are  often  de- 


$32 


Medicine . 


[March, 


fective,  and  which  this  author  has  properly  supplied.  To 
enable  the  reader  to  judge,  we  shall  give  an  extract  from  the 
article  Passions. 

u  Passions  have  been  styled,  not  unaptly,  by  a  number  of 
authors,  the  gales  of  life ;  and  from  them,  in  the  language 
of  scripture,  may  be  said  to  proceed  the  issues  of  good  and 
evil.  They  are  the  source  of  every  agreeable  and  of  every 
painful  feeling. 

cc  The  passions  have  been  properly  divided  into  two  kinds, 
the  exciting  or  enlivening  passions,  and  the  depressing  ones. 
They  operate  on  the  body  either  suddenly ;  or  in  a  slowr,  pro¬ 
gressive,  and  gradual  manner.  Death  has  been  known  to  be 
the  immediate  effect  of  the  former;  the  latter  generally  pro¬ 
duce  a  gradual  decay  and  consumption.  The  choleric  and 
sanguine  constitutions  sutler  chiefly  from  the  violent  pas¬ 
sions.  The  phlegmatic  and  melancholic  ones,  whose  sen¬ 
sations  are  dull,  fall  victims  to  those  of  an  opposite  kind .* 
The  long  continuance  of  one  passion,  by  harassing  opt  the 
mind,  is  ever  apt  to  produce  bodily  disease,  and  one  termi¬ 
nation  peculiar  to  the  effect  of  the  passions  is  also  apt  to  arise, 
viz.  incurable  mental  imbecility.  The  cure  of  mental  dis¬ 
eases  has  at  all  times  formed  the  most  difficult  task  for  the 
physician,  so  much  so,  as  to  render  it  proverbial.  Thus, 
in  the  language  of  Shakspeare, — u  who  can  minister  to  a 
mind  diseased  ?”  Change  of  objects,  of  impressions,  and 
ideas,  afford  the  only  means  for  the  guidance  of  reason,  and 
argument  has  generally  little  sway.  The  early  management 
of  the  mind,  by  a  proper  education,  is  the  best  guard  against 
the  mischievous  effects  of  the  passions  at  an  after  period. 
Their  controul  becomes  then  a  habit  with  the  individual,  and 
prevents  any  excesses  which  might  otherwise  spring  from 
their  occasional  excitement  by  unforeseen  circumstances. 
Hence  it  may  be  laid  down,  as  a  leading  maxim,  that  the 
controul  of  our  passions  is  an  indispensable  requisite  to  the 
proper  enjoyment  of  health.  But  in  order  to  point  out  the 


Medicine. 


$33 


1  809.] 


effects  of  passions  more  clearly,  it  will  be  necessary  to  con¬ 
sider  each  of  them  separately,  and  with  some  minuteness. 
The  first  of  the  passions,  and  one  we  naturally  wish  to  begin 
with,  is  joy.  It  is  that  state  of  mind  in  which  there  is  felt 
extraordinary  pleasure,  and  in  which  a  high  degree  of  ani¬ 
mation  takes  place.  The  heart  becomes  expanded;  circu¬ 
lation  is  rendered  free  and  vigorous;  the  eyes  sparkle;  the 
nerves  feel  a  sensation  connected  witli  complaisance  and  mild~ 
ness.  Hence  this  state  is  favourable  to  the  enjoyment,  and 
even  recovery  of  health,  where  it  is  languishing  under  dis¬ 
eases  of  a  slow  or  rooted  nature,  and  of  a  depressing  kind. 
Of  this  passion,  a  variety  of  modifications  or  degress  occur, 
under  the  names  of  gaiety,  cheerfulness,  mirth,  &c.  &c.” 

The  practice  in  this  work,  it  may  be  also  remarked,  is  not 
liable  to  the  imputation  of  inertness,  which  pervades  the 
maxims  of  Buchan.  It  is  active  without  being  too  bold,  and 
such  as  may  be  employed  with  safety.  The  reader  will  be 
able  to  form  his  opinion  of  this  by  detailing  the  practice 
recommended  in  gout. 

li  Treatment. — The  treatment  of  the  gouty  paroxysms 
must  be  varied  according  to  the  age  of  the  patient,  the  na¬ 
tural  strength  of  his  constitution,  and  more  particularly 
according  to  his  previous  habits  of  living.  Indeed,  so  vari¬ 
ous  are  the  constitutions  of  gouty  people,  that  it  is  impossible 
to  lay  down  a  general  or  invariable  plan,  either  for  the  cure 
of  the  paroxysm,  or  ;the  prevention  of  its  recurrence,  which 
are  the  two  indications  to  be  attended  to  in  its  treatment.  On 
the  approach  of  the  fit,  it  will,  in  all  cases,  be  proper  to  clear 
the  stomach  and  bowels  by  a  brisk  aperient  medicine.*’ 

On  the  whole,  if  popular  medicine  is  to  be  useful,  Dr. 
Reece  has  adopted  the  best  plan  ;  and  by  enriching  his  work 
with  a  copious  Pharmacopoeia,  he  has  added  to  its  value,  as 
the  forms  seem  well  adapted  to  the  purpose  intended  .  This 
being  the  first  dictionary  of  popular  medicine,  we  hope  it  will 
meet  the  approbation  of  those  for  whom  it  is  intended ?  a  nd 

VOL.  II.  n 


*34 


Medicine. 


[March, 


we  give  the  author  much  credit  for  his  industry  in  bringing 
forward  such  a  work,  which  will  not  fail,  from  the  other 
specimen  he  has  already  given,  to  meet  improvement  in  a  fu¬ 
ture  edition. 

FATAL  CASE  OP  PA?SION,  ATTENDED  BY  DR.  BUCHAN. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — The  influence  of  the  mind  on  the  body  is  bet¬ 
ter  felt  than  understood.  That  death  is  capable  of  being  pro¬ 
duced  by  violent  affections  of  the  mind  is  also  admitted; 
but  that  it  should  happen  in  an  instantaneous  manner,  as  if 
struck  down,  is  rather  uncommon.  A  case  occurred  about  ten 
days  ago  inTottenkam-court-road,  in  consequence  ofadispute 
on  some  trifling  affair,  in  which  a  female  was  hurried  into  such 
an  extreme  of  passion  as  instantly  to  drop  down.  Dr.  Bu¬ 
chan,  of  Perey-street,  w  ho  related  it  to  the  writer,  was  cal¬ 
led  in,  but  life  was  so  completely  extinguished,  that  every 
attempt  failed  to  produce  the  smallest  symptoms  of  resusci¬ 
tation.  The  patient  had  been  in  perfect  health  before,  and 
the  influence  of  the  mind  was  so  powerful,  as  to  produce  at 
once  apoplexy  in  its  most  fatal  form.  From  the  irritability 
of  the  female  system,  such  an  effect  is  certainly  more  apt  to 
happen  with  them  than  men,  and  caHses  of  provocation  should 
accordingly  be  more  studiously  avoided  when  they  are  con¬ 
cerned. 

I  am,  Gentlemen, 

Your  obedient  servant, 

Tottenhain-courl-road,  AN  OBSERVER* 

Feb.  20,  1809. 

COMMUNICATION  ON  CUTANEOUS  DISEASES,  BY  T.  M.  CATON, 

M.  D. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — Of  all  diseases  that  occur  in  practice,  the 
most  perplexing  are  chronic  eruptions  of  the  skin,  the 


Medicine ♦ 


1S09.] 


cause  of  which  is  obscure,  and  cannot  be  traced.  These  are 
at  present  too  often  met  with  :  and  in  such  cases  I  have 
followed  with  success  a  practice  first  pointed  out  by  Dr.  Clarke 
of  Dominica,  and  first  made  known  in  this  country  by  Dr. 
Garthshore.  It  is  the  oxyd  formed  by  a  combination  of 
minerals,  particularly  the  arseniates  of  antimony  and 
mercury. 

The  arseniate  of  antimony  is  prepared  with  the  acid  of 
arsenic,  and  the  crocus  or  vitrum  of  antimony,  in  the  same 
manner,  and  nearly  in  the  same  proportions  as  the  aniimonium 
tartarisatum,  only  with  a  larger  proportion  of  the  acid 
arsenici  filtered,  crystallised,  and  pulverised.  So  powerful 
is  this  medecine,  that  one-twelfth  of  a  grain  is  sufficient  for 
a  dose  twice  a  day,  which  may  be  gradually  increased  to 
one-eighth  in  the  same  manner.  This  will  be  found  by  every 
one  who  uses  it  a  most  powerful  and  successful  remedy.  Dr. 
Clarke  states  it  is  an  almost  certain  cure  in  leprosy.  Its 
action  is  by  sweat,  the  most  certain  method  of  producing  a 
favourable  issue  in  cutaneous  diseases.  As  obstinate  eruptions 
are  alleged  at  present  so  ^frequently  to  succeed  vaccination, 
and  which  have  received  lie  appellation  of  the  Psora 
Bovilla ,  this  medicine  will  be  found  one  of  great  importance* 
In  looking  over  Dr.  Willan’s  extensive  work  on  cutaneous 
diseases,  I  am  surprised  to  find  no  mention  made  of  this 
preparation.  I  am  convinced  it  would  only  require  a  trial 
from  the  ingenious  author  to  make  him  adopt  it  in  that  line 
of  diseases  which  forms  so  much  the  object  of  his  attention. 
I  shall  in  a  future  number  make  some  farther  remarks  on  this 
subject.  The  present  communication  is  meant  to  draw  the 
profession  to  the  use  of  this  remedy. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

T.  M.  CATON. 


Feb.  S3,  1809. 


Medicine. 


[March, 


ON  THE  MEDICAL  DEPARTMENT  OF  THE  ARMY. 

To  the  Right  Hon.  Sir  James  PuUeney ,  Bart.  Secretary  at 

War ,  S)C.  Sc. 

Sir — At  a  time  like  the  present,  when  the  exertions  of 
the  state  are  called  forth  in  the  most  energetic  manner 
to  serve,  what  no  Briton  would  perhaps  wish  to  acknow¬ 
ledge,  a  sinking  empire,  it  is  the  duty  of  every  individual 
to  add  his  mite  both  to  amend  what  is  really  deficient  in  the 
execution  of  any  department,  and  also  to  propose  what  may 
add  to  its  energies,  and  improve  the  benefits  it  is  intended  t© 
extend.  Parliament  has  abundantly  seen  the  necessity  for 
this  by  the  establishment  of  the  Commission  of  Military  In¬ 
quiry  ;  in  a  communication  to  his  Royal  Highness  the  Com¬ 
mander  in  Chief,  I  some  time  ago  pressed  on  his  attention 
the  necessity  for  a  code  of  Military  Medicine  and  Surgery,, 
drawn  from  the  reports  of  the  Army  Surgeons  at  large,  so 
as  to  include  the  whole  experience  of  that  department.  As 
the  subject  comes  equally  within  your  official  notice  as  his 
Royal  Highness’s,  and  as  it  is  one,  the  present  defects  of  which 
cannot  have  escaped  your  observation,  permit  me  to  con¬ 
firm  the  reasons  I  then  urged  so  strongly  for  the  improvement 
of  this  branch  of  the  service.  I  can  have  no  doubt  that 
one  like  you,  who  serves  his  country  without  emolument, 
can  only  be  actuated  by  the  highest  motives  of  honour  and 
patriotism ;  and  from  a  conviction  that  the  present  plan 
will  meet  the  full  approbation  of  sucli  a  character,  I  shall 
beg  leave  to  lay  before  you  the  outline  of  the  numerous  and 
important  topics,  which  a  code  of  medical  regulations,  such 
as  proposed,  would  embrace. 

Education . — The  first  object  which  such  a  code  should* 
naturally  consider,  would  be  the  proper  education  of  a  military 
practitioner,  and  the  circumstances  in  his  professional  studies, 
to  which  he  ought  peculiarly  to  bend  his  special  attention, 
with  a  view  to  his  future  line  of  practice.  This  being  point- 


5809.]  Medicine .  237 

ed  out  and  settled  upon,  he  is  next  to  be  regarded  as  making 
his  debut  in  the  service. 

Inspection. — One  of  the  first  objects  here,  on  which  he 
will  be  frequently  consulted,  is  the  Inspection  of  men.  He 
should  not  only  be  able  to  judge  that  they  are  free  from 
disease;  but  his  knowledge  should  extend  farther.  He 
should  be  able  to  determine  the  state  of  the  future  man  from 
the  appearance  of  the  boy,  and  the  particular  service  for 
which  each  recruit  will  be  best  fitted,  and  give  his  opinion 
accordingly. 

Outline  of  Practice.— In  the  actual  discharge  of  his 
medical  duty,  two  great  points  ought  to  be  embraced  by  him. 
The  first  is  the  prevention  of  diseases  ;  and  the  second  is  the 
actual  cure  of  them  . 

Prevention  of  Diseases. — If  attention  is  paid  to  the  former, 
much  of  the  disagreeable  part  of  his  duty  will  be  avoided, 
and  an  army  will  be  often  kept  effective  by  a  strict  regard 
,to  a  number  of  simple  and  apparently  trifling  particulars  in 

what  respects  the  regulation  of  barracks  and  quarters ,  of 

/ 

diet ,  of  clothing ,  of  sleep  and  watching ,  of  exercise  and 
discipline ,  which  neglected,  lead  to  serious  evils,  and  the 
certain  injury  of  the  service.  In  fact,  the  military  practitioner 
who  is  conscientiously  to  perform  his  duty,  must  look  more  to 
the  avoiding  of  malady  than  the  actual  cure  of  it ;  and  with¬ 
out  entering  into  the  minutiae  of  a  soldier’s  life,  he  is  unfit  to 
perform  the  most  important  part  of  his  task. 

Hospitals.— 1 The  cure  of  military  diseases  is  conducted 
chiefly  by  the  establishment  of  hospitals ;  certainly  the  best 
plan,  as  rendering  every  patient  more  immediately  under 
medical  direction  and  controul.  Military  hospitals  are 
accordingly  one  of  the  first  subjects  for  a  medical  practitioner 
to  study ;  and  their  regulations  should  be  formed  on  such  a 
scale,  as  not  only  to  comprise  a  set  of  general  rules,  but  they 
should  descend  to  particular  regulations  for  all  the  chief  forms 
*ofdiseases  to  which  a  military  life  is  subjected.  One  of  the  first 

it  ,3 


S38  i 


M edicint. 


[March, 


subjects  here  is  the  precautions  that  ought  to  be  observed  on 
the  introduction  of  patients  into  the  hospitals  according  to  the 
nature  of  the  diseases.  Fevers  and  dysentery  claim  this  at¬ 
tention  in  a  particular  manner,  and  demand  a  minute  set  of 
restrictive  directions. 

The  treatment  of  the  sick  in  the  hospitals  must  be  regulated, 
besides  the  form  of  the  disease,  by  the  various  circumstances 
of  climate  and  situation,  having  it  always  in  mind  that  military 
practise  requires  bold  and  energetic  measures  :  and  that  the 
absence  from  duty  in  the  day  of  actual  service  is  perhaps  an 
irreparable  loss  to  the  country.  Hence  the  necessity  of  a 
medical  practitioner  possessing  superior  professional  know¬ 
ledge  to  others,  much  decision ,  and  a  great  deal  of  acquired 
experience;  nay,  his  judgment  will  often  decide  him  to 
abandon  the  hospital  system,  to  choose  insulated  situations 
for  the  sick  in  warm  climates,  rather  than  croud  them 
together,  when  it  is  known  to  prevent  or  retard  recovery. 

Camps. — There  are  two  situations  you,  Sir,  know  well,  in 
which  the  life  of  a  soldier  is  passed ;  either  in  quarters  and 
barracks,  or  in  the  camp.  The  latter  is  the  situation  in  which 
lie  is  most  exposed  to  diseases ;  and  much  depends  on  the 
medical  practitioner  to  avert  these  by  judicious  advice,  and 
by  a  knowledge  of  what  will  oppose  the  evils  that  would 
otherwise  arise.  One  of  the  first  points  here  is  the  scite  of 
the  camp,  or  the  spot  where  it  ought  , to  be  formed  in  regard 
to  salubrity  and  convenience.  The  next  is  the  most 
proper  mode  of  fitting  up  the  residence  of  the  men ;  the 
3d  is,  the  regulation  of  their  conduct  while  in  camp :  and 
the  4th  is,  the  actual  treatment  of  their  diseases. 

These  are  a  few  only  of  what  I  may  term  the  preliminary 
subjects  that  belong  to  a  military  practitioner ;  but  even  these 
give  rise  to  observations  which  cannot  fail  to  strike,  one  of 
your  experience  in  military  concerns,  and  to  point  out  the 
necessity,  in  order  to  the  welfare  of  the  service,  that  the 
cpmmander  and  medical  practitioner  should  thoroughly 


Medicine. 


239 


1809.] 


understand  each  other  on  these  topics.  The  commander  is 
to  see  that  the  surgeon  performs  his  duty,  and  the  surgeon  is 
to  give  the  proper  advice  to  the  commander  in  what  may 
affect  the  health  and  convenience  of  the  men.  No  commander 
can  judge  whether  a  surgeon  is  competent  to  his  duty, 
without  some  code  of  regulations  or  instructions  to  give  him 
information;  no  surgeon  can  execute  his  duty  without 
having  experience  on  the  different  subjects  that  constitute 
ike  foundation  of  it;  and  which,  if  he  wants  a  set  of  proper 
regulations,  such  as  are  now  pointed  out  would  do  much  to 
supply. 

That  improvement  is  wanting  in  the  medical  department,  I 
have  the  evidence  of  the  Report  of  Military  Inquiry,  which  ex¬ 
pressly  declares  so,  toconfirm.  In  h is  interference  at  different 
times  no  doubt  his  Royal  Highness,  as  commander  in  chief,  has 
made  every  amelioration  in  his  power,  as  far  as  suggestions  were 
imparted  for  his  consideration.  But  the  professional  characters 
the  commander  in  chief  applied  to  had  no  wish,  and  what  is 
nearer  the  truth,  no  interest  in  making  alterations  that  would 
only  increase  the  duties  of  theif  situation.  Trifling  changes 
therefore,  of  little  moment,  could  only  be  looked  for.  His 
Royal  Highness  not  being  a  professional  character,  could 
not  be  supposed  to  find  out  a  radical  cure:  but  common 
sense,  and  the  general  opinion  of  mankind,  will  both  concur 
in  this  fact,  Give  the  military  practitioners  the  proper  share 
of  knowledge  they  ought  to  possess ,  and  this  is  the  highest 
of  improvement  in  this  department  that  the  service  requires. 
That  the  present  plan  proposed  may  be  termed  a  radical  cure 
will  not  admit  dispute;  for  if  medicine,  which  the  profession 
are  unfortunately  compelled  to  acknowledge,  is  at  best  a 
conjectural  acf,  the  great  improvement  it  requires  is  to  place 
it  as  far  as  possible  on  the  fixed  basis  of  united  collected 
experience,  and  not  leave  its  application  entirely  to  the 
caprice,  gnorance,  erroneous  judgment,  or  inexperience  of 
young  military  practitioners,  to  give  certain  established 

it  4 


24Q 


Medicine . 


[March, 

data  to  go  by,  certain  land  marks  to  carry  them  through  the 
abyss  of  professional  doubts  and  difficulties,  and  to  clothe 
the  greenhorn  with  the  garment  of  experience,  and  the  wis¬ 
dom  of  age.  In  doing  this,  Sir,  you  will  also  observe,  the 
present  plan  makes  no  infringement  on  the  present  order  of 
things  :  it  includes  every  improvement  which  has  come  from 
other  quarters,  while  it  strikes  at  the  foundation  of  every 
defect  without  crazing  a  stone  of  the  present  superstructure. 

With  these  important  facts  kept  in  your  view,  I  proceed, 
Sir,  in  my  detail. 

The  introductory  subjects  already  stated  lead  to  the 
main  object,  viz.  the  varied  circumstances  which  the  treat¬ 
ment  of  disease,  and  the  restoration  of  health  and  vigour  iil 
military  life  demand.  In  tracing  this  we  are  led  to  consider 
the  various  stations  of  military  service,  and  to  point  out 
what  is  peculiar  and  important  in  each. — The  dominions 
belonging  to  the  British  empire  are  so  extended  as  to  form, 
in  a  medical  view,  no  less  than  six  different  medical  stations  ; 
and  of  these,  the  first,  and  perhaps  least  important  of  the 
whole,  is  the  home  station. 

Home  Station.*—  The  diseases  of  Britain  may  be  divided 
into  those  of  the  winter,  and  those  of  the  summer  months. 
They  differ  from  the  diseases  in  civil  life  less  than  in  other 
military  stations,  because  the  service  of  the  home  station  is 
regular  and  established.  No  extraordinary  exertions  attend 
it,  such  as  in  scenes  of  action,  and  where  war  is  the  business 
of  the  day.  It  may  be  considered  merely  as  the  school  of 
discipline  to  prepare  for  foreign  service.  The  causes  of  dis¬ 
ease  here  are  also  less  varied,  and  they  arise  either  from 
vicissitudes  of  weather,  dr  excess  and  indulgence.  They 
occur  in  subjects  also  that  admit  a  bold  and  energetic  prac¬ 
tice.  On  these  accounts,  the  diseases  of  the  home  station  are 
not  the  field  to  give  experience  to  the  military  practitioner. 
They  want  the  malignity  of  appearance ;  the  rapid  progress, 
and  the  destructive  ravages  which  attend  the  steps  of  disease 


M edicine. 


1809 J 


241 


very  closely  in  the  foreign  stations.  The  surgeon  in  Britain 
may  trust  a  great  deal  to  the  efforts  of  nature  for  the  recovery 
of  his  patient,  and  recovery  will  take  place,  though  the 
service  may  be  longer  deprived  of  the  attendance  of  the  men 
pn  duty. 

Leaving,  then,  the  further  consideration  of  the  home 
station,  as  admitting  a  more  regular,  simple,  and  defined 
practice,  in  the  exercise  of  which  abilities  and  superior  expe¬ 
rience  are  less  required,  I  proceed  to  direct  your  attention  to 
services  of  more  unhealthy  occupation.  But  before  com¬ 
mencing  this  description,  permit  me  to  state  the  necessity  of 
an  acquaintance  with  certain  preliminary  points,  which, 
you  will  perceive,  form  no  less  an  object  of  the  surgeon’s 
duty. 

Introduction  to  Foreign  Stations. — These  are,  the  pre¬ 
cautions  to  be  observed  in  transporting  troops.  As  troops 
for  foreign  stations  must  all  be  conveyed  by  sea,  the  best 
method  of  shipping  them  is  certainly  a  subject  of  study; 

their  accomodation  also  while  at  sea  is  connected  with  it* 

/ 

The  various  circumstances  necessary  to  the  preservation  of 
their  health  in  this  situation  are  no  less  important  objects  of 
inquiry,  as  well  as  the  most  suitable  treatment  for  such  com¬ 
plaints,  as  arise  during  their  voyage,  should  these  precau¬ 
tions  prove  insufficient.  Without  a  due  regard  to  ail  these 
circumstances,  it  is  clear  the  troops  will  be  unfit  for  service 
when  landed,  and  the  very  object  of  fitting  out  an  expedition 
for  a  foreign  station  thus  defeated.  These,  you  will  allow, 
are  topics  highly  interesting  to  the  military  practitioner. 
No  man  can  acquit  himself  in  these  situations,  or  give  direc¬ 
tions  by  intuition,  and  where,  under  the  present  system,  is  he 
to  find  regulations  and  instructions  to  point  out  his  conduct? 
It  is  not  a  lesson  he  has  been  taught  at  school,  and  till  he  ac¬ 
quires  it  by  personal  experience,  he  must  commit  many 
serious  blunders.  These  are  plain  truths  that  must  speak  to 
your  mind,  and  to  the  conviction  of  every  itran  without  the 


242  Medicine.  [March, 

possibility  of  denial.  I  shall,  however,  suppose  the  troops 
are  landed  :  I  shall  next  trace  the  various  circumstances  in 
which  the  foreign  stations  differ  in  climate  and  diseases  from 
the  home  service. 

The  Mediterranean  Station. — The  first  of  the  foreign 
stations,  and  one  of  the  highest  interest  at  present,  is  the 
Mediterranean,  which  includes  the  three  settlements  of 
Gibraltar,  Minorca,  Malta,  and  perhaps  also  Sicily. 

This  station  may  be  considered  as  an  intermediate  situa¬ 
tion  between  the  service  of  Britain  and  that  of  the  tropical 
climates.  The  diseases  of  this  station  resemble  those  of  sum¬ 
mer  in  Britain,  and  do  not  make  that  rapid  progress  which 
distinguishes  those  of  the  tropical  regions.  They  consist 
chiefly  of  fevers,  inflammatory  affections  of  chest,  and  dy¬ 
sentery.  The  affections  of  chest  are  evidently  the  conse¬ 
quence  of  the  sudden  transition  from  the  variable  climate  of 
Britain  to  the  more  steady  and  temperate  atmosphere  of  the 
Mediterranean.  The  dysentery,  though  connected  with  the 
same  cause,  is  too  often  augmented,  if  not  produced  by  the 
excessive  use  of  wine,  a  beverage  to  which  troops  from  the 
mother  country  are  unaccustomed. 

The  certain  attack  of  these  diseases,  and  the  mortality 
they  produce,  will  point  out  to  you  of  what  importance  it  is 
to  prevent  them,  by  a  proper  attention  to  the  health  of  the 
men  on  their  passage,  by  lowering  the  inflammatory  habit  of 
the  colder  climate,  and  taking  such  precautions  as  may  render 
the  action  of  any  morbid  cause  on  their  arrival  less  effectual. 
Nor  is  an  attention  to  the  regulation  of  diet  less  requisite. 
The  directions  respecting  this  should  be  properly  laid  down 
by  the  surgeon,  and  enforced  by  the  commander.  It  is  expe¬ 
rience,  and  experience  only,  can  teach  the  means  of  doing 
this,  and  impress  the  necessity  of  its  being  complied  with. 

West-India  Station . — But  the  topical  climates  are  the 
fertile  seat  of  disease,  and  none  of  them  so  much  so  as  the 
TVest-India  station. 


A  edicine . 


2*3 


1809.  j 


The  mortality  of  the  West-India  islands  has  been  long 
and  deservedly  a  matter  of  the  deepest  regret,  while  they  form 
one  of  the  richest  gems  of  the  British  crown,  yield  a  revenue 
highly  productive,  and  prove  the  greatest  nursery  for  the 
naval  strength  of  the  country;  this  revenue,  and  these  im- 
portant  advantages,  it  must  be  admitted,  are  acquired  at  an 
expence  of  population  to  the  parent  state  alarming  in  the 
highest  degree.  Nor  has  this  mortality  been  confined  at  any 
time  solely  to  the  period  of  war.  The  same  ravages  of  dis¬ 
ease  have  embittered  the  enjoyment  of  peace,  and  the  laud¬ 
able  career  of  enterprise  and  industry  displayed  by  the  emL 
grants  from  the  mother  country,  is  too  often  cut  short,  ere 
they  have  well  fixed  themselves  in  their  colonial  situations; 
and  much  more  does  this  mortal ity  fall  upon  the  troops. 
The  mortality  of  this  station  has,  indeed,  been  long  prover¬ 
bial ;  of  late  years  it  has  increased  by  the  appearance  of  a 
new  disease,  rapid  in  its  progress,  and  fatal  in  its  nature: 
this  is  the  yellow  fever,  or  what  may  be  more  properly 
termed,  the  plague  of  that  hemisphere.  On  the  treatment  of 
this  disease,  you  are  aware  much  difference  of  opinion  pre¬ 
vails  even  among  the  most  experienced  of  the  profession. 
This  being  the  case,  is  it  not  proper  that  some  general  regu¬ 
lations  should  be  drawn  up  for  the  information  of  young 
practitioners  ?  In  a  disease  of  such  general  mortality,  is  it 
fit  that  every  practitioner  should  be  left  to  his  own  discre¬ 
tion?  Besides  on  this  station  there  are  not  only  diseases 
peculiar  to  the  climate,  but  also  to  certain  parts  of  it,  as 
witness  the  peculiar  diseases  of  Barbadoes,  which  are  totally 
unknown  in  Europe,  and  do  not  yield  to  European  practice. 
How  is  the  military  practitioner  to  know  these  without 
directions  ?  and  what  directions  w  ould  be  so  fit  as  those  drawn 
up  in  the  manner  I  propose  ?  On  such  points,  I  beg,  Sir,  you 
will  pause  :  they  cannot  be  answered  or  contradicted.  But 
if  the  mortality  of  the  West-India  station  is  so  great,  ought 
not  precautions  to  be  taken  also  in  the  passage  of  the  troops, 


S44 


Medicine. 


[March, 


to  guard  as  far  as  possible  against  their  attack  ?  Ought  riot 
the  regulations  proposed  with  this  view  to  be  pointed  out,  and 
in  the  possession  of  every  military  surgeon?  And  ought  not 
also  a  similar  medical  attention  to  the  conduct  of  the  troops 
upon  land  to  be  enforced,  in  order  to  prevent  excesses  which 
may  render  the  causes  of  disease  more  active? 

East- India  Station. — The  next  military  station  in  point 
of  importance  is  the  East  Indies.  Here,  from  the  extent  of 
territory  and  the  variety  of  climate,  a  wide  held  opens  for 
the  conduct  of  the  military  practitioner.  For  this  station  a 
separate  establishment  prevails,  under  the  direction  of  the 
East  India  Company,  and  one  in  many  respects,  if  you,  Sir, 
will  take  the  trouble  of  investigating  it,  superior  to  the  me¬ 
dical  establishment  of  the  other  parts  of  the  empire.  Bnt 
still,  though  the  surgeon,  from  the  constitution  of  the  esta¬ 
blishment,  and  the  promotions  by  seniority,  comes  sooner 
to  be  a  man  of  more  knowledge  and  medical  acquirement 
than  in  the  regular  establishment,  yet  his  first  onset,  his  de¬ 
but,  labours  under  the  same  disadvantages  and  imperfectoins 
as  elsewhere.  The  variety  and  extent  of  practice  require 
experience  and  observation,  which  he  wants,.  The  diseases 
are  also  many  of  them  peculiar  here,  and  differ  from  those  of 
the  other  tropical  regions.  Witness  the  Berbery  of  Ceylon, 
a  disease  only  known  in  that  quarter.  The  troops  also  are 
two-thirds  natives,  under  the  name  of  Seapoys,  whose  dis¬ 
eases  and  mode  of  living  are  different  from  European  troops. 
You,  Sir,  will  also  be  pleased  to  remark,  that  while  dysentery 
may  be  considered  as  the  most  fatal  malady  of  troops  in 
other  stations,  and  may  be  yiewed  on  land  in  the  same  light 
as  scurvy  at  sea,  hepatic  complaints  arc  the  most  formidable 
on  the  East  India  station.  All  this  a  military  practitioner 
may  be  told  in  general,  but  the  giving  accurate  and  minute 
directions  is  the  only  plan  that  can  lead  to  a  successful  prac¬ 
tice.  The  more  the  present  subject  is  prosecuted,  the  more 
you  will  be  convinced  of  the  propriety  of  the  suggestion* 


Medicine, 


24$ 


1809.] 


now  addressed  to  your  consideration.  But  I  shall  proceed  to 
the  remaining  stations. 

America,  as  now  open  to  the  British  troops,  confines  their 
situation  to  the  province  of  Canada,  the  temperature  of 
which  may  be  viewed  as  the  climate  of  Britain  in  extreme,— 
Long  and  severe  winters  are  succeeded  by  short  and  scorch¬ 
ing  summers  ;  the  winter  diseases  are  therefore  highly  inflam¬ 
matory.  Those  of  summer  tend  to  a  prutrescent  disposi¬ 
tion.  Though  this  station  does  not  afford  the  same  field  as 
the  tropical  ones,  yet  you  will  admit,  that  hardening  troops 
for  this  climate  is  a  point  of  important  consideration. 

Egypt. — The  last,  and  perhaps  what  may  be  termed  only 
an  occasional  station,  where  troops  are  sent  to,  is  Egypt ;  a 
country  peculiar  in  its  climate,  manners,  and  diseases,  the 
reliques  of  which  the  troops  of  Britain  have  every  day  cause 
to  deplore.  The  two  chief  diseases  of  this  climate  are  plague 
and  ophthalmia.  You,  Sir,  from  what  you  have  seen,  will 
not  surely  deny  the  necessity  of  experience  in  these.— 
Measures  to  check  the  progress  of  plague  have  met  the  en¬ 
couragement  of  every  government  in  Europe,  and  to  assist 
the  treatment  of  Egyptian  ophthalmia,  it  has  even  been 
found  necessary,  as  you  know,  for  the  inspector-general  to 
draw  up  directions.  Jf  these  directions  are  of  any  use  on 
one  subject,  why  are  they  not  extended  to  the  whole,  and 
where  is  the  plan  equal  to  what  is  now  suggested  ?  The 
foundation  of  all  science  is  facts  drawn  from  experience; 
experience,  unless  drawn  from  others,  is  the  slow  offspring 
of  time :  it  can  only  be  matured  in  the  manner  I  propose. 

In  finishing  this  outline  of  the  different  medical  stations  of 
military  service,  an  important  subject  remains  for  your  na-< 
tice,  the  precaution  that  ought  to  be  observed  in  the  change 
of  troops  from  Britain  to  the  warmer  regions. 

Seasoning  of  Troops . — It  is  well  known  the  human  con¬ 
stitution  can  accommodate  itself  to  every  change  of  tempera¬ 
ture  without  danger,  if  changes  are  brought  on  by  degrees* 


546  Medicine.  [  March  1 

We  are  the  children  of  habit,  and  custom  has  a  powerful  in¬ 
fluence  on  every  action,  feeling,  and  thought.  A  removal 
immediately  from  the  colder  regions  of  the  north  to  a  verti¬ 
cal  sun,  is  certainly  highly  injurious  to  all  those  whose  oc¬ 
cupations,  such  as  those  of  military  life,  are  connected  with 
active  exertions.  Thus  it  is  found  that  an  European  soldier 
is  nearly  two  years  in  the  East  Indies  before  he  is  able  to  en¬ 
dure  the  fatigues  of  active  duty.  What  was  the  great  me¬ 
rit  of  the  late  Lord  Lake  ?  Was  it  not  that  he  was  able,  by 
the  management  of  his  troops,  to  march  them  so  rapidly  that 
the  enemy  had  no  idea  of  their  being  able  to  make  such  pro¬ 
gress,  and  were  therefore  taken  by  surprise.  To  render  the 
European  troops,  then,  fit  for  the  service  of  the  warmer  re- 
gious,they  shold  be  first  seasoned  by  a  residence  in  the  Me¬ 
diterranean,  and  from  that  draughted  for  East  or  West  India 
service.  Thus  also  the  diseases  of  the  Mediterranean  station 
should  be  studied  as  a  cue  or  introduction  to  the  more  malig¬ 
nant  maladies  of  East  and  West  India  origin. 

Selection  of  Troops  for  Tropical  Serv ice. — Besides  this 
seasoning  of  troops  for  active  service  in  the  warmer  climates, 
a  selection  of  them,  in  order  to  the  preservation  of  their 
health,  is  no  less  necessary.  It  is  a  fact  well  established,  that 
the  virulent  contagions  of  the  East  and  West  Indies,  make  a 
stronger  impression  on  the  flower  of  youth  and  vigour  than 
after  the  age  of  forty.  This,  then,  is  an  important  point  to 
be  attended  to.  Certain  diseases  also  peculiar  to  the  colder 
climates,  particularly  consumption  of  the  lungs,  gout,  &c.  &c. 
are  removed  by  a  residence  in  a  warm  climate. 

In  this  cursory  view  I  am  only  permitted,  you  will  ob¬ 
serve,  merely  to  hint  at  the  various  medical  topics  which  be¬ 
long  to  military  service.  These  hints  as  yet  relate  to  medi¬ 
cine  alone,  and  a  military  practitioner  is  more  than  two- 
thirds  of  his  duty  employed  as  a  physician  rather  than  as  a 
surgeon.  The  distinctions,  therefore,  in  the  service,  are  a 
matter  of  no  moment:  a  military  practitioner  should  learn 


Medicine . 


1809.] 


247 


equally  the  business  of  the  physician,  of  the  surgeon,  and  of 
the  apothecary.  The  real  business  of  surgery  he  has  little 
occasion  for  but  in  the  field  and  during  the  scene  of  action  ; 
and  here  the  experience  and  instruction  I  contend  for,  is 
equally  necessary  as  in  every  other  part  of  the  service.  The 
coolness  and  precision  necessary  to  act  here  with  success,  can 
only  be  acquired  by  previous  instructions  and  experience.— 
The  great  object  he  is  to  have  in  view,  is  the  treatment  of 
gun-shot  wounds,  and  the  various  improvements  which  can 
be  made  to  alleviate  pain,  check  haemorrhage,  and  induce 
speedy  renovation,  are  the  points  to  seek  for  instruction  upon. 

Following  the  system  of  the  great  Frederick  of  Prussia,  he 
is  to  save  every  limb  possible,  and  avoid  mutilation.  On 
these  observations  I  might  still  enlarge,  for  even  the  prepara¬ 
tion  of  the  forms  of  medicine  for  military  practice  is  a  sub¬ 
ject  of  high  value  to  the  young  surgeon. 

But  I  shall  not  intrude  longer  on  your  patience.  I  trust  I 
have  said  enough  to  lead  your  attention  to  the  subject.  I 
submit  the  propriety  and  necessity  of  the  measure  to  every 
medical  character,  and  from  their  decision  I  leave  you  to 
draw  your  conclusion.  Instruct  the  military  practitioner  as 
he  ought  to  be,  and  draw  him  up  careful  rules  for  his  con¬ 
duct.  No  other  improvement  is  necessary  to  the  medical  de¬ 
partment.  Complicated  establishments  will  then  be  unne¬ 
cessary,  for  when  a  surgeon  is  taught  to  know,  he  will  sel¬ 
dom  be  backward  in  performing  his  duty. 


I  have  the  honour  to  be,  Sir, 
With  high  consideration, 
Y our  most  obedient. 


And  very  humble  Servant, 


London ,  Feb.  20,  1809. 


WM.  NISBET. 


Surgery. 


f  March* 


S4S 

II.  SURGERY. 

The  leading  merit  of  a  practical  Surgeon  is  to  be  found 
more  in  his  proper  management  and  mode  of  regulating  in¬ 
flammation  than  in  any  other  part  of  the  science.  It  is  by 
this  process  all  changes  of  parts,  whether  morbid  or  salutary, 
take  place,  and  to  terminate  it  happily  when  of  a  morbid  na¬ 
ture,  or  to  render  it  an  active  agent  to  produce  a  successful 
issue,  are  points  that  require  often  much  judgment,  nice  dis- 
crmination,  and  a  proper  knowledge  of  the  powers  and  ener¬ 
gies  of  the  living  machine. 

This  might  be  instanced  in  a  vast  variety  of  cases,  perhaps 
the  radical  cure  of  hydrocele  by  injection  is  one  of  the  most 
striking  examples.  If  the  inflammation  here  is  either  excited 
in  too  high  a  degree,  or  does  not  reach  the  proper  height,  the 
operation  in  both  cases  will  fail  of  its  effect  in  completing  an 
adhesion  of  the  sides  of  the  sac,  and  the  surgeon’s  after¬ 
management  entirely  guides  the  success  of  the  operation. 
The  treatment  of  inflammation,  then,  may  be  considered  as 
the  begmning  and  end  of  all  a  surgeon’s  knowledge,  and  his 
attention  to  it  cannot  be  inculcated  too  strongly. 

Next  to  inflammation,  the  treatment  of  wounds  is  a  sub¬ 
ject  of  great  importance.  To  be  able  to  determine  what  na¬ 
ture  wall  do  from  a  close  and  attentive  observation  of  her 
efforts  is  the  summit  of  practical  knowledge  in  this  branch. 
In  the  human  subject,  her  powers  are  not  equal  to  what  she 
displays  with  the  inferior  animals.  The  claw  of  a  crab  will 
be  entirely  renovated  when  torn  off,  and  an  eel  cut  in  pieces 
will  renew  its  lost  parts.  In  man,  however,  nature  proceeds 
to  renew  her  work  with  a  sparing  hand  ;  yet  still  we  are  at 
times  unexpectedly  surprised  with  cures  which  could  not 
be  looked  for.  It  was  perhaps  from  this  fact,  though  not 
frequent,  that  Balguer,  surgeon  to  the  great  Frederick  of 
Prussia,  laid  aside  entirely  the  operation  of  amputation  in 


[ 


1809.]  Surgery.  249 

gunshot  wounds.  In  this  way,  certainly  many  limbs  were 
saved/  but  whether  the  inconvenience  arising  from  tedious 
cores,  and  the  incomplete  use  of  the  member  afterwards 
might  not  counterbalance  the  advantages  attendant  on  pre¬ 
serving  it  has  been  doubted  by  many  authors. 


REPLY  OF  PR.  REECE  TO  T,  B.  ON  ADMIRAL  HENRY’S  CASE 

OF  CATARACT,  WITH  TIIE  ADMIRAL’S  OWN  STATEMENT. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — In  your  last  number,  an  explanation  is  re¬ 
quired  from  me  of  some  particulars  in  Admiral  Henry’s  case 
of  Cataract.  Whether  the  obscurity  stated  by  your  corre¬ 
spondent  is  owing  to  the  sublimity  of  my  style,  as  hinted,  or 
to  the  fault  your  correspondent  attributes  to  himself,  I  shall 
not  determine.  I  have  thought  it  best,  however,  to  make 
the  gallant  Admiral  tell  his  own  story,  which,  like  the  pro¬ 
ceeding  of  a  real  British  tar,  is  more  occupied  in  the  state¬ 
ment  of  facts  than  the  frivolity  of  expression. 

I  am,  Gentlemen,  your  obedient  Servant., 
Henrietta  Street ,  Feb .  15.  R.  REECE, 

Dear  Sir — I  received  your  favour  of  the  4th  inst.  yes¬ 
terday.  With  a  phial  bottle  about  5  in.  long,  and  about  f 
inch  diameter,  I  punched  my  eye,  and  rubbed  the  eyeball 
from  side  to  side,  with  as  much  violence  as  I  could  possibly 
bear,  and  with  the  rim,  at  the  mouth  of  the  bottle,  I  did  the 
same  up  and  down 5  when  the  eye  would  no  longer  bear  so 
violent  an  application,  I  let  it  rest  a  few  days  or  a  week,  and 
repeated  the  operation  as  soon  as  it  would  admit  of  it.  The 
complaint  in  my  eye  was  a  Cataract,  and  by  the  above  me¬ 
thod,  I  suppose  an  absorption  took  place,  and  I  see  with  it 
just  as  well  as  if  the  Cataract,  had  been  extracted.  I  see  to 
read  the  smallest  print  in  the  newspapers  with  a  glass  of 
in.  focus,  and  I  see  things  at  a  distance  tolerably  well  with 
one  of  in.  focus,  but  with  neither  glass,  so  well  as  when 

VOL.  it.  % 


[Marclir 


SjO  Surgery. 

the  eye  was  good.  Both  my  eyes  had  Cataracts  in  them, 
one  failed  after  extraction  from  inflammation  and  the  sight  is 
totally  lost. 

For  the  scout  and  rheumatism  I  recommended  the  same 
instrument,  and  to  be  applied  in  the  same  manner  to  the  parts 
affected  when  the  fit  is  off ;  with  the  addition  of  pinching  the 
parts  with  as  much  -strength?  as  the  fingers  and  thumb  earn 
give.  The  phial  should  be  corked  up  fight,  and  the  cork 
cut  close  to  the  glass.  I  recommended  a  phial  because  it 
never  breaks  up  the  skin.  It  is  always  best  to  operate  for 
the  gout  or  rheumatism  in  one’s  bed.  I  mean  to  be  in  Lon¬ 
don  in  May,  when  I  shall  be  glad  to  give  any  further  in¬ 
formation  in  my  power. 

I  am,  Sir,  your  most  obedient  Servant,- 

JOHN  HENRY. 

REMARKS  OR  ADMIRAL  HENRY’S  CASE. 

From  the  above  statement  I  can  have  no  doubt  that  ab¬ 
sorption  of  the  lens  must  have  taken  place.  The  lens 
being  articulated  to  the  capsule,  but  in  a  slight  man¬ 
ner,  any  change  which  may  produce  a  separation  oc¬ 
casions  the  lens  to  become  then  an  extraneous  body 
floating  in  the  humours,  and  its  vitality  being  thus  destroyed, 
it  must  shrink  and  be  absorbed.  It  is  only  in  this  way  we 
can  account  for  cures, of  cataract  frequently  taking  place  in 
the  hands  of  the  surgeon,  while  preparing  the  patient  for  the 
operation.  The  frequent  examination  and  irritation  of  the 
eye  may  in  the  hardened  state  of  the  lens  produce  this  sepa¬ 
ration  stated,  and  the  absorption  in  consequence  of  that  go 
on.  That  instances  of  the  absorption  of  the  capsule  also 
take  place  has  been  proved.  But  the  opinion  suggested,  we 
conceive  the  simpler  of  the  two,  and  as  no  dissections  have- 
been  made  to  ascertain  this  circumstance,  though  the  fact  of 
such  cures  is  sufficiently  established,  tfie  explanation  that  is 
easiest  and  simplest,  and  does  not  require  the  exertion  of  ex¬ 
traordinary  powers  in  the  part,  is  the  one  to  be  adopted. 


Surgery* 


251 


1809.] 


THE  CASE  OF  A  BOY  WHO  SWALLOWED  A  HALF-PENNY , 
FROM  THE  COMMUNICATION  OF  DR.  BLEG BO ROUGH. 

The  following  communication  was  given  viva  voce  by  our 
correspondent,  Dr.  Blegborough,  whose  avocations  at  present 
did  not  permit  bim  leisure  to  commit  it  to  paper.  The  case 
is  singular,  as  leading  to  several  important  conclusions. 

The  son  of  Mr.  Thompson,  coach-maker,  of  Pleasant-row, 
Blackfriars-road,  a  Boy  of  three  years  old  on  the  20th  of  June 
last,  on  the  29th  of  October  accidentally  let  a  half-penny 
down  his  throat,  for  we  cannot  say  he  swallowed  it :  it  con¬ 
tinued  in  the  gullet  to  the  31st  January,  when  it  was  dis¬ 
charged  in  a  fit  of  the  hooping-cough  with  which  he  had 
been  seized.  During  the  whole  of  this  time  the  lodgment  of 
this  extraneous  body  gave  no  uneasiness,  though  it  could  be 
even  felt,  and  on  carefully  inspecting  it,  it  does  not  appear 
to  have  suffered  any  solution  or  oxydation  from  the  action 
of  the  animal  fluids  secreted  in  its  neighbourhood  ,  and  coming 
in  contact  with  it.  A,  similar  case  occurred  to  the  same  gen¬ 
tleman  several  years  ago,  which  was  retained  for  the.  same 
length  of  time,  and  also  gave  no  uneasiness:  it  was  at  last 
brought  up  by  a  strong  exertion  of  vomiting. 

From  these  cases  the  following  conclusions  may  be  drawn  s 

First,  That  the  gullet  is  a  part  of  little  sensibility;  that  it 
is  Capable  of  much  extension,  without  inconvenience ;  and 
that  though  possessed  greatly  of  muscular  fibres,  which  are 
placed  both  in  a  longitudinal  and  circular  direction,  they 
do  not  seem  to  possess  that  strong  irritability  as  in  other 
parts.  Unless  this  be  the  case,  how  are  we  to  account  for 
the  retention  of  substances  for  such  a  length  of  time  without 
inconvenience  and  without  pain.  But  this  lessened  irrita¬ 
bility  w  ould  seem  as  if  confined  more  to  the  under  than  Upper 
part  of  the  canal ;  for  the  occurrence  of  spasm  and  other  ner¬ 
vous  symptoms  are  proofs  that  no  lessened  irritability  prevail® 
at  the  commencement  of  the  passage. 

A  second  conclusion  to  be  drawn  from  this  accident  is, 

s  8 


252 


Surgery. 


that  the  secreted  fluids  both  of  the  mouth  and  throat  possess 
little  power  of  solution.  Whatever  activity  the  saliva  may 
receive  on  passing  into  the  stomach,  and  mixing  with  the 
gastric  juice,  it  is  innoxious,  it  would  seem  in  its  original 
state. 

A  third  conclusion  to  be  drawn  is,  that  copper,  however 
virulent  as  a  poison,  is  only  rendered  so  by  oxydation,  and  no 
acid  being  present  to  produce  this  change,  even  if  accidentally 
produced  from  the  food  and  drink  passing  into  the  stomach, 
its  application  does  not  seem  to  have  been  made  sufficiently 
long  to  ensure  this  effect.  The  halfpenny  appears,  on  in* 
spection,  to  have  no  marks  of  solution. 

Since  writing  the  above,  a  still  more  remarkable  case  of 
the  same  kind  has  been  mentioned  in  Mr.  Capon,  who 
formerly  kept  the  Crown  Inn,  Lowestofte,  in  Suffolk.  This 
person  accidentally  getting  a  crown-piece  into  his  mouth,  it 
passed  into  the  throat,  where  it  was  retained  for  several 
years,  and  at  last  was  brought  up  in  a  fit  of  laughter. 
No  inconvenience  occurred  during  this  period  from  its 
retention . 


Practical  Observations  on  the  Diseases  of  the  Joints,  com¬ 
monly  called  White-swelling ;  with  Remarks  on  Caries , 
Necrosis,  and  scrofulous  Abscess ,  in  which  a  new  and 
succesful  method  of  treating  these  complaints  is  pointed 
out .  By  Bryan  Crowther ,  Member  of  the  Royal  Col- 
ledge  of  Surgeons  in  London,  and  Surgeon  to  Bridewell 
and  Bethlem  Hospital . 

(Continued  from  V ol.  IL  page  162.) 

In  our  continuation  ©f  this  useful  performance,  we  (have 
to  observe  that  many  of  Mr.  Crowther’s  ideas  on  this 
subject  are  new  and  all  very  important :  our  limits  will  not 
permit  us  to  make  many  extracts,  therefore,  we  shall  conclude 
this  Review  with  the  Author’s  statement  on  Necrosis. 

“  The  soft  parts  investing  the  bone  which  is  undergoing 


N 


) 


1809.]  Surgery,  253 

^necrosis,  suffer  in  the  same  manner  as  we  have  described 
in  white-swellings :  they  inflame  and  suppurate,  and  at 
this  period  the  patient  is  brought  into  a  very  alarming  and 
hazardous  situation.  To  relieve  this  complaint,  an  operation 
has  been  proposed,  that  of  denuding  the  new  osseous  shell, 
and  perforating  it  with  a  view  to  extract  the  sequestra.  In 
some  cases,  in  which  the  bone  has  become  dead  to  a  small 
extent,  and  is  thinly  covered,  such  an  attempt  might  be 
feasible;  but  in  the  majority  of  instances,  and  especially  in 
the  thighbone,  itmustbs  utterly  impracticable. — Amputation 
might  certainly  be  performed  in  these  cases,  but  not  without 
the  probability  of  extensive  exfoliation.  lean  recommend 
a  mode  of  treatment  which  supersales  the  necessity  of 
either  of  these  formidable  operations,  which  indeed  is 
exactly  similar  to  that  adopted  for  the  relief  of  soft  parts 
covering  a  diseased  joint. 

a  The  occasional  application  of  leeches,  combined  with  the 
use  of  blisters,  and  the  savine  cerate,  will  obviate  the 
occurrence  of  abscess ;  a  most  important  point  in  the 
treatment  of  the  complaint.  If  the  external  parts  are  kept 
free  from  disease,  by  these  means,  the  absorption  of  the 
sequestra  will  in  process  of  time  be  effected.  The  extent 
to  which  these  remedies  must  be  employed,  and  the  frequency 
of  their  repetition  must  depend  upon  the  irritation  excited 
in  the  external  parts.  If  there  is  an  interval  of  ease,  and 
the  limb  is  neither  swollen  or  tender  to  the  touch,  the 
treatment  may  be  interrupted  for  a  time;  but  whenever  pain 
is  again  felt,  the  use  of  leeches  must  be  immediately  resorted 
to  ;  and  when  ease  has  been  procured  by  their  application, 
blisters  and  the  savine  cerate  must  be  again  employed.  The 
firsi  case  I  ever  treated  in  this  manner,  I  mistook  for  a 
disease  of  the  thigh  bone.  The  patient  became  so  well  as  to 
quit  St.  Clement’s  Workhouse,  to  which  she  returned  after 
an  absence  of  above  six  months,  in  a  hectic  and  miserably 
jeduced  condition,  haying  just  quitted  a  hospiial,  in  which 

s  a 


254: 


[March, 


Surgery* 

she  had  been  salivated.  Although  I  succeeded  in  preventing 
the  formation  of  abscess,  she  died  in  three  weeks,  and 
afforded  me  an  opportunity  of  examining  her  disease,  which 
I  found  to  be  necrosis,  and  not,  as  I  first  examined,  a  carious 
bone.  I  have  been  equally  successful,  and  less  ignorant  of 
the  nature  of  the  case  in  other  instances  ;  but  I  will  not  claim 
the  merit  of  being  the  original  proposer  of  this  mode  of 
treatment:  for  when  I  communicated  my  notions  on  the 
subject  to  Mr.  Abernethy,  I  found  that  he  had  already  iu 
his  lectures  promulgated  this  doctrine ;  to  him  therefore 
mankind  is  more  largely  iudebted  for  the  usefulness  and 
propriety  of  this  mode  of  treatment,  than  may  have  been 
hitherto  conceived.  I  only  know,  that  we  think  alike  on 
the  subject  of  cure,  and  shall  leave  to  his  much  more  able  pen 
the  publication  of  his  own  remarks.” 

Observations  on  some  alleged  consequences  of  Gonorrhoea , 

by  Mr.  F.  Kiernan ,  Member  of  the  Royal  College  of 

Surgeons ,  London , 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen-- No  disease  is  perhaps  so  little  in  the  power 
of  the  Surgeon  as  the  treatment  of  Gonorrhoea,  That  it  will 
spontaneously  cease  without  any  means,  practitioners  agree, 
and  consequences  often  arise  from  this  apparently  simple  af¬ 
fection,  which  equally  surprise  and  distress  us.  1  allude 
here  to  some  peculiar  affections  which  have  been  mentioned 
by  authors  as  immediately  succeeding  sudden  suppression  of 
its  discharge,  and  which  has  led  of  course  to  a  confirmation 
of  the  opinion  formerly  entertained,  that  there  was  some¬ 
thing  critical  in  its  evacuation,  and  that  the  modes  of  prac¬ 
tice  should  be  such  as  promoted  it.  The  laws  of  sympathy 
we  are  as  yet  not  sufficiently  acquainted  with,  and  therefore 
to  deny  them  and  their  consequences,  would  be  presuming 
too  far,  though  to  admit  them  implicitly,  would  savour 
strongly  at  the  same  time  of  credulity.  Ail  the  affections 


1809,]  Surgery.*  255 

prising  from  this  source,  are  marked  by  a  violence  of  symp¬ 
toms  uncommon  to  the  nature  of  the  disease,  and  two  of  them 
iiave  been  particularly  insisted  on,  Ophthalmia  and  Deaf¬ 
ness. 

Both  of  these  affections  are  attended  here  with  the  most 
acute  inflammation,  more  so,  perhaps,  than  in  any  other 
<case,  so  as  totally  to  destroy  in  a  few  days,  if  continuing,  the 
functions  of  the  respective  organs.  The  former  of  these  was 
first  described  by  Mr.  Ives  in  his  Treatise  on  the  Diseases  of 
the  Eye.  It  was  afterwards  taken  notice  of  by  Dr,  Astruc, 
and  is  lately  mentioned  by  Dr.  Swediaur :  and  other  in¬ 
stances  of  it  occur  in  different  periodical  publications.  It  is 
now  by  more  modern  writers  assimilated  with  the  Egyptian 
Ophthalmia,  and  supposed  to  derive  its  origin  from  a  similar 
source.  The  eye  in  this  case  becomes  reddish  and  inflamed, 
with  considerable  pain,  and  a  constant  flow  of  tears.  The 
e}7e-lids  likewise  partake  of  this  state,  being  swelled  so  as  not 
to  cover  the  eye,  and  a  thickish  yellow  matter  oozes  from 
the  setaceous  glands.  The  disease,  if  continuing,  is  soon 
attended  with  an  opacity  of  the  cornea ;  and  though  symp¬ 
toms  of  lues  frequently  affect  the  eyes,  yet  they  are  never  at¬ 
tended  -with  the  dagger  of  the  present  complaint,  as  if  not  im¬ 
mediately  relieved,  blindness  commonly  ensues  in  a  few  days. 
The  cure  is  effected  in  two  way  s  5:  either, 

1st,  By  recalling  the  original  disease  ;  or  2d,  lessening  in¬ 
flammation  in  the  part,  by  scarification  of  the  conjunctiva, 
and  other  topical  means  of  removing  increased  action. 

Deafness,  the  other  affection  from  the  same  source,  is  equally; 
violent  in  its  symptoms  with  the  former,  attended  with  most 
acute  pains,  and  suppuration  soon  forms,  and  the  structure 
©f  the  ear  coming  to  be  destroyed,  the  loss  of  hearing  is 
never  to  be  again  repaired.  The  method  of  treatment  is 
much  the  same  with  that  of  ophthalmia,  allowing  for  the  dif¬ 
ferent  structure  of  parts,  and  the  grand  point  is  in  all  these  case? 

s  4 


256  Surgery*  [March, 

to  subdue  the  activity  of  the  inflammation  before  it  pass  into 
any  secondary  state,  particularly  suppuration. 

Paralysis  has  been  also  mentioned  as  an  effect  of  Retropulsed 
Gonorrhoea.  It  is  generally  partial,  and  in  the  6th  volume  of 
the  Medical  Commentaries  is  recited  a  very  remark  able  case  of 
this  kind,  which  obstinately  resisted  every  remedy  till  ar 
Mercurial  course  at  last  being  begun  a  complete  cure  was  ef¬ 
fected,  and  in  its  progress  the  original  affection  of  the  urethra 
returned  with  the  same  violence  as  marks  the  incipient  state 
of  the  disease. 

But  all  these  affections  are  to  be  considered  as  very  rare, 
and  as  yet  we  have  not  had  sufficient  experience  to  ascertain 
with  exactness  their  true  nature,  so  that  we  are  obliged  to  go 
by  the  opinions  of  authors  who  frequently  ascribe  to  this 
cause  whatever  affection  occurs  during  the  progress  of  gonor¬ 
rhoea,  where  it  perhaps  may  be  more  justly  referred  to  another 
source;  for,  even  the  cure  by  mercury,  and  also  the  return  of 
the  original  affection  are  by  no  means  certain  marks  of  the 
disease  arising  from  this  source :  Mercury  cures  many  diseases, 
and  its  stimulant  powers  are  certainly  fa  vourablein  many  cases ' 
to  the  removal  of  paralysis,  while  the  urethra,  we  know,  af¬ 
ter  gonorrhoea,  similar  to  other  parts  the  seat  of  hosmorrhage, 
retains  its  disposition  to  continue  the  discharge ;  and  this 
more  especially  when  an  universal  increase  of  circulation  is 
produced  by  the  action  of  mercury. 

If  the  above  hints  will  induce  any  of  your  correspondents 
to  favour  me  with  a  full  account  of  these  different  sympathe¬ 
tic  affections,  they  will  confer  an  obligation  on, 

i 

Gentlemen,  your  obedient  Servant, 

F.  KIERNAN, 

Charlotte  Sreet ,  Bedford  Square , 

Feb .  15,  1809. 


Midwifery. 


257 


1809.] 


*  •  i 

III.  MIDWIFERY. 


It  Las  been  long  a  subject  of  doubt  with  accoucheurs 
whether  labour  is  to  be  considered  as  a  state  of  actual  disease, 
^t  was  on  this  principle  practitioners  formerly  used  to  direct 
their  treatment,  and  the  antiphlogistic  plan  was  therefore 
carried  on  by  them  to  an  extent,  which  from  the  d  bility  in¬ 
duced  by  it,  frequently  ended  in  real  disease.  One  of  the 
great  modern  improvements  in  obstetrical  practice  is  treat¬ 
ing  the  patient  as  bordering  on  the  state  of  health,  and  nei¬ 
ther  subjecting  her  to  low  diet  or  tedious  confinement. 

Certain  symptoms  in  childbed  have  been  considered  as 
giving  a  prognosis  in  respect  to  recovery.  One  of  these  is 
the  regular  flow  of  the  lochia  ;  but  even  to  this,  many  excep¬ 
tions  frequently  arise.  A  case  occurred  about  a  month  ago 
to  an  eminent  accoucheur,  where  no  appearance  at  all  took 
place  from  the  very  termination  of  labour  to  the  period  of 
recovery,  and  the  patient  got  sooner  well  without  the  ap¬ 
pearance  than  in  any  of  her  former  lyings-in.  This  case, 
so  singular  in  its  course,  and  deviating  so  much  from  com¬ 
mon  habit,  was  minutely  examined  by  several  practitioners, 
whose  testimony  can  be  adduced  to  support  the  truth  of  it. 
All  general  rules  are  liable  to  exceptions ;  and  the  anxioms 

built  upon  them  shew  the  weakness  of  the  structure  on  which 

* 

they  are  raised. 


COMMUNICATION  ON  RETRO  VERTED  UTERUS,  BY  MR.  MEL- 
LIS,  MEMBER  OF  THE  ROYAL  COLLEGE  OF  SURGEONS. 


To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — In  a  former  number  of  your  valuable  work, 
a  case  was  related  of  inversion  of  the  uterus  ;  a  disease  gene¬ 
rally  fatal,  unless  immediate  relief  is  afforded.  There  is  ano¬ 
ther  disease  which,  though  not  so  fatal,  is  apt  to  prove  highly 
inconvenient  and  distressing  to  many  women  during  preg- 


[March, 


fS§  Midwifery. 

jiancy — that  is,  the  retroverted  uterus.  Dr.  Hunter  has  the 
merit  of  first  describing  this  formidable  complaint.  It  oc- 
curs  about  the  fifth  month,  immediately  before  the  uterus 
rises  to  be  supported  on  the  promontory  of  the  Sacrum.  At 
this  period  the  uterus,  being  weighty  from  some  cause,  it* 
fundus  is  apt  to  descend  suddenly  into  its  hollow,  which  oc¬ 
casions  the  os  tinea;  to  be  tilted  up  in  the  opposite  direction ; 
and  thus  the  situation  of  the  urethra  becomes  altered,  and 
an  obstacle  occurs  to  the  discharge  of  urine. 

The  symptoms  of  this  disease  are  at  first  mild  and  deceit¬ 
ful.  Some  uterine  pain  is  felt,  attended  with  a  slight  in¬ 
clination  to  void  urine.  It  passes  with  difficulty  at  first, 
but  as  the  efforts  and  pain  increase,  a  total  obstruction  occurs* 
This  obstruction  allowed  to  continue,  and  the  displacement 
of  the  uterus  always  augmenting,  produce  soon  the  most 
dangerous  situation  to  the  patient.  From  the  passages  of  the 
urethra  and  rectum  being  both  shut  up,  inflammation  and  aU 
its  consequences  arise,  and  it  is  sometimes  hardly  possible  to 
replace  the  retroverted  organ.  Of  this  disease  many  re¬ 
markable  instances  are  to  be  found  in  authors,  where  the 
quantity  of  urine  accumulated,  and  distension  of  the  blad¬ 
der  had  proceeded  to  the  most  extraordinary  length. 

The  late  Professor  Young  used  to  state  in  his  lectures  one 
case,  where  he  drew  off  no  less  than  18  pints.  The  late 
Dr.  Aikin  relates  another,  where  he  took  off  12  pints.  I 
have  myself  known  several  fatal  instances  of  this  disease. 
The  victims  of  it  arc  commonly  in  the  lower  order  of  life. 
Women  of  better  condition,  when  they  feel  uneasiness  and 
bearing-down  pains,  at  this  period,  are  inclined  to  take  rest, 
which  abates  the  symptoms,  and  prevents  the  disease  pro¬ 
ceeding  to  a  formidable  length.  The  prevention  should  in 
all  cases  be  the  great  object;  and  women  should  therefore  be 
cautioned  by  those  who  attend  them,  of  what  may  occur  at 
this  period,  so  that  any  formidable  increase  of  it  may  be  pre¬ 
vented.  Those  women  in  whom  the  pelvis  is  well  made,  and 


1809.]  Midwifery*  25S' 

capacious,  are  more  liable  to  it.  The  fatal  termination  in 
this  disease  is  either  by  fever  or  convulsions ;  and  before  the 
latter  ensue,  the  distension,  of  the  bladder  is  generally  so  great 
as  to  reach  as  high  in  the  abdomeh  as  what  marks  the  seventh 
or  eighth  month  of  pregnancy,  or  much  above  the  umbilicus. 

These  hints  are  merely  directed  to  young  practitioners,  in 
order  to  avoid  an  evil  which  may  always  with  a  little  care  be 
easily  prevented.  The  treatment  is  obvious  by  drawing  off 
the  urine  where  it  is  practicable,  and  replacing  the  organ. 
In  the  last  stage  of  the  malady,  this  is  too  often  not  easily 
accomplished ;  and  various  expedients  have  been  proposed 
for  producing  abortion  by  opening  the  os  tincce ,  or  even 
dividing  the  symphysis  pubis  by  the  operation  of  Sigault. 
The  first  is  difficult,  as  the  os  tincce,  in  these  cases  cannot 
easily  be  reached.  The  latter  is  hardly  admissible,  except 
in  the  most  forlorn  circumstances-;  neither  am  I  convinced 
that  it  would  prove  successful  if  performed. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

Thornhciugh  Street,  Feb.  12,  1809.  JOHN  MELLIS. 

OBSERVATIONS  ON  RIGIDITY  OF  THE  MEMBRANES. 

To  the  Editors  of  The  Medical  and  Surgicol  Spectator. 

Gentlemen — Thickness  of  the  membranes  has  been 
mentioned  as  a  cause  of  tedious  labour,  and  there  can  be  no 
doubt  of  its  frequently  proving  so.  This  thickness  or 
rigidity  is  not  in  general  to  any  great  extent ;  and  in  such 
cases  it  is  surprising  what  wonderful  effects  arise  from  a  single 
bleeding  to  expedite  the  labour.  1  have  seen  a  woman  who 
had  lain  for  hours  with  the  strongest  pains,  without  their  pro¬ 
ducing  the  smallest  effect,  and  after, the  tincce  had  been  fully 
dilated,  on  being  bled  to  the  extent  of  eight  or  ten  ounces, 
instantaneously  has  the  labour  accelerated,  and  she  has  been 
delivered  in  the  course  of  a  few  pains,  though  they  had  not 


260 


fMarch, 


before  had  the  smallest  influence,  or  a  total  suspension  of  them 
had  taken  place  for  a  great  many  hours.  Once  in  my  life 
I  met  wi<h  a  morbid  thickness  of  the  membranes  to  that 
degree  that  the  ovum  was  expelled  entire.  On  cutting  into 
them,  they  seemed  something  of  a  fleshy  texture,  and  in  this 
case  there  were  little  or  no  waters.  This  complete  expulsion 
of  the  ovum  has  been  considered  by  some  as  the  most 
natural  state  of  labour.  It  is,  however,  certainly  a  most 
dangerous  one,  as  flooding  may  occur,  and  nature  has 
provided  that  this  circumstance  should  rarely  happen  as  a 
precaution  against  it.  If  these  observations  contain  any  thing 
worthy  of  notice,  they  are  at  your  service,  from, 

Gentlemen,  your  obedient  servant, 

T.  BROWN. 


Oxford-Street ,  Feb .  1,2  1809. 


On  the  Symptoms  and  Nature  of  Schirrous  in  the  Utems , 

by  Mr .  Kilpatrick ,  Member  of  the  Royal  College  °f 

Surgeons ,  London. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — It  is  chiefly  by  changes  in  the  uterine 
system  of  females,  that  their  good  and  bad  health  is  found  to 
be  regulated.  This  disease  often  occurs  at  an  early  period 
of  life,  and  affects  mensuration,  See.  The  structure  of  the 
uterus,  like  those  of  the  liver,  is  very  liable  to  this  state,  though 
more'  frequently  it  takes  place  about  the  time  when  the 
menses  depart. 

The  symptoms  of  this  disease  are,  1st,  a  sense  of  weight  or 
heavy  pain  in  the  uterus  or  about  the  pubes. 

2d,  Irregular  and  long-continued  floodings,  seldom  drying 
up,  or  soon  returning. 

3d,  Morbid  state  of  some  contiguous  organs,  as  strangury, 
tenesmus,  &c. 

Though  schirrus  may  occur  at  any  time  of  life,  yet  it  if 
most  frequently,  as  we  observed,  towards  its  decline,  that  its 


561 


1809.J  Midwifery. 

attacks  are  made.  -The  several  glands  then  lose  much  of 
that  activity  which  they  displayed  in  the  former  period ;  to 
expedite  their  secretions,  and  the  loss  in  part  of  their  activity  , 
exposes  them  to  all  the  effects  which  slowness  of  circulation, 
rising  to  a  morbid  degree,  produces.  What  is  the  peculiar 
change  that  takes  place  in  schirrus  we  cannot  determine# 
By  many  authors,  a  partial  loss  of  vascular  substance  in  the 
part  is  supposed  to  arise;  but,  even  admitting  this,  it  is  not 
sufficient  to  account  for  the  peculiar  morbid  state  we  find 
induced. 

Injuries  of  the  uterus  have  been  supposed  a  common  cause 
of  schirrus.  They  may  be  so,  and,  it  is  probable,  are  so; 
but  we  find  that  women  who  have  had  children,  whose  uterus 
consequently  has  been  most  exposed  to  such  injuries,  are  the 
th£  least  subject  to  this  disease.  The  same  may  be  said  of 
many  other  causes  enumerated  by  authors.  From  obser¬ 
vation,  we  find  that  it  is  most  usually  from  some  internal 
source,  the  existence  and  operation  of  which  we  caDnot  detect 
till  it  is  beyond  our  power  to  remedy  it. 

The  treatment  of  this  disease,  it  is  in  vain  for  any  practi¬ 
tioner  to  attempt;  a  palliative  plan,  by  mild  diet  and  opiates, 
is  all  that  is  in  our  power.  I  have  never  seen  any  benefit 
from  the  preparations  of  iron,  so  much  praised  by  some 
practitioners.  The  advantages  of  a  water-diet  have  been 
strongly  pointed  out  by  Mr.  Pearson,  in  his  Treatise  on 
Cancer ;  and  the  same  have  been  prosecuted  farther  with  much- 
industry  by  Dr.  Lambe. 

Iam,  Gentlemen, 

Y our  obedient  Servant, 

St.  Martin's  Lane ,  Feb .  20, 1809.  W.  KILPATRICK. 


/ 


262  Midwifery.  [March* 

On  the  Use  of  the  Lever,  by  Mr.  Grice ,  Member  of  the 
Royal  College  of  Surgeons. 

Gentlemen — The  use  of  instruments  in  the  practice  of 
midwifery  has  been  blamed,  perhaps,  in  some  degree  it  does 
not  deserve.  Without  such  menas  in  tedious  cases,  the 
lives  of  many  females*  as  well  as  of  the  children,  could 
not  be  saved.  One  of  the  most  ..useful  instruments  in  this 
View  is  the  simple  lever  applied  either  to  the  pubes,  or  the 
side  of  the  pelvis.  In  the  former  case,  however,  it  has  most 
purchase. 

On  this  instrument  it  may  be  remarked*  that  before  its 
publication  astheRoonhuysian  secret,  it  possessed  a  degree  of 
credit  equal  to  the  greatest  discoveries  ;  but  no  sooner  was  it 
made  known,  than  it  lost  greatly  of  that  reputation  it  had 
formerly  acquired.  The  simplicity  indeed  of  the  contri* 
vance,  and  some  inconveniencies  that  appeared  to  attend  its 
application,  were  the  causes  of  this  change  :  and  the  forceps 
seemed,  therefore,  an  instrument  more  deserving  attention, 
as  well  as  more  capable  of  improvement.  Thus,  from  the 
time  the  forceps  came  to  be  employed,  most  of  the  writers  on 
midwifery  have  entered  into  a  comparison  of  the  relative  ad¬ 
vantages  attending  the  use  of  each. 

The  objections  urged  against  the  lever  are  chiefly  on  ac¬ 
count  of  its  fulcrum,  or  rest  in  action,  being  on  the  pubes ; 
as  its  power,  if  sufficiently  strong,  must  be  proportionally 
exerted  against  the  urethra,  or  bladder  of  urine.  On  this 
account,  many  accidents  have  been  known  to  succeed  its  ap¬ 
plication  ;  and  several  practitioners  have  directed  its  being 
introduced,  on  the  contrary,  from  the  side  of  the  pelvis,  or 
along  the  surface  of  one  of  the  ischia ;  but  in  this  situation 
it  cannot  act  with  the  same  advantage,  as  the  resistance  to 
the  passage  of  the  head  is  chiefly  from  the  transverse  diame¬ 
ter  of  the  pelvis. 

The  objections  thus  urged  against  the  lever,  we  contend, 
have  arisen  more  from  practitioners  when  employing  it,  not 


& 


1809.  J  Midwifery.  $6 

attending  to  particular  circumstances  in  its  form,  size,  and 
application. 

With  respect  to  its  size,  the  original  Roonhuysian  one 
was  too  small,  and  on  that  account  pressed  entirely  on  the 
situation  of  the  urethra,  not  being  sufficiently  expanded  to 
rest  upon  the  more  distant  parts  of  the  pubes.  It  was  at  the 
same  time  entirely  solid,  so  that  it  could  not  avoid  injuring 
the  part  on  which  it  pressed.  We  would,  therefore,  re¬ 
commend  that  its  breadth  be  pretty  considerable,  that  it* 
blade  should  also  be  hollowed  for  the  greater  part,  so  that  a 
sufficient  space  may  be  allowed  for  the  safety  of  the  urethra; 
which,  if  the  practitioner  is  attentive  in  his  application,  will 
escape  entirely  being  compressed  by  the  instrument.  In  re* 
gard  to  its  form,  its  blade  should  possess  a  greater  curve  than 
the  forceps?  so  as  to  be  applied  accurately  to  the  convexity 
of  the  occiput,  that  it  may  not  slip  after  being  applied ;  for 
it  is  generally  more  difficult  to  introduce  it  than  the  forceps^ 
the  space  being  more  confined,  and  this  difficulty  is  even  in¬ 
creased  by  its  curved  shape :  for  this  reason  the  late  Dr. 
Aikin  has  constructed  what  he  terms  a  living  lever,  which 
is  introduced  straight,  and,  by  turning  a  screwr,  it  then  re* 
eeives  the  proper  curve,  which  adapts  it  to  the  presenting 
part;  but  the  fault  of  this  instrument  is,  that  what  advan¬ 
tage  it  possesses  over  the  other  facility  of  introduction  is 
counterbalanced  by  its  proportionate  w  ant  of  power ;  for 
where  much  force  is  required,  it  bends  too  readily,  and  thus 
easily  loses  its  hold,  requiring  a  new  introduction. 

As  the  chief  objection  arose  against  the  lever,  from  its  rest 
being  on  the  pubes,  modern  practitioners  have  endeavoured 
by  means  of  a  hole  at  this  part,  through  which  a  piece  of 
string  is  fastened,  by  pulling  it  down  here  with  one  hand, 
while  the  other  is  applied  to  the  handle,  to  lessen  its  pressure, 
and  thus  avoid  the  consequences  which  its  use,  according  to 
the  former  method,  produced.  It  is  with  its  improvement 
that  it  is,  at  present,  much  employed  by  the  London  prac¬ 
titioners. 


m 


f  March, 


Midwifery. 

The  length  of  the  lever  is  also  a  circumstance,  in  order  to 
its  successful  application,  requiring  attention  ;  for  if  too 
short,  its  power  is  not  sufficient  to  bring  down  the  head  :  and 
the  longer,  therefore,  it  is  made,  the  more  successful  will  its 
application  be  found. 

For  these  reasons,  we  consider  the  lever  as,  in  many  cases, 
a  very  useful  instrument,  and  as  by  no  means  deserving  that 
indiscriminate  censure  it  has  received  from  many  authors. 
Its  application  would  certainly  be  by  no  means  proper  in 
liioh  cases  of  distortion,  neither  will  it  succeed  where  the 
presenting  part  is  still  high,  and  not  at  least  an  inch  within 
the  pubes ;  but  in  those  situations  where  the  head  hag  de¬ 
scended  low,  where  the  pelvis  is  well  formed,  and  where  the 
labour  is  protracted,  chiefly  by  the  absence  of  pain  from  the 
exhausted  slate  of  the  patient,  and  some  rigidity  of  the  soft 
parts,  it  is  an  instrument  better  calculated  for  delivery  than 
Um  forceps,  as  it  can  be  used  even  without  ihe  knowledge  of 
the  patient ;  and  its  aciion  may  be  increased  by  chang¬ 
ing  her  posture,  or  placing  her  on  her  knees,  while  her  arms 
are  extended  round  the  waist  of  another  person  seated  for  this 
purpose. 

I  am,  Gentlemen,  your  obedient  Servant, 
Charlotte  Street ,  Fitzroy  Square ,  Feb.  16,  1809.  T.  G. 

Remarkable  case  of  successful  delivery  in  extreme  distortion , 
such  as  is  generally  considered  to  require  the  Caesarian 
operation ,  by  Mr .  T.  Mainwaring . 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 
Gentlemen — Cases  of  extreme  distortion,  fortunately  for 
the  sex,  are  but  rarely  met  with,  and  where  delivery  is  ac¬ 
complished  in  such  unfavourable  situations,  it  is  aproof  of  the 
great  improvement  which  modern  times  can  boast  in  the  exer¬ 
cise  of  this  branch  of  the  healing  art.  In  looking  over  the  cases 
of  deformed  pelvis ,  in  which  the  Caesarian  operation  has  been 


265 


1809.]  Midwifery. 

performed,  it  will  be  found  that  none  of  them  were  more 
contracted  in  their  dimensions  than  in  the  following  case  : 

M.  G.  aged  twenty  years,  at  the  full  period  of  uterogesta- 
tion,  had  regular  labour  pains  at  four  o’clock  on  Monday- 
morning,  Dec.  30,  1799  ;  they  continued  until  eight  of  the 
same  evening,  when  the  membranes  were  ruptured  by  con¬ 
tractions  of  the  Uterus  ;  the  activity  of  which  was  rather  in¬ 
creased  until  Wednesday  at  noon,  January  1st;  when  T.  M* 
saw  her  for  the  first  time,  he  found  the  projecting  angle  of 
the  sacrum  so  near  to  the  ossa  pubis ,  as  left  no  more  space 
than  about  three  quarters  of  an  inch ;  on  the  right  side,  the 
space  did  not  amount  to  one  inch,  on  the  left  it  exceeded  it ; 
he  perforated  the  head  at  eight  in  the  evening  of  the  same 
day,  after  drawing  oft' the  water,  and  as  much  as  possible 
evacuated  its  contents  by  the  aid  of  the  curved  perforator, 
and  repeated  the  efforts  to  the  same  effect,  the  next  day,  with 
the  end  of  a  spoon,  the  patient  being  very  free  from  febrile 
affection,  though  the  pains  had  not  ceased  during  the  whole 
time, (with  very  little  sleep).  No  further  endeavours  were  made 
to  effect  a  delivery,  until  the  forenoon  of  Saturday  the  4th, 
when  the  pulse  being  so  frequent  a§  140  a  minute,  and  the  foetus 
highly  putrid,  some  of  the  bones  broken  by  the  perforator, 
were  found  to  have  been  pushed  near  an  inch  forward,  and 
somewhat  loosened  in  their  attachment.  And  several  pieces 
were  carefully  extracted  by  the  fingers  only ;  at  length  a  hold 
was  found,  and  the  crotchet  safely  fixed,  and  guardedly  acted 
with,  the  two  frontal  bones  were  brought  away  ; .  a  number 
of  efforts  were  made  to  get  another  hold,  but  unsuccessfully, 
the  labour  pains  continuing,  the  operator’s  fingers  were  em¬ 
ployed  in  extracting  pieces  of  the  upper  part  of  the  cranium, 
during  which  the  crotchet  was  again  applied  in  the  basis  of 
the  skull,  and  about  half  of  both  (acting  by  the  arm  so  as  to 
come  short  of  detaching  it),  the  body  was  brought  down. 
The  whole  time  employed  was  two  hours.  The  placenta  was 
suffered  to  remain  for  three  following  reasons;  first,  that  the 

VOL,  II,  t 


[March, 


§66  Midwifery. 

parts  were  much  irritated,  by  the  operation,  and  the  patient 
greatly  fatigued.  The  funis  so  likely  to  be  detached,  by 
lightly  acting  upon  it ;  and  above  all  the  difficulty  of  in¬ 
troducing  the  hand  into  the  uterus ;  that  it  was  determined 
to  let  it  remain  for  a  few  hours,  during  which  the  patient 
fell  into  a  sound  sleep  ;  when  she  awoke,  a  glyster  was  given 
in  the  evening  for  the  third  time ;  the  following  day,  light 
pressure  being  made  upon  the  abdomen,  the  placenta  came 
away,  without  acting  upon  the  funis  after  remaining  thirteen 
hours.  The  patient  passed  her  water  in  the  usual  way 
during  the  first  five  days,  after  which  it  came  away,  without 
her  knowledge,  of  course  without  uneasiness.  When  she 
became  able  to  leave  her  bed,  it  was  not  in  her  power  to 
retain  it  for  more  than  a  few  seconds,  after  the  inclination  took 
place.  It  should  not  be  concealed  that  the  bladder  in  a  small 
degree  sloughed,  so  as  to  let  the  urine  pass  through  the 
aperture :  this  misfortune  may  best  be  accounted  for,  by 
having  given  a  longer  time  for  the  bones  of  the  head  to 
loosen,  than  was  consistent  with  the  safety  of  that  important 
receptacle. 

At  the  distance  of  one  month  from  her  delivery,  the 
dimensions  of  the  pelvis  were  attempted  to  be  ascertained— 
the  deformity  was  found  somewhat  to  differ  now  from  its 
state  when  the  head  was  wedged  within  its  aperture,  the  left 
side  was  so  much  wider  than  the  right  that  it  admitted  three 
fingers  from  pubis  to  sacrum,  when  the  other  admitted  of 
only  one.  In  the  centre  it  did  not  quite  admit  of  two  fingers, 
but  that  state  of  it  most  remarkable,  was  the  projecting  angle 
of  the  sacrum,  which  had  the  shape  and  sizeof  a  considerable 
round  (and  hard)  tumor,  between  two  and  three  inches  in 
diameter,  projecting  so  far  forwards,  as  to  require  the  patient 
to  lay  on  her  right  side,  in  order  that  the  right  hand  of  the 
operator  might  make  the  examination  of  the  dimensions  with 
some  degree  of  accuracy.  I  am.  Gentlemen, 

Your  obedient  servant, 

T.  MAINWAEim 


Strand ,  Feb.  25,  1809. 


1809.] 


Pharmacy. 


267 


REMARKS. 

The  above  case  differs  from  the  celebrated  one  of 
Dr.  Osborne  thus  far,  that  the  projection  is  more  from  pubes 
to  sacrum  than  from  side  to  side.  The  patience  and 
perseverance  displayed  by  the.  operator  reflect  on  him  the 
highest  credit.  The  allowing  the  putrefaction  of  the  child 
fully  to  take  place  was  certainly  favourable  to  the  delivery, 
and  shewed  much  judgment.  Dr.  Bland,  we  understand, 
was  present  at  this  case,  and  the  patient  still  survives,  which, 
from  the  recovery,  exceeds  the  delivery  made  by  Dr. 
Osborne. 


IV.  PHARMACY 

At  present  offers  nothing  new  to  our  attention.  Many  of 
the  oxyds  lately  introduced  into  practice  have  again 
disappeared,  and  there  is  something  in  the  influence  of 
metallic  bodies  more  than  the  effects  arising  from  their 
oxydation. 

We  consider  the  decline  of  vegetable  remedies  in  the 
present  state  of  practice  as  a  serious  evil.  The  metallic  oxyds 
are  too  active  powers  to  be  strongly  used  or  too  long  con¬ 
tinued.  The  changes  of  morbid  action  produced  by  them 
must  always  be  at  the  expense  of  tka  constitutent  principles 
or  energies  of  the  living  fibre.  We  wish  to  see  the  simple 
system  of  vegetable  means  more  generally  revived  and  more 
actively  persevered  in. 

A  new  species  of  Bark  has  lately  been  shewn  us  from  the 
West  Indies.  It  possesses  much  astringency,  but  little 
aroma.  Of  its  qualities  we  shall  perhaps  be  able  to  speak  from 
experiments  with  it  in  our  next  number. 


258  Pharmacy..  [March, ' 

On  the  Influence  of  Metallic  Substances  as  Electric  Agents 

on  the  human  body. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — In  your  last  two  numbers  the  subject  of 
Electricity  has  been  discussed  in  certain  cases  of  disease. 
This  called  my  attention  to  so  interesting*  a  subject  as  well  as  to 
the  general  influence  of  metallic  substances  on  the  body,  &c. 

I  was  particularly  pleased  by  meeting  with  a  very  original 
and  rare  publication  by  my  friend  Dr.  Bache  of  Birmingham, 
which  possesses  so  much  ingenious  reasoning,  that  I  beg 
leave  to  request  your  insertion  of  the  following  part.  It  will 
be  new  to  your  readers,  as  I  believe  it  was  only  given  to  the 
Doctor’s  own  friends. 

“  In  the  wide  held  of  nature,  Electric  Matter  is  often  so 
active,  that  it  separates  the  most  dense  bodies  ;  it  fuses,  vitri¬ 
fies,  and  variously  combines  different  substances:  by  its  direct 
and  indirect  action  it  is  capable  of  producing  inflammation  in 
all  combustible  bodies,  and  of  causing  such  a  variety  of  efflu¬ 
via  and  gyrations  of  air,  as  are  capable  of  affecting  our  senses 
very  extensively:  all  these  phenomena  have  been  so  fre¬ 
quently  produced  by  lightning,  and  its  similarity  with  Electric 
Matter  has  been  so  clearly  proved  by  Dr.  Franklin  and  others, 
th^t  J  think  it  unnecessary  to  appeal  to  particular  experi¬ 
ments  for  a  farther  proof  of  the  certainty  of  any  of  them. 
The  degrees  of  motion  in  Electric  Matter  cannot  be  de* 
scribed,  as  they  depend  so  much  upon  particular  circum¬ 
stances,  that  at  one  time  it  has  been  observed  to  pass  through 
a  wire  of  three  miles  extent  in  less  than  a  second,  and  in  other 
instances  I  have  been  a  witness  that  a  small  quantity  has  been 
some  hours  in  making  its  escape  from  one  side  to  the  other 
of  a  small  open  vial. 

“  In  charging  and  discharging  the  Leyden  vial,  we  have 
an  evident  proof  that  this  matter  is  of  a  very  elastic  nature  ; 
this,  I  apprehend,  is  a  necessary  consequence  of  repellent 


m 


Pharmacy , 


particles  being  driven  into  the  sphere  of  each  others  action  : 
and  that  explosion  is  the  natural  effect  of  a  sudden  prevalence 
of  the  combined  power  of  such  particles  oyer  that  power  bj 
which  they  were  so  impelled,  together  with  these  circum¬ 
stances  taking  place  in  a  medium  possessing  the  properties 
of  air.  The  inherent  properties  of  Electric  Matter  are  probably 
but  few,  but  from  its  peculiarities,  subtiity,  and  force,  toge¬ 
ther  with  its  various  modes  and  degrees  of  combination  with 
Other  matters,  their  joint  actions  are  so  numerous,  so  much 
divaricated,  are  often  produced  in  such  a  gradual  manner, 
and  in  consequence  of  such  previous  and  numerous  concurring 
circumstances,  that  they  extend  too  far  beyond  the  reach  of 
our  senses  for  us  ever  to  be  able  to  decide  upon,  or  perhaps  to 
form  a  tolerably  just  conception  of  them;  they  may  therefore 
properly  be  termed  infinite.  I  cannot  however  help  observing 
thatit  is  by  much  too  common  with  mankind,  either  from  su¬ 
perstition,  or  an  unpliiIosophicaldegreeoffear(lestthey  should 
find  a  solution  upon  natural  principles  above  their  reach)  to 
refer  every  wonderful  phenomenon  in  nature,  to  the  immediate 
influence  of  a  Divine  Energy :  such  ideas  encourage  indolence 
in  researches,  by  plausibly  shielding  it  from  reproach ;  but 
had  Lord  Verulam’s,  or  Sir  Isaac  Newton’s  genius,  fallen 
victims  to  such  ignoble  prejudices,  their  names  would  never 
hare  been  enrolled  in  the  annals  of  science,  and  our  own 
understandings  would  probably  have  been  more  circumscrib¬ 
ed.  Electric  Matter  is  generally  diffused  through  the  system 
of  nature; — this  appears  by  its  being  easily  obtained  in  every 
quarter  of  the  globe  w  here  electrical  experiments  have  been 
attempted.  ' 

cc  It  is  also  a  natural  agent,  which  does  sometimes  evi¬ 
dently  answer  purposes  highly  important  to  animal  life  :  of 
this  we  have  a  striking  instance  in  the  Gy mnotas.  This 
animal  employs  it  as  the  means  both  of  procuring  its  food, 
and  annoying  its  enemies and  when  we  have  such  clear 
testimony  of  its  existence,  in  an  animal  whose  natural  resi- 

t  3 


% TO  Pharmacy,  [March, 

clence  seems  to  be  the  most  unfavourable  of  all  others  for  the 
employment  of  it,  as  a  constituent  part  of  its  system,  surely 
we  can  find  no  difficulty  in  conceiving  that  it  may  exist  in 
the  bodies  of  beings,  that  are  apparently  much  more  favour¬ 
ably  circumstanced  for  its  retention,  and  that  it  may  be  in 
them  a  source  of  effects  which  are  in  the  highest  degree  im¬ 
portant  to  their  welfare ;  and  as  various  natural  occurrences 
and  experiments  give  their  united  countenance  to  the  idea  of 
its  being  the  Primum  Mobile  of  the  animal  machine,  it  will 
appear  to  be  deserving  of  some  pains  to  bring  into  one  view, 
various  instances  of  its  connection  with  the  human  system, 
that  we  may  form  some  judgment  of  its  importance  to  its 
welfare,  and  of  the  injuries  that  may  result  to  our  constitu¬ 
tions,  from  its  deficiencies  or  excess.  Also  to  point  out  some 
probable  means  of  its  introduction  into  the  system,  and  of 
accelerating  and  retarding  its  escape  from  it,  that  we  may  be 
able  to  increase  or  diminish  its  influence  in  some  degree 
according  to  the  direction  of  our  will,  and  thus  to  employ  it 
medically  with  advantage.  Captain  Brydone  observes,  that 
during  the  Siroc  wind  at  Naples,  he  was  scarcely  able,  by  his 
electrical  machine,  to  obtain  any  electric  matter ;  and  that 
persons  exposed  to  the  influence  of  that  wind,  were  commonly 
•so  much  affected  by  it,  in  the  state  of  their  spirits,  that  those 
who  at  other  times  were  the  most  active  and  volatile  that  can 
be  imagined,  became  so  destitute  of  vivacity,  as  to  render 
them  the  proverbial  objects  of  comparison  for  whatever  is 
totally  void  of  that  principle ;  he  observes,  that  it  unfits 
both  the  body  and  mind  for  performing  their  usual  func¬ 
tions. 

66  We  are  also  informed  by  the  same  gentleman,  that  he 
has  collected  from  a  clean  and  strong  head  of  hair,  as  much 
electric  matter,  in  a  few  minutes,  as  he  found  was  sufficient 
to  kindle  common  spirits,  and  by  means  of  a  small  vial,  to 
give  many  smart  shocks  to  a  company  who  w  ere  present  at  the 
experiments. 


1809.]  Pharmacy .  271 

Ci  In  diseases  I  have  observed,  that  the  hair  commonly 
becomes  soft,  and  when  combed,  the  action  is  generally  suc¬ 
ceeded  by  head  ache  or  languor. 

“  In  Clavus  Hystericus,  where  the  disease  has  been  of  long 
standing  (in  most  instances  that  have  fallen  under  my  ob¬ 
servation)  I  have  found  the  hairs  as  grey  as  in  old  age  upon 
the  part  affected,  though  not  so  upon  any  other  part  of  the 
head.  Over  that  part  of  the  human  head,  where  the  brain  is 
situated  (which  is  considered  as  the  fountain  of  nervous 
energy)  there  is  a  considerable  quantity  of  hair  at  the  period 
of  birth,  and  it  generally  increases  as  long  as  the  energy  of  the 
system  continues  to  do  so,  and  to  become  somewhat  darker  in 
its  colour  ;  but  as  the  vigour  of  the  body  declines,  it  generally 
becomes  lighter,  and  gradually  falls  off. 

*c  It  is  observable  also,  that  hair  does  not  grow  upon  the 
pubes  in  any  remarkable  quantity,  until  that  period,  when 
the  nervous  energy  in  those  parts  becomes  more  considerable 
than  in  the  system  at  large,  and  then  its  increase  is  great. 
When  Electric  Matter  is  collected  by  a  machine,  and  thrown 
into  the  human  body,  the  hair  of  the  head  expands ;  it  is 
observable,  also,  that  a  similar  effect  has  sometimes  been 
seen  to  take  place,  in  cases  of  great  fright :  and  the  records  of 
medicine  afford  us  some  instances  of  syncope  taking  place 
on  shaving  the  head. 

i6  To  suppose  the  hairs  destitute  of  use,  is  to  arraign  the 
wisdom  or  power  of  the  great  Author  of  nature,  in  their 
institution:  and  I  think  the  several  particulars  specified 
above,  together  with  the  nature,  figure,  and  situation  of 
the  hairs,  give  some  countenance  to  their  being  one  of 
the  excretory  organs  to  the  nervous  system.  Every 
other  matter  employed  in  the  body,  after  having  ex¬ 
erted  its  influence  for  a  time,  seems  so  far  changed  in  its 
nature,  as  to  require  expulsion,  that  other  matter,  similar  to 
it,  in  a  primary  state,  may  be  introduced,  and  by  exerting 
its  influence  fox  a  time;  may  support  the  continued  vigour  of 

x  4 


272  PhrirMbp*  ^i*±uicu  $ 

the  animal,  which  the  alterations  induced  in  the  former  would 


no  longer  admit  of  its  doing:  and  analogy  leads  me  to 
suspect  that  electric  matter  may  be  subject  to  like  changes ; 
for  succession,  as  far  as  we  can  observe,  seems  to  take  place 
in  all  other  matter  as  necessarily,  and  naturally,  as  in  time,, 
But  the  human  mind  has  its  horizon,  as  well  as  the  organs  of 
vision.  The  boundaries  of  nature  are  extended  beyond  our 
reach,  and  as  the  laws  of  matter  are  too  much  divaricated  for 
its  complete  investigation,  it  becomes  us  to  remain  satisfied,  if 
assiduity  and  the  stretch  of  our  mental  powers  can  bring  us 
within  the  sphere  of  probability,  where  mathematical  demon¬ 
stration,  or  positive  proof,  cannot  be  obtained. 

a  If  we  attend  to  all  the  particulars  above  recited,  I  presume, 
we  shall  find  but  little  room  to  doubt  that  electric  matter 


forms  a  constituent  part  of  the  human  system ;  and,  when 
we  consider  its  very  active  nature,  and  extreme  subtilty,  we 
must  admit,  that  great  obscurity  will  inevitably  attend  many 
of  its  operations,  but  that  it  is  of  great  importance,  if  if  really 
forms  a  constituent  part  of  the  human  system,  to  discover 
the  means  by  which  it  is  introduced  into  it— also  its  modes, 
and  degrees  of  combination  and  evolution,  with  their  several 
causes,  should  be  investigated  as  far  as  possible,  by  the  me¬ 
dical  faculty  :  and  till  they  are  in  some  measure  attended  to 
and  understood,  we  shall  continue  to  wonder  at  the  pheno¬ 
mena  they  produce,  shall  frequently  ascribe  them  to  false 
causes,  and  must  therefore  often  be  very  erroneous  and  un¬ 
successful  in  our  modes  of  application,  for  the  removal  of 
many  diseases ;  and  that  there  really  are  many,  which  do 
now  remain  the  aprobria  of  all  past  and  present  medical  prac¬ 
tice,  I  presume  I  need  take  no  pains  to  evince  to  you,  as  it 
has  often  been  publicly  acknowledged  by  the  sage,  the  truly 
ingenious,  and  ingenuous  professor  of  the  practice  of  medi¬ 
cine  in  this  university. 

u  It  is  very  observable,  that  a  frequent  application  df  food 
is  necessary  to  support,  the  human  body  in  a  state  of  vigour 


1809.]  Pharmacy .  $TO' 

through  ail  the  different  stages  of  infancy,  youth,  manhood, 
and  old  age.  The  articles  of  food  are  extremely  various  in 
their  nature  ;  some  of  them  seem  to  possess  two  distinct  pro¬ 
perties,  one  of  which,  by  being  fitted  to  nourish  the  fluids, 
enables  them  to  support  the  solids ;  and  the  other  seems 
much  better  constituted  to  support  nervous  energy.  With 
respect  to  the  processes  by  which  these  effects  are  produced, 
they  are  indeed,  at  present,  involved  in  much  obscurity,  and 
every  attempt  to  investigate  them  will  probably  be  attended 
with  many  mistakes ;  but  I  am  disposed  to  hope,  that  per¬ 
severance,  and  repeated  corrections,  may  do  much  towards 
placing  the  matter  in  a  tolerably  clear  view,  and  thus  render 
the  human  judgment  a  far  better  agent  than  it  is  at  present,  for 
administering  to  the  comfort  and  happiness  of  our  species. 

iC  Under  the  influence  of  this  idea,  I  shall  now  venture  to 
throw  out  some  conjectures  respecting  the  nature  and  mode  of 
operation  of  the  various  articles  of  food. 

c<  I  think  it  highly  probable,  that  every  distinct  substance 
in  nhfure  possesses  a  portion  of  electric  matter,  which  is  pecu¬ 
liar  to  itself;  or,  in  other  words,  that  it  has  chemically  com¬ 
bined  with  it  a  certain  quantity  of  electric  matter,  by  which, 
if  I  may  be  allowed  the  expression,  it  is  as  it  were  exactly 
saturated';  and,  as  it  changes  its  nature  by  means  of  chemical 
attractions  or  decomposition,  its  prior  quantity  of  electric 
matter  is  diminished  or  increased,  according  to  the  manner 
of  its  changes ;  and  hence,  when  different  substances,  taken 
into  the  body,  are  decompounded  by  the  digestive  process, 
.  and  their  component  parts  form  new  affinities,  a  portion  of 
the  electric  matter  which  they  primarily  possessed  may  be 
evolved  into  the  system,  and  employed  in  invigorating  its 
animal  spirits,  whilst  other  portions  of  it,  forming  a  consti¬ 
tuent  part  of  the  chyle,  may,  with  it,  enter  the  blood  in  a 
state  of  chemical  combination,  and  afterwards  be  secreted  by 
the  brain  in  its  passage  through  it,  and  be  diffused  by  that 


274  Pharmacy .  [March, 

organ  through  the  nerves,  as  being  the  best  conducting  parts 
of  the  animal  system. 

“  I  also  think  it  not  improbable,  that  it  may  often  be  corn- 
Jbined  with  other  very  subtle  matters,  that  may  retard,  acce¬ 
lerate,  or  otherwise  vary  its  modes  or  degrees  of  operation  on 
various  parts  of  the  body,  and  subject  it  to  a  particular  in¬ 
fluence  from  various  substances,  internally  or  externally  ap¬ 
plied  to  it. 

€C  In  support  of  these  opinions  I  must  observe,  that  those 
substances  which  are  found  to  be  most  nutritious  to  the  ani¬ 
mal  system,  generally  contain  either  much  gelatinous  matter, 
or  much  of  the  principle  of  inflammability,  as  is  easily  ob¬ 
servable  in  animal  fibres,  fats,  vinous  spirits,  fermented  li¬ 
quors,  &c,  and  thus  some  of  them  may  contribute  to  sup¬ 
port  the  body,  by  restoring  its  wastes  and  decays,  and  others 
more  immediately  renew  the  powers  of  the  mind  ;  and,  when 
taken  in  excess,  excite  in  it  an  inordinate  and  irregular  degree 
of  action.  It  is,  I  think,  natural  to  conceive  that  these  sub¬ 
stances  may,  by  various  means,  each  be  contaminated,  and 
may  thus  become  both,  in  different  ways  and  degrees,  im¬ 
proper  subjects  for  nutrition ;  giving  out  other  matters,  or 
other  proportions  of  them,  in  the  process  of  digestion,  than 
what  may  be  consistent  with  the  health  of  the  body.  For  I 
consider  health,  as  the  result  of  a  balance  of  powers  ;  but 
admitting  of  a  very  considerable  latitude,  before  injury  is 
sensibly  perceived  to  take  place,  either  in  the  functions  of 
the  body  or  the  mind. 

“  Some  years  back  I  amused  myself  by  endeavouring  to  ac¬ 
count  for  the  sudden  metastasis,  often  observed  to  take  place 
in  the  gout ;  and  was  led  to  suspect  that  both  gouty,  and 
other  pains,  might  often  depend,  in  some  degree,  upon 
either  a  depraved  state,  or  quantity  of  electric  matter  in  the 
system.  I  sometime  afterwards  had  the  following  opportu¬ 
nities  for  experiment,  which  I  embraced ;  and  now  solicit 


1809.]  Pharmacy.  '  275 

jour  attention,  whilst  I  faithfully  and  particularly  recite 
them. 

C{  A  gentleman  of  my  acquaintance  was  seized  with  the  gout 
in  both  his  great  toes ;  he  had  confined  himself  to  his  bed 
about  two  days,  when  I  first  saw  them,  I  took  off  the  flan¬ 
nels  in  which  one  of  them  was  wrapt,  and  begged  that  he 
would  give  me  leave  to  lay  a  bit  of  bees-wax,  about  the  cir¬ 
cumference  of  a  shilling,  upon  the  joint  affected  ;  he  submit, 
ted  to  my  request,  but  in  less  than  two  minutes  he  complain¬ 
ed  that  the  part  became  extremely  hot;  I  endeavoured  to 
divert  him  from  such  an  idea,  and  begged  he  would  permit 
the  wax  to  remain;  he  did  so,  but  in  a  few  minutes 
more,  said  that  the  heat  became  too  intolerable  to  be  borne. 
I  removed  the  wax,  lapped  the  foot  up  as  before,  and  put  it 
into  bed ;  I  then  asked  a  lady  in  the  room  to  favour  me  with  a 
silk  ribbon;  I  obtained  the  object  of  my  request,  and  after 
having  held  it  to  the  fire  for  some  time,  to  make  it  perfectly 
dry,  I  begged  of  the  gentleman  to  let  me  see  his  other  foot ;  he 
put  it  out  of  bed ;  I  took  off  the  flannels,  and  lapped  the  ribbon 
round  it  as  loosely  as  possible.  I  then  put  on  the  flannels 
as  before,  and  replaced  the  foot  in  bed,  begging  that  he  would 
permit  the  ribbon  to  remain  on  until  I  should  see  him  again, 
which  I  promised  to  do  in  an  hour  and  an  half;  he  assured 
me  he  would  comply  with  my  solicitation;  I  left  him,  and 
returned  in  the  time  mentioned,  but  no  sooner  had  I  entered 
the  room  than  he  reproached  me,  in  very  strong  terms,  and 
said,  I  had  caused  him  the  most  excrutiating  pain  he  had 
ever  felt ;  I  expressed  a  degree  of  surprise  at  the  charge,  and 
begged  that  he  would  explain  to  me  how  I  had  injured  him  ; 
he  said  he  did  not  know  how  the  effect  was  produced,  but  ob¬ 
served  that  the  foot  upon  which  I  had  put  the  ribbon,  very 
soon  became  extremely  hot,  and  was  attended  with  shooting 
pains,  which  he  submitted  to  for  about  half  an  hour,  when, 
being  unable  to  bear  them  any  longer,  he  ordered  the  ribbon 
to  betaken  off,  and  he  then  assured  me,  that  upon  that  foot 


276 


Pharmacy. 


the  gout  was  got  up  into  the  ancle.  I  examined  it,  and 
found  it  inflamed ;  I  begged  that  he  would  permit  me  to  ap¬ 
ply  a  bit  of  tin-foil  to  the  part,  and  assured  him  that  I  be¬ 
lieved  that  he  would  not  find  any  inconvenience  from  it.  He 
submitted  with  reluctance ;  but  after  the  metal  had  continued 
on  for  some  time,  he  thought  himself  much  eased  by  it.  The 
part  underneath  the  foil  became  very  moist, and  the  inflamma¬ 
tion  was  apparently  much  abated. 

u  A  young  lady  of  my  acquaintance,  during  the  last 
stage  of  a  tabes  mesenterica,  complained  of  a  violent  pain, 
which  shot  down  from  the  cervical  vertibrae  to  her  right 
wrist.  The  pain  usually  began  about  eleven  o’clock  in  the 
forenoon,  and  four  in  the  afternoon,  and  continued  each  time 
about  one  hour.  I  desired  that  she  would  give  me  leave 
to  put  a  bit  of  metal  round  her  arm.  She  consented,  and 
1  applied  a  bit  of  rolled  tin,  about  the  middle  of  the 
humerus ;  at  the  two  next  periods  of  her  attack,  the  pain 
descended  as  far  as  the  metal,  but  no  farther.  I  afterwards 
took  it  off,  and  at  the  next  paroxysm,  the  pain  descended  tb 
the  wrist  as  before :  she  requested  that  I  would  apply  the 
metal  again;  I  did  so,  and  on  the  return  of  the  pain,  it  did 
not  extend  farther  than  the  metal,  as  before.  Encouraged  by 
this  degree  of  success,  I  entertained  a  hope  that  by  con¬ 
necting  another  piece  of  metal,  extending  from  that  upon  the 
arm  to  the  cervical  vertibrae,  the  whole  of  the  pain  might  be 
taken  off;  I  made  the  trial,  but  without  any  sensible  ad¬ 
vantage,  for  the  pain  continued  to  extend  to  the  arm,  without 
any  perceptible  degree  of  mitigation. 

u  A  friend  of  mine,  in  Warwickshire,  after  complaining 
for  some  days  of  slight  pain  in  the  region  of  the  kidneys,  a 
sense  of  heat  in  the  urethra  upon  making  water,  and  a  loss  of 
appetite;  called  to  his  assistance  an  eminent  physician.  The 
doctor  at  first  apprehended  the  affection  to  be  a  nephritic  one; 
the  patient  found  but  little,  or  no  benefit,  from  the  medicines 
administered.  In  a  few  days  fresh  symptoms  took  place,  which 


180&]  Pharmacy ;  *  £77 

caused  the  physician  to  change  his  sentiments  respecting  the 
nature]  of  the  disease,  and  he  then  termed  it  a  lumbago. 
Various  applications  were  made,  but  without  any  sensible 
advantage;  various  hypochondriac  symptoms  came  on, 
flatus,  lowness  of  spirits,  frequent  perspiration  about  the 
precordia,  and  in  the  palms  of  the  hands :  on  going  to  bed, 
Ik?  every  night  felt  an  uneasy  sensation  of  heat  upon  his 
back,  and  a  creeping,  as  he  expressed  it,  which  was  so 
troublesome  as  to  prevent  his  sleeping  during  the  night;  these 
sensations  usually  went  off  about  six  o’clock  in  the  morning, 
from  which  time  he  commonly  slept  till  near  nine :  when 
he  awoke  he  was  but  little  refreshed,  was  languid  and  dull 
through  the  day,  but  did  not  complain  of  any  pain;  his 
pulse  was  a  little  irregular,  and  rather  low,  his  tongue  clean, 
and  belly  bound  ;  his  urine  was  rather  small  in  quantity, 
stimulating  to  a  frequent  discharge,  was  not  changed  in  its 
colour,  and  did  not  depose  any  sediment.  When  the  uneasy 
sensations  in  the  patient’s  back  had  continued  about  a  fort¬ 
night,  he  requested  my  sentiments  concerning  them.  I  sus-* 
pected  they  might  be  the  effects  of  an  electric  matter,  that 
had  not  a  proper  means  of  escape  from  the  body;  andob-r 
served  to  him,  if  my  own  situation  was  similar  with  his, 
I  would  try  the  application  of  a  metallic  substance  to  the 
part.  By  my  direction,  he  obtained  a  strip  of  thin  rolled 
silver,  such  as  is  commonly  used  for  plaiting  buckles,  &c« 
Its  length  was  sufficient  to  go  round  his  body,  and  its  width 
about  three  inches  ;  a  bit  of  flannel  was  sewed  upon  each 
edge.  This  instrument  was  seen  by  the  physician,  and 
smiled  at  as  a  ridiculous  application ;  but  as  he  acknowledged 
it  could  do  no  injury,  is  was  applied  all  night,  during 
which  time  the  patient  did  not  feel  any  of  his  former  sensa* 
tions :  he  slept  well,  and  arose  in  the  morning  very  much 
refreshed :  the  doctor  however  refused  to  admit,  that  the 
metal  had  had  any  influence  in  producing  these  effects,  and 
ascribed  them  to  the  patient’s  former  fatigue.  The  metal 


978  Pharmacy,  [March, 

was  applied  the  succeeding  night,  and  ease  and  comfortable 
sleep  ensued  as  before.  The  doctor  still  continued  to  assert, 
that  the  metal  was  a  ridiculous  application,  and  said  that 
he  had  no  doubt  if  it  were  laid  aside,  that  the  same  circum¬ 
stances  would  take  place  as  when  it  was  applied  to  the  body. 
The  patient  submitted  to  the  trial  the  ensuing  night,  but  had 
a  return  of  the  sense  of  heat,  creeping,  and  want  of  sleep, 
to  as  great  a  degree  as  before  the  metal  was  first  applied  ; 
he  resolved,  therefore,  to  yield  no  more  to  the  doctor’s 
request  of  laying  it  aside.  He  applied  it  again  for  several 
ensuing  nights,  when  ease  and  sleep  uniformly  accompanied 
its  application,  until  by  the  flexures  of  the  body,  the  edges 
began  to  break,  and  starting  through  the  flannel  gave  him 
some  uneasiness.  I  desired  it  should  then  be  laid  aside,  and 
that  his  back  should  be  bathed  with  tepid  water  every  nigh^- 
before  he  got  into  bed,  expecting  that  it  would  act  as  a  con¬ 
ductor  and  relaxent  to  the  skin,  and,  by  those  means,  pro¬ 
duce  the  same  beneficial  effects  as  the  metal  had  before  done  5 
and  in  this  expectation  I  was  not  disappointed.  About  a 
week  after  we  took  a  small  journey  together  in  a  post  chaise ; 
the  s  first  afternoon  we  travelled  only  fourteen  miles  :  in  the 
evening  he  expressed  a  concern  that  he  could  not,  at  an  inn, 
conveniently  get  his  back  bathed.  I  offered  him  my  assis¬ 
tance  in  that  particular ;  he  gladly  accepted  of  it,  and  at  bed 
time  called  for  a  bason  of  warm  water,  and  a  bit  of  soft  rag ; 
they  were  brought,  and  my  friend  then  took  off  his  coat  and 
waistcoat,  and  drew  up  his  shirt :  there  was  not  the  least  ap¬ 
pearance  of  disease  upon  his  back.  I  bathed  it  equally  for 
about  a  minute  or  two,  when  I  observed  two  spots,  upon 
which  was  a  change  of  colour;  they  soon  became  very  red. 
I  was  surprised  at  the  appearance,  but  was  silent  respecting  it, 
until  I  had  inquired  in  what  part  of  the  back  he  felt  the 
sensations  he  had  before  complained  of?  He  put  liis  hand 
behind  him,  and  laid  it  first  upon  one  and  then  upon  the  other, 
of  the  places  that  had  changed  in  theiy  colour.  The  patient 


1809.] 


Pharmacy. 


STD 


was  not  benefited  by  tlie  excursion  we  were  then  npon,  but 
soon  after  our  return  home  he  went  to  Buxton,  bathed,  drank 
the  waters,  and  rode  upon  the  neighbouring  hills  daily  for 
near  a  month,  and  then  came  back  to  his  family  in  tolerable 
health. 


Reply  of  Mr.  Lowndes  to  Mr.  Calderwood  on  his  Com¬ 
munication  on  Medical  Electricity. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen- — In  the  last  number  of  your  valuable  and 
scientific  work,  I  had  the  honor  of  being  particularly  noticed 
by  Mr.  Calderwood  ;  and  as  Mr.  Calderwood  and  I  differ 
entirely  in  the  principles  of  our  reasoning,  the  conclusions  we 
draw  cannot  accordingly  meet  in  unison  on  the  subject  of 
electricity. 

I  agree  perfectly  with  Mr.  Calderwood ’s  maxim,  that  any 
active  remedy,  in  proportion  asit  is  capable  of  doing  good,  is 
also  capable  of  doing  mischief.  This  being  granted  I  shall 
proceed  to  shew  that  the  size  of  my  machine  as  I  contend 
for  is  the  great  and  leading  point  on  which  the  success  of 
electricity,  inthecureof  diseases,  depends.  The  principle 
on  which  Mr.  Calderwood  sets  out,  is  that  electricity  acts 
entirely  by  its  stimulant  operation.  If  this  were  the  truth, 
every  stimulant  acting  with  the  same  degree  of  operation 
would  be  equally  successful  in  the  cure  of  diseases;  but 
we  find  even  in  the  case  Mr.  Calderwood  adduces  for  the 
success  of  electricity  in  his  own  hands,  that  other  stimulant 
and  active  plans  were  resorted  to  without  any  effect.  Were 
stimulus  alone  wanted,  a  small  machine  might  certainly  in 
most  cases  answer  every  purpose  and  give  shock  sufficient  to 
have  an  influence  on  the  morbid  action.  But  contrary  to  Mr. 
Calderwood’s  sentiments,  I  contend  that  electricity  is  a 
peculiar  matter,  the  stimulus  of  which  is  only  a  secondary 
point;  that  this  matter  is  analogous  to  that  secretion  which 


280 


Pharmacy \ 


Is  supposed  to  give  power  and  sensation  to  the  nervons  system, 
and  that  the  quick  supply  of  this  matter  to  parts,  where  they 
have  lost  their  energy  in  consequence  of  its  being  deficient, 
is  the  great  principle  that  constitutes  the  cure.  If  this  prin¬ 
ciple  is  just,  a  quick  accumulation  of  this  matter,  Mr.  Cal- 
derwood  will  perceive,  can  only  be  made  by  a  large  machine, 
it  is  not  my  practice  to  operate  much  by  shocks,  nor  have  I 
seen  much  benefit  from  them.  I  have  tried  machines  of  every 
description  and  size,  and  what  I  have  stated  in  regard  to 
this  essential  point  is  from  a  long  and  extensive  experience. 
I  hope  Mr.  Calderwood  will  be  satisfied  ;  I  allow  him  every 
merit  for  his  treatment  of  the  case  he  has  published,  and 
though  we  differ  in  principle  on  this  subject,  we  both  agree  in 
the  wish  of  being  useful  by  our  observations  to  society.  I  am, 

Gentlemen, 

St.  Paul’s  Churchyard,  Your  obedient  humble  Servant, 
Feb.  19,  1809.  F.  LOWNDES. 


On  the  New  Chemical  Nomenclature ,  as  adopted  in  the 
Specimen  of  the  College  Pharmacopoeia . 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen— The  profession  anxiously  look  for  the  New 
Pharmacopoeia  of  the  College,  which  has  been  so  long  under 
the  inspection  of  that  respectable  body.  In  the  specimen  I 
have  seen  of  that  work,  circulated  through  the  members, 
there  is  a  circumstance  which  does  not  seem  to  have  struck 
them,  but  which  would  certainly  be  highly  useful  to  prevent 
mistakes.  The  College  have  yery  properly  adopted  the 
latest  chemical  nomenclature.  Chemistry  may  be  termed  a 
revolutionary  science,  which  has  been  shifting  its  terms  so 
frequently,  that  mistakes  are  very  apt  to  arise  from  this 
source.  There  are  at  present  three  stages  of  nomenclature; 
the  old ,  the  modern ,  and  the  wxy  modert}.  It  would  be 


1809.]  Pharmacy .  281 

highly  advantageous  that  each  article  in  the  most  modern 
term  should  have  appended  to  it  the  other  synonymes.  The 
mistakes  of  one  substance  for  another,  the  College  cannot  but 
be  aware,  may  be  attended  with  the  most  dangerous  conse¬ 
quences,  and  they  must  likewise  know,  that  the  older  part  of 
the  profession  find  it  difficult  to  unlearn  the  lessons  formerly 
taught  them.  Such  a  simple  addition  would  do  much  for  the 
benefit  of  the  public,  as  well  as  relieve  from  much  per¬ 
plexity  many  who,  though  well  acquainted  with  the  steps 
they  ought  to  pursue,  may  be  in  danger  at  times  of  mis¬ 
taking  the  proper  instrument  that  ought  to  be  employed. 
This  is  merely  hinted  by  one  who,  though  a  well-wisher  to 
every  improvement,  thinks  no  sacrifices  ought  to  be  made  or 
lives  endangered  for  the  parade  of  Chemical  purity  in  dic¬ 
tion.  I  am,  Gentlemen, 

Your  obedient  Servant, 

Hay  market,  Feb.  16,-1807.  AN  OLD  CHEMIST. 

ON  THE  USE  OF  ALKALIES  IN  MEDICINE. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator , 

Gentlemen — The  use  of  alkalies  has  lately  been  extended  in 
practice,  and  the  principle  of  it  is  certainly  founded  On  ac¬ 
curate  observation.  The  fluids  of  the  stomach  are,  in  their 
natural  state,  neither  acid  nor  alkaline ;  but  when  the  de¬ 
rangement  of  this  organ  takes  place,  they  evidently  partake 
of  an  acid  tendency,  which  occasions  new  arrangements  to  be 
formed,  and  the  natural  chylifactive  process  to  be  inter¬ 
rupted.  This  state  occurs  in  most  diseases  ;  and  though  the 
use  of  alkalies  is  by  no  means  to  be  held  out  as  general  reme¬ 
dies,  yet  they  will  be  found  in  a  high  degree  to  palliate  those 
symptoms  of  irritation  in  the  primes  vice  which  tend  either  to 
continue  or  aggravate  the  original  affection. 

VOL.  II,  V 


282  Pharmacy.  [March* 

In  the  complaints  of  children,  they  have  long  been  con* 
sidered  as  highly  beneficial ;  and  from  this  circumstance,  a 
theory  of  the  diseases  incident  to  that  period  of  life  was 
founded  ;  but  though  this  reasoning  was  erroneous  in  not 
making  a  distinction  between  the  actual  diseases  and  the 
symptoms  merely  of  the  primce  vice,  their  good  effects  as 
palliatives  cannot  be  disputed.  The  practice  introduced 
by  Harris  has  therefore  been  continued  to  the  present  day, 
though  his  reasoning  is  laid  aside. 

In  the  diseases  of  women,  the  same  state  of  the  primes  vias 
exists  as  in  childhood.  A  disengaged  acid  appears  on  any 
irritation  of  the  primer  wee,  and  the  use  of  alkalies  is  there¬ 
fore  found  beneficial,  not  as  specifics  for  the  disease,  but  as 
correctors  of  uneasy  symptoms  occupying  this  situation, 
which  continue  it  or  aggravate  its  violence. 

The  same  may  be  said  of  gouty  habits,  in  whom  a 
similar  derangement  of  the  stomach  occurs,  and  an  attention 
to  the  use  of  alkalies  becomes  here  generally  useful  and 
necessary. 

In  venereal  complaints,  also,  where  an  excess  of  oxygen  is 
introduced  by  mercury  into  the  system,  and  the  solid  passes 
into  a  state  of  ulceration  in  different  parts,  alkalies  form  the 
only  remedy  against  such  ravages.  They  require  to  be 
largely  used,  and  the  vegetable  alkali  is  the  most  successful. 

In  scrofula,  alkalies  are  no  less  specific.  In  this  habit, 
a  state  of  incomplete  animal isation  occurs,  and  this  state  of 
the  stomach  prevails  where  a  disengaged  acid  is  conspicuous. 
Though  alkalies  are  here  so  useful,  I  do  not  mean  to  say 
that  the  disease  depends  on  this  predominant  principle.  All  I 
contend  for  is,  that  as  a  symptom  of  this  imperfect  animali- 
sation,  there  prevails  in  scrofula  a  derangement  of  stomach 
and  bowels  connected  with  a  predominant  disengaged  acid; 
and  that  the  relieving  this  symptom,  if  it  does  not 
cure,  by  taking  off  a  source  of  irritation  existing  in  so  im- 


March,]  Pharmacy 283 

portant  an  organ,  yet  forms  a  leading  step  towards  it. 
I  consider,  therefore,  an  extensive  use  of  alkalies  as  of  material 
service,  and  they  are,  perhaps,  better  employed  in  the 
carbonated  state  than  in  any  other, 

I  shall,  if  the  above  remarks  are  worthy  of  insertion, 
proceed  farther  on  the  subject.  In  the  mean  time, 

I  am,  Gentlemen, 

your  obedient  servant, 

Exeter,  Feb.  10,  1S09.  *  S.  T. 

ON  THE  BEST  MEANS  OF  PROMOTING  SUPPURATION  IN  TU¬ 
MOURS. 

i  '  'r  t 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — To  apply  means  equal  to  the  etfect  required, 
is  the  great  and  successful  principle  that  ought  to  direct  our 
practice.  These  means  seem  to  fail  more  in  surgery  than  in 
medicine,  and  in  the  case  of  tumours  it  is  often  a  most  tedi¬ 
ous  and  perplexing  circumstance  to  bring  them  to  suppu¬ 
ration.  It  is  the  rule  witii  the  first  surgeons  to  trust  gene¬ 
rally  to  the  common  poultice ;  as  the  action  of  this  remedy 
depends  entirely  on  its  degree  of  heat,  it  is  clear  that  the 
moment  that  it  loses  its  increased  temperature  at  that  moment 
it  loses  all  its  influence  in  promoting  suppuration.  Besides 
the  teguments  can  only  bear  a  certain  degree  of  increased 
temperature,  not  so  high  as  is  really  sufficient  to  produce  a 
quick  change  on  the  first  stage  of  inflammation  in  the  part. 
The  loss  of  heat  in  the  poultice  occasions  it  to  lie  an  useless  and 
hurtful  mass  on  the  tumour,  and  from  its  coldness  rather  to 
retard,  than  hasten  the  process  for  which  it  was  intended. 
To  obviate  this  circumstance  it  has  been  usual  to  cover  the 
poultice  with  some  stimulant  applications,  as  gum  galbanum, 
little  camphor,  mustard  flour,  &c.  But  such  stimulants, 
however  proper  in  their  principle,  I  contend,  are  not  sufficiently 

tj  2 


284:  Surgery.  [March, 

penetrating  to  answer  the  purpose,  and  at  the  same  time  they 
they  give  much  pain  and  much  irritation.  Instead  of 
this  practice  for  the  maturation  of  indolent  tumours,  I  would 
propose  substituting  the  use  of  some  of  the  cheaper  essential 
oils.  They  possess  a  all  sharp,  acrid  and  burning  taste.  They 
are  of  a  deeply  penetrating  and  powerfully  stimulant  nature, 
so  as  in  their  concentrated  state,  to  act  even  as  caustics.  In 
blending  them  as  maturants,  they  should  be  blended  in  a 
certain  proportion  with  some  of  the  unctious  plaisters,  but 
not  in  that  proportion  as  to  lessen  or  destroy  their  full  in¬ 
fluence.  The  most  useful  and  the  cheapest,  I  have  found  to 
be  the  oil  of  pepperment,  and  this  application,  I  have 
experienced  the  most  successful  in  many  tumours  of  the 
most  indolent  nature. 

The  form  of  a  plaister  is  also  for  the  patient  a  more  con¬ 
venient  one  than  a  poultice.  Camphor  has  been  a  substance 
much  applied  as  a  maturant,  but  this  substance  is  not  rea¬ 
dily  dissolved,  neither  does  it  act  in  the  same  complete  and 
imperceptible  manner  as  the  essential  oils.  The  subject  is 
one  which  comes  so  often  under  the  care  of  the  surgeon, 
that  too  much  attention  cannot  be  paid  to  hit  on  the  most 
effectual  means  to  bring  them  to  a  speedy  and  effectual  issue. 
Modem  surgery  is  in  pharmaceutic  preparations  often  too 
inert.  The  principle  of  trusting  to  the  powers  of  nature 
in  the  change  and  renovation  of  parts  has  been  carried  too  far, 
and  though  a  proper ruleto  lay  down,  it  admits  of  more  excep¬ 
tions  in  the  class  of  tumours  than  in  any  other  local  diseases. 

Every  one  acquainted  with  this  subject  will  concur  in  it. 
The  class  of  tumours  is  more  extensive  than  any  other  clas* 
of  local  diseases.  They  are  divided  into  two  kinds,  the 
acute  and  chronic ;  but  this  division  is  not  sufficiently  mi¬ 
nute  to  lead  to  an  acquaintance  with  their  real  nature.  Mr. 
Abernethy  has  properly  formed  a  more  scientific  division, 
which  approaches  a  step  nearer  to  what  is  wanted.  The  best 
arrangement  would  be  one  formed  from  the  particular  kind  of 


,1809.]  Pharmacy .  §85 

structure  affected,  as  discovered  by  dissection,  because  the 

term  would  then  explain  both  the  morbid  change,  and  also 

point  out  the  mode  of  treatment  to  be  adopted. 

How  often  do  we  see  Aneurism  mistaken  for  a  tumour 

of  another  description,  even  by  surgeons  of  experience; 

and  how  often  has  schirrus  of  the  testicle  been  mistaken  for 

simple  hydrocele.  These  are  proofs  how  imperfect  is  our 

knowledge  of  this  class  of  diseases  in  their  proper  diagnos- 

* 

tics ;  and  consequently  how  deficient  must,  in  many  re¬ 
spects,  be  our  treatment. 

I  am,  Gentlemen, 

Your  obedient  servant, 

AN  HOSPITAL  SURGEON. 

London ,  Feb.  10,  1809. 


On  the  Neglect  of  the  Medical  Police  in  regard  to  the 
Situation  of  the  Public  Buildings  of  the  Metropolis , 
occasioned  by  the  late  Fire  at  Drury  Lane  Theatre. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — The  frequent  and  fatal  accidents  which  have 
latety  spread  terror  through  the  metropolis  and  its  vicinity, 
by  the  destruction  of  so  many  places  of  public  fascination 
by  fire,  call  loudly  for  the  interference  of  the  legislature  to 
prevent  as  far  as  possible  the  dangerous  and  extensive  evils 
which  are  apt  to  arise  from  the  casualties  to  which  such 
places  are  unavoidably  more  than  others  subjected.  The 
first  circumstance  that  must  naturally  strike  every  one  in  the 
way  of  precaution  is  this — they  should  be  built  in  a  separate 
or  insulated  situation,  unconnected  with  any  edifices  or 
buildings,  having  the  avenues  to  them  spacious  and 
free.  However  valuable  the  property  of  ground  may  be 
in  London,  no  expense  should  be  spared  where  the  public 
safety  is  so  materially  concerned. 

u  3 


2S6 


Phdrfnattj* 


Another  advantage  attending  an  insulated  Und  spacious 
situation  is,  that  such  a  construction  of  the  edifice  can  take 
place  as  may.  best  ensure  the  preservation  of  health.  One- 
third  of  the  deaths  of  the  metropolis  may  be  dated  from  colds 
caught  at  places  of  public  amusement,  or  from  the  vitiated 
and  unwholesome  atmosphere  breathed  in  such  situations. 
To  be  kept  for  a  length  of  time  in  the  stewing  heat  of  a 
crowded  playhouse,  bathed  in  constant  perspiration,  and 
then  suddenly  exposed  to  the  chilly  damp  of  a  winter  night, 
is  more  than  most  constitutions  can  bear.  No  wonder  that 
the  young  and  the  gay,  who  are  so  mnch  the  frequenters  of 
these  scenes,  are  so  quickly  cut  off.  Indeed  it  is  almost  im¬ 
possible  that  those  with  weak  lungs  can  escape.  The  sudden 
check  to  the  fluids  on  the  surface  repels  their  circulation  inter¬ 
nally,  and  accumulates  it  in  the  lungs,  while  those  organs, 
accustomed  for  some  hours  to  draw  in  a  heated  and  unwhole¬ 
some  current  of  air,  loaded,  in  the  languge  of  chemistry, 
with  azote,  as  suddenly  arc  brought,  on  getting  out  of  doors, 
to  inhale  a  cold  oxygenated  fluid,  disposing  them  strongly 
to  inflammation.  This  change  of  temperature,  joined 
with  their  accumulated  circulation,  immediately  begins  the 
pulmonic  disease  which  too  often  proves  fatal.  Nor  are 
the  victims  of  such  rashness  rendered  wiser  even  where  they 
escape.  The  giddy  round  of  pleasure  still  attracts  them  to 
the  fatal  gulph  of  disease,  and  they  generally  fall  victims 
to  a  second  or  at  most  a  third  attack  of  what  they  term  a  cold 
caught  at  seeing  some  favourite  piece. 

But,  independent  of  cold,  public  places,  in  the  confined 
situations  in  which  they  are  built,  in  this  metropolis,  aretoo- 
often  visited  by  the  seeds  of  febrile  contagion ;  and  from 
these  seats  of  amusement  the  fatal  poison  is  inhaled,  which 
saps  the  principle  of  life  and  enjoyment.  It  is  from  a  con¬ 
sideration  of  these  circumstances  that  the  situation,  structure, 
and  regulation  of  public  places,  I  contend,  should  form  a  sub^ 


1809*]  Pharmacy,  28? 

j$ct  of  the  first  importance.  The  pobiic  interest,  not  the 
emolument  of  individuals,  should  be  the  first  object,  and  to 
that,  every  thing  else  should  bend.  The  legislature,  with 
proper  advice,  should  direct  every  thing  respecting  these 
points ;  and  it  would  be  well  if  the  same  attention  were  paid 
to  the  subject  as  is  done  on  the  continent,  where  public 
amusements  are  an  object  of  the  regulation  of  government, 
and  are  not  left  to  the  caprice  of  individuals. 

These  hints,  I  flatter  myself,  will  not  be  lost*  All  the  acci¬ 
dents  from  pressure  and  crowds,  as  well  as  the  predisposition 
to  disease,  from  improper  or  neglected  ventilation,  would 
be  then  avoided. 

I  am,  Gentlemen, 

Your  obedient  servant, 

Feb,  25,  1809*  MEDICUS  POLITICUS* 

ON  THE  MfcUlCAL  EFFECTS  OF  PHOSPHORUS* 

To  the  Editors  of  The  Medical  and  Surgical  Spectator * 

Gentlemen — For  some  time  past  it  has  been  much  the  cus¬ 
tom  to  adopt  German  medicine  as  well  as  German  literature 
and  morality.  The  plays  of  Kotzebue  have  sapped  the  foun¬ 
dations  of  female  virtue  in  this  country,  and  the  writings 
of  several  of  the  German  physicians  have  led  to  wild  and 
speculative  remedies  in  practice,  the  action  of  which  is 
founded  entirely  on  chemical  theory.  One  of  the  most 
powerful  and  dangerous  of  these  is  the  well  known  substance 
we  term  phosphorus,  which  may  be  considered  in  no  other 
light  than  as  liquid  fire .  It  combines,  it  is  well  known, 
with  oxygen  at  the  lowest  temperature :  and  when  exposed 
to  atmospheric  air,  it  emits  a  white  fume  of  a  foetid  smeL,  and 
is  highly  luminous  in  the  dark.  With  these  strong  similarities 
to  fre  itself ,  its  qualities  as  a  medicine  must  be  of  a  mora 


[March, 


Pharmacy . 

than  phlogistic  nature;  and,  however  in  combination  its 
powers  may  be  modified,  so  as  to  form  a  constituent  principle 
of  the  more  solid  parts  of  the  animal  machine,  in  its  pure  state 
it  is  the  most  powerful  agent  that  can  be  employed  to  des¬ 
troy  it.  It  has  been  represented  by  the  German  physicians  as 
an  instrument  of  such  powerful  animal  excitement  as  to 
recall  the  fleeting  breath  as  it  passes  through  the  lungs,  per¬ 
forming  respiration  in  its  last  struggles.  It  produces,  we 
are  told,  by  its  action,  an  universal  heat  and  glow,  and 
quickens  the  pulse,  rendering  it  at  the  same  time  full  and 
strong ;  but  it  is  added,  that  it  is  one  of  those  rapidly  ex¬ 
citing  agents,  which  is  only  safe  where  the  vital  powers  are 
extremely  low ;  where  the  functions  of  nature  are,  as  it  were, 
altogether  suspended ;  and  where  every  chance  of  recovery 
is  past.  Hence  it  is  strongly  recommended  in  the  last  stage 
of  typhus,  where  involuntary  stools  and  urine  have'come  on. 
In  such  cases  I  have  several  times  seen  it  tried,  but  not  with 
the  success  or  marvelous  effects  which  the  German  phj^si- 
cians  declare. 

One  of  these  cases  was  with  my  respectable  friend  Dr. 
Garthshore,  who,  zealous  in  the  pursuits  of  his  profession, 
and  anxious  to  give  every  scientific  practice  a  fair  trial,  pre¬ 
scribed  it  in  a  case  of  the  last  stage  of  typhus,  attended  also 
by  Messrs.  Main  waring  and  Jones.  The  first  exhibition  of 
it  roused  the  patient,  and  gave  a  short-lived  and  deceptive 
appearance,  which  immediately  afterwards  was  succeeded 
by  a  more  gloomy  relapse ;  and  the  patient  did  not  long 
survive.  Since  that  time  1  have  witnessed  the  same  result  in- 
several  other  instances.  It  is  clear  that  this  remedy  can  only- 
act  by  exciting  inflammation,  and  the  inflammation  it  excites 
is  of  that  very  active  and  overwhelming  nature,  that  a  very 
short  period  completes  its  triumph  over  the  unhappy  patient. 
Hence  even  its  German  panegyrists  observe,  that  where  it  is 
improperly  used,  the  worst  consequence^  have  attended  its 


Miscellaneous * 


289 


1809.] 


administration.  Balancing,  then,  the  injury  arising  from 
what  is  termed  its  improper  use3  and  the  uncertainty  of  its 
permanent  benefit  in  cases  where  it  does  really  apply,  it  is  a 
medicine  which  I  think  ought  to  be  wholly  discarded.  We 
have  mischievous  remedies  enough  in  this  country,  without  the 
Germans  teaching  us  to  swallow  liquid 'fire.  I  observe  the  phos¬ 
phoric  acid  and  ether  is  prescribed  in  certain  cases  of  impo- 
tency  by  Mr.  Roberton  of  Edinburgh.  Perhaps  future 
and  more  enlarged  experience  will  make  him  abandon  this 
highly  prized  specific. 

I  am.  Gentlemen, 

Your  obedient  servant, 

CLINICUS. 


London ,  Feb .  10,  1809. 


Communication  on  Medical  Education ,  by  Dr.  John  Reidy 
Licentiate  of  the  Royal  College  of  Physicians ,  and  late 
Senior  Physician  to  the  Finsbury  Dispensary . 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — The  success  with  which  you  have  developed 
the  artifices  of  empiricism,  entitles  you  to  the  gratitude  as 
well  of  the  medical  profession  as  of  the  public  at  large, 
but  to  cleanse  the  accumulating  filth  of  this  Augean  stable 
is  a  labour  that  the  legislative  power  only  can  ever  hope  to 
achieve.  Many  other  professional  abuses,  however,  call 
loudly  for  reformation,  nor  do  I  conceive  that  the  <c  Medical 
Spectator”  can  be  more  usefully  employed  in  its  censorial 
capacity,  than  in  bringing  some  of  these  fairly  before  the 
public,  and  in  suggesting  such  expedients  for  their  removal, 
as  a  due  consideration  of  them  will  necessarily  produce. 
That  the  general  routine  of  Education  usually  pursued  by 
medical  students  is  radically  and  essentially  defective,  few 
will  be  disposed  to  deny.  It  is  indeed  a  lamentable,  but  an 
undoubted  fact,  that  among  the  ipimerous  students  that  an- 


990 


Miscelanies. 


[March, 


nually  resort  to  the  metropolis  for  the  acquisition  of  medical 
knowledge,  very  few  are  properly  prepared  by  scholastic 
acquirements  for  the  reception  of  that  information  which  is 
the  object  of  their  pursuit.  If  to  one  class  of  men  more 
than  another,  a  liberal  education,  an  enlarged  understand¬ 
ing  and  a  well  cultivated  mind,  are  indispensably  requisite ; 
If  in  one  station  of  life  more  than  another,  Urbanity  of 
manners  and  an  intimate  acquaintance  with  the  human  hearty 
are  absolutely  required ;  surely  those  who  are  engaged  in 
either  of  the  departments  of  the  u  healing  art,”  ought  in  an 
eminent  degree  to  possess  these  necessary  qualifications. 
How  then  does  it  happen  that  young  men  designed  for  the 
practice  of  Surgery  and  Medicine  are  often  so  miserably  defi¬ 
cient?  Is  it  true,  persons  in  a  sphere  of  life  where  the  culti* 
vation  of  literature  is  less  attended  to,  introduce  their  sons 
to  the  profession,  or  does  it  arise  from  the  necessity  that  ex¬ 
ists  of  removing  early  from  school  a  boy  destined  to  the 
drudgery  of  pharmaceutical  preparation  for  the  next  seven 
years  ?  To  the  latter  of  these  causes,  I  think  the  evil  is  in 
general  to  be  attributed.  A  youth  at  the  age  of  fourteen  is 
taken  from  school  and  placed  behind  an  Apothecary’s  counter. 
There  the  mixing  of  potions,  powders,  &c.  probably  occu¬ 
pies  most  of  his  time.  The  Pharmacopoeia  is  perhaps  given 
him  to  study,  and  in  due  time  he  is  initiated  into  the  mys¬ 
teries  of  bleeding  and  tooth-drawing.  In  the  course  of  his 
apprenticeship,  he  will  most  likely  collect  a  fewr  empirical  ideas 
respecting  the  efficacy  of  medicines,  and  will  perhaps  learn 
to  make  a  suitable  application  to  a  sore.  He  may  even  by 
some  lucky  chance  attend  a  pauper  in  a  fever,  and  after  much 
ineffectual  search  be  fortunate  enough  to  discover  the  pulse, 
though  certainly  without  knowing  the  distinction  between  an 
artery  or  a  vein.  Curiosity  may  sometimes  induce  him  to 
take  up  a  <c  system  on  anatomy”  or  u  Cullen’s  first  lines!’* 
but  the  alphabet  of  every  science  is  dry  and  uninteresting. 
He  feels  the  want  of  a  classical  key,  and  is  soon  disgusted 


Miscellaneous > 


m 


1809.] 


tftth  names,  phrases  and  descriptions  that  (to  him  are  incom¬ 
prehensible.  Confinement  is  always  irksome,  but  particu¬ 
larly  so  at  that  time  when  the  mind  begins  to  expand,  and 
the  youth  feels  himself  become  a  man.  He  therefore  natu¬ 
rally  looks  forward  with  patience  to  the  day  of  liberation, 
and  fondly  fancies  that  liberty  includes  every  enjoyment  that 
human  nature  is  capable  of  tasting.  A  new  scene  now  opens 
to  his  view*  He  arrives  in  London,  enters  at  the  Hospitals* 
and  is  expected  in  the  course  of  six  or  twelve  months  to  make 
such  a  proficiency  in  anatomy  and  surgery  as  will  enable 
him  to  pass  an  examination  at  u  the  Hall,”  which  is  held 
out  as  being  the  grand  object  of  solicitude.  But  here  again 
obstacles  occur  to  impede  his  improvement..  Released  so  re¬ 
cently  from  restraint,  and  transported  at  once  from  perhaps 
an  obscure  country  district  to  the  centre  of  the  metropolis, 
without  experience  to  guard  or  discretion  to  direct  him,  can 
we  wonder  if  the  blandishments  of  pleasure  induce  his  atten¬ 
tion  from  the  sober  path  of  professional  duty,  or  that  stimu¬ 
lated  by  the  example  of  too  many  of  his  associates,  and  at¬ 
tracted  by  the  novelties  with  which  he  is  surrounded,  his 
attendants  should  be  lax  and  irregular,  and  his  mind  be¬ 
come  dissipated  and  unbent.  Grant  however,  that  from 
lectures,  dissections  and  hospital  practice,  a  general  outline 
of  useful  knowledge  is  gleaned.  The  ordeal  of  examination 
passed,  and  the  student  thus  fledged,  ready,  to  take  his  flight 
into  the  country,  there  to  erect  his  standard  as  a  licensed 
destroyer,  or  perhaps  having  procured  an  appointment,  is 
dispatched  to  tamper  with  the  lives  of  our  soldiers  and  sai¬ 
lors,  which  at  the  present  juncture  are  so  valuable  both  in  a 
political  and  pecuniary  point  of  view.  If  this  picture  be 
not  overcharged,  (and  for  the  correctness  of  it  I  can  confi¬ 
dently  appeal  to  every  man  who  has  had  opportunities  of 
making  observations  on  any  of  our  modem  schools,)  it  only 
remains  for  me  to  inquire  ought  these  things  to  be  ?  Is  an 
apprenticeship  necessary,  or  even  desirable  as  an  introduction 


Medical  Intelligence .  [Marcia 

to  the  medical  profession,  and  ought  not  some  system  of  in¬ 
struction  to  be  formed  and  enforced  to  insure  it  from  being 
invaded  by  incapable  and  unworthy  members  ?  Without  a 
classical  education,  no  pupil  should  be  admitted,  and  gram¬ 
mars  of  anatomy,  chemistry,  &c.  might  easily  be  compiled 
for  the  use  of  such  boys  while  at  school,  as  were  intended 
for  the  different  departments  with  which  those  sciences  are 
Connected.  If  the  dispensing  of  medicines  cannot  be  alto¬ 
gether  omitted,  a  youth  from  the  age  of  sixteen  to  eighteen 
might  be  employed.  The  present  mode  of  Hospital  attend¬ 
ance  requires  a  complete  revolution,  and  might  with  advan¬ 
tage  be  placed  upon  a  footing  somewhat  similar  to  that  at 
our  universities.  A  certain  sum  of  money  should  be  paid 
on  entrance,  and  a  certain  course  of  study  be  laid  down 
from  which  no  pupil  could  deviate.  To  this  plan,  three 
years  at  least  should  be  devoted,  and  a  rigid  examination 
should  then  take  place  in  each  particular  branch  of  science,  and 
those  only  who  should  be  found  in  every  respect  competent, 
should  be  allowed  to  practise.  These  desultory  hints,  hastily 
thrown  together,  are  submitted  to  the  candour  of  the  Editors, 
with  the  hope  that  they  may  excite  the  attention  of  men 
better  informed  on  the  subject,  who  may  have  the  wisdom  to 
suggest,  and  the  power  to  put  in  execution  some  permanent 
plan  for  the  better  regulation  of  medical  instruction. 

I  am,  Gentlemen, 

Your  obedient  servant, 

Greville  Street ,  Brunswick  Square.  JOHN  REID. 

MEDICAL  INTELLIGENCE. 


Accounts  from  Brazil  state,  that  the  vaccine  inoculation,  first  practised 
in  St.  Salvador,  towards  the  close  of  1 S04,  has  since  been  spread  through 
all  the  provinces,  by  the  orders  of  the  Prince  Regent.  His  royal  higbnes* 
appointed  Dr.  J.  A.  Barbaso  to  superintend  and  promote  the  new  practice  $ 
and  so  beneficial  have  been  its  effects,  that  the  small-pox,  formerly  very 
destructive  there,  has  totally  disappeared. 


293 


1809.]  Medical  Intelligence. 

A  species  of  wasp  which  builds  its  nests  in  trees  has  lately  "been  observed 
an  various  parts  of  this  country,  and  was  frequently  met  with  during  the  last 
summer  in  different  parts  of  the  West  Riding  of  Yorkshire.  It  appears  to 
be  a  new  introduction,  and  is  supposed  to  have  been  brought  across  the  At¬ 
lantic  into  some  of  the  ports  on  the  western  shore  of  the  island,  and  is  gra¬ 
dually  introducing  itself  through  the  country.  The  trees  on  which  the  nests 
have  been  most  frequently  observed,  are  the  gooseberry  and  currant,  and 
an  instance  of  it  has  been  met  with  on  the  common  elder,  to  which  insects 
in  general  are  averse.  This  species  is  smaller  than  the  common  wasp,  but 
it  is  much  less  voracious,  and  less  easily  irritated. 


An  improvement  on  obstetrical  instruments  has  for  some  years  been  in¬ 
troduced  in  his  private  practice  by  Mr.  Mainwaring,  which  is  of  consider¬ 
able  importance.  In  those  unfortunate  cases  of  distortion,  where  a  dimi¬ 
nution  of  the  child’s  head  is  unavoidable  to  permit  delivery,  the  instruments 
commonly  in  use  are  the  long  scissars  and  crotchet,  or  blunt  hook.  The 
latter  is  perhaps  an  unnecessary  instrument.  Mr.  Mainwaring  has,  with 
much  advantage  and  simplicity,  conjoined  the  two  former  instruments  into  one. 
This  instrument  is  a  pair  of  long  scissars  completely  blunt  on  all  sides, 
except  at  the  points,  at  a  small  distance  from  which  are  placed  two  pro¬ 
jecting  points  or  stops.  When  the  perforation  of  the  head  takes  place  to 
the  full  extent,  and  the  evacuation  is  made,  which  can  be  all  done  with 
the  same  instrument  on  expanding  the  blades  to  a  certain  extent,  the 
stops  take  a  firm  hold  of  any  projecting  parts  of  the  bones  of  the  head  in 
the  same  manner  as  the  crotchet,  and  are  not  so  liable  to  slip  as  that  in¬ 
strument,  neither  of  slipping  from  their  blunt  surface  to  do  injury.  The 
slipping  of  the  crotchet  is  always  a  dangerous  circumstance,  unless  well 
guarded  by  the  hand  of  the  operator,  and  even  the  withdrawing  one  instru¬ 
ment  after  perforating  and  employing  another,  is  attended  with  inconveni¬ 
ence,  and  much  delay  in  the  delivery.  On  these  accounts  we  hope  the  pro¬ 
jector  of  this  improvement  will  make  it  generally  known,  and  state  the  par¬ 
ticulars  of  his  own  experience  with  it. 

Another  extraordinary  instance  of  abstinence  at  present  exists  in  North- 
Wales. — This  extraordinary  being  is  also  a  woman,  named  Mary  Thomas. 
She  is  now  of  the  age  of  84  years;  63  of  these  she  has  been  confined  to 
the  bed;  and  duripg  this;  long  period  has  lived  nearly  without  eating  of 


[March, 


Medical  Intelligence . 


drinking.  For  ten  years,  about  the  middle  of  this  long  term,  she  was  sup¬ 
ported  absolutely  without  food  of  any  kind ;  then  lying  in  a  torpid  state, 
unconscious  of  her  own  existence.  In  1 807  her  ingestce  were  confined  to 
one  ounce  of  bread  and  a  glass  of  water  in  fourteen  days;  and  this  was  in¬ 
variably  rejected  from  her  stomach  in  a  few  minutes  after  being  taken, 
IJnder  this  extended  period  of  abstinence  she  is  reduced  to  a  breathing 
nkeleton.  An  eminent  artist,  Mr.  James  Ward  of  Newman  Street,  h»3 
in  his  possession  an  admirable  sketch,  unique  in  its  kind,  of  this  being, 
taken  from  the  life  by  himself.  It  is  superfluous  to  observe  how  much  phi¬ 
losophers  and  physicians  would  be  gratified  by  an  etching  from  this  curious 
portrait,  executed  with  the  truth  and  spirit  its  possessor  is  capable  of  giv¬ 
ing  to  it ;  and  accompanied  with  such  authentic  facts,  as  Mr#  Ward’s  know¬ 
ledge  of  the  woman  can  supply. 


By  the  Report  of  the  Small  Pox  Hospital,  it  appears  that  the  discontinu¬ 
ance  of  Inoculation  for  Small  Pox  has  by  no  means  checked  the  casual  disease, 
and  that,  on  the  contrary,  the  mortality  from  Small  Pox  has  increased  from 
an  average  of  42  in  April  and  May,  to  141  each  for  the  months  of  October 
and  November.  This  proceeds  chiefly  from  the  .dislike  of  many  to  the 
practice  of  Vaccination.  The  following  is  the  statement  of  patients,  andi 
fcjie  result  of  their  cases  from  January  to  November, 

In-Patients.  Out-Patients. 


January  - 
February  - 
March  -  - 

April-  -  - 
May  -  -  - 

June  -  -  - 
July  —  - 
August  -  - 
September 
October  - 
November 


i 

Small- Pox. 

Inoculated. 

Vaccinated. 

Vaccinated. 

Inoculated. 

Deaths  by  the 
Small- Pox,  as 
reported  by  the 
Bills  of  Morta¬ 
lity. 

Of 

7 

21 

32 

67 

174 

•30 

9 

19 

40 

96 

102 

- 

9 

29 

101 

190 

89 

- 

4 

36 

113 

484 

46 

- 

4 

25 

214 

196 

39 

• 

15 

16 

1 

117 

51 

aw 

14 

10 

2 

53 

92 

mm 

3 

10 

105 

78 

m 

6 

20 

156 

103 

. 

10 

23 

3 

159 

96 

24 

29 

114 

167 

3809.]  Medical  Intelligence .  295 

Dr.  John  Reid,  we  are  sorry  to  understand,  intends  discontinuing  his 
Monthly  Reports  of  Diseases.  The  advantages  of  such  reports,  we  are  of 
opinion,  are  very  great  for  the  information  of  practitioners;  and  we  should 
wish  to  see  theqi  extended  in  the  manner  pointed  out  in  a  former  number  of 
this  work. 


LECTURES  on  the  THEORY  and  PRACTICE  of  MEDICINE,  by 
Dr.  REID,  Member  of  the  Royal  College  of  Physicians,  late  Senior  Phy¬ 
sician  to  the  Finsbury  Dispensary,  &c. 

The  Course  will  comprise  Thirty-five  Lectures, 

The  Lecturer  conceives  that  this  number  will  afford  sufficient  scope  for 
that  extent  of  acquisition  which  is  requisite  to  lay  a  foundation  for  the  at¬ 
tainment  of  practical  knowledge. 

The  science  of  life  will  he  treated  of  as  distinct  from,  although  not  in- 
dependant  of,  other  branches  of  inquiry. 

Tne  principles  of  Brown  will  be  explained,  and  a  yiew  taken  of  other 
systems  which,  iq  the  present  day,  have  any  claim  to  critical  investigation. 

The  advantages  which  have  been  derived  from  an  application  of  the 
principles  of  modern  Chemistry  to  medical  knowledge  will  he  pointed  out- 
Strictures,  at  the  same  time,  will  be  made  on  the  unjustifiable  degree  to 
which  chemical  philosophy  has  been  extended,  for  the  purpose  of  ex¬ 
plaining  the  Phenomena  of  health  and  disease. 

The  high  importance  of  attention  to  the  conduct  and  direction  of  the  in¬ 
tellectual  and  moral  condition  of  man,  as  affecting  his  physical  organization 
and  character,  will  be  stated  and  illustrated  by  examples. 

The  order  of  the  Course  wi}l  be  iq  a  great  pleasure  guidgd  by  the  no¬ 
sology  of  Cullen. 

A  printed  Syllabus,  including  the  heads  of  each  Lecture,  will  be  delivered 
to  a  pupil  upon  his  entrance  in  the  Course. 

The  introductory  Lecture  will  be  given  at  nine  o’clock  in  the  morning,  on 
Wednesday,  March  15,  at  Dr.  Reid’s  House,  where  the  subsequent  Lectures 
Will  be  delivered,  at  the  same  hour,  on  Mondays,  Wednesdays,  and  Fridays. 

Terms  of  Attendance — For  one  Course,  21.  2s.  Od. — Perpetual  Pupil, 
31.  3s.  Od. 

Further  particulars  may  be  learned,  by  applying  at  Dr.  Reid’s  House, 
No.  6,  Grcvillerstreet,  Brunswick-square. 

Dr.  Ramsbotham  will  commence  his  Course  of  Spring  Lectures  on  the 
science  and  practice  of  Midwifery,  at  his  house,  No.  y,  Old  Jewry,  on  Mon¬ 
day,  the  13th  March,  at  seven  o’clock  in  the  evening.  Two  Courses  will 
be  given  during  the  Summer  season ;  the  first  of  which  will  be  commenced 


296 


[March* 


Medical  Intelligence • 

the  second  Monday  in  May,  at  ten  o’clock  in  the  morning ;  each  subject  of 
these  Lectures  is  elucidated  by  appropriate  specimens  of  natural  and  diseased 
parts  from  a  celebrated  anatomical  collection . 

NEW  MEDICAL  PUBLICATIONS. 

Burn’s  Observations  on  some  of  the  most  frequent  and  important  Diseases 
of  the  Heart,  Svo.  7s.  boards. 

The  Physician’s  Yade  Mecnm ;  containing  the  Symptoms,  Causes,  Diag¬ 
nosis,  Prognosis  and  Treatment  of  Disease,  accompanied  by  a  select  collec¬ 
tion  of  formulae,  and  a  glossary  of  teams.  By  Robert  Hooper,  M.  D. 
tmall  8 vo.  6s.  boards. 

IN  THE  PRESS. 

Mr.  Charles  Bell’s  second  volume  of  his  operative  surgery,  founded  on 
the  basis  of  anatomy,  will  appear  in  a  few  days. 

Two  highly-finished  engravings,  the  size  of  nature,  one  representing  the 
basis  of  the  human  brain,  the  other  the  cavity  jn  which  it  is  contained ; 
together  with  two  plates  of  outline  to  the  same,  with  figures  of  difference, 
also  a  full  description  of  the  origin  of  the  nerves  arising  from  that  organ, 
and  the  openings  of  the  cranium  through  which  they  pass.  By  T.  J.  Petti¬ 
grew,  Fellow  of  the  London  Medical  Society. 

The  drawings  executed  from  nature  by  T.  Baxter,  and  engraved  by  J. 
Hopwood ;  the  whole  under  the  inspection  of  John  Taunton,  Esq.  Member 
of  the  Royal  College  of  Surgeons,  London;  Surgeon  to  the  City  and  Fins¬ 
bury  Dispenearies,  City  Truss  Society,  and  Lecturer  on  Anatomy,  Phy¬ 
siology,  &c.  Price  15  s. 

A  system  of  Surgery.  By  James  Russell,  F.  R.  S.  E.  4  vols.  8vo. 


TO  CORRESPONDENTS. 

We  are  sorry  to  inform  J.  C.  that  we  cannot  insert  his  let * 
ter  on  Hydrophbia :  it  contains  too  many  personalities , 
and  too  few  facts  to  deserve  insertion •  W.  D’s.  hint  shall 
be  attended  to  in  our  next.— There  is  nothing  new  in  the 
mode  of  operating  in  cancerous  cases  recommended  by  A 
Constant  Reader;  it  is  known  and  acted  upon  by  many 
eminent  surgeons  of  the  day < 


. . . 

Vol.  II.]  April ,  1809.  [No.  IX. 

■r1"  II  I  — -  --  -  -—  WJL.  „■■■».  '  ,  ,  

THE  LONDON 

Metrical  an!)  Surgical 

SPECTATOR. 


EMPIRICISM. 

*  ♦ 

AS  Quackery  extends,  in  a  political  view,  the  profession 
are  benefited.  The  mischief  from  this  source  falls  to  be  re¬ 
paired  by  scientific  hands,  and  the  Quack  is  the  active  agent 
to  cut  out  work  for  the  regular  practitioner.  Since,  then,  the 
predilection  to  this  department  of  the  healing  art  is  too 
strongly  rooted  to  be  erased,  and  since  the  revenue  drawn 
from  the  same  source  is  too  strong  a  temptation  to  put  a  stop 
to  this  trade  against  health  and  constitution,  the  best  plan 
would  be  to  restrain  it  within  limits  of  salutary  extent  by 
establishing  a  board  of  medical  inquiry  to  license  these  tem¬ 
ples  of  Circaean  deception,  and  for  admitting  only  such  ar¬ 
ticles  for  sale,  the  composition  of  which  should  be  unfolded 
to  the  individuals  of  this  board  under  secrecy  of  not  being 
divulged;  and  by  their  authority,  if  approved  of,  the  no¬ 
strum  should  be  admitted  to  sale.  In  this  way  few  or 
no  medicines  would  be  rejected ;  for  the  individuals  com¬ 
posing  the  board,  if  they  saw  any  articles  of  the  com¬ 
position  dangerous,  or  not  applying  to  the  purpose  stated, 
as  medical  men,  could  advise  the  substitution  of  another 
ticle  in  place  of  it,  so  that  the  nostrum  would  always  come 
forward,  and  in  this  way  in  an  improved  state  as  a  medicine* 
yon.  n.  x 


298 


[April, 


Empiricism , 

By  such  a  regulation  society  would  be  benefited  in  a  high 
degree,  and  even  the  revenue  to  government  improved.  For, 
as  the  compositions  of  the  Patent  Warehouse  would  not  then 
be  so  detrimental  to  health,  the  patients  would  continue  the 
use  of  them  longer,  and  not  so  soon  fall  a  prey  to  their  in- 
jurious  consequences. 

The  diseases  of  children  open  a  wide  field  for  the  specula* 
tions  of  the  empiric,  and  worms  are  a  never-failing  cause  to 
account  for  every  ailment  that  may  attack  them.  The  sale  of 
worm-medicines  is  therefore  beyond  calculation,  and  we  shall 
consider  the  merits  of  a  few  of  the  principal  of  these  speci¬ 
fics,  beginning  with  the  celebrated 

ching’s  worm  lozenge. 

The  form  of  a  lozenge  is  certainly  a  convenient  one  for 
children.  As  being  a  sweet- meat,  it  is  easily  swallowed, 
and  has  the  advantage  of  giving  no  disgust  to  the  child, 
dung’s  specific  is  the  calomel  and  jalap  made  up  in  the  fob 
lowing  manner  into  a  yellow  and  brown  lozenge  : 

YELLOW  LOZENGE. 

Take  of  calomel,  lib. — White  sugar,  2  lbs.— Saffron, 
half  an  ounce— Spring  water,  1  pint. 

BROWN  LOZENGE. 

Take  of  resin  of  jalap,  lbs.— Calomel,  9  ozs. — White 
sugar,  9 lbs. — Spring  water,  sufficient  to  make  a  mass. 

One  of  the  first,  or  yellow  lozenge,  is  given  at  night,  and 
a  brown  one  in  the  morning  to  work  it  off. — This  remedy,  it 
is  clear,  is  nothing  more  than  the  common  medicines  used 
in  worms  by  the  regular  apothecary  f  and  we  can  make  no 
objection  to  Mr.  Ching’s  prescription,  if  proper  regard  is  had 
to  the  doses,  suited  to  the  ages  of  the  patients.  But  that  a 
ct  vimon  remedy  should  be  held  in  this  ipanner  as  a  specific  is 
both  ridiculous  and  dishonest ;  and  that  the  powers  of  such  a 
common  remedy  should  be  farther  vouched  by  noble,  reve¬ 
rend,  and  scientific  characters,  shews  thembeci  lity  of  the 


299 


1809.]  Empiricism, 

human  mind  under  certain  impressions,  and  that  the  prin¬ 
ciples  of  science  do  not  run  through  their  whole  line  of  con¬ 
duct,  however  dignified  or  learned  in  other  respects  they 
may  be,  Th  is  may,  perhaps,  be  one  strong  reason  in  favour 
of  popular  medicine,  as  a  more  thorough  acquaintance  with 
its  powers  would  withdraw  from  the  mind  those  extraordi¬ 
nary  impressions  which  only  gross  ignorance  can  excuse  from 
the  testimonies  in  favour  of  particular  remedies  which  we 
every  day  see  brought  forward. 

dr.  Gardner's  worm  medicine. 

This  is  another  nostrum,  of  which  such  tales  are  told  as 
exceed  even  the  improbabilities  of  Baron  Munchausen.  Dr. 
Gardner  even  loses  sight  of  common  sense  in  his  narrations, 
much  less  has  a  semblance  of  probability.  The  museum  of 
worms,  which  he  has  collected  to  astonish  his  customers,  is 
in  a  great  part  a  deception  formed  for  the  purpose  of  point¬ 
ing  out  the  frequency  of  the  disease,  and  the  great  practice 
lie  has  in  that  line.  They  are  chiefly  made  of  chickens’ 
guts,  which,  coiled  up  in  his  manner,  and  suspended,  re¬ 
semble  the  tape- worm,  and  may  be  easily  mistaken  for  it. 
The  idea  of  worms,  as  a  cause  of  disease,  is  a  popular  one, 
and  persons  recollecting  how  they  may  have  been  infested  by 
them  in  childhood,  are  very  easily  made  to  credit  that  the 
same  may  still  exist  after  they  are  grown  up.  Dr.  Gardner’s 
medicine  happens  to  be  nothing  more  than  a  common  purg¬ 
ing  pill ;  the  prescription  for  which  accidentally  fell  into  hi® 
way  while  in  the  humble  station  of  a  soldier  in  the  guards  ; 
and  considering  the  pill  as  a  more  dignified  weapon  than  the 
bayonet,  he  gave  up  the  one,  and  has  continued  his  warfare 
on*society,  we  are  told  very  successfully,  with  the  other. 
The  chief  ingredients  in  the  pill  are  jalap,  gamboge,  and  ca® 
lomel,  which  require  strong  bowels  in  the  common  doses  in 
which  such  medicines  are  exhibited,  not  to  be  irreparably  in¬ 
jured.  Whether  Dr.  Gardner  conceives  he  has  any  title  to  a 
patent  for  such  a  remedy,  we  shall  leave  the  public  to  judge. 

x  2 


500  Empiricism .  [April, 

WORM  NUTS. 

This  is  nothing  more  than  calomel  introduced  into  this 
form,  and  is  the  same  with  Ching’s  lozenge.  The  same  ob¬ 
jections,  therefore,  that  apply  to  the  one,  affect  the  other  5 
and  if  left  in  a  damp  place,  that  the  solution  of  the  sugar,  or 
saline  matter,  in  their  composition  is  effected,  the  calomel  ac¬ 
quires  an  increased  activity,  which  adds  to  the  danger  of 
their  use  in  very  young  or  weakly  constitutions. 

THE  SWISS  REMEDY;  OR,  WORM  SPECIFIC  OF  MADAME 

NOUFLER. 

This  remedy  acquired  so  much  reputation  on  the  conti¬ 
nent  for  the  cure  of  worms,  particularly  the  tape-worm,  that 
the  secret  was  purchased  by  the  King  of  France,  and  pub¬ 
lished  for  the  benefit  of  society.  It  was  then  found  to  be  the 
powder  of  the  male  fern,  which,  possessing  some  tonic  and 
aromatic  qualities,  by  strengthening  the  bowels,  would  tend 
to  destroy  the  disposition  to  worms.  The  exhibition  of  the 
powder  was  followed  by  a  drastic  purge  at  intervals,  and  a 
perseverance  in  this  plan  for  some  time  generally  effected  a 
cure.  The  principle  of  this  medicine  was  certainly  a  proper 
one— the  keeping  it  a  secret  as  a  specific  constituted  the  im¬ 
position. 

With  these  remedies  of  the  Patent  Warehouse  for  the  use 
of  worms  we  shall  contrast  a  few  of  what  constitute  the  spe¬ 
cifics  of  regular  practice. 

COWAGE. 

The  cowage,  or  a  West  India  "remedy,  was  first  made 
generally  known  by  Mr.  Chamberlayne,  whose  treatise 
on  this  subject  shews  the  success  of  this  medicine  in  a 
very  convincing  manner.  We  consider  it  as,  perhaps, 
in  its  operation,  the  safest  of  all  the  anthelmintics  by 
acting  entirely  in  a  mechanical  manner,  and  thus  re¬ 
moving  the  very  nidus  or  bed  in  which  such  insects  arc 
generated. 


1809.] 


Medicine . 


301 


fFILINGS  OF  TIN 

Are  an  old  remedy  acting  on  the  same  principle  of  me¬ 
chanical  attrition,  and  have  been  equally  successful  in  dis- 
lodging  worms  as  any  other. 

INDIAN  PINK 

Ii  an  American  production.  An  infusion  of  the  root  is  a 
specific  for  worms.  It  possesses  tonic  and  narcotic  powers, 
so  that  the  principle  of  its  action  is  easily  understood.  For 
the  same  reason,  all  bitters  possessing  something  of  a  narcotic 
property  will  be  equally  successful. 

Lime-water  and  oils  operate  differently :  the  former  is  a 
certain  specific  against  the  ascarides,  and  acts  both  as  a  poi¬ 
son  to  them,  and  decomposes  the  mucus  or  slime  in  which 
they  are  inclosed.  The  latter  is  a  poison  to  the  smaller  worms, 
as  well  as  to  many  other  species  of  insects. 


REGULAR  PRACTICE. 


I.  MEDICINE. 

DOCTRINE  OF  TEMPERAMENTS. 

It  is  a  common  observation  which  a  practitioner  daily 
hears  his  patients  apply,  that  such  a  person,  accustomed  to 
attend  them,  is  better  acquainted  with  their  constitution  than 
another.  This  is  certainly  pointing  out  in  other  words  the 
advantage  of  experience ;  but,  in  the  language  of  medicine, 
it  goes  farther — it  includes  a  proper  acquaintance  with  that 
temperament  or  habit  of  body,  by  which  6ne  individual  is 
distinguished  from  another.  The  doctrine  of  temperaments  is 
one  that  ought  to  form  a  leading  foundation  in  practice.  On 
this  subject  much  has  been  written  by  physicians ;  u  and  the 
more,”  says  Dr.  Ferguson,  u  I  think  on  this  subject,  the  more 
I  am  impressed  with  its  importance,  and  I  find  that  the  most 
celebrated  physicians  have  been  of  the  same  opinion.  When 
the  theory  and  practice  of  medicine  are  established  upon  a 


30* 


Medicine • 


[April, 


sure  foundation,  which  can  only  render  it  eminently  useful 
to  the  physician,  the  doctrine  of  the  temperaments  will  be 
no  longer  imperfect,  unintelligible,  or  embarrassed ;  the  light 
thrown  upon  the  one  will  be  reflected  by  the  other.  I  shall 
now  offer  a  few  observations  for  your  consideration:  Cullen, 
and  all  the  modern  writers  upon  this  subject,  consider  the 
nervous  power  as  modifying  the  temperaments  of  men,  and 
upon  its  state  depends  the  state  of  all  the  other  parts.  The 
brain  is  the  organ  which  is  the  seat  of  nervous  power  and 
mental  action. — It  is  acted  upon  by  our  sensual  motions,  and 
its  own  functions,  which  give  sensation  and  motion  to  all 
parts.  It  appears,  therefore,  that  all  our  motions  are  derived 
from  the  action  of  the  brain,  which  is  peculiarly  organized 
for  the  purpose,  and  which  communicates  a  contractile  power 
to  the  muscular  system.  This  contractile  power  is  the  prin¬ 
ciple  of  all  animal  motion.  It  is  excited  into  action  by  de¬ 
sire  or  aversion,  which  is  termed  volition.  If  our  pleasures 
and  pains  depend  upon  the  imagination,  certainly  our  voli¬ 
tions  are  much  connected  with  it ;  and  some  are  of  opinion, 
that  judgment,  memory,  and  reason,  are  only  modifications 
of  this.  (i  The  imagination  perceives,  reasons,  judges,  pe¬ 
netrates,  and  dives  into  things.  The  finest,  the  greatest,  and 
the  strongest  imagination,  is  therefore  the  properest  for  the 
sciences  as  well  as  arts.”  What  would  the  man  of  science, 
the  orator,  or  poet,  be  without  it?  A  certain  quantity  and 
strength  of  it  are  necessary  for  the  comparing  the  analogy  or 
resemblance  of  ideas.  The  power  of  the  imagination  in 
marking  the  various  relations  of  the  qualifications  useful  to 
ourselves  and  others,  gives  occasion  to  volitions;  therefore, 
the  operation  of  the  imagination  in  marking  the  fitness  or  un¬ 
fitness  of  things,  and  difference  of  this  operation,  with  a 
quicker  or  slower  perception  of  relations,  are  the  distinguish¬ 
ing  characters  of  the  temperaments  of  men.  It  appears,  there¬ 
fore,  that  the  temperaments  depend  upon  the  condition  of  the 
imagination,  which  condition  is  different  upon  certain  occa- 


Medicine . 


1809.] 


sions  in  the  same  person.  The  facility  of  renewing  our 
ideas,  and  the  degree  of  reflex  sensation,  or  pleasure  and 
pain  attending  them,  are  owing  to  the  state  of  the  imagina¬ 
tion.  Is  it  not  by  the  imagination  that  we  can  combine  our 
ideas ;  that  we  can  acquire  sensations  of  relation ;  that  our 
ideas  are  renewed  by  our  memory ;  that  wre  can  compare  our 
ideas  ;  and  that  our  sensations  are  modified  ? 

66  Imagination  is  the  chief  faculty  employed  in  description, 
invention,  and  persuasion,  and  in  forming  the  various  opi¬ 
nions  by  which  mankind  are  governed.  These  opinions  or 
imaginations  are  confirmed  by  habit ;  and  when  erroneous, 
are  not  corrected  even  by  experience.  He  that  has  most  ima¬ 
gination,  ought  to  be  regarded  as  endowed  with  most  wit 
and  genius.”  There  are  certain  conditions  of  it  necessary  for 
the  formation  of  orators,  musicians,  painters,  and  poets,  and 
a  different  condition  for  the  philosopher. 

cc  Although  the  imagination  be  weak  in  some,  yet  it  is  very 
impetuous  and  quick  in  others,  especially  in  young  persons, 
where  it  requires  to  be  bounded  by  study  and  experience;  it 
seems  also  to  be  dependent  on  the  energy  of  the  brain,  organs 
of  sense,  and  excitability.  Is  it  not  evident,  that  where  the 
imagination  is  strong,  there  is  vigorous  excitability,  vivacity, 
understanding,  and  knowledge  ?  Persons  of  this  tempera¬ 
ment  have  large  brains  and  strong  nerves ;  they  are,  how¬ 
ever,  very  liable  to  be  affected  with  particular  pains  and 
stimuli.  The  sanguine  and  choleric  temperaments  of  the  an¬ 
cients  seem  to  be  varieties  of  this.  The  opposite  of  the  above 
temperament  is  attended  with  a  dull  imagination ;  the  brain 
is  small,  and  the  nerves  slender.  This  agrees  with  the  phleg¬ 
matic  temperament  of  the  ancients ;  the  excitability  is  lan¬ 
guid,  ideas  are  defective,  and  the  judgment  weak.  Persons 
of  this  temperament  are  more  able  to  bear  fatigue  and  hard¬ 
ship  of  every  kind,  than  those  of  the  quick  temperament. 
Of  these  two  wre  may  consider  all  the  temperaments  to  bs 

x  4 


304 


Medicine • 


[April* 

formed,  those  of  debility,  as  well  as  those  of  strength,  the 
sanguine,  the  melancholy,  the  phlegmatic,  and  choleric. 

u  We  may  consider  the  strength  of  the  system  to  be  regu¬ 
lated  by  the  functions  of  the  brain;  for  where  there  is  a  quick¬ 
ness  of  imagination,  there  is  a  facility  of  performing  volun¬ 
tary  motion,  a  stronger  energy  of  the  brain,  and  a  more  vi¬ 
gorous  excitability,  or  that  facility  of  muscular  contraction, 
termed  irritability.  '  ■  -<4&. 

u  I  perceive  Mr.  Humbold  thinks  it  C(  highly  probable, 
that  the  property  of  matter  to  be  affected  by  stimulus,  depends 
upon  its  composition,  and  that  every  thing  altering  this,  mo¬ 
difies  its  excitability ;  and  he  therefore  concludes,  that  no¬ 
thing  is  of  itself  either  stimulating  or  sedative,  and  that  the 
action  entirely  depends  on  the  state  of  the  organs  with  which 
it  enters  into  combination ;  and  that  the  great  process  of  life 
consists  in  a  perpetual  alterationof  decomposition  and  union, 
and  that  substances  arbitrarily  added  to,  or  abstracted  from 
living  matter,  sometimes  diminish,  and  sometimes  increase 
the  activity  of  the  organs.*’  It  is,  therefore,  very  probable 
that  the  different  proportion  and  combinations  of  elasticity 
and  density  may  modify  the  excitability.  We  must,  how¬ 
ever,  remain  in  a  state  of  uncertainty  with  respect  to  that 
peculiar  state  of  the  organs  of  sense  and  motion,  which  mo¬ 
difies  the  vitality  and  temperament,  until,  as  you  observe, 
we  are  better  acquainted  with  the  chemical  changes  which 
happen  during  the  functions  of  life.  But  let  us  proceed  with 
our  observations  on  the  particular  temperaments. 

6C  I  should  suppose,  in  the  temperament  of  vigorous  ima¬ 
gination,  where  the  sensibility  is  in  its  utmost  perfection,  that 
the  functions  of  the  brain  were  performed  with  great  regula¬ 
rity,  that  the  secretion  of  the  nervous  fluid  was  in  due  pro¬ 
portion  and  of  proper  density,  that  the  vis  nervea  was  of 
sufficient  force,  and  obeyed  the  volitions  of  the  imagination, 
and  that  the  excitability  was  vigorous:  in  consequence  of 


Medicine. 


5G5 


1809.] 

this,  I  should  suppose  the  judgment  to  be  strong,  attended 
with  greatness  of  mind,  and  those  qualities  agreeable  to  our¬ 
selves  to  be  predominant,  as  knowledge,  cheerfulness,  cou¬ 
rage,  tranquillity,  and  benevolence.  6C  Nor  should  I  suppose 
this  character  destitute  of  those  qualities  considered  agreeable 
to  others,  as  justice,  good  manners,  wit,  and  ingenuity. 
Does  he  not  esteem  justice,  fidelity,  honour,  veracity,  alle¬ 
giance,  and  chastity,  on  account  of  their  tendency  to  pro¬ 
mote  the  good  of  society  ?  And  is  not  that  tendency  insepa¬ 
rable  from  humanity,  benevolence,  lenity,  generosity,  grati¬ 
tude,  moderation,  tenderness,  friendship,  and  all  the  other 
social  virtues  ?  Nor  can  it  be  doubted  that  industry,  discre¬ 
tion,  frugality,  secrecy,  order,  perseverance,  fore-thought, 
judgment,  and  the  whole  class  of  virtues  and  accomplish¬ 
ments,  of  which  many  pages  would  not  contain  the  cata¬ 
logue  :  can  it  be  doubted,  I  say,  that  the  tendency  of  these 
qualities  to  promote  the  interest  and  happiness  of  their  pos¬ 
sessor,  is  the  foundation  of  their  merit? 

u  Who  can  dispute  that  a  mind,  which  supports  a  perpe¬ 
tual  serenity  and  cheerfulness,  a  noble  dignity  and  undaunt¬ 
ed  spirit,  a  tender  affection  and  good  will  to  all  around,  as  it 
has  more  enjoyment  within  itself,  is  also  a  more  animating 
and  rejoicing  spectacle,  than  if  dejected  with  melancholy, 

tormented  with  anxiety,  irritated  with  rage,  or  sunk  into  the 
* 

most  abject  baseness  and  degeneracy  ?  And  as  to  qualities 
immediately  agreeable  to  others,  they  speak  sufficiently  for 
themselves  ;  and  he  must  be  unhappy  indeed,  either  in  his 
own  temper,  or  in  his  situation  and  company,  who  has  never 
perceived  the  charms  of  a  facetious  wit  or  flowing  affability, 
of  a  delicate  modesty  or  decent  gentleness  of  address  and  man¬ 
ner. This  temperament  we  have  supposed  to  be  of  the  most 
finished  cast,  possessing  the  most  enjoyment  and  the  least 
suffering,  with  the  most  perfect  mental  organization,  free 
from  imbecility;  with  a  spacious  forehead,  well  defined 
featu^s,  and  a  large  brain.  Of  a  healthy  and  fresh  colour, 


30(5  Medicine*  [April* 

with  union  and  harmony  in  the  form.  The  expression  of  the 
countenance,  indicative  of  the  state  of  the  mind,  having  a 
beautiful  serenity,  or  a  mixture  of  modesty*  sensibility,  and 
sweetness.  Nor  should  we  suppose  the  following  signs  of 
force  and  vigour  absent,  viz. cc  Broad  shoulders,  a  lank  belly, 
firm  joints,  and  taper  legs.”  This  is  the  temperament  most 
capable  of  moderation,  and  of  doing  most  good,  and  will 
serve  to  answer  the  four  following  queries.  <c  Which  is  the 
temperament  most  capable  of  friendship  ?  Which  is  happiest 
united  in  marriage  ?  Under  what  temperament  do  men  live 
longest?”  and,  “  Which  is  most  free  from  disease?”  Some 
will  observe,  that  there  are  very  few  who  enjoy  such  a  happy 
temperament  as  I  have  described ;  I  rather  suppose,  that  there 
are  a  great  many  of  this  temperament,  and  that  there  would 
be  more,  if  it  were  not  owing  to  ambition,  avarice,  and  in¬ 
temperance.  The  times  in  which  we  live,  require  the  great¬ 
est  diligence  and  ©economy,  to  procure  a  respectful  appear¬ 
ance,  and  supply  our  wants,  which,  from  our  increased  de¬ 
sires,  are  become  many.  Professional  men  are  eager  in  the 
pursuit  either  of  fame  or  riches.  Commerce  gives  such  a 
bent  to  the  mind,  that  is  often  productive  of  the  worst  con¬ 
sequences. 

u  There  are  so  many  different  scenes  to  be  met  with  in 
fashionable  life,  which  affect  the  mind  in  such  a  manner, 
that  it  is  no  wonder,  when  they  excite  in  us  the  most  de¬ 
structive  passions,  and  enervate  our  mental  functions  ;  they 
are  too  frequently  productive  of  luxury  and  dissipation, 
which  lead  to  follies,  absurdities,  and  crimes. 

We  are  not  therefore  to  expect  that  we  shall  often  meet 
with  this  temperament  among  professional  men,  nor  the  com¬ 
mercial  world  in  general.  We  ought  to  meet  with  it  where 
the  wants  are  least,  especially  among  those  who  enjoy  a  happy 
retirement  from  the  busy  scenes  of  life  ;  who  neither  indulge 
in  luxury  nor  dissipation,  but  enjoy  a  calm  domestic  agricul¬ 
tural  life.  May  we  not  expect  to  meet  with  it  in  clergymen  ? 


Medicine . 


SOT 


1809.] 

<c  The  opposite  temperament  to  this  I  should  suppose  t<* 
consist  of  a  small  brain  with  slender  nerves ;  the  imagination 
less  vigorous;  the  excitability  either  more  languid  or  ex¬ 
hausted;  less  sensibility;  ideas  more  defective;  judgment 
weaker ;  memory  untenacious ;  and  greater  irregularity  and 
weakness  of  the  mental  functions;  we  are  not  therefore  to 
expect  those  virtues  and  qualities  agreeable  to  ourselves  and 
others,  to  be  so  eminently  displayed  as  in  the  former  tempe¬ 
rament  ;  but,  on  the  contrary,  there  must  be  less  enjoyment 
and  more  suffering,  because,  instead  of  those  duties  referable 
to  probity  and  justice,  there  is  nothing  but  malice,  folly^ 
fear,  sensuality,  and  dissipation. 

(C  The  effects  of  a  dull  imagination  will  be  evident  in  the 
countenance,  which  is  the  index  of  the  mind  ;  the  condition 
of  our  mental  faculties  is  represented  there,  and  every  pas¬ 
sion  and  mode  of  thinking  has  its  peculiar  expression.  We 
can  be  at  no  difficulty  in  distinguishing  when  a  man  looks 
upon  us  with  pleasure  or  pain;  or  where  there  is  a  deficien¬ 
cy  of  ideas,  by  the  vacant  and  unmeaning  aspect. 

cc  Nor  is  it  to  be  expected  that  in  this  temperament  there 
should  be  such  a  beauty  or  uniformity  in  the  appearance. 
u  The  body  and  mind  have  such  mutual  influence,  that 
whatever  contributes  to  change  the  human  constitution  in  its 
form  or  aspect,  has  an  equal  influence  on  its  powers  of  reason 
and  genius.  And  these  again  have  a  reciprocal  effect  in 
forming  the  countenance. ” 

u  Thus  have  I  considered  the  two  classes  of  temperaments, 
depending  upon  the  state  of  the  imagination  and  mental  fa¬ 
culties,  which  diversify  to  infinity  the  differences  that  are  to 
be  found  among  men.  It  is  to  this  that  some  are  called  good, 
and  others  dull,  rustic,  choleric,  melancholic,  phlegmatic, 
cruel,  malicious,  and  dissipated ;  wicked,  virtuous,  and  vi¬ 
cious;  learned  and  unlearned;  reasonable  and  unreasonable. 
There  is  a  certain  balance  of  the  mental  functions  which  is 
necessary  to,  and  constitutes  the  first  class  of  temperaments; 


SOS 


Medicine * 


[April, 


this,  when  properly  supported,  gives  energy  to  the  nervous 
system ;  but  if  by  any  means  this  balance  is  broken,  either 
by  intemperance  or  excess  of  the  passions,  predisposition  and 
disease  are  the  consequence.  The  same  balance  gives  to 
the  mind  its  share  of  good  and  evil,  and  is  also  necessary 
to  the  excitability  of  the  system  and  action  of  the  brain. 
The  imagination  in  excess  may,  therefore,  be  the  means  of 
destroying  this  balance ;  and  a  permanent  predisposition  be 
formed  to  mania,  fever,  and  inflammation.  This  is  similar 
to  the  temperament  known  by  the  name  of  choleric.  There 
is  often  a  degree  of  energy  and  ferocity  in  the  countenance; 
small  eyes  and  contracted  cyedbrows;  the  actions  of  the 
muscles  quick,  especially  in  walking  and  speaking ;  much 
inclined  to  dreaming ;  fond  of  fermented  liquors  and  animal 
food  ;  eager  to  undertake  hazardous  enterprises,  and  very 
desirous  of  commanding. 

u  When  the  imagination  is  weak,  with  deficiency  of  exci¬ 
tability  and  sensation,  this  is  always  accompanied  with  mo¬ 
ral  weakness,  and  corresponds  with  the  melancholic  tempera¬ 
ment  ;  there  is  a  languor  of  the  countenance,  the  muscles  of 
the  eye-lids  and  brows  hang  down,  and  give  a  dejected  ap¬ 
pearance  to  the  face  ;  the  hair  black ;  they  bear  pain  better 
than  labour;  are  much  affected  by  the  changes  of  the  atmo¬ 
sphere,  and  are  disposed  to  have  cold  feet;  their  volitions 
are  slow  ;  although  they  are  very  attentive,  yet  they  are  slow 
to  learn ;  they  submit  to  labour  with  patience,  and  are  very 
frequently  passionate  and  revengeful.  Those  of  this  tempera¬ 
ment  are  subject  to  hysteric  affections,  spasms,  haemorrhages, 
nervous  fevers,  and  the  other  diseases  of  debility. 

£c  The  hypochondriac  is  a  variety  of  this  temperament; 
they  have  been  supposed  to  be  very  subject  to  diseases  of  the 
liver;  at  any  rate  they  are  very  whimsical,  discontented, 
and  envious.  God  forbid  that  any  magistrate  should  be  of 
this  temperament.  From  the  different  mixtures  of  the  quick 
and  dull  temperaments,  all  the  others  may  be  supposed  to 


Medicine . 


S09 


1809.] 


be  formed ;  the  mild,  the  rustic,  the  female,  &c.  The  fe¬ 
male  temperament  may  be  supposed  to  differ  in  several  re¬ 
spects  from  the  male.  They  are  formed  for  giving  pleasure, 
and  are  therefore  tender,  delicate,  and  affectionate,  but  weaker 
than  men.  There  is  also  a  difference  occasioned  by  the  ute¬ 
rine  and  mammillary  systems,  which  have  a  very  great  effect 
upon  their  excitability.  Although  they  have  not  such  a 
depth  of  thought  as  the  male,  their  sensibility  is  greater,  and 
they  have  a  very  quick  conception  of  things.  Their  passions 
are  for  the  most  part  strong,  and  they  have  not  the  same 
power  over  them  as  the  male ;  they  are  very  credulous  and  en¬ 
thusiastic,  and  yet  their  affection  and  love  are  more  durable 
than  the  male ;  they  are  also  very  patient,  benevolent,  and 
modest,  but  are  very  easily  sunk  into  melancholy,  or  raised 
to  rapture.  I  observe  that  novel  writers  make  their  heroines 
very  liable  to  syncope  upon  very  trifling  occasions.  Is  this 
a  characteristic  of  the  female  temperament  ?  I  believe  they 
are  more  permanently  predisposed  to  the  diseases  of  debility 
than  the  male.” 

HEREDITARY  DISEASES. 

Connected  with  temperament,  and  proceeding  on  the 
same  principle,  may  be  considered  hereditary  or  family  dis¬ 
eases. 

It  cannot  be  disputed,”  says  M.  Portal,”  that  there  are 
diseases  which  are  transmitted  from  parent  to  child  ;  while  the 
latter  inherits  the  general  exterior  resemblance  of  his  father,  or 
even  his  shape,  characteristic  traits,  looks,  or  voice,  he  also  in¬ 
herits  his  father’s  health,  strength,  and  sometimes  his  diseases. 
Thus  Femel,  the  celebrated  physician  of  Paris,  observes, 
Maxima  ortus  nostri  vis  est ,  nee  parum  f  dices  bene  nati. 
It  cannot  be  denied  that  there  are  also  families,  the  indivi¬ 
duals  of  which  attain  a  greater  age  than  others  ;  and  this 
circumstance  has  occasioned  a  remark,  that  there  are  short  as 
well  as  long-lived  families. 

6 !  We  may  safely  add,  that  if  children  have  a  physical  re- 


$10 


Medicine, 


[April, 


semblance  to  tbe  parents,  they  resemble  them  in  their  moral 
character  also.  *c  We  find,”  says  Montaigne,  “  that  not 
only  are  the  marks  of  the  body  transmitted  from  father  to 
son,  but  also  a  resemblance  of  temper,  complexion,  and  in¬ 
clinations  of  the  mind.”  This  is  well  ascertained  by  the 
result  of  examples  which  frequently  fall  under  our  observa¬ 
tion  ;  and  is  not  one  of  these  resemblances,  physical  or 
moral,  a  natural  consequence  of  the  other  ?  Would  not  the 
moral  resemblance  be  more  striking  and  more  frequent,  if 
education  did  not  produce  a  difference? 

u  We  may  venture  to  assert,  that  nature  originally  formed 
mankind  in  the  most  perfect  manner  possible,  as  well  as  all 
other  beings,  both  as  to  the  structure  of  the  different  parts, 
their  configuration,  size,  and  relative  situations.  Thus  man, 
in' the  state  of  nature,  would  enjoy  the  best  health,  the 
greatest  strength,  and  the  finest  and  most  regular  shape  ? 
finally,  the  moral  faculties  would  exist  in  all  their  energy, 
if  some  extraneous  cause  did  not  intervene  to  weaken  them  ; 
can  we  refuse  to  admit  this  as  an  incontrovertible  axiom  } 
a  But  there  are  many  causes  which  derange  this  ad¬ 
mirable  harmony ;  may  not  the  parents  previous  to  their 
marriage  have  contracted  diseases,  which  have  occasioned 
in  their  organs  real  affections,  rendering  them  totally  different 
to  what  they  were  in  a  stale  of  nature  ?  Thus,  at  the  moment 
of  procreation,  they  receive  the  different  characteristics  of 
their  parents,  which  they  have  unfortunately  acquired,  and 
which  they  may  transmit  to  their  progeny.  Has  not  the 
mother  during  pregnancy  an  influence  over  the  infant  in  her 
womb,  either  by  assimilating  it  to  herself  in  some  measure 
by  the  nourishment  she  gives  it,  or  by  causing  it  to  feel  a 
part  of  the  evils  she  herself  experiences,  and  communicating 
some  impressions  resulting  from  these  causes  ? 

The  infant,  on  coming  into  the  world,  may  be  very  dif¬ 
ferent  from  what  it  would  have  been  had  these  causes  not 
existed,  which  are  as  it  were  extraneous  to  it,  and  which 


Medicine, 


311 


1809.] 


make  it  differ  from  its  parents  as  to  their  primitive  state 
of  health,  and  make  it  resemble  them  in  their  diseases ;  and 
as  the  number  and  inveteracy  of  diseases  increase  as  men 
advance  in  life,  however  strong  or  healthy  they  may  have 
been  originally,  the  children  of  old  men  are  subject  to  here¬ 
ditary  diseases,  and  their  constitutions  more  feeble.  The 
nursing  of  the  child  by  its  own  mother,  or  by  a  strange 
nurse,  may  also  produce  other  differences  more  or  less  re¬ 
markable,  with  respect  to  its  physical  or  moral  constitution, 
but  which  will  produce  a  resemblance  to  its  nurse.  Thus 
the  ancients,  who  regarded  the  nurse  as  a  second  mother, 
comprehended  among  hereditary  diseases  the  morbi  congenitiy 
cognati ,  seu  connutriti  of  Hippocrates,  the  morbi  parent  ales 
of  Pliny,  the  hcereditarii  of  Fernel,  and  those  which  infants 
contract  from  their  nurses ;  and  in  fact,  these  are  too  fre¬ 
quently  conspicuous. 

c<  Hippocrates,  Galen,  Fernel,  Ingrassias,  Baillou,  Lazare, 
Ri  viere,  Mead,  Boerhaave,  Morgagni,  Stahl,  Senac,  Lieutaud, 
Haller,  Zeller,  Van  Swieten,  and  other  great  physicians, 
whom  it  would  be  futile  to  name  after  them,  have  admitted 
of  hereditary  or  family  diseases,  and  have  included  in  this 
class,  scrophula,  rachitis,  mania,  epilepsy,  convulsions, 
apoplexy,  paralysis,  diseases  of  dentition,  pulmonary  con¬ 
sumption,  aithma,  dropsy,  gout,  and  stone  in  the  bladder ; 
and  can  there  be  a  single  practitioner,  more  especially  in  a 
great  city,  where  the  examples  of  these  diseases  are  more  nu¬ 
merous,  who  is  not  convinced  from  personal  observation, 
that  the  children  of  parents  who  have  been  subject  to  these 
diseases,  have  generally  inherited  them?  We  say  generally, 
because  there  are  numerous  exceptions  on  this  head,  even 
when  the  legitimacy  of  birth  cannot  be  questioned. 

€<  To  these  hereditary  diseases  may  we  not  add  cancer  and 
cataract,  with  deafness  and  dumbness  from  the  birth  ?  Mor¬ 
gagni  saw  three  sisters  who  were  dumb  from  their  infancy. 
Other  authors  have  mentioned  similar  instances ;  and  many 


512  Medicine ,  [April, 

/ 

such  have  come  under  our  own  observation.  Those  ac¬ 
quainted  with  herniary  complaints  do  not  hesitate  to  affirm 
that  hernia  is  more  frequent  in  some  families  than  in  others  ; 
so  far,  therefore,  from  limiting  the  number  of  hereditary 
diseases,  and  still  farther  from  denying  their  existence  en¬ 
tirely,  as  some  authors  have  done,  we  think  their  numbers 
are  very  considerable.  Without,  however,  wishing  to  go 
to  the  extent  that  Hippocrates  has  done,  who  was  of  opinion, 
that  all  diseases  were  hereditary,  aliqua  quidem  ex  parte ; 
and  that  all  children  inherited,  more  or  less,  the  temperament 
of  their  fathers. 

u  The  opinion  of  Hippocrates  has  been  followed  by  all 
except  Sennert,  Ethmuller,  and  Maurice  Hoffman,  who  do 
not  admit  of  any  acute  diseases  being  hereditary.  As  to  the 
transmission  of  chronic  diseases  from  father  to  son,  they  have 
regarded  it  not  only  as  possible,  but  as  very  common  ;  and 
this  doctrine  was  so  generally  adopted  in  1748,  that  the 
Academy  of  Dijon  proposed  a  prize  question,  with  a  view  to 
determine  how  the  transmission  look  place .  M.  Louis,  who 
subsequently  became  so  celebrated  in  the  Annals  of  French 
Surgery,  instead  of  answering  the  question  proposed,  pub¬ 
lished  a  well, written  Dissertation,  in  order  to  prove,  that 
there  were  no  hereditary  diseases ;  but  his  arguments  on 
this  subject  are  more  ingenious  than  well  founded. 

<c  The  difficulty,  or  rather  the  impossibility  of  a  satisfac¬ 
tory  explanation  of  the  communication  of  diseases  from 
parents  to  children,  has  more  than  once  given  occasion  to 
medical  authors,  to  deny  the  existence  of  hereditary  taints ; 
as  if  it  were  always  necessary,  before  admitting  an  effect, 
to  know  its  cause ;  and  yet,  by  a  strange  contradiction,  the 
same  writers  do  not  hesitate  to  recognise  the  external  resem¬ 
blance  between  children  and  their  parents,  Which  they  can¬ 
not  account  for.  Rerum  e'centa  magis  arbitror ,  quam  causas , 
says  Cicero,  quceri  oportere ;  et  hoc  sum  contentus  quod 
etiam  si  quomodo  quidquidjiat  ignorem ,  quod Jiat  intclligo « 


Medicine. 


313 


1809.] 


Cc  Let  us  study  the  phenomena  of  nature,  even  when  she 
conceals  from  us  the  means  she  employs  for  producing  them ; 
to  be  acquainted  with  them  is  always  curious,  and  it  is  useful 
if  it  facilitates  the  progress  of  the  healing  art. 

iC  The  Royal  Society  of  Medicine  gave  out,  as  Questions 
for  the  Prize  Dissertations  for  1787 — 1st,  Do  hereditary  dis¬ 
eases  exist,  and  what  are  they  l  2dly,  Is  it  in  the  power  of 
medicine  to  hinder  their  deveiopement,  or  to  cure  them  when 
they  have  broken  out  ? 

u  Some  of  the  memoirs  presented  on  this  occasion  have 
been  printed,  but  what  their  authors  have  said,  does  not 
appear  to  us  to  have  exhausted  the  subject.  The  present 
remarks  being  the  result  of  our  clinical  and  anatomical  ob¬ 
servations,  prove  that  there  are  family  or  hereditary  diseases, 
and  also  seem  to  lead  us  to  the  knowledge  of  the  nature  and 
treatment  of  several  of  these  diseases. 

<c  Hereditary  disease  consists  not  only  in  mal -conforma¬ 
tions,  more  or  less  extensive,  of  the  external  parts,  but  fre¬ 
quently  also  of  internal  deformities,  and  which  dissection 
alone  can  demonstrate ;  it  is  from  these  internal  mal -con¬ 
formations,  and  also  from  peculiarities  in  structure,  that  the 
alterations  of  the  functions,  or  the  various  symptomatic  he¬ 
reditary  diseases,  proceed.  We  shall  endeavour  to  prove 
this  in  the  following  pages. 

u  After  mentioning  such  mal-conformations  as  are  exter¬ 
nal,  we  shall  proceed  to  speak  of  those  which  we  have  dis¬ 
covered  in  the  internal  parts. 

It  cannot  be  denied,  that  there  are  families,  the  indivi¬ 
duals  of  which  have  larger  heads  than  usual.  There  are 
some  also,  but  not  so  common,  who  have  small  heads  and 
large  bodies :  at  other  times,  and  in  the  same  family,  we 
meet  with  craniums,  long,  narrow,  broad,  short,  or  high  in 
proportion;  this,  however,  is  of  no  consequence  relative  to 
the  moral  and  physical  constitution,  if  the  capacity  of  the 

VOL,  II.  T 


514  Medicine .  [April, 

cranium  be  the  same,  'which  is  generally  the  case,  as  Hippo¬ 
crates  and  other  accurate  observers  have  remarked. 

66  To  return  to  the  differences  observed  in  families : — The 
children  of  some  parents  have  the  nasal  bones  and  cartilages 
more  elevated  or  flattened ;  shorter  or  longer ;  and  more  or 

f  '  :  v  •  •  »  ... 

less  covered  with  a  fatty  substance.  Hence  it  follows,  that 
the  individuals  of  certain  families  have  noses  of  a  form  and 
size  which  distinguish  them  from  others;  thus,  the  family  to 
which  Charles  Boromaeus  belonged,  was  remarkable  for  large 
aquiline  noses,  which  are  to  this  day  observable  in  his  de¬ 
scendants.  The  Bourbons  have  all  large  noses,  and  the  in¬ 
dividuals  belonging  to  the  Austrian  branch  have  thick  lips. 
I  have  known  families,  in  which  the  ears  were  very  large, 
and  in  others  in  which  they  were  small,  and  almost  without 
any  lobulae. 

u  There  are  individuals  also,  the  bones  of  whose  faces  are 

f  \  i  •  •  i  . 

more  or  less  convex,  the  lower  part  of  the  chin  hollow  or  ele¬ 
vated  ;  the  face  more  or  less  oval,  or  irregularly  triangular 
or  square ;  more  prominent  or  flat,  and  sometimes  as  if  trun¬ 
cated  at  the  lower  extremity  from  a  defect  in  the  develope- 
ment  of  the  lower  jaw. 

u  In  certain  families  the  individuals  have  capacious 
chests,  and  in  others  this  cavity  is  narrow  and  con¬ 
tracted  ;  some  families  have  broad  shoulders,  others  narrow, 
and  this  last  defect  coincides  with  that  of  a  too  narrow 
chest. 

iC  There  are  many  families,  the  individuals  of  which  are 
hunch-backed.  1  know  one  family  at  Paris,  in  which  there 
are  seven  of  this  description ;  others  have  their  limbs  distort¬ 
ed,  or  too  short,  or  too  long,  in  proportion  to  the  rest  of  their 
bodies. 

“  There  are  persons  also,  with  small  or  large  hands,  and 
with  short  or  long  feet.  A  man  was  once  exhibited  to  us,  at 
the  Academy  of  Sciences,  whose  hands  were  of  a  mon- 


1809.]  Medicine .  315 

strous  size,  and  he  assured  us  that  his  father’s  were  equally 
large, 

6i  Some  families,  as  mentioned  by  M.  Morand,  in  a  pa¬ 
per  printed  among  the  Memoirs  of  the  Academy  of  Sciences 
(1769)  were  remarkable  for  having  children  with  six  fingers. 

iC  External  deformities  in  families  have  been  noticed  in  all 
ages,  and  the  ancients  never  doubted  that  they  were  heredi¬ 
tary,  They  were  so  convinced  that  children  resembled  their 
parents,  that  they  used  the  terms  7nacrocephali  d  macroce - 
phalis  ;  and  the  Romans,  capitones  d  capitonibus ,  pumUioncs 
d  pumilionibus , 

u  Independently  of  these  differences  with  respect  to  the 
developement  of  the  bones,  we  may  remark  in  some  families 
real  differences  in  the  volume  of  the  muscles  of  the  trunk 
and  of  the  limbs.  I  have  seen  instances  where  a  father 
and  his  two  sons  had  the  left  side  of  the  body,  with  re¬ 
spect  to  the  muscles,  much  larger  than  the  right ;  they 
therefore  used  the  left  side  and  limbs  more  frequently  than 
the  right,  and  were  of  course  left  handed.  In  some  per¬ 
sons  the  left  side  is  stronger  than  the  right ;  but  this  is  very 
rare,  for  men  of  all  countries  are  generally  strongest  ig  thq 
right  side. 

-  I  knew  a  family  5  the  father  and  children  of  which  pos¬ 
sessed  such  a  disposition  in  the  muscles  of  the  nose  and  of 
the  lips,  and  such  great  mobility  in  the  cartilage  of  the 
nose,  that  they  could  not  speak  without  moving  them.  In 
the  act  of  speaking,  the  point  of  the  nose  was  constantly  in 
motion. 

u  I  knew  a  Spanish  nobleman  who  had  one  cheek  larger 
than  the  other,  the  maxillary  bone  on  one  side  and  the 
integuments  being  larger  than  the  natural  size.  He  told 
me  that  his  father  and  his  uncles  had  a  similar  deformity, 
which  was  certified  to  me  by  several  Spaniards  then  in  Paris. 

<c  Some  authors  have  described  families  of  triorcliidcs ,  or 

y  2 


■  1  I 

'316  Medicine*  [April, 

f 

with  three  testicles,  among  which  the  Coglioni  have  been 
mentioned.  On  this  subject,  however,  we  should  not  forget, 
that  we  may  sometimes  mistake  a  preternatural  tumour  in 
the  bursas,  or  an  epiplocele,  for  a  testicle. 

These  external  deformities  ought  to  lead  us  to  inquiries 
with  respect  to  the  interior  of  the  human  body.  May  there 
not  be  natural  or  morbid  relations  between  the  internal  and 
external  parts  ?  1  have  collected  several  examples  of  external 
resemblances  in  persons  of  the  same  family,  who  died  of  the 
same  diseases ;  and  I  do  not  doubt,  that  if  the  inquiries  now 
suggested  are  followed  up,  the  results  will  every  day  prove 
more  interesting.  Future  anatomical  researches  will  shew, 
that  the  viscera  in  the  individuals  of  certain  families  were 
larger  or  smaller,  and  more  or  less  different  in  their  sub¬ 
stance,  so  as  to  produce  hereditary  diseases. 

(e  Among  several  facts  of  this  kind,  which  I  have  collect¬ 
ed,  I  shall  confine  myself  to  two  families ;  those  of  V  itel,  Rue 
Saints  Peres ;  and  Villemeht,  perfumer,  Marche  St.  Martin. 
In  these  families  several  individuals  died  of  palpitation  of  the 
heart,  after  medical  assistance  had  been  administered  in  vain. 
I  was  present  at  the  opening  of  the  bodies  of  two  of  these  pa¬ 
tients,  one  in  each  family,  and  I  saw  that  the  left  ventricle 
Was  very  much  dilated,  although  the  parietes  of  this  ven¬ 
tricle  was  enormously  thick  in  both  subjects.  As  other  rela¬ 
tions  had  also  died  under  circumstances  perfectly  similar,  we 
may  reasonably  suppose  that  if  they  had  been  opened,  the 
same  mal-conformation  would  have  been  found. 

(e  Palpitations  of  the  heart,  in  consequence  of  aneurism, 
have  been  often  noticed  by  authors,  and  particularly  by  Lan- 
cisi,  who  cites  cases  of  this  kind,  wrhich  he  witnessed  in 
Italy,  and  which  are  still  very  frequent  in  that  country.  I 
have  often  been  consulted  myself  by  Italians  for  similar  com¬ 
plaints.  The  Gonzalvi  family  presents  a  striking  example  of 
this  description,  now  under  our  observation. 


Medicine . 


3 17 


1809.] 


% 


<c  Are  there  not  also  nervous  and  spasmodic  affections  in 
families,  which  derange  the  functions  of  the  mind?  or,  do 
these  functions  remain  unaffected  during  convulsions  or  in¬ 
ordinate  exertions  of  the  muscles  ? 

u  How  many  families  are  there,  in  which  mania,  hysterics, 
and  shakings  of  the  limbs  are  hereditary  ?  At  Paris,  we  have 
seen  the  Marechal  de  BeauveaU  and  four  of  his  sisters,  who 
were  subject  to  very  singular  shakings  of  the  head.  It  may 
perhaps  be  supposed,  that  this  kind  of  convulsion  was  the 
effect  of  imitation  from  the  parties  frequently  seeing  each 
other,  of  which  there  are  examples ;  but  it  could  not  be  so  in 
this  case,  for  the  parties  were  never  long  resident  together  in 
one  place.  It  is  also  remarkable,  that  this  shaking  of  the 
head  attacked  all  of  them  at  nearly  the  same  age. 

<c  Morgagni  has  recorded  the  history  of  a  family,  some  of 
the  individuals  of  which  died  from  excessive  vomiting.  In 
one  of  these  persons,  whose  body  was  opened,  the  stomach 
was  found  shrivelled  up,  the  pancreas  hard,  as  if  schirrous, 
and  there  were  numerous  concretions  which  united  the  peri¬ 
cardium  to  the  heart. 

<(  There  are  families  remarkable  for  having  the  epiploon 
enormously  surcharged  with  fat,  or  with  larger  bellies  than  is 
requisite  for  their  size  in  other  respects;  this  kirld  of  mal- 
conformation  is  frequently  followed  by  dropsy,  and  on  open¬ 
ing  the  bodies  of  persons  of  this  description,  steatomatus  con¬ 
cretions  are  generally  found.  I  could  adduce  several  ex¬ 
amples  in  support  of  what  I  advance. 

u  Do  these  hereditary  diseases  arise  from  various  causes, 
or  are  they  to  be  ascribed  in  most  cases  to  one  alone?  This 
question  seems  worthy  of  some  attention. 

tc  In  the  first  place,  it  is  certain,  that  several  of  these 
diseases  are  indicated  by  the  external  configuration  of  the 
bony  parts,  tending  more  or  less  to  rachitis,  which  is  of 
course  propagated  in  families. 

r  3  - 


/ 


818 


Medicine. 


[April, 


u  May  not  epileptic  and  maniacal  persons  have  an  exter¬ 
nal  conformation ;  of  the  cranium  for  instance,  which  inclines 
more  or  less  to  rachitis  ? 

cs  Are  not  pulmonary  phthises  announced  by  the  narrow¬ 
ness  of  the  chest,  a  bad  conformation  of  the  sides,  or  the 
clavicles  with  a  projection  of  the  shoulders  from  behind 
( s cap  nice  alatce )  ?  If  these  questions  are  answered  in  the 
affirmative,  it  follows  that  several  hereditary  diseases  are  more 
or  less  allied  to  rachitis. 

((  This  vicious  conformation,  however,  does  not  exerci»e 
all  its  bad  effects  in  a  visible  manner  upon  the  osseous  part 
of  the  trunk  ;  it  produces  internal  deformities.  These  are 
often  discovered  in  the  female  pelvis,  when  the  body  appears 
in  other  respects  well  formed. 

u  But  rachitis,  or  the  affection  of  the  bones,  which  alters 
their  form,  being  an  effect  of  the  alteration  in  the  lymph,  well 
ascertained  by  the  symptoms  of  the  disease  and  by  dissec¬ 
tions,  the  alteration  .of  these  substances  from  the  same  cause 
may  probably  take  place  in  other  internal  parts,  without  the 
bones  being  visibly  affected.  A  thousand  facts  might  be  ad¬ 
duced  in  support  of  this  opinion. 

u  However  different  these  diseases  may  appear,  there  is 
little  doubt  that  they  are  the  effects  of  one  cause,  differing 
only  with  respect  to  a  few  modifications,  and  with  respect 
to  the  diversity  of  the  different  organs  affected,  the  function* 
of  which  are  variously  disturbed, 

(C  Thus  there  are  scrophulous  persons  who  have  steato- 
matous  congestions  in  the  internal  parts,  without  having  the 
glands  swelled ;  in  the  same  way,  rachitis,  which  is  the 
effect  of  a  scrophulous  habit,  particularly  of  an  hereditary 
taint,  may  produce  a  developement  more  or  less  irregular  of 
the  tody,  or  of  some  of  its  parts,  or  even  a  deficiency  of 
nutrition ;  in  such  a  manner  that  certain  parts  acquire  an 
increase  of  size*  and  others  lose  it.  This  necessarily  occa- 


Medicine . 


319 


1809.] 


sions  diseases,  which  are  propagated  in  families  as  the  schro- 
phulous  taint  is  visibly  transmitted  when  it  is  well  charac¬ 
terized. 

cc  The  brain  in  maniacs,  epileptic  and  apoplectic  persons, 
from  their  infancy,  (whether  the  craniums  of  subjects  that 
have  died  of  these  diseases,  have  more  or  less  deformity,  as 
is  very  common,  or  appear  in  their  natural  state,)  is  always 
more  or  less  hardened  by  steatomatous  substances,  and  par¬ 
ticularly  the  medulla  oblongata ,  and  the  adjoining  parts  of  the 
brain  ;  as  is  the  case  in  scroplmla.  This  fact  is  proved  by 
anatomical  observation. 

Out  of  the  many  cases  of  this  description,  with  which 
I  am  acquainted,  I  shall  only  mention  that  of  a  young  man 
who  died  of  epilepsy,  and  whose  mother  was  scrophulous,  as 
was  manifested  in  the  glands  of  the  neck,  and  who  was  also 
subject  to  epilepsy  herself.  The  son  died  of  an  apoplexy 
after  an  epileptic  fit,  as  is  generally  the  case  ;  and  M.  Mark¬ 
ham,  my  assistant,  opened  the  body.  He  found  in  the  me¬ 
dulla  oblongata,  and  in  the  productions  of  the  brain  and  of 
the  cerebellum  adjoining  to  it,  an  almost  cartilaginous  indu¬ 
ration  ;  there  was  no  apparent  malcouformation  in  the  bones 
of  the  cranium. 

cc  Anatomists  have  frequently  observed  similar  indura¬ 
tions  in  the  brain,  and  sometimes  also  in  other  organs  of 
the  chest  and  abdomen,  with  swellings  in  the  lymphatic 
glands,  in  patients  who  had  been  maniacal,  or  who  had  died 
of  apoplexy,  and  whose  parents  expired  under  the  same  dis¬ 
ease,  without  any  malcouformation  of  the  cranium. 

u  The  same  appearances  have  been  found  in  subjects 
when  the  mind  was  partially  and  at  times  alienated;  in  these 
there  is  sometimes  an  apparent  malconformation  of  the 
cranium,  or  some  symptoms  of  a  scrophulous  taint,  or 
perhaps  none  of  these  morbid  affections  were  accompanied 
by  external  signs ;  but  are  the  indurations  of  the  brain  of 

y  4 


320  '  Medicine .  [April, 

the  same  nature  ?  It  is  impossible  to  attribute  any  other  to 
them.” 

HYDROPHOBIA 

Offers  nothing  farther,  since  our  last,  to  remove  the  veil 
of  obscurity  that  overshadows  it.  Amid  the  lack  of  means 
which  medicine  bestows  to  counteract  the  effects  of  this  sub¬ 
tle  and  too  active  poison,  the  random  injection  of  medicines, 
and  the  application  of  gases,  have  been  proposed.  Both  these 
plans  we  should  consider  equally  dangerous,  and  imcompe- 
tent  for  the  end  proposed. 

SPASMODIC  DISEASES. 

Spasmodic  Diseases  are  a  class  of  more  frequent  occur¬ 
rence  in  modern  life  than  most  others.  In  their  mild  form 
they  are  much  under  the  command  of  the  practitioner ;  but 
in  their  aggravated  state,  as  tetanus  and  its  several  varieties, 
they  too  often  baffle  every  means  of  relief.  The  history  of 
these  diseases,  in  their  worst  stage,  is  instructive,  and  we  are 
presented  with  two  by  Mr.  Howship,  arising  both  from 
wounds,  which  he  thus  details  : 

u  Case  I.  Of  Lock  Jaw  with  Tetanus ,  which  terminated 

fatally* 

((  On  the  ever  memorable  21st  of  October,  1805,  a  lad,  six¬ 
teen  years  of  age,  was  struck  on  the  hip  by  a  splinter,  while 
engaged  on  board  H.  M.  S.  Colossus.  The  wound  was  just 
opposite  to  the  spine  of  the  right  os  ilium ;  it  was  not 
large,  but  it  was  deep,  and  like  the  general  run  of  wounds 
from  gunshot,  very  foul  and  slow  of  digestion.  Very 
little  pain  was  felt  either  in  the  wound  or  its  neighbourhood. 

u  On  the  5th  day  after,  he  complained  of  difficulty  in 
swallowing ;  this,  however,  was  but  the  prelude  to  sufferings 
infinitely  more  severe.  On  the  8th  day,  when  I  visited  that 
part  of  the  hospital,  he  was  in  dreadful  agonies,  full  of  di¬ 
stress  and  spasm.  His  jaws  by  this  time  were  firmly  closed. 
In  order  to  ascertain  whether  any  visible  action  could  be  ob* 


( 


Medicine. 


321 


served  in  those  situations  where  the  pains  were  described  to 
be  most  urgent,  the  clothes  wrere  thrown  aside,  when  the 
whole  of  the  muscles  of  the  abdomen  and  limbs  w  ere  found 
in  a  state  of  alternate  vibration,  falling  in  succession  under 
the  influence  of  the  pain  and  irritation. 

u  The  limb  below  the  wounded  part  he  complained  much 
of,  as  also  of  the  whole  of  liis  breast.  A  warm  bath  was  pro¬ 
posed  and  got  ready  ;  but  it  was  not  without  great  difficulty 
and  infinite  distress,  that  the  patient  could  be  raised  from  his 
bed  and  placed  in  the  bath.  He  found  himself,  however, 
considerably  relieved  from  the  violence  of  the  spasms  after 
the  first  ten  minutes.  In  twenty  his  strength  failed  ;  he  was 
therefore  raised  from  the  bath,  well  rubbed,  and  laid  in  dry 
blankets: 

66  The  benefit  derived  from  this  experiment  was  a  tempo¬ 
rary  alleviation  in  the  severity  of  the  symptoms.  It  w  as 
proposed  to  try  the  effect  of  mercury,  the  ointment  of  which 
was  several  times  rubbed  in  over  the  spine  and  limbs.  The 
spasms  were  now  universal,  and  probably  from  the  irritation 
being  constant,  the  spasmodic  action  was  constant  also,  or 
rather  the  contractions  returned  in  so  rapid  a  succession,  as 
to  keep  the  whole  frame  in  unceasing  and  terrible  action ; 
while  the  poor  creature  at  times  grinding  his  teeth,  was 
constantly  moaning  from  the  excessive  violence  of  the  pain. 

6C  In  the  middle  of  the  day  after  he  had  used  the  bath,  the 
pulse  was  even,  quick,  and  softer  than  before.  On  the  next 
day  (the  9th),  the  frequency  of  the  spasms,  and  the  hor¬ 
rible  torments  they  produced,  continued  to  increase  upon 
him. 

a  Towards  the  evening  the  spasms  became  more  and  more 
severe  in  their  effects  upon  the  orgaRs  of  respiration,  and  at 
length  he  expired,  apparently  at  the  time  when  the  same 
spasmodic  action  seized  upon  the  heart. 

In  this  case,  the  only  point  in  the  treatment  which  may 
be  considered  to  have  promised  any  thing,  was  that  of  in- 


Medicine. 


[April, 


troducirig  into  the  system  a  sufficient  quantity  of  mercury  to 
alter  the  prevailing  tone  and  disposition  of  the  nervous  sy- 
tem.  The  frictions  did  not  in  this  experiment  produce  any 
decided  effect  upon  the  mouth  :  but  in  other  Oases,  in  which 
the  most  satisfactory  proofs  of  the  full  action  of  the  remedy 
have  existed,  it  has  been  found  to  have  no  power  to  arrest  the 
progress  of  this  most  formidable  disease. 

“Case  IL  In  which  Lockjaw ,  attended  with  Tetanus*, 
ended  fatally"  within  a  Period  uncommonly  short. 

“  W.  Richey,  an  Italian,  aged  SO,  seaman  on  board  his 
Majesty’s  ship  Bellerophon,  lost  his  right  arm,  which  was 
shot  away  by  a  heavy  balh  Part  of  the  upper  extremity  of 
the  humeruS  remaining,  it  was  removed  soon  after  by  an  ope¬ 
ration  similar  to  that  which  is  performed  for  amputation  at 
the  shoulder-joint.  Unfortunately  the  limb  had  been  carried 
away  so  close  to  the  body,  that  it  was  not  possible  to  make 
any  provision  for  the  formation  of  a  round  stump  by  a  fold 
of  the  integuments.  The  muscular  parts  projected  consider¬ 
ably  beyond  the  edge  of  the  skin,  ai?d  neither  pressure  nor 
adhesive  applications  rendered  much  assistance  in  bringing 
it  into  form. 

u  This  man  constantly  said  he  felt  but  very  little  pain  in 
or  about  the  wound.  On  the  8th  day  he  complained  of 
stiffness  and  pain  about  the  angles  of  the  jaw,  and  these 
pains  increased  and  extended  their  influence  so  rapidly,  that 
he  was  with  much  difficulty  raised  up  in  his  bed  on  the  fol¬ 
lowing  morning,  in  order  to  his  being  dressed  and  shifted* 
There  seemed  by  this  time  to  be  an  established  state  of  ge¬ 
neral  rigidity  affecting  all  the  muscular  parts  of  the  body 
and  limbs,  which  prevented  him  from  all  voluntary  motion; 
while  his  being  in  any  manner  disturbed  in  his  person,  was 
constantly  productive  of  aggravated  pain. 

cC  On  the  next  day  (the  10th)  he  was  worse,  all  his  suf¬ 
ferings  being  greatly  increased ;  in  the  evening,  he  had,  with 
much  difficulty,  been  raised  up  to  drink  some  water ;  he  re- 


Medicine . 


32$ 


3809.] 


turned  the  vessel  to  the  nurse,  after  he  had  swallowed  some 
of  the  fluid,  without  any  apparent  increase  of  pain,  or  other 
aggravation  of  bis  symptoms;  he  complained  of  no  distress 
or  new  uneasiness;  he  laid  himself  back  in  the  bed,  and 
silently  breathed  his  last*  not  even  uttering  the  least  sound 
expressive  of  disturbance. 

ce  In  this  case  the  progress  of  the  disease  was  so  rapid, 
that  almost  before  any  vigorous  measures  were  adopted  for 
his  relief,  the  man  was  lost.  Mercurial  frictions  were  com¬ 
menced  upon,  but  only  on  the  day  before  the  evening*  on 
which  his  dissolution  took  place. 

<c  There  is  not  a  doubt,  but  that  in  this  case  also,  the  sud¬ 
den  and  unexpected  close  of  the  scene  was  the  consequence  of 
a  sudden  spasm  seizing  upon  the  heart,  and  probably  the 
organs  of  respiration ;  the  most  general  mode  of  termination 
in  this  disease,” 

PULMONARY  CONSUMPTION. 

The  infectious  nature  of  this  malady  is  a  subject  on  which 
authors  are  much  divided.  In  Spain  and  Portugal  it  is  con¬ 
sidered  so  certain,  that  the  clothes,  and  every  thing  the  diseased 
has  used,  as  bedding,  &c.  are  regularly  burned.  Some  ob¬ 
servations  of  Dr.  Kinglake  tend  to  confirm  this  opinion: 
<c  It  is  well  known,”  he  observes,  <c  that  diseases  of  various 
descriptions  generate  and  evolve  during  their  existence,  and 
more  particularly  towards  their  termination,  a  certain  pro¬ 
perty,  whether  of  a  material  or  motive  nature,  that  has  a 
tendency  to  impart  its  morbid  quality  to  those  who  may  come 
within  the  sphere  of  its  active  power,  and  whose  constitu¬ 
tional  susceptibility  may  be  favourable  to  its  infectious  influ¬ 
ence.  The  occasional  extension  of  common  fever  by  per¬ 
sonal  intercourse,  as  well  as  that  of  a  more  typhoid  character, 
evinces  its  capability  of  communicating  infection.  This  ef¬ 
fect,  however,  is  not  dependent  on  the  mere  existence  of  an 
infectious  power,  and  on  an  opportunity  of  imparting  that 
infection,  but  on  a  variety  of  collateral  circumstances  with 


324  Medicine .  [Aprils 

which  the  relative  efficiency  of  these  causes  is  essentially 
connected.  These  circumstances  are  chiefly  a  given  concen¬ 
tration  of  the  infectious  cause,  and  a  certain  capability  or 
aptitude  for  receiving  its  active  impression  ;  if  either  the  one 
or  the  other  should  fail,  happily  no  effect  is  produced.  This 
incongruity  fortunately  often  prevents  and  confines  the 
empire  of  infectious  disease  within  comparatively  narrow 
limits. 

u  Matter,  in  all  its  various  arrangements,  possesses  pro¬ 
perties  characteristic  of  the  particular  nature  of  its  existence. 
Its  active  powers  in  some  form  are  more  direct  and  efficient 
than  in  others ;  but  in  no  shape  whatever  is  it  reasonable 
to  suppose  it  quite  inert.  In  the  peculiar  conditions  neces¬ 
sary  to  animal  health,  no  deviation  can  happen  consistently 
with  the  avoidance  of  disease.  When  disease  actually  oc¬ 
curs,  effects,  different  from  those  of  health,  necessarily  arise. 
These  will  be  various,  accordingly  to  the  degree  or  intensity 
of  the  morbific  cause,  and  will  possess  properties  and  exert 
an  influence  correspondent  to  the  particular  nature  of  the 
active  power.  It  is  in  this  mode  of  estimating  the  efficiency 
of  morbid  power,  that  some  just  conclusion  may  be  drawn 
respecting  the  infectious  agency  of  diseases  in  general,  and 
more  especially  of  those  that  seem  directly  to  impart 
their  morbid  influence  in  suitable  circumstances  for  its  ope¬ 
ration. 

u  In  the  advanced  stage  of  phithisis  pulmonalis,  more 
particularly,  occurs  an  aggravated  state  of  disease  that  would 
seem  well  adapted  to  concentrate  and  give  full  effect  to  any 
infectious  powers,  which,  in  common  with  all  diseased 
changes  from  the  healthful  condition  of  life,  it  may  be  sup¬ 
posed  to  possess.  The  hectic  commotion,  the  wearing  de¬ 
composition,  the  consequent  extrication  of  the  constituent 
principles  of  animal  matter,  and  the  new  arrangement  which 
may  be  formed  of  these  substances,  saying  nothing  of  the 
peculiar  morbid  action  obtaining  in  this  disease,  and  which 


Medicine. 


325 


mo.] 

may  be  embodied  and  transferred,  render  it  extremely  pro* 
bable  that  this  disease  is  capable  of  exerting  infections  influ¬ 
ence,  and  that  it  actually  does  appear  to  me  verified  by  some 
instances  of  its  having  been  imparted  to  persons  closely  at¬ 
tending  the  last  stage  of  its  existence.  I  have  more  particu¬ 
larly  in  my  recollection  the  case  of  one  sister  sleeping  with 
and  closely  associating  with  another,  who  laboured  under 
phthisis  pulmonalis  in  its  worst  form,  in  whom,  ulceration  of 
the  lungs  appeared  to  have  taken  place,  accompanied  with 
the  most  embarrassing  state  of  cough,  foetid  expectoration, 
and  cadaverously  smelling  night-sweats.  Death,  at  length, 
closed  this  hopeless  scene  of  disease.  The  surviving  sister, 
who  had  anxiously  watched  and  assisted  during  its  destruc¬ 
tive  progress,  soon  became  disordered  by  strictured  breath¬ 
ing,  painful  cough,  febrile  rigours  and  heats,  loss  of  appe¬ 
tite,  and  sleepless  nights ;  to  these  symptoms  were  speedily 
added,  bloody  expectoration,  night-sweats,  and  every  other 
appearance  of  an  advanced  and  irreparable  state  of  pulmo¬ 
nary  consumption,  which  scton  terminated  as  the  preceding 
instance. 

u  It  should  be  remarked,  that  in  neither  of  these  cases  did  he¬ 
reditary  or  scrophulous  predisposition  to  pulmonary  disease 
appear  to  exist.  Both  sisters  had  been  uniformly  free  from 
every  suspicion  of  even  a  tendency  to  the  disease,  until  it  ac¬ 
tually  surprised  the  one,  and  overtook  the  other,  as  a  pro¬ 
bable  consequence  of  an  unremitted  personal  intercourse.  I 
have  often  had  an  opportunity  of  observing  a  threatening  de¬ 
gree  of  pulmonary  affection  to  have  apparently  resulted  from 
incautiously  inhaling  the  distempered  vapour  of  phthisical 
patients,  but  do  not  recollect  any  instance  in  which  the  effect 
was  so  direct  and  unequivocal  as  in  the  case  recited. 

cc  It  does  not  follow,  that  on  every  occasion  in  whicli  in¬ 
jury  is  done,  that  it  should  be  of  the  irreparable  naturc 
which  marks  pulmonary  consumption ;  it  may  disorder  the 
lungs  without  inducing  that  deeply  diseased  affection  of 


Medicine * 


[April* 


326 

t 

them :  it  may  produce  a  disposition  to  asthma,  and  an  ap¬ 
titude  for  pulmonary  ailment  on  occasions  which  might  not 
otherwise  have  become  active.  In  this  view  of  the  subject, 
it  would  be  adviseable  to  avoid  being  too  closely  inmated 
with  patients  in  the  dying  stage  of  pulmonary  disease.  At 
a  period  when  no  benefit  can  be  rendered  and  much  mischief 
may  arise,  it  will  be  no  imputation  on  humanity  to  withhold 
unnecessary  attendance. 

cc  It  does  not  appear  that  Hie  ground  for  suspecting  the  in¬ 
fectious  nature  of  phthisis  pulmonalis  would  warrant  a  be¬ 
lief  that  it  is  of  that  active  quality  as  would  justify  even  the 
timid  in  not  paying  a  due  degree  of  personal  attention  to  the' 
diseased  ;  it  is  the  in  caution  of  dwelling  with  such  patients, 
in  leaning  oyer  them  by  the  hour,  in  breathing  in  the  imme¬ 
diate  atmosphere  of  their  lungs  without  restraint,  that  de¬ 
serves  to  be  pointed  out  as  exceptionable,  because  in  itself 
useless,  and  certainly  fraught  with  serious  evil  to  those  who 
may  pursue  that  hitherto  unobjected  and  supposed  unob” 
jectionable  course  of  conduct.’’ 

OBSERVATIONS  ON  HYDROPHOBIA. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — -The  government  having  directed  the  attention 
of  the  medical  world  to  Hydrophobia,  I  beg  leave  to  submit 
the  following  observations  to  your  care.  The  medical  pro¬ 
fession  are  divided  on  this  dreadful  disease  ;  one  party  con¬ 
sider  it  only  an  aggravated  case  of  Tetanus,  while  the  other 
refer  it  to  a  specific  contagion  communicated  to  man  by  an 
animal  in  a  rabid  state.  To  the  latter  I  belong.  In  the  first 
place,  to  render  this  disease  a  complete  case  of  tetanus,  we 
must  suppose,  that  in  every  instance  usually  termed  hydro- 
phobic,  the  bite  must  necessarily  produce  such  a  quantum  of 
compression  and  laceration,  as  shall  occasion  the  symptoms 
that  mark  the  common  cases  of  tetanus,  otherwise,  down 
go  the  contest  and  controversy :  we  will  take  the  well- 


Medicine , 


180$.] 


marked  case  of  Ann  Chandler,  in  which  I  think  I  am  war¬ 
ranted  to  say,  and  which  a  reference  to  the  case  will  confirm, 
that  the  compression  and  laceration  produced  by  the  inser¬ 
tion  of  the  cat’s  teeth,  were  not  so  violent  as  to  induce  tetanus 
if  the  cat  had  been  in  a  state  of  health.  Many  are  the  facts 
that  prove  animal  saliva  to  be  inimical  to  the  human  con¬ 
stitution,  and  none  more  than  that  of  the  dog,  who,  perhaps, 
among  the  animal  creation,  may  be  ranked  the  only  beast  that 
delights  in  foetid  ulcers ;  yet  that  saliva  in  a  state  of  health  and 
tranquillity  has  never  been  known  to  produce  tetanus  or  hy¬ 
drophobia  ;  why  then  perplex  us  with  vain  and  futile  hy¬ 
potheses?  why  deny  the  cause  of  a  disease  which  corre¬ 
sponding  facts  prove?  Is  nottheXz^es  Venerea  communicable? 
Is  not  the  Lues  Bovilla ,  a  disease  peculiar  to  covrs,  communi¬ 
cable  to  men  ?  Is  not  Hydrophobia  acknowledged  to  be  a 
disease  peculiar  to  dogs  ?  When  I  say  peculiar,  I  mean  a 
disease  spontaneously  arising  without  previous  cause  or 
infection.  Having  established  this  fact,  the  inference  I  draw 
is  this,  that  if  the  Lues  Bovilla  can  be  communicated,  of 
which  the  Jennerian  system  is  a  proof,  why  shall  we  deny 
the  cause  of  Hydrophobia,  unless  we  wish  to  place  society 
in  a  delusive  state  of  security  ?  A  doubt  on  my  mind  remains 
not  respecting  this  point,  that  an  animal  in  a  rabid  state  can 
communicate,  by  the  insertion  of  a  specific  contagion,  from 
whatever  unknown  cause,  a  certain  disease,  similar  in  charac¬ 
ter  and  symptoms  to  that  under  which  it  labours,  and  that 
the  vehicle  of  this  contagion  should  be  the  saliva,  is  not  at 
all  singular  when  we  reflect  that  dogs  never  perspire ;  there¬ 
fore,  as  nature  is  ever  correct  in  her  operation,  the  salival 
glands  are  to  them,  what  the  miliary  glands  are  to  man,  and 
in  a  state  of  heat,  thirst,  or  anxiety,  the  dog  discharges  more 
saliva;  and  as  that  saliva  in  a  state  of  irritation  becomes 
acrid,  fever  and  delirium  succeed ;  thus  the  customary  law 
of  the  animal  economy  becomes  confused,  and  death  closes 
the  terrific  scene.  If  the  facts  were  not  sufficiently  conclusive 


Medicine . 


[April, 


to  sceptical  minds,  let  them  take  analogy  for  their  guide,  and 
see  what  effects  obstructed  perspiration  produces  on  man: 
fever,  delirium,  frenzy,  are  its  effects  ;  but  here  delirium  arises 
not  so  much  from  the  concussion  and  laceration  of  the  part 
wounded,  as  from  the  vitiated  state  of  the  blood,  ,  nor  is  de¬ 
lirium  a  necessary  concomitant,  for  many  cases  are  on  record 
where  the  patient  retained  the  full  possession  of  his  reason ; 
nor  has  the  mind  any  thing  to  do  with  the  aversion  to  food 
and  drink  any  more  than  it  has  in  anorexia ;  this  aversion, 
though  the  strongest  characteristic  of  hydrophobia,  depends 
entirely  on  the  connected  spasmodic  affection  of  the  aeso- 
phagus ;  and  therefore  I  conclude  from  these  corresponding 
facts,  that  the  disease  known  by  tiie  name  of  hydrophobia  is 
absolutely  communicated  by  a  rabid  animal,  and  that  we 
never  shall  ascertain  the  particular  nature  of  this  disease 
until  we  have  an  opportunity  of  seeing  it  in  all  its  stages 
in  the  animal  itself.  It  is  of  the  first  importance  to 
society,  to  endeavour  to  secure  the  life  of  the  rabid  animal, 
and  till  that  desirable  object  is  obtained,  the  cure  of  the 
disease  is  beyond  human  power. 

The  following  case  illustrates  these  observations  :  u  Da¬ 
vid  Hale,  of  Bidford,  Warwickshire,  a  young  man  about 
twenty  years  of  age,  while  leaning  over  the  gate  of  his 
father’s  garden,  on  the  evening  of  the  1st  of  September, 
1808,  observed  a  cat  coming  down  the  garden  walk  towards 
him.  As  the  animal  resolved  to  pass  under  the  gate,  the 
young  man  placed  his  foot  in  the  way  to  prevent  her,  which 
she  instantly  seized,  and  on  putting  down  his  hand  to  extri¬ 
cate  himself,  she  bit  him  very  severely  by  the  thumb.  The 
father  of  the  young  man  hearing  a  noise,  ran  out  of  the  house 
with  a  stick  ;  he  pointed  it  towards  the  cat  several  times,  and 
she  as  often  seized  it  in  the  most  ferocious  manner.  Mr. 
Hale  then  declared  the  animal  was  mad,  and  immediately 
destroyed  her.  The  young  man  went,  without  delay,  to 
Witminster,  and  w  as,  according  to  the  opinions  of  advisers 


Medicine . 


180-9.  ] 


there,  properly  dipped  in  the  salt  Water,  in  lire  hope  of 
averting  the  dreadful  consequences  that  might  otherwise  arise 
from  the  bite  of  the  animal.  He  returned  home  a<min,  and 
for  more  than  a  month  enjoyed  his  usual  health.  On  Tues¬ 
day,  the  lltli  of  October,  the  young  man  was  taken  ill  with 
the  head-ache.  On  Wednesday,  his  head-ache  continued 
and  got  worse ;  and  in  the  evening  he  had  symptoms  of  a 
sore  throat.  On  Thursday,  the  soreness  of  his  throat  in¬ 
creased;  he  could  not  swallow;  his  head  was  very  bad; 
and  if  any  liquid  was  offered  him,  was  much  agitated  and 
convulsed.  On  Friday,  he  could  not  suffer  any  liquid  t& 
pome  near  him  ;  but  he  ate  a  small  bit  of  toasted  bread.  He 
was  sensible  of  his  situation,  and  desired  every  one  not  to  en¬ 
danger  themselves  by  attending  him.  He  foamed  at  the 
mouth  very  much,  and  at  times  was  greatly  convulsed.  On 
Saturday,  his  malady  increased  ;  and  on  Sunday  lie  was  con¬ 
fined  in  his  bed  raving  mad.  Two  people  were  constantly 
employed  in  wiping  the  foam  from  him,  which  issued  from 
his  nfouth  and  nose  in  large  quantities.  On  Monday  morn- 
ing,  the  7th,  the  unfortunate  young  man  was  released  from 
the  most  dreadful  of  all  human  afflictions ;  he  expired  about 
seven  o’clock  in  the  greatest  agonies.” 

I  remain,  Gentlemen, 

Your  obedient  servant, 

Londpny  March  25,  1809.  T.  MOTT  CATON. 

OBSERVATIONS  ON  THE  PECULIAR  STRUCTURE  OF  CERTAIN 

PARTS. 

To  the  Editors  of  The.  Medical  and  Surgical  Spectator. 

Gentlemen— -A  curious  and  perhaps  useful  subject  enter¬ 
ed  into  by  physiologists  is,  the  reasons  for  the  peculiar  struc¬ 
ture  of  certain  parts.  In  applying  this  on  the  subject  of  the 
genital  system  in  the  sexes*  I  shall  beg  leave  to  hazard  a  spe¬ 
culation  which  may  perhaps  lead  to  some  important  conclu¬ 
sions. 

% 


yql.  ii. 


Medicine . 


[April, 


330 

In  examining  then  the  difference  of  these  parts  of  the  body 
in  the  sexes,  I  would  remark,  that  the  sensibility  of  all  parts 
is  increased  by  secretion :  hence,  in  the  male,  that  union  of 
passages  adapted  both  to  'the  urinary  and  genital  parts;  for 
the  use  of  the  genital  part  taking  place  only  at  times  by 
means  of  the  urine  constantly  pervading  the  passages,  the 
latter  are  retained  in  a  certain  sensible  state.  That  this  is 
the  case,  appears  from  the  different  situation  of  the  urethra 
in  the  female,  in  consequence  of  the  menses  having  the  same 
effect ;  and  we  find  in  general  that  a  fluid  pervades  all  sen¬ 
sible  parts,  and  seems  necessary  to  continue  their  sensibility. 
Hence,  from  this  effect  of  the  fluid  we  deduce  the  propriety 
of  attempting  to  lessen  its  power,  and  by  dilution  blunt 
the  irritation  of  its  stimulus,  either  where  its  acrimony  is 
morbidly  increased,  or  the  surface  it  pervades  is  in  too  sen* 
sible  a  state. 

All  the  principal  parts  of  the  genital  system  are  particularly 
liable  to  be  increased  in  their  size  by  irritation.  Hence  we 
find,  especially  after  venereal  affections,  they  never  regain 
entirely  their  original  state.  They  are  always  largest  in  sa¬ 
lacious  animals ;  and  on  this  account  they  are  observed  most 
so  in  the  inhabitants  of  the  warmer  climates,  bearing  no  pro¬ 
portion,  as  is  conspicuous  in  the  other  organs,  to  the  natural 
proportions  of  the  body.  In  the  testicles  this  is  so  remark¬ 
able,  as  to  be  mistaken  for  enlargement  from  disease ;  and  of 
this  you  will  find  examples  in  Jje  Graaf,  though  the  mere 
effect  of  venereal  excesses. 

The  exact  structure,  therefore,  of  all  the  parts  of  the  ge¬ 
nital  system  is  of  material  consequence  to  be  known  for  pro¬ 
perly  understanding  the  treatment  of  their  complaints.  With¬ 
out  it,  we  can  never  fully  ascertain  those  various  consequences 
which  are  known  to  succeed  the  primary  action  of  the  vene¬ 
real  yirus  in  gonorrhoea,  and  which  frequently  during  life 
continue  their  effects  on  those  parts.  It  is  remarked  by  Mr. 
Pott  in  his  pectures,  that  no  part  is  so  liable  to  become  dis* 


Mt  dicing. 


33 1 

eased  from  the  effects  of  any  preceding  disease,  as  the  pros¬ 
tate  in  the  male.  These  effects  are  seldom  felt,  as  the  pri¬ 
mary  disease  is  forgotten  til!  advanced  life,  when  the  fluid 
secreted  by  it  ceases  to  flow,  and  it  becomes  in  a  maimer 
useless,  as  no  longer  designed  for  generation.  It  is  then  par¬ 
ticularly  in  those,  who  have  been  often  under  gonorrhoea, 
that  the  prostate  and  parts  connected  become  extremely  pain¬ 
ful  from  its  hard,  indurated  state,  which  renders  the  re¬ 
mains  of  life  generally  miserable.  Hence  the  necessity  for 
paying  attention  to  the  early  removal  of  those  complaints  of 
the  urethra  which,  from  sympathy,  have  a  tendency  to  af¬ 
fect  these  parts. 

The  manner  in  which  the  functions  of  -the  genital  system 
are  performed,  and  their  influence  on  the  rest  of  the  body, 
are  no  less  important  than  the  preceding  topic. 

Though  the  nervous  system  is  allowed  to  be  the  medium 
of  sensation,  and  should  occupy,  therefore,  our  chief  atten¬ 
tion  in  the  consideration  of  the  economy,  yet  the  origin  of 
this  sensation  may  be  considered  as  the  effect  of  that  process 
peculiar  to  the  structure  of  glands,  and  which  has  in  general 
received  the  name  of  secretion.  This  particular  effect  of 
glands  has  occasioned  some  of  them,  in  which  it  is  more 
apparent,  to  receive  from  physiologists  the  appellation  of  in¬ 
centive,  and  under  this  title  we  would  especially  compre¬ 
hend  the  brain,  and  those  glands  that  are  characteristic  of 
tike  sexes.  The  first  of  these  lias  afforded  much  dispute,  and 
w  hether  acting  by  means  of  a  fluid  whose  influence  pervades 
the  system,  or  depending  on  a  simple  state  of  fibre  affected, 
has  been  often  and  most  unsuccessfully  combated.  We  ob¬ 
serve,  however,  that  it  is  subject  to  those  diseases  peculiar  to 
glands;  that  the  acuteness  of  sensation  is  every  where  height¬ 
ened  by  a  glandular  structure ;  and  the  subtility  of  some 
particular  fluids  favours  strongly  the  supposition.  The  struc¬ 
ture  of  all  the  incentive  glands  appears  to  possess  much  ana- 
logy,  In  all?  the  secretion,  where  we  can  detect  it,  is  car- 


332 


Medicine . 


ried  on  slowly,  and  its  rapidity  seems  even  prevented  by 
the  manner  in  which  the  circulation  to  them  is  supplied. 
This  is  very  remarkable  in  the  testicles.  The  spermatic  arte¬ 
ries  are  perhaps  longer  than  any  others  of  the  body.  They 
are  small  and  dense  in  proportion  to  the  size  of  the  glands 
they  supply,  and  by  feeling  the  pulse  in  tfye  quadruped  be¬ 
fore  they  arrive  at  the  testicles,  their  circulation  is  found 
even  more  languid.  In  i his  way  the  blood  is  retarded  in  the 
glands,  and  their  veins  we  find  very  liable  to  become  vari- 
cous.  In  the  brain,  again,  we  observe  the  force  of  the  blood 
broken  as  it  ascends  by  the  angles  which  ihe  arteries  form  in 
their  entrance  to  the  skull?  by  their  various  convolutions, 
which  are  even  more  minute  than  those  of  the  testicles,  and 

■ 1  /  '•  .  i  -  - 

the  circulation  is  also  retarded  in  its  return  by  the  reception 
of  the  blood  into  large  sinuses,  where  a  slow  passage  through 
them  is  only  permitted.  In  the  ovarium  of  females  the  sper¬ 
matic  arteries  observe  a  similar  distribution.  They  take  their 
rise  at  a  considerable  length  from  the  glands,  and,  after  arriv¬ 
ing  at  them,  make  a  number  of  serpentine  turns,  which  cer¬ 
tainly  serve  a  particular  purpose. 

prom  the  moment  of  existence,  the  action  of  the  brain  com^ 
mences.  It  supplies  that  energy  to  every  part  which  is  ne¬ 
cessary  to  the  exercise  of  its  functions.  This  energy,  as 
far  from  observation  as  we  can  determine,  seems  to  consist  in 
a  certain  excitement  of  the  part,  which  increases  the  original 
quantity  of  fluids  determined  to  it,  and  thus  renders  stronger 
the  mutual  re-action  on  which  life  depends.  This  energy, 
however,  is  not  communicated  to  every  organ  in  the  same 
de  gree  at  the  same  time.  Certain  laws  determine  this,  con¬ 
nected  with  the  original  formation  of  the  body  ;  and  in  con¬ 
sequence  of  these  laws,  the  incentive  glands  peculiar  to  the 
$exes  receive  only  this  energy  at  a  particular  period  of  life, 
which  has  been  termed,  from  the  appearances  then  occur¬ 
ring,  the  age  of  puberty.  It  is  at  this  age  the  facility  of  the 
fibres  tp  elongation  begins  to  diminish,  and  the  determination^ 


.1809,]  Medicine  I  \  333 

which  indiscriminately  took  place  to  every  part  during  the 
former  period,  is  now  directed  chiefly  to  certain  glands.  The  ' 
redundancy  of  fluids  peculiar  to  the  puerile  state,  which 
served  by  its  retention  for  a  ready  supply  of  additional  mat¬ 
ter,  and  for  the  quick  elongation  of  that  matter  when  formed 
into  solid,  is  now  converted,  from  the  resistance  of  the  solid, 
to  the  same  rapidity  of  elongation,  to  form  new  secretions, 
which  have  an  effect,  by  giving  additional  tone  to  the  action 
of  the  solids,  to  increase  the  different  discharges,  and  to  dis¬ 
sipate,  as  no  longer  necessary,  the  redundance  of  fluid  parts. 
The  semen,  therefore,  is  absorbed  into  the  circulation,  and 
acts  as  a  natural  stimulant  on  the  sensible  fibre,  and  as  af¬ 
fording  additional  vigour  to  the  contractions  of  the  heart. 
Hence  we  may  consider  a  certain  re-action  between  the  brain 
and  the  other  incentive  organs  as  taking  place,  and  the  con¬ 
sequence  of  this  re-action,  which  is  at  the  same  time  a  proof 
of  if,  we  find  to  be  the  cure  of  many  diseases  depending  on 
the  state  of  the  brain,  and  particularly  on  the  force  of  its 
circulation.  But  as  the  constitution  of  the  female  is  intended 
to  differ  from  that  of  the  male,  this  additional  vigour,  which 
the  age  of  puberty  would  otherwise  induce,  and  which  would 
prove  unfavourable  to  the  purposes  of  generation,  the  prin¬ 
cipal  object  of  the  sex,  is  counteracted  by  a  discharge  of  a 
particular  nature,  which  is  frequent,  profuse,  and  immedi¬ 
ately  affects  the  force  of  the  heart,  by  proceeding  from  the 
general  mass  of  fluids,  and  consequently  destroys  the  tone  of 
the  system.  This  is  the  menses;  and  their  origin  depends 
on  the  same  causes  which  influence  the  secretion  of  the  tes¬ 
ticles;  for  the  blood  being  determined,  as  we  formerly  re¬ 
marked,  in  considerable  quantity,  to  all  the  incentive  glands, 
is,  by  the  manner  of  their  circulation,  retarded  there ;  a 
proof  of  which  we  gave  in  the  frequent  varicose  state  of  the 
spermatic  vein.  Jn  the  female,  from  the  structure  of  the 
vessels  of  the  part,  and  the  intention  which  nature  possesses 
to  produce  a  discharge,  the  determination  at  times  occasions 

5?  3 


Meditine* 


[April, 


their  rupture  at  the  most  resisting  part,  and  this  rupture  is 
always  repeated  on  a  certain  degree  of  accumulation  taking 
place,  which  the  natural  texture  of  the  vessels,  the  degree  of 
irritation  on  the  ovaria  from  the  brain,  and  custom  itself  at 
last  establishes  in  regard  to  its  frequency.  The  action  of  the 
incentive  organs  peculiar  to  the  sexes  lasts  only  a  certain  pe¬ 
riod,  which,  duiing  its  continuance,  has  been  termed  the 
age  of  passion  ;  and  the  propensities  and  desires  which  their 
action  creates,  are  much  stronger  than  any  other,  which  ac¬ 
tuate  the  human  frame.  The  mischiefs  in  society  from  this 
source  occupy  equally  the  pulpit  and  the  bench. 

•I  am,  Gentlemen, 

Your  obedient  servant, 


Manchester,  March  2,  IS 09.  T.  W  , 

SINGULAR  CASE  OF  CONTAGIOUS  MANIA  IN  ANIMALS,  BY 
MR.  FRANCIS  KIERNAN,  MEMBER  OF  THE  ROYAL  COLLEGE 
OF  SURGEONS. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 
Gentlemen— Since  the  attention  of  medical  men  has  been 
called  of  late  so  particularly  to  the  subject  of  Hydrophobia, 
its  appearance  and  progress  in  the  brute  creation  ought  to 
form  the  basis  on  which  their  observations  are  made.  It  ap¬ 
pears,  besides  the  virus  of  hydrophobia,  there  are  other 
sources  of  active  contagion  affecting  animals,  which  prove  in 
their  consequences  equally  fatal.  This  remark  I  have  been 
induced  to  make  from  a  circumstance  just  now  related  to  me 
of  a  very  extraordinary  nature.  Two  horses,  the  property 
of  Mr.  Stanford,  of  Bond-street,  were  seized  suddenly  with  all 
the  symptoms  of  furious  insanity  to  such  a  degree,  that  with 
their  teeth  they  tore  the  manger,  and  the  flags  of  the  floor  of 
the  stable  were  forcibly  rent  up  with  their  hoofs.  In  this 
state  of  extreme  and  unaccountable  agony  they  continued  ^Iiree 
days,  when  they  died.  So  sudden  was  the  attack,  that  one 
of  the  horses  had  been  out  the  day  previous  to  his  illness. 


Medicine . 


1800.] 


feoon  after  this,  a  dog,  the  property  of  the  same  gentleman, 
and  which  lived  in  the  stable,  was  seized  in  the  same  manner 
as  the  horses,  and  the  disease  likewise  in  him  proved 
equally  fatal.  A  cat,  which  was  also  an  inmate  of  the  same 
place,  was  equally  unfortunate,  and  fell  a  victim  to  a  simi¬ 
lar  train  of  symptoms.  This  disease  was  clearly  not  hydro-* 
phobia,  and  yet  it  w/as  one  of  a  highly  contagious  nature. 
The  animals,  though  in  extreme  agony,  shewed  no  disposi¬ 
tion  to  bite,  so  common  in  hydrophobic  cases.  Neither  could 
the  disease  be  one  of  simple  inflammation,  or  increased  ex¬ 
citement;  otherwise,  though  it  affected  the  horses,  it  would 
not  have  been  communicated  to  the  other  animals.  This  fact 
then  only  points  out  the  varied  nature  of  contagion,  and  the 
difficulties  that  attend  our  detecting  either  its  origin  or  its 
nature.  This  should  teach  those  employed  on  the  subject  of 
hydrophobia  to  proceed  with  extreme  caution,  and  to  form 
no  deductions  which  are  to  influence  the  mode  of  treatment, 
but  such  as  are  sure  and  unerring.  If  any  of  your  corre¬ 
spondents  can  throw  light  on  the  above  statement,  they  will 
oblige. 

Gentlemen,  your  obedient  servant, 
Charlotte-street ,  Bedford- square ,  F.  KIERNAN. 

March  10,  1809. 


ON  THE  ORIGIN  OF  THE  SPECIFIC  CONTAGION  OF  TYPHUS. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — The  debarkation  of  the  troops  from  Spain 
at  the  different  ports,  has  of  late  presented  scenes  of  disease 
that  tend  to  horrify  the  picture  of  war  in  even  more  detest¬ 
able  colours  than  what  reason  and  philosophy  generally 
paint  it :  SO  and  40,  we  are  told,  are  daily  falling  the  de¬ 
voted  victims  in  spite  of  every  medical  exertion,  being  cut  off 
by  a  typhus  fever,  the  consequence  of  complete  exhaustion. 
It  is  on  this  subject  I  would  beg  leave  to  offer  a  few  observa- 

z  4 


336  Medicine*  \  [April) 

lions.  It  certainly  would  he  cf  much  importance  to  decide 
whether  such  a  fever  ever  exists  without  the  application  of 
contagion  to  produce  the  specific  form  as  a  disease.  Authors 
in  general  leave  this  point  undecided  ;  and,  in  enumerating 
the  causes  of  fever,  conceive  it  to  be  generated  independent 
of  a  contagion,  on  the  idea  of  mete  debility.  But  if  the  dis¬ 
ease  can  be  proved  to  exist  under  circumstances  in  which  no 
debility  is  present,  as  is  well  known  to  take  place,  then  the 
theory  of  mere  debility  is  destroyed.  The  fact  that  destroys 
entirely  the  supposition  of  a  non-contagious  principle  is  the 
circumstance,  that  typhus  contagion  once  abroad  attacks 
more  frequently  the  flower  of  }routh  and  manhood,  the  prime 
of  life,  than  any  other  period.  A  contagious  principle, 
then,  being  evidently  the  origin  of  typhus,  the  question 
next  is,  how  is  this  principle  generated  ?  The  actual  manner 
it  is  certainly  impossible  to  detect ;  but  a  leading  point  is, 
does  the  suppurative  process  in  wounds  tend  any  way  to  its 
production  ?A  If  this  were  the  case,  then  the  treatment  of  such 
patients,  and  confining  them  as  much  as  possible  to  situa¬ 
tions  by  themselves  would  be  a  point  to  be  greatly  studied  in 
all  hospitals.  \Y e  know  indeed  that  erysipelas  of  a  conta¬ 
gious  nature  is  a  common  consequence  of  such  injuries, 
where  large  suppurations  take  place,  and  attack  all  in  the 
same  wards,  or  within  the  precincts  of  the  same  atmosphere. 
But  we  should  conceive  that  the  state  of  Suppuration  is  not 
capable  of  generating  this  specific  cause  of  typhus,  that 
mortality  must  first  proceed  to  a  great  degree,  and  that  then 
the  decomposition  of  animal  matter  which  death  occasions, 
under  certain  circumstances  of  activity,  gives  origin  to  this 
contagious  principle  which  produces  the  typhoid  form  of  dis¬ 
ease.  Hence  the  necessity  of  flying  every  crowded  scene  of 
mortality,  which  may  generate  this  cause;  and  we  should 
therefore  doubt  whether  a  vitiated  atmosphere  from  mere 
confinement  of  a  number  of  persons  crowded  together,  or 
from  any  other  way  in  which  the  air  becomes  tainted,  would 


Medicine . 


W09;} 


SS7 


operate  to  produce  this  peculiar  matter.  We  conceive  the 
source  of  typhus  to  be  a  contagion  generated  from  the  de¬ 
composition  of  dead  animal  matter  alone,  under  circum¬ 
stances  with  which  we  are  yet  unacquainted. 

I  am,  Gentlemen,  your  obedient  servant, 
Plymouth ,  March  16,  1809.  W.  R. 

Observations  on  some  of  the  most  frequent  and  important 
Diseases  of  the  Heart ;  on  Aneurism  of  the  Thoracic 
Aorta ;  on  preternatural  Pulsation  in  the  Epigastric 
Region  :  and  on  the  unusual  Origin  and  Distribution  of 
some  of  the  large  Arteries  of  the  Human  Body .  Illus¬ 
trated  by  Cases.  By  Allan  Burns ,  Member  of  the  Royal 
College  of  Surgeons ,  London  ;  and  Lecturer  on  Anatomy 
and  Surgery ,  Glasgow .  Edinburgh.  1809.  pp.  322. 
It  is  with  pleasure  we  present  these  Observations  to  the 
attention  of  the  profession  ;  we  have  seldom  read  a  work  more 
replete  with  sound  doctrine  and  general  information  than  the 
one  before  us  ;  and,  under  a  conviction  of  its  general  utility, 
we  think  a  medical  library  would  be  incomplete  without  it. 
But  to  give  an  idea  of  a  work  that  will  materially  tend  to 
facilitate  the  acquisition  of  morbid  anatomy,  and  lead  to  a 
more  certain  mode  of  treatment  in  the  diseases  of  this  organ, 
we  have  selected  Mr.  Burns’s  observations. 

<e  On  the  consequences  resulting  from  change  of  structure 
of  the  substance  of  the  heart. 

Ci  Mr.  John  Hunter  very  justly  observes,  that  a  heart 
cannot  be  essentially  necessary  for  circulating  the  blood,  in 
as  much  as  some  animals  altogether  want  it.  In  the  cater¬ 
pillar  tribe,  we  have  no  defined  heart;  there  is  no  reservoir 
where  the  blood  is  collected  to  be  delivered  over  in  quantity 
to  the  arteries.  On  the  contrary,  the  returning  veins  ter¬ 
minate  directly  in  the  artery  which  descends  along  the  back 
of  the  animal;  where  it  can,  through  the  transparent  skin, 
be  seen  contracting  on  its  contents,  forcing  them  on>  with  an 


ms 


Medicine . 


[April, 

undulatory  mdtibn.  When  we  ascend  a  step  higher  in  the 
scale  of  being,  we  meet  with  an  imperfect  heart,  and  in  some 
tribes,  we  see  this  heart  entirely  appropriated  to  the  pulmo¬ 
nic  circulation,  the  systemic  being  carried  on  as  in  the  ca¬ 
terpillar,  by  the  arteries.  In  other  varieties,  the  arrangement 
is  recorded ;  we  find  no  heart  for  propelling  the  blood  into 
the  pulmonary  vessels,  but  we  perceive,  that  these  vessels 
deliver  over  their  contents  to  a  heart  which  is  attached  to  the 
systemic  arteries.  The  fish  has  a  pulmonic  heart ;  the  snail  a 
systemic  one.  These  were  facts  with  which  Mr.  Hunter  was 
familiar  ;  I  cannot  therefore  conceive,  what  led  this  distin¬ 
guished  physiologist  to  conclude,  that  in  the  human  subject, 
the  ventricle  sends  the  blood  through  the  body,  and  is  there¬ 
fore  the  proper  heart,  while  the  auricle  is  only  an  append¬ 
age.  Having  once  embraced  this  notion,  he  observes  :  c<  And 
as  the  ventricle  is  the  part,  which  propels  the  blood  to  the 
different  parts  of  the  body,  its  muscular  power  must  be  ade¬ 
quate  to  that  purpose,  and  therefore,  it  has  a  very  strong 
muscular  coat.” 

tc  To  prove  that  the  auricles  are  subservient  to  the  ven¬ 
tricles,  Mr.  Hunter  has  stated,  that  in  those  animals  where, 
the  veins  near  the  heart  are  large,  there  is  no  auricle,  and 
he  has  convinced  himself,  and  endeavoured  to  persuade 
others,  that  the  ventricle  is  more  valuable  than  the  auricle ; 
because,  when  the  heart  is  imperfect,  we  always  find  that 
the  ventricle  is  the  part  present,  I  should  be  very  averse  to 
start  objections  to  any  of  Mr.  Hunter’s  opinions,  for  they 
are,  in  general,  the  result  of.  cautious  induction  from  un« 
questionable  facts.  Comprehensive  and  accurate  as  his  Views 
generally  were,  and  elevated  as  his  mind  was  above  the  level 
of  most  of  his  predecessors,  still  it  would  have  been  expect¬ 
ing  too  much  to  have  looked  for  absolute  perfection  in 
all  his  opinions ;  although  most  of  them  have  stood  the 
test  of  the  strictest  criticism,  and  are  now  considered  as 
axioms  in  medical  science.  In  appreciating;  however,  the 


1S09-0 


Medicine.  *  339 

relative  value  of  the  different  parts  of  the  hearty  and. 
even  of  the  heart  itself,  with  respect  to  other  parts  of  the 
system,  I  think  he  has  erred.  For,  although  we  regard, 
in  general,  the  ventricles  as  stronger  than  the  auricles,  we 
must  not  from  thence  conclude,  that  this  is  because  the 
ventricles  in  a  state  of  health  are  a  the  chief  agents 
in  the  circulation.”  Until  we  possess  clear  notions  re¬ 
specting  the  natural  function  of  a  part,  our  ideas  con¬ 
cerning  its  morbid  actions  can  never  be  otherwise  than 
vague  and  unsatisfactory.  But  often  our  opinions  regard¬ 
ing  healthy  function  are  corrected,  by  observing  what 
takes  place  in  disease.  In  the  present  instance,  it  is  prin¬ 
cipally  by  attending  to  the  deviations  from  the  natural 
condition,  that  we  come  to  a  knowledge  of  the  true  rela¬ 
tion  which  the  heart  be^rs  to  the  sanguiferous  system.” 

<c  We  may  be  still  more  certain,  that  the  heart  does 
not  circulate  the  blood,  from  attending  to  what  often 
takes  place,  where  the  aortic  valves  arc  ossified.  It  is  a 
fact  well  known,  and  fully  substantiated  by  observation, 
that  in  this  disease  the  heart  contracts  sometimes  twice 
for  each  pulsation  of  the  arteries,  which  could  not  hap¬ 
pen,  if  in  reality  the  heart  by  the  vis  a  ter  go  drove  on 
the  blood.  On  the  contrary,  when  so  small  a  quantity 
of  fluid  is  sent  out  from  tho  ventricle,  that  the  artery  is 
not  fully  filled,  it  does  not  re-act  on  its  contents,  till  the 
next  contraction  of  the  heart  fills  it ;  then  it  acts,  and 
then  the  pulse  is  again  felt.  If  we  would  estimate  justly 
the  value  of  the  heart,  we  must  look  on  the  auricles  as 
reservoirs  to  the  ventricles,  aud  the  latter  again  as  serv¬ 
ing  the  same  purposes  to  their  respective  arteries. 

i%  That  the  ventricles  during  natural  circulation,  by 
their  percussion,  drive  the  blood  along  the  vessels,  is  hard 
to  conceive.  To  my  apprehension,  they  only  propel  it 
with  due  vigour  into  the  arteries,  and  they  of  themselves 
circulate  it.  The  cases  which  are  afterwards  to  be.  de- 


340 


Medicine* 


tailed,  are  clear  and  convincing  proofs  of  this;  and  these 
afford  an  ample  refutation  of  Mr.  John  Bell’s  conjecture, 
that  the  ductus  arteriosus  cx  gives  the  full  force  of  the 
right  ventricle  to  the  blood  of  the  aorta,  in  addition  to 
that  of  the  left;”  for  in  them  the  blood  was  circulated 
without  the  aid  of  either  ventricle.  Some  have  said,  that 
the  parts  of  the  aorta  near  the  heart  act  vigorously  on 
the  blood ,  but  that  the  parts  more  remote  have  need  of 
the  vis  a  ter  go  to  drive  on  the  fluid.  If,  however,  it  be 
admitted,  and  few  will  pretend  to  deny,  that  any  portion 
of  an  artery  can  propel  its  blood  independent  of  any 
impulse  communicated  from  the  heart,  surely  we  may 
be  allowed  to  infer,  that  the  whole  artery  can  do  as\ 
much;  so  that  a  vessel  thirty-six  feet  in  length,  shall  be 
just  as  capable  of  propelling  its  contents,  as  one  of  a  single 
'  foot. 

“  It  may  naturally  then  be  asked,  why  have  we  both 
an  auricle  and  a  ventricle,  if  the  circulation  can  be  car¬ 
ried  on  without  either  ?  In  reply,  I  would  observe,  that 
according  to  the  scheme  of  the  perfect  circulation,  both 
parts  are  necessary.  No  doubt,  we  see  in  the  lower  ranks 
of  the  creation,  that  the  animals  do  equally  well  without 
a  heart  as  with  one,  or  with  a  single,  as  a  double  heart. 
Tire  caterpillar  without  a  heart  discharges  in  perfection 
all  its  necessary  functions;  and  the  fish,  although  it  has" 
no  heart  to  propel  the  blood  through  its  long  and  flex¬ 
ible  body,  yet  circulates  it  with  ease  and  regularity,  by 
the  sole  unassisted  action  of  its  vessels.-  In  none  of  these 
animals,  however,  do  we  find  the  functions  so  complicated 
as*  in  man  ;  their  wants  are  few  and  simple ;  their  mode 
of  life  and  oeconomv  are  fitted  to  their  inferior  rank  in 
organization.  Man,  however,  has  oilier  functions  to  per* 
form,  and  other  relations  to  maintain,  and  for  the  dis¬ 
charge  of  his  multifarious  duties,  the  structure  of  lus 
frame  requires  to  be  more  complicated ;  yet  it  is  only  so 


Medicine. 


1809.] 


much  so,  as  to  fit  him  to  hold  the  station  which  has  been 
assigned  him,  in  the  scale  of  created  beings. 

n  In  the  caterpillar,  and  its  tribe,  the  body  is  small, 
and  the  vessels  comparatively  large ;  so  that  in  them, 
there  is  no  necessity  for  a  reservoir  to  collect  the  blood, 
and  to  propel  it  into  the  artery  in  sufficient  quantity  to 
distend  it  canal.  In  the  human  subject,  however,  from 
the  proportion  which  the  vessels  bear  to  the  body,  a  heart 
is  rendered  necessary  ;  a  reservoir  is  required  to  collect  such 
a  quantity  of  blood,  as,  when  impelled  into  the  vessels,  shall 
let  them  feel  that  they  are  in  some  degree  distended.  Be’- 
sides  had  there  been  only  an  aorta,  and  veins  in  the  human 
subject,  the  blood  could  not  of  necessity  have  circulated  an 
equal  number  of  times  in  a  given  period  ;  neither  could  the 
pulsations  have  been  equally  frequent,  if  he  had  only  had 
an  auricle  appended  to  his  sanguiferous  system.  To  circu¬ 
late  the  blood  sufficiently,  frequently,  and  harmoniously,  an 
auricle  and  ventricle  are  both  provided.  The  auricle  di¬ 
lates,  is  filled,  contracts,  and  propels  its  contents  into  the 
ventricle,  and  while  the  latter  is  acting  on  the  fluid  it  con¬ 
tains,  the  auricle  is  again  filling,  and  by  the  time  that  the 
ventricle  is  emptied,  the  auricle  is  ready  to  contract ;  thus 
the  vascular  system  is  always  kept  full,  for  the  heart  sends 
out  just  twice  the  quantity  of  blood,  that  it  could  have  done 
with  the  same  exertion,  had  there  only  been  a  ventricle.  In 
this  mechanism,  I  see  a  beautiful  contrivance  for  furnishing 

4 

such  a  quantity  of  arterial  blood  to  the  system,  as  shall  be 
sufficient  for  its  wants  ;  but  I  cannot  do  otherwise  than  be¬ 
lieve,  that  so  long  as  the  heart  and  arteries  continue  healthy, 
they  act  in  a  manner  independent  of  each  other ;  each  per¬ 
forms  its  own  part,  but  both  tend  to  the  same  purpose  ; 
unity  results  from  their  action.  Still  without  being  imme¬ 
diately  fatal,  one  part  of  the  heart  may  lose  its  muscularity, 
or  the  arteries  may  have  their  power  of  contracting  greatly 
impaired.  In  the  first  instance,  however,  that  part  of  th* 


M2 


Medicine* 


[April 

heart  which  remains  healthy,  performs,  besides  its  own  func¬ 
tions,  a  considerable  portion  of  the  action  belonging  to  the 
part  diseased  ;  and  in  the  latter  case,  the  heart  is  compelled 
to  act  with  redoubled  vigour,  for  in  proportion  to  the  loss  of 
arterial  power,  so  is  the  heart  called  on  to  make  up  the  defi¬ 
ciency.  The  circulation  can  in  either  case  be  carried  on,  but 
the  vascular  system  is  in  a  precarious  state ;  very  trifling 
causes  derange  this  mode  of  circulation  ;  nay,  in  some  cases, 
put  a  final  stop  to  it.” 

The  Physician's  Vade-Mecum;  containing  the  Symptoms , 
Causes ,  Diagnosis ,  Prognosis ,  and  Treatment  of  Dis¬ 
eases .  Accompanied  by  a  select  Collection  of  Formulas , 
and  a  Glossary  of  Terms .  By  Robert  Hooper ,  M.  D. 
Licentiate  in  Physic  of  the  University  of  Oxford,  and 
the  Royal  College  of  Physicians  o  f  London  ;  Physician 
to  the  St.  Mary-ie-bone  Infirmary  ;  and  Lecturer  on  Me¬ 
dicine  in  London.  1809*  Small  8 vo.  pp.  274. 
Reviewing  a  book  is,  at  any  time,  a  painful  task  :  for 
how  seldom  does  it  happen  that  an  author  thinks  the  man 
who  takes  upon  himself  to  decide  upon  the  merits  or  demerits 
of  his  work,  to  be  actuated  by  pure  motives  or  impartiality. 

Dr.  R.  Hooper’s  book,  we  admit,  is  replete  with  erudition  : 
—but  we  cannot  help  thinking  it  too  much  on  the  plan  of 
a  ready-reckoner  : — In  the  mercantile  world,  it  may  be  of 
advantage,  for  the  dispatch  and  convenience  of  business,  to 
have  a  book  which  may  at  once  save  much  useless  and  tedious 
calculation,  but  in  the  science  of  physic,  we  fear  it  is  otherwise. 
Dr.  Hooper’s  intentions  are  certainly  well  meant,  but  we  think 
that  books  of  this  class  are  already  so  numerous,  that  to  mul¬ 
tiply  them  is  unnecessary.  It  rather  tends  to  make  the  stu¬ 
dents,  who  are  the  general  readers  of  them,  idle,  and  to  trust 
too  much  to  the  scanty  and  curtailed  information  they  con¬ 
vey.  Dr.  Hooper,  we  believe,  has  been  at  much  pains  with 
this  little  volume;  and  ho  certainly  deserves  the  character 


Medicine, 


343 


1809.] 

of  a  laborious  and  indefatigable  writer.  His  object  is  to 
furnish  a  set  of  school-books,  which  are  always  best  applied 
when  commented  upon  by  the  master.  As  text-books  to  his 
own  lectures,  they  may  do  very  well ;  but  we  think  them  not 
sufficiently  extended  for  general  perusal. 

In  looking  over  the  work,  we  are  sorry  to  be  obliged  to 
point  out  what  we  consider  as  a  defect.  In  the  enumera¬ 
tion  of  symptoms,  he  brings  into  his  description  every 
symptom  which  can  arise,  without  specially  dwelling  on 
the  leading  ^or  pathognomonic  ones,  and  holding  them  to 
marked  attention.  We  shall  give  an  instance  in  his  state¬ 
ment  of  catarrh,  taking  in  the  whole  disease  to  shew  his 
plan,  though  it  is  the  enumeration  of  symptoms  we  chiefly 
object  to. 

<e  Catarrhus,  or  Catarrh . — Species.  Catarrhus  a  frigore; 

common  cold.  - contagious,  the  influenza. — An  increased 

scretion  of  mucus  from  the  mucous  membrane  of  the  nose, 
fauces,  and  bronchi®,  attended  with  pyrexia. 

Symptoms. — Pyrexia  ;  weight  and  pain  in  the  head  ;— - 
oppression  of  the  chest,  and  impeded  respiration ; — sense  of 
fulness  and  stopping  up  of  the  nose; — watery  inflamed 
eyes ;— coryza ; — cold  shivcrings,  succeeded  by  transient 
flushes  of  heat; — soreness  of  the  fauces  and  trachea; — - 
cough; — pains  about  the  chest;  rheumatic  pains  in  the 
neck  and  head  ; — increased  secretion  of  mucus  from  the  mu¬ 
cous  membrane  of  the  nose,  fauces,  and  bronchi®. 

i(  Causes. — Remote.—*  Cold  applied  to  the  body; — conta¬ 
gion. — Proximate. — An  inflammation  of  the  mucous  mem¬ 
brane  of  the  nose,  fauces,  bronchi®,  &c. 

cc  Prognosis. — It  is  seldom  attended  with  danger,  when  in 
a  mild  form,  and  arising  from  common  causes.  Unfavour¬ 
able. — Predisposition  in  the  constitution  to  phthisis; — tend¬ 
ency  to  asthma,  or  peripneumonia. 

“  Treatment. — Indications .  To  reduce  the  febrile  action 
of  the  system. — To  allay  the  irritation  of  the  affected  parts. 
(c  General  bleeding  may  be  necessary,  if  the  type  of  the 


344 


Medicine . 


[April, 


fever  be  synochal,  and  tlie  symptoms  are  violent:  in  such 
eases  purges  will  be  beneficial,  saline  diaphoretics,  and  the 
antiphlogistic  diet,  as  recommended  against  syuocha,  or  in¬ 
flammatory  feyer. 

6C  When  the  system  evinces  typhoid  actions^  the  contrary 
must  be  observed. 

cC  The  second  indication  requires,  1.  Frequent  use  of  tepid 
diluents,  mucilaginous  and  oily  demulcents. — R.  Spermatis 
ceti,  two  drachms — Vitellum  ovi  unius — Syrupi  simplicis, 
half  an  ounce — Aquas  cinnamomi,  two  ounces —  —  distil? 
lata,  four  ounces.— Fiat  mistura  cujus  capiat  aeger  cochleare 
magnum  frequenter. 

Ci  R.  Olei  amygdalae,  six  drachms— Syrupi  tolutani,  one 

ounce — Aqua}  distillatae,  five  ounces - * - kali  preparati, 

q.  s. — Fiat  emulsio  cujus  sumantur  cochlearia  duo  secunda 
quaque  bora,  vel  urgenti  tusse. 

<4  R.  Mucilaginis  Arabici,  one  ounce  and  a  half — Aquas 
cinnamomi,  five  ounces — Syrupi  mori,  one  ounce — M.  cujus 
sit  dosis  cochleare  medium  urgenti  tusse. 

u  2.  Mild  expectorants  and  diaphoretics. — R.  Aceti  scil- 
lae,  one  drachm — Aquae  menthae  sativae,  five  ounces — Syrupi 
croci,  one  ounce. — M.  cujus  sumat  cochleare  magnum  quando 
raucedo  urget. 

44  R.  Oxymellis  scillae,  half  an  ounce — Spiritus  aetheris  ni- 
trosijtwo  drachms — Aquae  menthae  sativae,  five  ounces — Syrupi 
corticis  aurantii,  three  drachms. — Fiat  mistura  de  qua  capiat 
aeger  cochleare  magnum  subinde. 

i£  R.  Nitri  purificati,  one  drachm — Lactis  amygdali,  seven 

% 

ounces — Tincture  scillae,  one  drachm — Syrupi  tolutani,  half 
an  ounce.— M.  sit  dosis  cochleare  magnum  subinde. 

44  3.  Mild  opiates  and  diaphoretics  when  the  inflammatory 
diathesis  is  reduced. — R.  Syrupi  papaveris  albi,  one  ounce 
- — Nitri  purificati,  one]  drachm — Aqua}  menthae  sativae,  six 
ounces. — Fiat  mistura. 

44  R.  Syrupi  papaveris  albi,  one  ounce — Oxymellis  scillae, 
half  an  ounce — Aquae  menthae  sativae,  six  ounces. — Fiat  mis? 


1809.]  Surgery.  34& 

ttira  cujus  sum&ntur  cochlearia  duo  mngna  iertia  quaque 
hora. 

tc  R.  Pulveris  ipecacuanliae  compositi  two  grains  and  a 
half— Con  servae  rosae,  q.  s. — Fiat  (alula  quarts  quaque  hora 
sumenda. 

cc  The  trochisci  glycyrrhizas  cum  opio,-— R.  Decocti  hor- 
dei  compositi,  fourteen  ounces  and  a  half — Syrupi  papaveris 
albi,  one  ounce  and  a  half — M.  cujus  capiat  aeger  ciathum  yi- 
nosum  parvum  secunda  quaque  hora. 

66  4.  Blisters  to  the  breast,  if  there  be  uneasiness  there,  of 
pain,  or  difficult  expectoration,  or  sense  of  oppression. 

<(  5.  Inhaling  the  steam  of  warm  water.” 

Upon  the  whole,  the  book  of  Dr.  Hooper  may,  it  is  true, 
be  of  great  assistance  to  the  young  practitioner  ;  but  we  be¬ 
lieve  of  no  real  utility  to  the  experienced  professional  man, 
whose  proper  Vade-mecum  ought  to  be  so  much  at  his  finger’s 
ends  as  not  to  require  the  aid  and  information  which  this 
book  affords. 


II.  SURGERY. 

Among  the  objects  of  Surgery,  the  diseases  of  the  genital 
system  form  a  leading  part,  and  are  more  frequent  subjects 
of  a  practitioner’s  attention  than  any  other. 

The  urethra  in  the  male,  as  the  passage  to  the  bladder,  or 
urinary  organs,  is  subject  to  a  variety  of  diseases  from  that 
source,  independent  of  its  other  functions,  connected  with 
the  purpoes  of  generation. 

LACERATION  OF  THE  URETHRA. 

A  remarkable  case  of  laceration  of  the  urethra  is  de¬ 
tailed  with  much  interest  and  practical  utility  by  Mr.  Bel¬ 
lamy  : 

Robert  Dainty*  a  seaman,  of  his  Majesty's  ship  Glory, 

VOL.  II. 


A  A 


346 


[April, 


Surgery. 

on  the  20th  of  May,  1806,  fell  from  the  gangway,  across  the 
gunwale  of  a  launch  along  side;  he  was  much  shook,  in 
considerable  pain,  and  a  little  faint ;  but  walked  with  a  little 
help  to  the  sick  birth.  On  examining  the  peri  n  am  in,  there 
was  no  appearance  of  injury,  except  a  trifling  fulness,  and 
scarce  any  pain  to  the  touch  ;  he  so  soon  recovered  as  to  be 
earnest  to  return  to  his  labour,  which  I  would  not  allow, 
fearing  more  serious  consequences ;  a  large  compress  with 
saturnine  lotion  was  applied,  and  strict  rest  enjoined.  My 
fears  were  too  soon  realised,  for  in  about  an  hour  afterwards, 
on  attempting  to  make  water,  he  fainted  away,  and  not  one 
drop  passed,  and  yet  he  felt  the  bladder  empty ;  a  greater  sense 
of  fulness  occupied  the  perinasum,  but  as  yet  no  appearance 
of  swelling  or  fluctuation.  Anticipating  great  inflammation, 
lie  was  immediately  bled,  ad  lbi.  The  cold  lotion  was  assi¬ 
duously  applied,  and  an  opiate  given;  two  saline  enemas 
were  administered  in  the  evening,  which  operated  copiously  ; 
he  had  also  a  natural  stool. 

At  4  A.  M.  on  21st.  v.  s.  ad  lbi.  He  was  confined  to  bed, 
and  the  scrotum  suspended.  This  day  no  fever,  but  repeat¬ 
ed  the  enema,  lotion,  and  kept  him  very  low ;  only  a  little 
tea,  and  that  as  sparing  as  possible,  to  prevent  secretion  of 
urine.  He  lies  quiet  and  half  asleep ;  occasionally  a  very 
sharp  pain  for  about  a  minute  in  an  hour,  about  the  mem¬ 
branous  part  of  the  urethra  ;  extremely  acute,  as  if  the  urine 
came  so  far  and  went  back  again.  To  the  question,  if  he 
felt  a  sense  of  water  trickling  through  ?  He  said.  Yes,  some¬ 
thing  of  that  kind.  A  considerable  rigour  followed  his 
fainting ;  very  much  like  Sharp’s  case.  The  perinamm  soon 
began  to  swell,  and  the  scrotum  likewise,  followed  by  dis¬ 
colouration,  and  rapidly  extending  in  every  direction,  so  as 
to  become  this  morning  one  livid  mass ;  the  whole  scrotum 
and  penis  swelling,  and  as  it  were  filling  out  together ;  so 
also  around  the  perinaeum  and  tuberosities  of  the  ischium, 
presenting  a  horrid  appearance,  like  a  part  in  a  complete 


347 


1809.]  Surgery* 

state  of  sphacelus ;  but  it  is  chiefly  the  effect  of  extravasa¬ 
tion  and  the  blow,  and  the  suppression  of  circulation,  from 
the  quantity  of  urine  insinuated  into  the  cellular  membrane. 
The  prepuce  is  puffed  like  a  large  phimosis,  or  as  in  extensive 
anasarca  of  the  penis;  the  glans  is  quite  hid,  and,  in  short, 
the  whole  of  those  parts  are  about  six  times  their  natural  size. 
Perinaeum  very  sensible  to  the  touch,  but  no  heat  or  tension; 
feels  most  like  a  bladder  about  half  full  ;  the  region  of  the 
bladder  is  quite  flat,  and  not  sore,  as  if  there  was  not  a  drop 
of  water  in  it.  From  the  first  moment  I  suspected  serious 
mischief,  therefore  acted  as  in  a  case  of  inflammation.  It 
was  now  necessary  to  examine  the  state  of  the  bladder,  as  he 
had  not  passed  off  any  urine  since  II  A.  M.  of  20th;  the 
desire  was  continual,  but  every  effort  gave  intense  though 
not  long  pain  in  perinaeum.  Proceeded  to  ascertain  the  state 
of  the  bladder  :  at  the  first  attempt  it  went  very  little  beyond 
the  membranous  part  of  the  urethra;  felt  some  resistance; 
would  not  force,  but  withdrew  the  instrument ;  about  two 
ounces  of  clear  blood  came  off ;  a  bad  indication  ;  shews 
internal  rupture  of  blood-  vessels ;  some  clots  also  came  off. 
The  introduction  of  the  catheter  did  not  give  much  pain, 
and  at  the  second  attempt  it  passed  easily  its  whole  length 
into  the  bladder,  but  not  one  drop  of  water  came  off;  a 
little  more  blood,  then  fainting,  rigour  continuing,  and  the 
swelling  fast  advancing.  I  still  directed  ray  attention  to  the 
effects  of  inflammation ;  determined  either  that  the  bladder 
is  burst,  or  the  membranous  part  of  the  urethra  lacerated. 
He  had  drank  about  a  quart  since  the  last  micturition.  Feels 
a  sense  of  water  passing,  and  constant  filling  of  the  peri¬ 
naeum  and  scrotum. 

Got  him  into  bed ;  had  a  stool  in  the  evening  rather  in¬ 
voluntary;  I  emptied  the  rectum  also  by  a  stimulatingenema, 
and  seeing  the  importance  of  an  empty  bladder  in  case  of  in¬ 
flammation,  passed  the  catheter  a  third  time  ;  no  force  requir¬ 
ed  or  resistance  made,  no  urine  flowed ;  continued  a  very  U- 

A  A  2 


34S  Surgery.  £  [April 

beral  application  of  the  cold  lotion,  and  in  the  evening, 
when  the  circulation  was  restored  from  faintings,  and  hav¬ 
ing  some  fever,  and  a  little  fulness  of  pulse ;  bled  him 
ad  one  pound.  Rep.  enema,  and  gave  opium,  gr.  1. 

(C  Has  had  several  slight  rigours,  and  as  his  pulse  is  still 
full,  bled  again  this  morning,  ad  one  pound,  at  4  A.  M. 
since  which  he  has  looked  pale  and  weak,  pulse  small,  soft, 
and  not  quick. 

cc  Not  a  drop  of  water  has  passed,  and  bladder  is  quite 
flaccid  ;  he  feels  about  every  hour  the  greatest  desire  to  make 
water,  and  a  few  drops  seem  to  pass  through  into  the  pcri- 
ineum;  and  as  this  happens,  so  also  the  penis  and  scrotum 
distend,  and  also  around  the  ischium,  anus,  &c.  Except  at 
those  times  of  a  few  minutes  sense  of  micturition,  he  lays 
pretty  easy,  and  sleeps  tolerably.  What  more  can  now  be 
done,  than  first  to  obviate  the  danger  of  inflammation,  which 
appears  pretty  well  obviated  at  present ;  has  no  serious  symp¬ 
toms  of  fever,  or  pain  in  the  belly ;  have  less  reason  to  fear 
rupture  of  the  bladder,  and  increasing  reason  to  believe  that 
of  the  membranous  part  of  the  urethra ;  must  w  ait,  and  per¬ 
sist  against  drink,  although  lie  begs  and  prays  for  it;  as  a 
great  point  will  be  to  remove  what  fluid  there  is,  and  to  pre¬ 
vent  the  accession  of  more,  till  nature  can  operate,  if  pos¬ 
sible,  some  favourable  change. 

“  Through  this  day  I  gave  up  the  apprehension  of  rup¬ 
tured  bladder,  and  became  confirmed  in  that  of  the  mem¬ 
branous  part  of  the  urethra,  in  which  part,  at  night,  the 
swelling  was  larger,  fuller,  and  more  tense,  giving  the  feel 
of  extra vasated  fluid;  by  lightness,  most  probably  water, 
dispersed  in  the  cellular  membrane;  the  scrotum  full  the  size 
of  a  small  bullock’s  bladder ;  no  fever,  and  (olerably  easy, 
except  at  the  time  of  sense  of  micturition.  In  the  evening 
additional  confirmation,  if  any  required,  for  now  the  scro¬ 
tum  is  so  distended  that  it  is  not  able  to  bear  any  more,  and 


3P3 


1809.  ]  Surgery. 

the  region  of  the  bladder  above  the  pubis  not  a  little  distend¬ 
ed,  and  become  sensible  to  the  touch,  and  his  danger  must 
rapidly  increase,  unless  some  evacuation  be  procured.  In¬ 
troducing  two  trocas  in  the  depending  and  rather  posterior 
part  of  the  scrotum  ;  a  thin  fluid  oozed  out,  to  the  taste  that 
of  urine,  and  tinged  with  blood ;  secured  the  canulas,  and 
got  off  before  eight  o’clock  a  full  pint ;  of  course,  to  the 
great  relief  of  the  patient,  but  yet  no  diminution  of  the  size 
of  the  scrotum,  because  it  filled  up  as  fast  as  he  feels  the  de¬ 
sire  to  micturate,  but  got  ofl*  a  pint  and  a  half  more  to  the 
evident  great  reduction  of  the  bladder,  and  a  little  of  the 
scrotum;  about  four  ounces  of  blood  mixed  with  the  urine; 
one  or  two  very  slight  chills  in  the  night.  Repeated  the 
enema  twice  this  day,  and  gave  opium,  gr.  i.  vespere.  Ene¬ 
ma  feels  comfortable,  empties,  even  composes  to  sleep, 
though  only  of  warm  water. 

(e  May  22.  To  assist  the  perforation  of  the  trocar,  last 
evening,  I  made  a  few  pretty  deep  incisions  with  a  lancet 
in  the  scrotum  and  penis,  and  all  oozed  something  and 
helped  the  general  intention.  In  the  middle  watch  last  night, 
another  pint  and  a  half  dropped  olF,  so  that  at  4  A.  M.  there 
was  a  striking  flaccidity  of  the  whole,  especially  of  the 
bladder,  but  the  parts  are  equally  discoloured,  quite  black, 
and  only  sensible  to  pain  about  the  perinaenm ;  slept  tolera¬ 
bly  well ;  forbears  drink  ;  has  not  had  above  a  pint  since 
hurt,  to  S  this  morning.  The  reduction  of  the  swelling  con¬ 
tinues,  and  if  f  can  keep  him  from  fluids,  and  he  is  an  obe¬ 
dient  patient,  may  hope,  if  the  perforations  continue  to  ooze, 
for  a  total  reduction  of  the  swelling ;  he  evidently  has  no 
fever,  or  other  mark  of  inflammation.  I  cannot  always  keep 
him  parching  with  thirst,  but  I  have  done,  I  believe,  all  that 
is  justifiable  at  present ;  and  if  I  have  obviated  general  in¬ 
flammation,  may  have  now  to  apprehend  only  local  inflam¬ 
mation,  and  consequent  fistula  in  perinaeo  ;  but  there  is  also 
danger  of  gangrene,  communicated  inflammation,  and  the 

A  3 


350  Surgery.  [April, 

great  obscurity  which  all  these  parts,  and  the  nature  of  their 
affection  are  wrapped  in.  I  had  an  idea,  if  the  plan  of  per¬ 
forating  the  scrotum  had  failed,  and  the  bladder  had  filled 
to  excess,  of  peforating  it ;  now  to  do  that,  the  rectum  is  the 
east  objectionable  way  ;  it  would  be  a  present  indication  of 
cure,  for  the  water  to  flow  that  way,  till  nature,  assisted  by 
art,  might  restore  the  mischief  in  the  canal.  Repeat  the 
emena  twice  a  day,  give  opium  gr.  i.  pro  re  nata  ;  keep  him 
low  ;  keep  the  parts  clean  and  cold  by  lot.  saturn.  At  night 
looked  rather  sunk,  and  pulse  weak;  several  rigours,  and 
regular  chattering  of  the  teeth ;  scrotum  and  bladder  kept 
well  emptied,  of  course  little  or  no  oozing,  only  one  pint  the 
whole  24  hours ;  he  cries  out  bitterly  for  a  few  moments,  at 
each  sense  he  has  of  the  urine  trickling  from  the  bladder, 
which  being  an  involuntary  act,  shews  a  paralysed  sphincter ; 
swelling  just  kept  at  bay  by  oozing,  and  the  absence  of 
drink.  Can  take  no  food  ;  great  distress  from  thirst;  lips  a 
little  black,  pulse  regular  in  time,  skin  without  heat,  peri- 
naeum  yet  very  full,  hard,  and  all  round  to  the  anus  the 
whole  is  black,  but  sensible  in  every  part  to  the  touch ;  the 
most  sensible  part  has  always  been  the  right  groin,  and  the 
side  of  the  scrotum  touching  that  part.  By  frequent  rigours, 
I  apprehend  matter  is  forming  in  the  perinaeum;  no  hiccup 
nor  mortification;  thus  may  hope  for  formation  of  abscess, 
and  fistulous  opening  for  the  urine,  as  the  only  probable 
chance  of  saving  him.  What  if  an  artificial  opening  be 
made  on  purpose  ?  but  cannot  tell  the  exact  place ;  may 
do  it  below  the  wounded  aperture,  and  communication  wiih 
the  cellular  membrane;  besides,  why  not  hope  to  restore 
the  urine  to  the  regular  canal  ?  for  if  lacerated  on  the  lower 
side,  it  does  not  follow,  when  all  swelling  and  inflammatory 
thickening  and  obstruction  are  gone,  that  the  urine  should 
not  pass  on  through  the  regular  canal.  There  has  also  been 
a  glary  discharge  for  some  time  after  the  accident,  which  1 


fSO§.]  Surgery.  351 

attributed  to  injury  of  the  prostate,  but  now  in  the  form  f 
matter,  and  is  rather  putrid ;  some  confirmation  of  the  hope 
that  matter  is  forming ;  remember  the  state  of  such  discharge 
from  Sharp,  whose  case  was  not  much  unlike  it,  and  relief 
given  to  the  narrowness  produced  by  former  inflammation, 
by  the  formation  of  abscess  and  fistula,  and  so  might  have 
lived,  though  a  burthen,  many  years,  if  not  for  that  unlucky 
secondary  inflammation  and  gangrene;  such  will  be  the 
course  here,  either  abscess  or  mortification,  and  to  day  23d, 
by  the  severity  of  rigour,  strong  chattering  of  teeth,  and 
more  frequent  recurrence,  at  least  a  dozen  since  8  o’clock  last 
night;  hope  for  the  formation  of  abscess  in  perimeo,  which 
part  continues  very  full  and  hard;  not  yet  fluctuating,  where¬ 
as  all  the  rest  remain  lax,  and  very  little  larger  than  nature,' 
and  now  able  to  draw  back  the  prepuce.  Matter  oozes  from 
the  penis  still,  with  a  little  blood ;  all  the  effect  of  the  great 
bruise,  giving  hopes  of  matter  forming  there  ;  injecting  some 
warm  water  into  the  urethra,  does  not  return,  which  confirms 
the  opinion  of  the  rupture  of  the  membranes  of  the  urethra, 
and  that  the  water  escapes  into  the  cellular  substance; 
must  therefore  be  cautious  how  I  repeat  the  injection. 

u  Last  evening  he  seemed  to  sink  a  little,  very  weak  and 
pale,  looks  low  to  day.  Allowed  half  an  ounce  of  wine  four 
times  a  day,  just  to  keep  up  strength  and  tone,  also  a  little 
soup  ;  had  yesterday  about  a  gill  of  soup,  and  in  the  whole 
twenty-four  hours  about  a  pint  of  fluid;  in  fact,  just  as 
much  as  I  think  will  ooze  off',  and  keep  the  parts  empty; 
some  acid  eructations,  but  no  hiccup.  Some  fear  of  gan¬ 
grene,  because  less  pain  in  every  respect,  and  particularly  in 
that  of  water  going  through  ;  does  not  cry  out  so  much  as 
he  did.  Apply  large  hot  poultices  to  perinasum,  and  suspend 
scrotum  well ;  continually  apply  hot  fomentations  to  region 
of  the  bladder  ;  last  evening  took  an  early  hint  by  seeing  a 
greater  occurrence  of  rigour,  and  hopes  of  matter,  to  leave  off 
repellant  and  cold  system,  and  began  warm  fomentations^ 

A  A  4 


352  Surgery,  [April  f 

which  felt  more  comfortable,  and  necessary  to  encourage  cir- 
eolation  in  the  parts  so  relaxed,  and  for  fear  of  gangrene  ; 
shall  also  give  a  cordial  in  small  form.  Confect,  aromatic 
gr.  x.  augendo  de  die,  because  most  afraid  of  debility  ;  thirst 
is  highly  distressing,  but  must  persist  against  drink* 

ei  24.  On  the  whole  is  worse,  in  great  danger,  scarce  pos- 
isible  to  live  ;  the  danger  of  gangrene  has  greatly  increased ; 
by  noon,  yesterday,  the  eructations  amounted  to  hiccup, 
which  has  increased  so  as  to  shake  and  hurt  him  much;  has 
had  at  least  twenty  tits  of  it  $  face  sunk,  eyes  deadly ;  pulse, 
though  regular  in  time,  is  weak ;  skin  cool,  tongue  brown 
and  dry  ;  lips  and  teeth  somewhat  black;  no  head-ach;  and 
again,  contrary  to  mortification,  there  are  strong  signs  of 
inflammation  and  formation  of  matter;  rigours  much  stronger 
and  longer,  till  8  last  night,  since  that  slower  and  weaker, 
but  yesterday  very  severe,  by  regular  chattering  of  teeth ; 
very  distressing,  yet  he  got  a  little  sleep.  I  have  continued 
strictly  a  large  hot  cataplasm  and  fomentation  to  the  whole 
pubes,  scrotum,  &c.  which  ease  and  soothe ;  most  of  the 
orifices  continue  to  ooze,  but  not  equal  to  fluid  taken,  which 
was  rather  more  indulged  yesterday,  on  account  of  hjs  cries 
for  it,  and  to  be  allowed  more  freely ;  after  a  most  pleasing 
circumstance,  at  2  P.  M.  of  passing  the  catheter,  a  very 
small  one,  pretty  easity,  when  at  the  part  supposed  to  be 
injured,  and  kept  the  point  of  it  bearing  on  the  upper  side  of 
the  canal,  for  fear  of  entering  the  lacerated  part,  bid  it  went 
completely  in,  and  drew  otf  a  whole  pint  of  water,  to  my 
great  satisfaction  and  his  delight ;  though  by  the  uneasy  po¬ 
sition  he  almost  fainted.  Bladder  did  not  feel,  or  appear  to 
be  full.  I  began  to  pass  the  catheter  chiefly  with  a  view,  by 
gentle  means,  of  ascertaining  if  any,  and  where,  the  obstruc¬ 
tion  might  be,  as  also  to  induce  a  true  passage  by  keeping 
it  open,  not  unawares  of  the  danger  of  exciting  new  inflam¬ 
mation,,  Scrotum  had  not  enlarged,  though  felt  harder,  and 
believe  it  mostly  to  be  by  the  water  from  the  small  syringe, 


1809.]  Surgery.  333 

injected  to  wash  out  matter  and  mucus,  with  a  little  blood 
from  the  penis ;  no  water  returned  again  when  done  last 
night,  ahd  scrotum  seemed  to  get  harder  still ;  to  be  more 
backward  in  its  use,  especially  if  I  can  succeed  occasionally 
passing  the  catheter,  then  may  hope  much,  if  gangrene 
does  not  advance;  but  loss  of  strength,  faintness,  hiccup, 
black  tongue,  &c.  are  strong  and  dangerous  signs;  no  deli- 
rium,  but  loss  of  spirits;  feels  dejected,  and  says,  now  is 
very  ill ;  is  very  fretful.  At  night  got  worse ;  much  pain  in 
bottom  of  belly,  no  doubt  from  inflammation  there ;  still  di* 
reels  chiefly  to  the  right  side  of  inguen,  just  above  the  pubes, 
where  to  day  there  is  an  evident  swelling,  very  distinct  from 
the  bladder,  and  remaining  after  its  evacuation,  which  was 
repeated  this  morning  very  happily,  but  not  half  a  pint 
drawn  off,  yet  the  bladder  seemed  emptied  by  it,  although 
so  much  more  has  been  drank;  this  I  account  for  by  the 
greater  oozing  from  the  per  hue  um,  where,  on  the  left  side, 
I  made  last  night  a  deep  incision,  to  ascertain  if  any  mat¬ 
ter;  found  none.  Integuments  very  hard,  by  thickening  ; 
incision  about  half  an  inch  long.  I  foresaw  this  advantage, 
if  no  matter  was  found,  that  by  oozing  of  urine  and  blood, 
there  would  be  a  diminution  of  tension,  hardness,  fulness, 
and  redness  of  that  side ;  besides,  having  now  access  to  the 
bladder,  there  appeared  a  diminution  of  all  danger,  but  that 
of  gangrene,  and  even  of  that,  if  I  can  keep  up  his  strength 
without  exciting  inflammation  of  the  bladder,  or  urethra ; 
so  must  cautiously  support  and  stimulate,  to  encourage 
maturation  of  the  perinamm,  by  cataplasm  and  fotus.  This 
may  lessen  a  great  cause  of  extensive  irritation  and  mischief 
from  effusion  of  urine,  if  I  am  so  happy  to  continue  drawing 
it  off,  which  I  could  not  do  at  feur  this  morning.  At  twelve, 
after  being  dressed,  lie  expressed  great  uneasiness,  and  sense 
of  fulness  of  the  bladder,  but  to  external  feeling  not  dis¬ 
tended;  greatest  distress,  tension^  and  pain  is  in  the  right 
inguen, 


354 


Surgery .  [April, 

cc  At  4,  resistance  to  catheter,  but  not  prudent  to  employ 
force.  Gave  opium  two  grains,  last  night,  but  scarce  slept ; 
and  the  distress  and  restlessness  for  drink  was  so  great, 
was  obliged  to  increase  the  indulgence ;  in  the  last  24  hours 
has  taken  three  half-pints  of  tea ;  he  looks  forward  to  the 
hope  of  satisfying  his  thirst,  as  the  greatest  possible  blessing. 

i(  At  9  this  morning,  after  a  few  attempts  with  great  cau¬ 
tion,  a  very  small  catheter  got  in,  but  not  the  whole  length, 
little  farther  than  neck  of  the  bladder ;  yet  so  opened  it,  at 
least  the  obstructed  part,  that  the  urine  flowed  freely :  now 
it  may  be  that  the  urine  is  lodged  without  the  bladder,  and 
stopped  by  the  lacerated  part  externally,  where  closed  by  in¬ 
flammation,  thickening,  &c.  He  strained  and  vomited  a 
little  last  night;  not  to  day;  and  has  kept  down  a  gill  of 
soup;  also  confect,  aromatic  gr.  x.  quart  horis.  c.  vin.  half 
an  ounce,  with  about  four  ounces  of  lemon  juice,  and  as 
much  w  ine  besides.  Seeing  the  great  good  of  the  last  inci¬ 
sion  in  perinaeo,  made  a  still  more  ample  one  on  the  other 
side,  close  down  to  the  muscles  :  he  slept  a  little  to  day,  since 
water  evacuated,  and  took  a  cup  of  tea ;  also  last  night  a 
few  ounces  of  gruel,  and  a  tea  spoonful  of  brandy  in  it. — No 
foetor  from  the  scrotum,  and  not  vesicated  or  having  any 
more  putrescent  appearance;  rather  wonderful  with  all  the 
rigour,  hiccup,  &c.  that  a  crisis  has  not  taken  place.  To 
check  hiccup,  and  stimulate  gently,  though  it  will  excite 
water,  yei  given  because  it  will  at  the  same  time  cool,  and 
be  anti-putrescent,  kali  gr.  v.  in  effervescence  with  acid  wine 
alternately  every  two  hours,  with  confect,  aromat.  in  vin. 
one  ounce  singul.  dos. 

u  R.  Catap.  fotus,  &c. 

“  25th.  The  poor  fellow  is  closing  his  sufferings  fast, 
they  have  been  immense,  but  now  less  by  the  relief  of  deli¬ 
rium  ;  he  is  so  restless,  that  it  is  impossible  to  steady  him  ; 
cannot  now  keep  on  any  dressing,  but  have  hitherto  persisted 
in  the  use  of  cataplasm  to  perinaeum  and  inguen,  but  on  the 


355 


1809.]  Surgery. 

latter  the  weight  of  it  is  too  great ;  the  part  is  so  extremely 
sensible  of  pain,  equal  to  touching  the  eye;  kept  tolerably 
composed,  and  had  some  sleep  after  drawing  off  about  a  pint 
of  water  yesterday. 

C(  At  4  A.  M.  took  some  tea  at  breakfast;  felt  refreshed, 
but  the  fever  continued.  Teeth  quite  black,  tongue  dry 
and  brown ;  less  hiccup  all  day ;  one  or  two  slight  rigours 
only,  but  state  of  parts  worse,  now  in  solution  and  perfect 
gangrene,  but  no  foetor;  to  day  one  spot,  half  dissolved,  and 
breaking  through  at  the  bottom  of  the  scrotum  ;  it  is  alto¬ 
gether  a  most  dreadful  case  of  extreme  anguish  ;  so  as  to  pro¬ 
duce  in  a  most  firm  mind,  frequent  restlessness  and  delirium, 
yet  at  times  he  is  rational  and  patient. 

u  I  have  succeeded,  by  great  pains,  in  the  application  of 
the  catheter,  in  drawing  off,  at  kthree  different  times,  three 
half  pints  of  urine ;  but  the  canal  is  full  of  interruptions, 
as  if  closed  by  inflammatory  thickening,  especially  in  the 
membranous  part.  We  come  now  to  a  new  view  of  the 
case.  The  part  he  has  always  most  complained  of,  was  the 
right  inguen,  which  yesterday  appeared  fallen,  but  by  noon 
it  became  rather  red  and  hot,  more  prominent,  and  extremely 
sensible  to  the  touch  •  this  redness,  fulness,  and  degree  of 
pointing  by  the  pink  colour  of  the  centre,  has  gradually  ad¬ 
vanced. 

(£  There  seems  to  be  a  general  and  deep  thickening 
through  the  whole  depth  of  the  parietes  of  the  abdomen,  and 
I  doubt  not  the  explanation  of  all  the  rigours,  internal  pain, 
&c.  is  to  be  found  in  distinct  inflammation  of  the  coats  of  the 
bladder ;  feel  assured  that  if  he  could  live  long  enough, 
should  see  suppuration  of  the  bladder  take  place.  But  I  an¬ 
ticipate  that  he  is  very  soon,  at  all  events,  to  finish  the  sum 
of  his  sufferings,  as  great  as  ever  I  beheld.  We  recollect 
how  soon  Sharp  sunk  under  a  nearly  similar  state;  with  the 
extraordinary  combinations  of  inflammation  and  gangrene  at 


m 


[April, 


Surgery, 

the  same  time;  there  is  excessive  pain,  heat,  redness,  rigours, 
disposition  to  suppuration,  and  actually  local  inflammation, 
whilst  some  parts  are  half  putrid,  and  all  along,  since  dan” 
ger,  a  slow  fever:  black  teeth,  dry  brown  tongue,  and  small 
pulse,  cold  skin,  hiccup,  discoloration  ;  not  all  the  effect 
of  bruise  and  extravasation  of  blood  and  urine ;  it  is  truly  a 
fit  case  to  be  compared  with  Sharp’s.  In  passing  the  ca¬ 
theter,  not  much  pain  expressed,  which  would  be  if  the  blad¬ 
der  was  inflamed .  Dissection  would  be  highly  explanatory 
and  useful,  as  I  had  so  much  more  pain  in  evacuating  the 
bladder,  and  as  thirst  was  his  greatest  distress,  and  had  yes¬ 
terday  indulged  him  in  various  fluids,  such  as  tea,  succ. 
limon.  and  every  two  hours  vin.  one  ounce,  e.  confect, 
aromatic  and  kali  pp.  as  also  with  some  soup,  and  a  little 
wine  occasionally.  He  often  felt  faint  yesterday,  and  in  the 
night,  and  once  greatly  so  at  2  A.  M.  appeared  to  be  going 
off;  on  the  whole  it  appears  vain,  farther  to  try  any  means 
,pf  cure.  Keep  him  as  clean  and  quiet  as  possible,  indulge 
his  desire  for  drink,  which  has  not  been  evacuated  in  pro¬ 
portion  to  what  he  has  received;  and  as  the  scrotum  was 
very  tense,  though  not  so  large  as  formerly,  yet  I  made 
several  deep  punctures  in  the  scrotum  last  evening,  from 
which  there  was  a  considerable  oozing;  this  will  allow  the 
freer  use  of  fluids,  which  appears  to  be  his  greatest  con¬ 
solation;  and  a  mercy  now  to  let  him  die  as  easy  as  I  can. 

a  26.  The  poor  fellow  can  scarce  be  said  to  be  alive,  and 
has  not  had  a  rational  interval  since  6  A.  M.  yesterday;  the 
restlessness  is  immense^  it  is  impossible  to  keep  on  any  dress¬ 
ing.  The  eye  became  fixed  about  4.  Pulse  gradually  fell, 
scarce  perceptible,  body  stretched  out. 

((  At  9,  breathing  laborious,  and  he  was  thought  to  be 
going  off,  but  pulse  got  up  again,  and  he  seemed  to  be  better 
the  rest  of  the  day  ;  there  was  also  more  heat  of  the  body, 
even  of  the  feet  than  for  two  days  past:  which,  with  moisture; 


1809.]  Surgery .  SSf 

of  body,  as  is  often  felt  before  the  last  period,  and  which,  to 
one  unexperienced,  might  lead  to  an  opinion  he  was  better, 
but  it  is  only  the  last  effort  and  labour  of  nature. 

6(  27.  He  survived  all  yesterday  till  7  P.  M.  when  he 
breathed  his  last  very  quietly. 

u  I  proceeded  to  dissect.  The  first  object  was  to  ascer¬ 
tain  the  nature  of  the  swelling  of  the  groin;  it  was  nothing 
more  than  extravasated  urine,  which  the  scrotum  was  not 
able  to  hold;  it  was  evacuated  upwards,  only  under  the  in¬ 
teguments  a  few  ounces  lodged  there,  and  the  cellular  mem¬ 
brane  was  dissolved  and  corroded  by  it,  and  gangrene  also ; 
so  that  the  extreme  sensibility  there  was  the  effect  of  in¬ 
flammation  of  the  integuments ;  muscles,  though  thicker  on 
that  side,  not  decidedly  inflamed,  nor  was  any  of  the  perito¬ 
naeum  attached  to  the  bladder;  found  the  bladder  sunk  deep 
in  the  pelvis,  small,  and  hard,  partly  solid,  and  partly  of 
that  thickness  produced  by  inflammation;  its  fundus  exter¬ 
nally  red,  not  a  drop  of  urine  in  it,  firmly  united,  but  not  so 
strongly  as  Sharp’s,  by  adhesive  layers,  but  yet  very  firmly 
to  the  peritonaeum  behind,  and  on  its  sides,  and  to  the  arclr 
of  the  pubis.  The  next  object  was  the  state  of  the  scrotum  ; 
integuments  gangrened,  the  dartos  was  covered  with  feet  id 
matter,  and  nearly  black,  mixed  with  serum,  urine,  and 
blood  ;  so  also  the  same  kind  of  matter  beneath  all  the  parts 
which  were  dissolved, 

u  This  layer  of  matter,  supposed  to  be  the  cause  of  the 
repeated  and  severe  rigours,  but  undoubtedly  many  of  those 
rigours  also  attended  as  indicative  of  the  great  inflammation; 
for  the  integuments  of  the  scrotum  did  not  seem  to  have  rim 
into  gangrene,  as  the  effect  of  inflammation  alone,  but 
mostly,  perhaps,  the  effect  of  extravasated  blood,  and  dis¬ 
organization  from  the  fall.  Tunica  vaginalis  thickened,  and 
firmly  united  to  septum  scroti,  but  bodies  of  testes  natural ; 
so  was  also  the  cord.  Now  the  great  point  is  to  refer  to 
the  peringeum  ;  I  dissected  off  the  integuments  cautiously, 


358  Surgery *  [April* 

exposed  in  the  anterior  part  (speaking  as  a  body  is  usually 
placed  for  such  dissection)  of  the  membranous  part  of  the 
urethra;  an  aperture  decidedly  not  made  by  the  knife,*  it 
has  all  the  appearance  of  an  old  hole,  about  the  size  of 
a  small  oblong  bean.  I  had  previously  introduced  the  ca¬ 
theter  as  far  as  it  could  go,  but  not  into  the  bladder,  even 
now  after  death ;  it  appeared  to  be  stopped  by  the  neck  of  the 
bladder.  Here  was  a  fu  11  explanation  of  the  cause  and  na¬ 
ture  of  his  disease.  In  proceeding  to  take  out  the  bladder, 
and  dissecting  the  sides  of  the  urethra,  where  it  attaches  to 
the  arch  of  the  pubis,  found,  on  the  right  side,  the  knife  un¬ 
expectedly  to  slip  into  a  large  cavity,  exterior  to  the  pel¬ 
vis;  when,  by  taking  off  some  of  the  integuments  of  peri- 
naeum,  and  towards  the  anus,  sawr  a  distended  layer  of  the 
membranous  part  of  the  urethra,  to  the  size  of  a  small  hen's 
egg;  it  was  soft,  and  so  putrid  that  it  would  not  bear  the 
knife,  and  being  then  accidentally  divided,  a  few  ounces  of 
urine  came  out ;  so  this  part  had  formed  a  sac  for  urine, 
the  parietes  of  which  were  formed  above  by  the  still  remain¬ 
ing  entire  side  of  the  urethra,  till  it  came  to  the  immediate 
laceration  spoken  of,  which  was  rather  on  the  left  side;  here 
the  waters  first  escaped,  since  that,  gradual  solution  of  the 
inflamed  sides  of  the  urethra  has  gone  on,  so  that  at  last  infe¬ 
rior  parietes  of  the  sac  were  formed  rather  by  the  perinasum 
itself,  which  alone  suspended  the  urine  there  lodged;  this 
decay  has  been  the  work  of  the  inflammation,  and  consequent 
gangrene  :  had  it  fortunately  terminated  in  abscess  at  first,  as 
was  hoped  for,  fistula  in  perinaeo  might  have  saved  him  ;  but 
the  contusion  had  been  too  great,  and  there  was  no  indica¬ 
tion  for  making  an  aperture  in  perinaso,  for  want  of  a  place 
indicated ;  as  also  the  state  of  the  parts  forbid  it ;  moreover, 
till  the  last  clay,  after  the  first  inflammation,  the  urine  had 
been  evacuated  by  the  catheter ;  in  short,  it  appears,  in  my 
opinion,  that  nothing  could  have  saved  him. 

6i  Compare  this  case  with  that  of  poor  Sharp;  it  is  sin- 


1809.]  Surgery.  '  359 

gular  that  I  should  have  two  such,  so  quick,  and  so  highly 
important,  interesting,  and  unfortunate  in  their  consequences. 
In  this  case  1  would  presume  to  fix  the  attention  of  the  prac¬ 
tical  surgeon  on  this  grand  and  leading  particular ;  that  when 
the  urethra  is  divided,  the  passage  of  urine  through  such 
aperture,  will  not  be  a  remote  and  secondary  consequence, 
but  a  primary  and  immediate  effect.” 


HYDATIDS  OF  T1IE  URETHRA. 

A  singular  disease  that  sometimes  occurs,  though  rare,  is 
hydatids  of  the  urethra,  and  the  following  instance  of  it  is 
recorded  by  Mr.  Ken  worthy  : 

“  In  August,  1808,  I  was  requested  to  visit  a  man  in  the 
poor-house  of  Saddle  worth,  about  45  years  of  age,  who  was 
suffering  excessive  pain  from  long  retention  of  urine.  I  im¬ 
mediately  introduced  the  catheter,  and  drew  away  about  two 
pints  of  high-coloured  foetid  urine,  which  produced  the 
same  glutinous  effect,  as  it  dried  on  my  hand,  as  a  weak  solu¬ 
tion  of  gum  arabic  or  glue.  During  the  time  of  its  flowing 
off,  I  several  times  applied  the  tip  of  my  finger  to  the  mouth 
of  the  catheter,  for  the  purpose  of  preventing  faintness  by  its 
sudden  discharge.  When  the  bladder  was  completely  emp¬ 
tied,  I  questioned  him  particularly  respecting  the  progress  of 
his  disease,  and  he  informed  me,  that  upwards  of  three  years 
he  had  been  troubled  with  uneasiness  in  the  urinary  organs, 
which  had  never,  during  that  time,  entirely  left  him ;  such 
as  a  frequent  and  ineffectual  desire  to  make  water,  pain  in 
his  loins  and  throughout  the  hypogastric  region,  with  other 
symptoms  of  disarrangement,  which  had  gradually  increased 
during  the  whole  of  the  time.  In  the  early  stages  he  had  no 
sickness,  heat,  nor  thirst;  but,  towards  a  later  period,  he  had 
frequently,  after  using  an  increased  exercise,  or  change  of 
weather,  suffered  from  the  characteristic  symptoms  of  sym- 


/ 


SCO  iurgtry.  [Apri!, 

pathetic  inflammatory  fever,  from  which  I  suspected  that 
Some  latent  inflammation  had  been  carried  on ;  the  testes 
■were  frequently  painful  to  the  touch,  and  particularly,  when 
Ire  had  more  uneasiness  in  making  water,  they  retracted  very 
considerably ;  there  was  a  numbness  in  the  buttocks  extend¬ 
ing  down  the  thighs ;  and  within  the  three  or  four  months 
preceding  the  time  I  first  saw  him,  he  had  suffered  exceed- 
ingly  from  nausea  and  vomiting ;  feverish  symptoms  and  rest* 
lessncss,  and  an  excessive  and  frequent  desire  for  micturition, 
which  induced  him  to  strain  so  violently  at  times,  as  to  force 
the  rectum  down  to  the  extent  of  several  inches.  He  in¬ 
formed  me,  that  in  June  he  had  been  examined  by  a  Mr.  B. 
who  sounded  him,  and  gave  it  as  his  decided  opinion,  there 
Was  a  calculus  in  the  vesica  urinaria;  he  accordingly  or¬ 
dered  him  to  Manchester  Infirmary  for  operation,  the  man 
not  being  capable  of  discharging  the  expenses  likely  to  be 
incurred;  but  as  the  surgeons  of  that  institution  could  not 
possibly  discover  any  thing  of  the  nature  of  a  stone,  he  wras 
consequently  returned  without  operation. 

cc  While  yet  the  catheter  was  retained  within  the  urethra, 

I  endeavoured  to  examine  whether  there  was  any  extraneous 
body  lodged  within  the  vesica  urinaria,  and  in  passing  the 
point  of  the  instrument  carefully  in  different  directions,  I 
discovered  a  tumour  of  considerable  magnitude,  attached 
near  to  the  neck  of  the  bladder,  of  a  rather  soft  consistence, 
yielding  to  the  point  of  the  catheter,  without  inducing  the 
least  pain .  The  cause  of  retention  was  evidently  mecha¬ 
nically  effected  by  this  preternatural  growth,  acting  as  a 
valve.  Pursuing  my  examination,  as  to  the  bulk,  form,  &c. 
of  the  tumour,  I  accidentally  ruptured  one  side  of  it,  and  a 
large  quantity  of  hydatids,  from  three-fourths  of  an  inch 
diameter  to  the  size  of  a  pin’s  head,  were  slowly  discharged 
through  the  canal  of  the  urethra,  perhaps  to  the  amount  of 
three  half  pints,  I  ordered  him  the  following  mixture : 


1809.]  Surgery,  3&1 

u  R:  01.  amygdal  diilc.  Mucil:  g.  arab.  aa.  six  drams. 
Tinct.  opii  gtta.  thirty.  Aquae  distillat.  four  ounces  and  a 
half.  M.  sign  a.  Capt.  cochl.  major,  ij.  3  qq.  hora. 

<c  The  pubes  and  perinaeum  to  be  fomented  with  warm 
water ;  confined  him  to  a  recumbent  position,  and  directed 
the  use  of  infus.*  simenis  lini,  together  with  a  diet  of  milk, 
broths,  &c.  He  continued  in  this  course  about  a  fortnight; 
he  has  suffered  no  material  inconvenience  since,  and  now  en¬ 
joys  a  good  state  of  healtli ,  except,  that  at  times  he  feels  a 
slight,  uneasiness  from  excess  of  exercise,  or  the  variations  of 
the  atmosphere.5* 


TINEA  CAPITIS, 

"YVe  have  already  stated,  in  a  former  Number,  is  a  disease 
which  often  disappoints  the  practitioner  in  its  cure.  A  suc¬ 
cessful  method  is  pointed  out  by  Mr.  Morison,  of  Dublin,  in 
the  following  case 

u  The  friends  of  B.  D.  aged  about  16,  made  application 
to  me  concerning  his  disease,  which  was  a  case  of  inveterate 
Tinea,  Capitis,  attended  with  those  troublesome  symptoms 
observable  on  such  occasions  ;  such  as  extreme  itching,  heat, 
&c.  On  a  minute  inquiry  into  the  progress  of  this  formi¬ 
dable  complaint,  I  was  told,  that  he  had  applied  to  every 
medical  and  surgical  advice  that  this  great  metropolis  could 
afford,  without  the  necessary  relief,  and  that  it  had  continued 
uninterruptedly  for  about  four  years. 

“  When  I  carefully  examined  the  parts  affected,  I  per¬ 
ceived  the  entire  scalp  to  be  overspread  with  a  loathsome  in* 
crustated  appearance,  and  that  it  emitted,  at  the  same  time,  a 
singularly  offensive  fcetor  ;  there  was,  moreover,  a  disposition 
to  debility  in  his  habit  of  body  ;  the  digestive  powers  were 
much  impaired,  and  many  predisposing  marks  of  a  scrofulous 
constitution  were  apparent. 

“  Though  an  intimate  acquaintance  with  the  structure  of 

VOL.  II. 


B  e 


3G2 

the  human  body  is  indispensably  necessary  to  qualify  a  man 
for  becoming  a  good  surgeon,  yet  many  who  are  not  adepts 
in  anatomy  may  be  instructed  so  as  to  assist  their  fellow- 
creatures  in  cases  of  emergency.  The  operation  for  perfects 
ing  a  radical  cure  in  cases  of  tinea  capitis,  I  have  seen  per¬ 
formed  by  persons  unacquainted  with  the  profession,  and  with 
amazing  facility. 

16  I  gave  directions  to  the  subject  of  this  case  to  have  his 
head  as  closely  shaved  as  was  possible,  and  in  such  parts 
thereof  as  the  razor  could  not  touch,  the  scissars  was  necessa¬ 
rily  substituted ;  a  common  poultice  was  then  applied  over 
the  parts  affected  ;  at  the  same  time  my  patient  was  advised 
to  call  upon  me  in  the  course  of  a  few  days. 

u  When  he  came  as  instructed,  I  observed  that  the  poultice 
had  effected  its  purpose,  so  far  as  to  render  soft  the  incrusta* 
iion  ;  yet  it  exhibited  a  very  foul  appearance,  and  with  little 
or  no  diminution  of  foetor;  also,  the  scabs  continued  to  rigp 
higher  and  thicker  above  the  surface. 

u  After  another  careful  removal  of  the  hair,  and  the  head 
being  well  washed  with  warm  soap  and  water,  I  applied  the 
paste  compounded  as  below,  and  spread  on  strips  of  strong 
linen  :  Of  yellow  resin,  two  ounces ;  of  best  ale,  one  pound  ; 
of  the  finest  flour,  three  ounces.  To  the  melted  resin,  add 
the  ale  and  flour  gradually,  the  two  latter  ingredients  having 
been  previously  intermingled  in  a  bason  together* 

“  Each  morning  I  removed  the  paste,  strip  after  strip, 
which  gave,  on  the  first  applications,  some  degree  of  pain 
and  uneasiness.  It  was  also  attended  with  a  slight  effusion 
of  blood ;  yet  he  told  me,  with  much  satisfaction,,  after  its 
removal,  that  his  head  was  much  easier  than  he  had  remem¬ 
bered  it  since  the  commencement  of  the  disease,. 

“  I  cautiously  and  attentively,  for  three  weeks,  removed 
and  re-applied  this  adhesive  paste,  observing  that  my  pa¬ 
tient  was  less  affected  with  pain  after  each  succeeding  appli¬ 
cation  :  I  also,  with  a  pair  of  scissars,  clipped  off  the  hair 


Surgery* 


£  April* 


1S09*]  Surgery.  £63 

which  began  to  grow,  and  gently  separated  such  rising  parts 
a§  might  prevent  the  adhesion  of  the  paste.  From  the  first 
application  to  that  period  wherein  I  could  pronounce  a  per¬ 
fect  cure,  the  effusion  of  blood  was  observed  to  diminish 
gradually,  that  had  issued  on  the  first  dressings,  and  all 
other  appearances  proceeded  favourably. 

u  Some  j^ears  ago,  1  inserted  a  paper  in,  the  Annals  of  Me¬ 
dicine  of  Edinburgh,  on  the  foregoing  disease,  which  has 
Since  been  transcribed  into  the  fourth  edition  of  Doctor  Un- 
der wood’s  Treatise  on  the  Diseases  of  Children.  In  that 
Case,  with  the  account  therein  given  of  its  radical  cure  by  the 
above  paste,  I  perceive,  what  must  have  been  an  error  of  thb 
plrtss,  the  yellow  resin  is  directed  to  be  added  to  t be  other 
ingredients  ;  the  intention  (according  to  the  rules  of  phar¬ 
macy)  Was  to  have  the  resin  first  dissolved,  and  to  add  the 
thinnest  part  of  the  ale  and  flour  gradually ;  continually 
Stirring  it  in  a  brass  skillet,  on  a  brisk  fire,  until  the  whole  be 
perfectly  incorporated,  and  assume  a  thick  gelatinous  ap¬ 
pearance. 

u  The  paste  was  directed  to  be  spread  as  above  and  re¬ 
newed  each  day,  whilst,  at  the  same  time,  the  head  was  to  be 
rubbed  well  With  a  coarse  cloth,  towards  the  termination  of 
the  disease.  By  this  mode  of  procedure,  I  have  radically 
cured,  in  about  eleven  years,  forty-eight  patients ;  and,  as 
far  as  I  can  understand,  not  one  of  them  has  had  the  least 
return  of  the  Complaint;  they  most  generally  enjoy  good 
health,  and  have  remarkably  fine  hair.” 

We  are  sorry  to  observe,  that  we  do  not  conceive  that  the 
above  paste  can  be  formed.  That  the  only  effect  which  the 
ale  can  produce  must  arise  from  the  alcohol,  and,  therefore, 
that  the  preparation  may  be  made  in  a  much  easier  and  even 
more  effectual  manner. 


£  B  £ 


364 


Surgery. 


[April, 


ON  THE  REMUNERATION  OF  MEDICAL  MEN,  AND  THE  PRO¬ 
PRIETY  OF  THE  LEGISLATURE  ENACTING  CERTAIN  REGU- 

>  •  \  '  ;  ■  - 

LATIONS  ON  THAT  HEAD. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen . — The  profession  of  medicine  is  properly  a  li¬ 
beral  one,  and  in  the  exercise  of  it  is  often  too  liberal  an  one ; 
for  it  must  be  allowed,  there  is  not  that  remuneration  attend¬ 
ing  its  services  which  is  paid  to  the  labours  of  the  law  and 
the  church.  The  care  of  the  goods  and  chattels  is  repaid  in  a 
more  munificent  manner  than  the  care  of  life  and  health,  and 
the  opening  prospect  of  immortality,  which  the  churchman 
holds  forth,  secures  a  better  reeompence  in  this  world  than 
what  he  often  sets  before  his  votaries  in  the  next.  The  ad* 
vantage  to  these  professions  arises  from  their  being  interwoven 
with  the  constitution  of  the  country;  the  one  being  the 
guardian  of  property,  and  the  other  supposed  to  be  of  morals. 
The  health  and  constitution  is  left  out  of  the  business  as  an 
inferior  consideration.  From  this  circumstance,  the  situation 
of  the  medical  profession  is  rather  a  hard  one.  The  fee  of 
the  physician  is  entirely  a  gratuitous  business ;  and  he  can 
have  no  claim  for  his  reeompence  but  in  the  generosity  of 
the  patient ;  a  generosity  which  is  too  often  forgotten  when 
the  hour  of  pain  is  past.  Law  does  not  even  sanction,  or  if 
he  put  in  his  plea,  allow  it  to  be  made  good.  The  surgeon 
stands  much  in  the  same  situation.  His  claim  can  be  dis¬ 
puted,  and  his  science  and  operative  dexterity  pass  unremu¬ 
nerated,  The  apothecary  is  the  only  one  that  is  entitled  to 
possess  a  legal  claim,  because,  in  the  language  of  trade,  he 
furnishes  goods,  and  gives  what  John  Bull  considers  as  value 
received.  He  is  obliged,  therefore,  to  pay  for  what  he  terms 
the  Doctor's  stuffy  while  the  knowledge  and  advice  of  the 
physician,  and  the  manual  skill  of  the  surgeon,  are  weighed 
in  a  lesser  scale,  and,  in  his  opinion,  found  wanting. 

Would  it  not  be  to  the  honour  and  credit  of  the  Legisla- 


1809.]  Surgery ,  S63 

ture,  that  the  medical  profession  were  put  under  similar  re¬ 
gulations  with  the  other  kindred  professions  of  the  law  and 
the  church.  It  would  be  paying  a  proper  attention  to  the  in¬ 
terest  of  the  community,  and  it  would  be  placing  those  whose 
care  and  skill  are  directed  to  the  noblest  of  purposes,  the  relief 
of  their  fellow -creatures;  on  a  more  sure  footingthan  they  at 
present  stand.  While  their  privileges,  as  a  college,  are 
protected  by  royal  charter,  their  remuneration  is  left  to  the 
whim  and  caprice  of  every  one  they  attend.  It  is  well  known 
that  neither  generosity  nor  gratitude  are  qualities  universally 
prevalent ;  and  where  they  are  wanting,  and  there  is  no  com¬ 
pulsion,  recompence  may  be  forgotten,  or  justice  both  lame 
and  blind  on  the  occcasion. 

We  contend,  therefore,  that  it  would  be  an  act  beneficial 
equally  to  the  community  as  to  the  profession,  that  medical 
fees  were  regulated  by  law,  and  that  these  regulations  should 
extend  to  the  three  orders  of  the  profession,  in  their  separate 
departments  of  physician,  surgeon,  and  apothecary.  On  the 
continent,  the  fees  of  the  physician  are  settled  by  law,  and  the 
consequence  of  this  is,  that  the  public,  knowing  the  extent  of 
their  expense,  he  is  called  in  regularly  on  the  most  trifling 
occasions,  and  thus  mischief  prevented,  either  from  neglect, 
from  a  dread  of  expense,  or  from  passing  into  ignorant  hands. 
In  Britain,  the  same  plan  ought  to  be  adopted,  and  the  fees  re¬ 
gulated  by  the  value  of  money,  as  ascertained  by  the  rates  of 
living.  Indeed,  we  are  of  opinion,  such  a  measure  should  be 
concerted  by  the  profession  themselves,  in  a  regular  meeting 
of  the  physicians,  surgeons,  and  apothecaries,  in  their  sepa¬ 
rate  capacities,  and  resolutions  should  be  entered  into  by  them 
of  petitioning  parliament  on  this  head.  Such  a  step  would 
by  no  means  be  a  bar  to  generosity.  On  the  contrary,  it 
would  render  it  more  striking,  and  satisfy  the  patient  to  what 
extent  he  was  carrying  it. 

If  one  profession  deserves  to  be  liberally  rewarded  more 
than  another,  it  is  that  of  physic.  When  we  consider  the 

b  b  3 


366  Surgery,.  ,  [April* 

anxiety  tliat  attends  tbe  conduct  of  a  medical  practitioner, 
the  nice  circumstances  with  which  his  reputation  is  con¬ 
nected,  and  the  certainty  of  blame  being  attached  to  him,  too 
often  without  a  cause,  from  the  caprice  of  the  patient,  and 
the  slow  progress  that  has  as  yet  been  made  in  this  conjectural 
art ;  it  may  be  justly  said  that  the  services  of  the  profession 
cannot  be  bought  too  high.  So  true  is  the  language  of  John¬ 
son  on  this  point,  that,  when  speaking  of  medicine,  he  says, 
u  It  is  the  most  disgusting  of  all  professions,  for  it  consists  of 
a  melancholy  attendance  on  misery,  a  mean  submission  to, 
peevishness,  and  a  continual  interruption  of  rest  and 
pleasure.” 

Yet,  instead  of  high  remuneration,  it  will  be  found  that  the 
fortunes  made  by  physic  are  few  indeed  ;  and  that,  after  an 
expensive  education  and  arduous  study,  to  prepare  for  prac¬ 
tice,  a  life  is  spent  in  pursuing  the  latter,  without  being  able 
to  retire  to  the  oliurn  with  what  may  be  termed  bate  comfort* 
much  less  cum  digmkUe. 

On  the  contrary,  the  practitioner  in  law  soon  amasses,  from 
his  fees,  a  handsome  independence,  and  while  yet  his  powers 
are  entire,  withdraws  himself  from  the  bustle  of  business,  and 
closes  the  evening  of  life  in  happiness,  the  fruit  of  industry, 
no  doubt  ,  but  still  of  less  anxious  care  than  what  has  attended 
the  life  of  the  medical  practitioner.  A  new  system,  there¬ 
fore,  should  be  adopted  in  physic ;  and,  as  the  labourer  is 
ever  worthy  of  his  hire,  the  profession  should  seriously 
apply  to  place  themselves  in  a  situation  that  they  may  know 
what  they  should,  receive,  and  also  have  it  in  their  power  to 
enforce  it. 

I  am,  Gentlemen, 

Your  obedient  servant, 

G.  BAKER. 


Salisbury,  March  5,  1809. 


1809.] 


Surgery. 


867 


ON  THE  MANAGEMENT  OF  THE  TEETIJ,  AND  THE  EMPIRI¬ 
CAL  APPLICATIONS  IN  USE  FOR  CLEANING  AND  PRE¬ 
SERVING  THEM. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gentlemen — ‘Why  the  diseases  and  management  of  the 
teeth  should  be  given  up  by  the  surgeon,  and  made  a  sepa¬ 
rate  business,  I  cannot  surmise.  The  dentists  avail  them¬ 
selves  of  the  influence  of  the  surgeon  i  and  make  this  branch 
of  what  is  properly  surgery,  a  lucrative  concern,  not  only 
in  their  operations,  but  by  means  of  their  quack  preparations 
for  beautifying*  as  it  is  in  fact,  and  preserving  the  teeth. 
The  directions  for  the  use  of  these  are  replete  with  the 
most  ridiculous  and  unintelligible  nonsense,  written,  I  pre¬ 
sume,  to  amuse  the  mind  and  catch  the  attention  of  the  igno¬ 
rant,  and  especially  of  the  fair  sex. 

Placing  myself  in  the  situation  of  one  who  have  a  set 
of  teeth,  I  suppose  I  may  be  allowed  to  consider  the  dis¬ 
eases  to  which  they  are  subject,  without  incurring  the  impu¬ 
tation  of  presumption  from  these  gentlemen.  It  appears  to 
me  that  many  of  the  diseases  t«  which  the  teeth  are  subject, 
originate  from  a  disordered  state  of  the  gums.  The  matter 
that  collects  in  the  teeth,  scientifically  termed  by  the  dentist 
tartar,  is  e  violently  a  morbid  secretion  from  this  part,  in  conse¬ 
quence  of  its  inflammation,  its  spongy  state,  or  its  being  de¬ 
tached  from  the  teeth,  the  latter  of  which  is  the  most  frequent 
source  of  this  collection.  Thebrushand  tooth -powder employ¬ 
ed  for  the  purpose  of  removing  this  matter,  both  tend  to 
aggravate  the  evil,  by  detaching  the  gum  from  the  teeth, 
and  irritating  its  edges.  Hence  people,  who  are  in  the 
habit  of  using  them,  are  obliged  to  do  it  every  morn¬ 
ing  to  remove  the  concretion  that  collects  during  the  night. 
People,  on  the  contrary,  who  are  only  in  the  habit  of  using 
a  sponge  and  cold  water,  have  no  such  collection,  The 
gums  are  also  less  spongy,  and  their  edges  level  with  the 
teeth,  The  gums.,  judging  from  the  firmness  of  their  tex* 


368 


Surgery.  [April,  • 

i  T  / 

ture  and  vascularity,  not  only  afford  a  great  support  to 
the  teeth,  but  also  give  them  nourishment ;  and  if  they 
be  diseased,  the  teeth  vyill  be  liable  to  assume  the  same 
state  which  the  mechanical  action  of  the  tooth  powder 
will  accelerate.  On  examining  a  diseased  tooth,  we  are 
certain  always  to  find  the  surrounding  gum  either  con- 

v  * 

siderably  abraded,  discoloured,  or  soft  and  tender.  The 
enamel  of  the  tooth  I  believe  to  be  principally  or  entirely 
supported  by  the  gum,  and  if  it  be  detached  or  irritated 
every  day,  a  tooth  will  not  be  properly  nourished,  and  ca¬ 
ries  will  of  course  follow.  Every  tooth-ache  I  believe  to  be 
an  inflammation  of  the  membrane  lining  the  socket,  and  this 
inflammation  generally  terminates  in  the  formation  of  matter 
termed  gum  boil. 

Pentists  tell  us  not  to  employ  acids  of  any  kind,  be¬ 
cause  they  destroy  the  enamel;  and  if  that  be  destroyed, 
caries  will  certainly  follow.  But  I  have  known  many 
people  who  have  had  their  teeth  broke  off  by  accidents, 
which  have  not  been  succeeded  by  caries,  and  therefore  I  am. 
inclined  to  doubt  the  veracity  of  this  doctrine ;  besides,  few 
chemists  will  allow  that  diluted  mineral  or  vegetable  acids 
(with  which  dentists  are  very  free  themselves)  will  act  on 
a  healthy  tooth.  If  a  person  gently  washes  the  gum  three 
times  a  week  with  a  little  sponge  (fastened  to  the  end  of 
a  little  ivory)  moistened  with  an  astringent  tincture,  as 
that  of  Rhatany  Root,  or  Cinchona,  he  will  find  that 
liis  teeth  will  not  only  be  firmer  and  sounder,  but  free  from 
tartar  and  tooth-ache;  and  if  he  will  take  the  trouble  to> 
examine  the  gums  of  those  who  have  been  in  the  constant 
habit  of  using  powder  and  brushes,  he  will  be  convinced  of 
their  destructive  effects. 

These  few  hints  are  intended  to  lead  persons  to  pay  more 
attention  to  the  sta(e  of  their  gums  than  to  the  teeth  them¬ 
selves  ;  for,  if  the  gums  are  kept  healthy,  an  application 
to  the  dentist  will  seldom  be  necessary.  It  would  be  well, 


1809.]  s  Surgery  f  869 

then,  that  surgeons  were  in  this  department  resuming  their 
own  rights,  and  treating  the  diseases  of  the  teeth  as  a  class 
deserving  their  attention  equally  with  those  in  other  parts 
of  the  body.  Mr,  John  Hunter  has  shewn  us,  in  his  judir 
cious  treatise  on  the  natural  history  and  diseases  of  the  teeth, 
that  it  is  a  subject  worthy  investigation,  and  had  the  outline 
he  chalked  out  been  minutely  tilled  up,  and  studied  more 
by  surgeons,  a  door  would  have  been  shut  against  the  der 
ceptions  of  empirical  pretenders.  There  is  no  dentist  with- 
our  his  tooth  powder  or  tincture,  which  are  both  considered 
as  valuable  secrets,  though  the  first  is  generally  an  absorbent 
powder,  as  the  scuttle-fish-bone,  with  a  proportion  of  myrrh 
or  other  aromatic,  and  coloured  with  red,  either  with  In¬ 
dian  pink,  or  sanders,  to  give  it  a  pleasing  appearance. 
The  tincture  again  is  a  vegetable  astringent,  infused  in  spirits, 
either  with  tincture  of  myrrh,  or  bark,  and  containing  a  pro¬ 
portion  of  mineral  acid. 

I  might  enlarge  on  this  subject,  but  I  hope  these  few 
observations  will  answer  the  intention  of  calling  the  minds  of 
the  profession  to  so  interesting  a  topic. 

I  remain,  Gentlemen, 

Y our  obedient  servant, 

Henrietta- Street,  March  6,  1809.  R.  REECE. 

A halomico-  Ch irurgical  Views  of  the  Nose,  Mouth ,  Larynx" , 
and  Fauces ;  with  appropriate  Explanations  and  Refer¬ 
ences.  By  John  James  Watt ,  Surgeon.  Together  with 
an  additional  Anatomical  Description  of  the  Parts .  By 
Mr.  W.  Lawrence ,  Demonstrator  of  Anatomy  at  St. 
Bartholomew' s  Hospital . — The  Engravings  executed  by 
Ilopwoody  from  Original  Drawings ,  by  T.  Baxter.  Folio. 
Price  \l.  11s.  6d.  plain ,  or  21.  2s.  coloured. 

The  publications  on  anatomy  have  of  late  years  much 
^creased.  Little,  however,  original  has  been  added  to 
our  stock  of  knowledge  on  the  subject,  and  the  labour  of 


370  Surgery.  [April, 

authors  has  been  chiefly  expended  in  elucidating  some 
controverted  points,  and  giving  interest  and  importance  to 
the  study  by  their  delineations.  The  author  before  us  has 
selected  certain  parts  of  the  body  of  high  consequence,  in 
order,  by  placing  them  in  new  positions,  to  elucidate  more 
clearly  their  structure,  with  a  view  to  render  the  seat  of 
their  diseases  more  distinct,  and  their  treatment  better  under* 
stood. 

The  first  plate  exhibits  an  outline  of  the  back  part  of  the 
head,  to  shew  the  posterior  position  of  the  oesophagus  and 
trachea,  in  points  of  view  in  which  they  are  not  usually 
taken  by  other  anatomists . 

The  same  plate  is  continued  by  a  delineation,  according 
to  the  natural  appearance,  done  with  care  and  fidelity,  and 
equally  creditable  to  the  anatomist  and  engraver.  The  ex¬ 
planation  of— 

The  second  plate  exhibits  a  front  view  of  the  same  parts, 
first  in  outline,  and  then  according  to  the  natural  appear* 
ance,  the  parts  being  cut  open  in  such  a  manner  as  to  gi  ve 
a  clear  and  perspicuous  view  of  the  whole. 

The  third  plate  delineates  a  side  view  of  the  same  parts 
Of  the  human  structure,  and  has  equal  merit  with  the 
farmer.  '  '  '  *  '■  '"H%  •$?* 

The  fourth  plate  gives  a  view  of  some  parts  not  so  di¬ 
stinctly  laid  open  in  the  former ;  continuing  the  former 
view,  and  the  whole  is-  finished  by  a  brief  demonstration 
of  the  organs  delineated,  and  their  functions,  from  the  pen 
of  Mr.  Lawrence. 

The  anatomical  demonstrations  in  this  work  are  very  mi* 
ante,  accurate,  and  well  described.  The  explanation  of 
the  plates  is  by  Mr.  Watt  himself.  We  can  only  say,  if 
anatomy  is  to  be  learned  by  delineations,  which  we  think  is 
the  best  plan,  the  present  publication  has  a  title  to  stand 
high  in  point  of  beautiful  engravings,  accurate  descrip¬ 
tion,  and  prominent  line  of  viewing  the  subjects,  Wjs 


c 


1809.] 


37! 


hope  Mr,  Watt  will  extend  his  present  plan  with  equal 
fidelity  and  merit,  and  his  subscribers,  who  are  numerous  and 
respectable*  will  not  fall  off  from  this  first  specimen. 


■*  • 


III.  MIDWIFERY. 

As  the  class  of  slow  labour  is  more  perplexing  to  the  ac* 
jcoueheur  than  any  other,  an  acquaintance  with  the  cause 
fhould  always  he  studied  early  to  lay  down  a  proper  mode  of 
procedure.  Many  fanciful  causes,  have  been  enumerated  by 
authors,  and  among  them  has  been  stated  shortness  of  the  umr 
bilical  cord.  The  umbilical  cord  is  indeed  sometimes  twisted 
found  the  child’s  neck,  but  rarely  to  that  degree  that  it 
would  retard  the  child’s  labour.  The  good  effects  of  blood* 
Jetting,  in  slow  labours,  particularly  in  women  of  a  tense 
fibre,  and  after  a  certain  period  of  life,  are  well  known  to 
practitioners ;  and  though  this  practice,  as  [recommended  on 
different  principles  from  what  direct  us  in  this  country  by 
JDr.  Rush,  may  be  carried  too  far,  yet  a  reasonable  bleeding 
in  a  slow  labour  will  do  more  to  expedite  delivery  than  any 
Other  means.  This  fact  is  strongly  contended  for  by  Mr. 
JJfowii  in  the  following  communication  : 

u  Mrs.  G.  aged  32,  a  powerful  strong  woman,,  of  large  sta* 
ture,  was  taken  in  labour  of  her  first  child,  on  Sunday  morn¬ 
ing,  at  four  o’clock.  When  I  saw  her,  at  twelve  o’clock,  it 
was  reported  to  me,  that  her  pains  had  been  almost  incessant, 
and  as  strong  as  she  could  possibly  support.  Accustomed  to 
these  expressions,  I  did  not  at  first  much  regard  them ;  but 
I  found  the  representation  had  not  been  incorrect,  for  the 
distress  induced  by  the  pains>  and  their  frequent  and  appt> 
rent  violence  were  fully  corroborated  by  my  own  observation. 
The  os  uteri  I  found  slightly  dilated,  jigid,  and  unyielding, 
gjid  its  cervix  appeared  constricted  internally,  as  if  by  a  li* 
g  amenta  us  band  of  some  breadth,  From  this  period  till 


372 


Midwifery .  [April, 

seven  o’clock  in  the  evening,  in  which  time  I  saw  her  fre¬ 
quently,  there  did  not  appear  any  material  alteration,  ex¬ 
cepting  that  the  pains  were  more  frequent,  and  the  conse¬ 
quent  distress  to  the  patient  greater,  as  the  labour  did  not 
seem  advanced  by  them.  The  os  uteri,  at  this  time,  ap¬ 
peared  dilated  to  nearly  the  size  of  half  a  crown,  but  equally 
rigid  and  thick  as  before,  with  the  same  degree  of  constric¬ 
tion  at  its  cervix, 

*£  I  now  determined  upon  bleeding,  as  the  most  likely  means 
of  diminishing  those  powers  of  resistance  which  prevented 
the  progress  of  the  labour.  I  took  away  twenty  ounces  of 
blood.  Its  first  effect  appeared  to  protract  the  recurrence  of 
the  pains,  and  to  render  their  remission  more  perfect  in  conse¬ 
quence.  The  subsequent  effect  upon  the  uterus,  was  to  relax 
the  constriction  and  diminish  the  rigidity  of  the  os  uteri ; 
so  that  each  succeeding  pain  produced  its  proper  effect. 
The  relaxation  of  the  vagina  and  os  externum  were  in  equal 
ratio;  and  by  ten  minutes  past  twelve  the  child  was  born. 
Considering  the  time  of  bleeding  and  that  at  which  the  child 
was  born,  it  was  not  reasonable  to  expect  that  the  result 
could  have  been  more  speedy  or  favourable, 

(i  This  being  the  first  instance,  ki  an  extensive  practice  of 
thirteen  years,  in  which  1  have  resorted  to  bleeding  under 
difficult  parturition,  its  complete  success  induced  me  to 
believe  that  the  publication  of  it  might  be  useful  to  the 
younger  practitioners  of  this  island.” 


To  the  Editors  of  The  Medical  and  Surgical  Spectator , 

Gentlemen — Were  there  no  other  objection  to  the  use  of 
the  lever,  in  the  practice  of  midwifery,  and  there  are  many, 
it  might  be  strongly  opposed  upon  the  very  ground,  for 
which  your  correspondent,  T.  G»  page  262,  of  your  last 
number,  chiefly  recommends  it,  namely,  that  it  can  be  used 
without  the  knowledge  of  the  patient.  I  am  sorry  to  find  a 


sis 


Midwifery, 

single  line  in  your  useful  publication  ’which  can  be  supposed 
to  countenance  the  very  improper  practice  of  using  instru¬ 
ments  secretly.  The  subject  may  be  brought  into  a  small 
compass  :  if  instruments  are  not  necessary,  except  to  save  the 
time  of  the  practitioner,  it  is  highly  reprehensible  to  make  use 
of  them,  even  suppose  they  can  be  safely  used :  what  then  can 
we  say  when  an  instrument  is  recommended  for  common  use, 
the  management  of  which,  according  to  your  correspondent’s 
own  confession,  requires  great  management  and  adroitness  l 
If,  on  the  contrary,  a  case  in  midwifery  occurs,  requiring  the 
aid  of  instruments,  it  adds  much  to  the  reputation  of  a  prac¬ 
titioner  that  he  was  able  to  conduct  a  woman  safely  through  a 
labour  attended  with  such  untoward  circumstances,  so  that 
he  loses  credit  by  using  his  instruments  secretly. 

No  possible  means  exist  of  preventing  the  unnecessary  and 
injudicious  use  of  instruments,  in  the  practice  of  midwifery, 
unless  accoucheurs  candidly  state  to  the  friends  of  the  patient 
when  they  become  indispensable,  and  apply  them,  not  only 
with  the  consent  of  the  patient,  but  with  the  approbation  of 
the  by-standers,  who  are,  in  general,  much  more  ready  to  re¬ 
quest  that  instruments  may  be  employed,  than  the  conscien¬ 
tious  accoucheur  is  to  have  recourse  to  them. 

Another  correspondent,  p.  259,  supposes  that  the  rigidity 
or  thickness  of  the  membranes,  in  some  cases  of  labour,  is  to 
be  remedied  by  blood-letting.  The  accoucheurs  in  France 
were  formerly,  and  perhaps  still  are,  of  opinion  that  blood¬ 
letting  might  be  usefully  employed  during  labour,  with  a 
view  of  facilitating  delivery  :  the  same  plan  w  as  occasionally 
adopted  by  Smellie  and  other  English  practitioners,  and  has 
lately  been  revived  in  America  to  an  enormous  amount,  not 
for  the  purpose  of  relaxing  the  membranes,  but  for  relaxing 
the  soft  parts  of  the  woman,  viz.  the  os  uteri,  vagina,  and  os 
externum. 

The  abstraction  of  blood  for  this  purpose  is,  doubtless, 
sometimes  useful  j  but  the  indiscriminate  adoption  of  bleed- 


1809.] 


m  Midwifery.  [April, 

ing,  particularly  to  the  immense  amount  w£  are  told  of  in 
America,  cannot  be  other  than  mischievous,  of  which  some 
proofs  may  be  collected  from  the  American  cases :  but  by 
what  means  the  drawing  of  blood  from  the  arm  can  take  off 
the  thickness  and  rigidity  of  the  membranes,  viz.  the  chorion 
and  amnios,  remains  to  be  explained. 

Your  correspondent  informs  us,  that  he  has  seen  a  woman* 
who  had  lain  for  hours ,  with  the  strongest  pains,  without 
their  producing  the  smallest  effect,  and  after  the  os  tine#  had 
been  fully  dilated This  woman,  on  being  bled  to  the  ex« 
tent  of  eight  or  ten  ounces,  was  delivered  in  the  course  of  a 
few  pains.  Now,  I  cannot  conceive,  after  the  os  uteri  is 
fully  dilated ,  that  the  rigidity  of  the  membranes  can  present 
an  obstacle  to  delivery  for  several  hours ,  while  the  strongest 
pains  are  acting,  nor  that  bleeding  is  equal  to  remove  such  an 
obstacle  if  it  did  exist.  The  obvious  remedy,  under  such 
circumstances,  would  be  to  rupture  the  membranes,  which 
Would  be,  at  such  a  time,  perfectly  justifiable.  But  if  the 
delivery  were  retarded  by  rigidity  of  the  soft  parts,  blood¬ 
letting  would  certainly  be  the  more  appropriate  remedy,  and 
rupturing  the  membranes  hurtful. 

While  I  have  the  pen  in  my  hand,  permit. me  to  request  a 
more  detailed  account  of  the  case  of  obliteration  of  the  os 
Uteri,  spoken  of  in  a  former  number.  Was  not  this  a  case  of 
retroversion  of  the  uterus  ? 

I  remain,  Gentlemen,  &e. 

March  3,  1800.  OBStlTOR. 


ON  LACERATION  OF  THE  PERINEUM  IN  LABOUR. 

To  the  Editors  of  The  Medical  and  Surgical  Spectator. 

Gentlemen — It  is  a  point  of  practical  midwifery  not  yet 
determined,  what  support  should  be  given  to  the  perineum 
in  labour,  in  order  to  prevent  laceration.  This  part  towards 
the  termination,  as  the  head  advances,  is  more  on  the  stretch 
than  any  other,,  and  unless  the  progress  of  labour  is  gradual,  it 


is  an  accident  which  cannot  fail  to  happen  frequently .  There 
are  two  situations  in  which  it  is  more  especially  to  be  guarded 
against.  The  one  is  a  first  labour,  and  particularly  where 
the  patient  is  very  young.  The  parts  being  both  contracted, 
and  not  having  the  expansion  of  full  growth,  a  rupture  will 
certainly  ensue,  if  the  pains  are  strong  and  rapid.  The  other 
is  where  the  pelvis,  or  bony  cavity,  is  capacious,  and  well 
made,  and  where,  from  the  violence  of  the  pains,  the  head 
suddenly  descends  to  the  under  part  of  the  pelvis  without 
making  its  common  turns.  In  this  case,  it  is  often  pre¬ 
cipitated  with  such  force  as  to  be  expelled  through  the 
perimeum,  instead  of  the  natural  passage.  An  instance  of 
this  came  under  my  care  some  years  ago,  where  the  head  was 
at  once  precipitated  through  the  perinamm,  making  a  com¬ 
plete  rupture  of  it  without  inclining  to  force  its  way  through 
the  natural  passage.  The  rupture  was  afterwards  healed, 
and  in  the  succeeding  delivery,  which  was  not  so  rapid,  the 
head  was  protruded  at  the  natural  opening.  That  some 
benefit  may  arise  from  giving  some  support  with  the  hand  to 
the  part,  I  have  no  doubt.  In  giving  this  support,  however, 
the  pressure  should  not  be  so  great  as  to  bruise  the  part  by 
the  resistance  which  the  head  of  the  child  will  oppose  to  it, 
in  other  cases,  this  accident  is  the  consequence  of  a  diseased 
state  of  the  part,  which  is  unable  to  bear  the  force  of  the 
stretching  power  from  the  weakness  of  the  solids,  and  accord¬ 
ingly  gives  way.  Here  the  cure  must  be  tedious,  and  such 
a  state  of  the  part  may  probably  often  be  connected  w  ith  a 
venereal  cause.  Partial  laceration  of  the  per  in  as  urn  will 
always  easily  be  repaired ;  but  a  complete  laceration,  extend¬ 
ing  to  the  anus,  must  always  be  tedious  and  troublesome  in 
its  treatment,  and  often  incomplete  in  its  cure.  A  young 
practitioner,  therefore,  cannot  be  too  much  on  his  guard  to. 
give  every  assistance  to  prevent,  if  possible,  this  accident. 

I  am,  Gentlemen, 

Your  obedient  Servant, 

G.  HART. 


Bethnal-green  ^  March  16,  1809. 


St  0 


Midwifery  \  '  [Aprils 

ON  CONVULSIONS  IN  PREGNANCY.' 

To  the  Editors  of  The  Medical  and  Surgical  Spectator . 

Gent lem eri—Q n e  of  the  most  alarming  diseases  of  preg¬ 
nancy  is  the  Occurrence  of  convulsions.  They  are  here 
sudden  in  their  attack,  without  any  previous  signs  to  indi¬ 
cate  their  approach  ;  more  rarely,  however,  they  are  pre¬ 
ceded  by  a  weight,  or  heavy  pain,  in  the  uterine  region, 
such  as  marks  distension. 

This  disease  attacks  in  paroxysms  or  tits.  They  are  gene¬ 
rally  preceded  by  violent  pains  in  the  head,  varying  in  its 
situation ;  wild  motion  of  the  eyes,  which  roll  in  an  uncom¬ 
mon  manner  in  their  sockets  ;  and  a  general  determination  to 
the  head,  appearing  from  the  flushing  and  turgescence  of  the 
face.  In  the  paroxysm  itself,  all  sense  and  motion  come  to 
be  lost,  and  the  face  and  some  of  the  extremities,  are  distort¬ 
ed  in  a  particular  manner,  while  a;  frothy  moisture  issues  at 
the  same  time  from  the  mouth,  and  the  tongue  is  forced  out, 
or  retained  closely  between  the  teeth,  so  as  to  suffer  consider¬ 
able  injury. 

That  this  disease  in  pregnancy  is  sympathetic,  and  arisen 
from  uterine  irritation,  is  not  to  be  doubted;  but  it remains 
a  matter  of  doubt,  whether  in  this  case  a  fulness  of  the 
vessels  of  the  brain  necessarily  attends  this  uterine  irritation. 
Convulsions  in  pregnancy  we  find  occur  in  very  opposite 
habits ;  at  one  time  they  attack  the  robust  and  evidently  ple¬ 
thoric,  at  another  time  they  attack  those  of  an  irritable  and 
debilitated  constitution  :  lienee  we  would  infer,  that  a  tur¬ 
gescence  of  the  vessels  of  the  brain,  or  an  increased  impetus 
of  the  circulation  to  the  head,  is  by  no  means  necessary  to 
this  affection ;  that,  as  the  circulation  is  generally  irtregular 
in  the  time  of  the  paroxysm,  such  an  accidental  plethora 
may  occur.  But,  in  the  cure  of  the  disease  itself,  it  requires 
no  primary  attention;  and  that  the  uterine  irritation,  or  ori¬ 
ginal  morbid  cause,  demands  chiefly  our  attention.  To  re- 


377 


1809.]  Midwifery . 

move  this  in  absence  of  the  paroxysm,  venesection  taking  off 
the  uterine  accumulation,  should  be  performed,  and  that 
even  liberally  ;  the  intestines  are  then  to  be  cleared,  and 
afterwards  a  large  opiate  exhibited  in  glyster  to  the  seat  of 
the  affection  itself :  the  principal  indication  seems  to  be  to 
restore  the  energy  of  the  brain,  and  that  by  the  sudden  appli¬ 
cation  of  cold  to  the  face.  This  is  a  practice  recommended 
by  Dr.  Denman,  and  which  he  has  found  succeed  after  every 
other  means,  particularly  bleeding,  has  been  ineffectually 
employed.  Bleeding,  however,  in  all  cases  of  pregnant  con¬ 
vulsions,  is  found  a  useful  palliation.  It  is  recommended  by 
every  writer  on  the  subject ;  and,  among  the  French  particu¬ 
larly,  was  formerly  used  in  this  disease  to  a  most  extravagant 
height;  but,  in  delicate  women,  the  after-consequences  of 
such  evacuations  are  to  be  considered,  and,  where  the  disease 
is  mild,  and  approaches  somewhat  to  hysteria,  venesection 
should  be  very  sparingly  employed. 

But  this  disease  often  arises  from  certain  accidental  causes, 
which  cannot  be  relieved  by  lire  treatment  enjoined  :  thus  it 
sometimes  depends  on  an  improper  position  of  the  festal  head, 
pressing  on  some  part  of  the  pelvis ;  or  it  is  produced  at  times 
by  an  oblique  position  of  the  uterus,  in  some  cases  of  distor¬ 
tion,  where  its  expansion  is  prevented. 

Where  convulsions  begin  early  in  pregnancy,  they  are 
less  to  be  dreaded;  but  in  the  latter  months  they  are 
often  alarming,  and  a  single  paroxysm  has  been  known  to 
kill. 

In  the  convulsions  of  pregnancy,  particularly  where  ad¬ 
vanced,  there  is  this  peculiar  circumstance,  that  the  motion  of 
the  child  is  felt  uncommonly  strong ; — a  proof  of  that  sym¬ 
pathy  which  subsists  between  the  nervous  system  of  the 
mother  and  that  of  the  foetus. 

Some  authors  have  observed,  that  convulsions  at  this 
period  are  more  common  to  the  inhabitants  of  some  countries 
than  others,  and  that  they  occur  more  frequently,  for  exam- 

VOL.  II. 


c  c 


378 


Midwifery .  [April, 

pie,  in  England  than  in  Scotland.  This  fact,  however,  may 
be  called  in  question ;  and  I  know,  from  some  eminent  prac¬ 
titioners,  that  in  some  parts  of  England  a  case  of  them  is 
almost  never  known  to  occur. 

How  alarming  this  disease  is  in  pregnancy  ;  convulsions 
are  no  less  alarming  in  labour,  every  appearance  of  convul- 
sions  in  labour  is  to  be  considered  as  alarming.  Their 
attack  is  generally  sudden ;  and  the  symptoms  preceding 
them  are  violent  pain!  of  the  head  (chiefly  the  forehead), 
staring  or  wild  motion  of  the  eyes,  which  appear  red  and 
turgid,  and  general  flushing  of  the  face. 

The  causes  of  this  affection  in  labour  may  be  reduced  to 
three  heads. 

1.  Morbid  irritability  of  the  os  tineas.  Hence  it  is  fre¬ 
quent  in  a  first  labour,  and  in  this  case  a  proof  of  it :  the 
vagina  too  feels  so  painful  and  irritable,  as  hardly  to  bear  ex- 
aminatiom 

2.  Over  distension  of  the  uterine  cavity.  Thus  it  often 
occurs  in  case  of  twins,  and  affords,  even  before  the  delivery 
of  the  first,  a  proof  of  them. 

3 .  Pressure  on  sentient  parts  sympathising  with  the  brain. 
It  is  for  this  reason  it  is  not  uncommonly  met  with  in  prater- 
natural  cases. 

Our  prognosis  in  such  cases  is  determined  by  an  attention 

,  •  •  t  i  '  •  *  *  ’  ■  ,  '  ■  1 

to  three  circumstances, — their  frequency,  duration ,  and  effect . 

With  respect  to  the  first,  many  have  more  than  a  single 
paroxysm  without  anj'  repetition  ;  others  have  them  fre- 
quentlyjin  time  of  labour,  as  twelve  in  the  course  of  eighteen, 
or  twenty  in  the  twenty-four  hours,  and  that  even  without 
any  danger  ;  so  that  less  stress  is  to  be  laid  on  this  circum¬ 
stance,  and  even  the  more  so  if  the  patient  has  been  formerly 
subject  to  the  disease,  or  to  hysteria  in  a  violent  degree.  It  is 
surprising  they  often  observe  a  periodical  recurrence,  or  re¬ 
gular  distance  between  the  paroxysms,  so  that  you  can  count 
on  the  repetition  of  their  attack  within  a  few  minutes. 


1809.]  Midwifery,  379 

In  regard  to  the  second  circumstance,  or  their  duration, 
we  observe  that  in  some  they  last  a  much*shorter  time  than  in 
others.  The  symptoms  also  are  in  some  less  exquisitely 
marked,  and  approach  more  to  the  nature  of  hysteria,  while 
Jin  others  the  paroxysm  is  often  so  violent  as  to  prove  fatal  at 
once. 

The  third  circumstance,  or  their  effect  on  the  system  after 
the  paroxysm  is  fiipshed,  has  been  most  generally  attended 
to  in  forming  a  prognosis.  Thus  we  find,  that  recollection  in 
many  returns  as  soon  as  the  paroxysm  is  ended,  or  at  least 
in  a  few  minutes  afterwards.  In  others  the  senses  seem  alto- 
gather  suspended,  when  the  patient  either  continues  in  a 
state  of  stupefaction,  or  delirium  succeeds.  In  this  last  si¬ 
tuation  they  generally,  though  not  always,  prove  fatal. 

A  prognosis  may  also  be  drawn  with  respect  to  their  influ¬ 
ence  on  the  labour  itself.  Thus,  where  slight,  the  labour- 
pains  are  generally  assisted  by  then*,  or  rendered  more  ef- 

<  1  '  f 

fectual.  Where  very  violent,  again,  the  child  is  either  sud¬ 
denly  thrown  off  in  a  paroxysm,  or  the  uterine  efforts  are  en¬ 
tirely  suspended. 

For  the  treatment  of  convulsions  in  labour,  two  methods 

t  v  i  •  f 

prevail,  which  in  different  situations  are  both  equally 
proper. 

The  first  is  merely  palliative,  and  trusts  entirely  to  nature, 
after  obviating  symptoms  for  theaccomplishment  of  delivery. 

The  other  consists  in  assisting  the  palliative  treatment,  by 
the  application  of  mechanical  means,  as  soon  as  in  our  power 
to  facilitate  the  progress  of  labour. 

In  executing  the  former,  three  indications  come  to  be 
formed. 

The  first  is  to  lessen  primary  irritation  in  the  original 
affected  part,  which,  being  the  uterus,  we  attempt  it  by  a 
full  dose  of  opium  in  glyster,  at  once  taking  oft'  its  irrita¬ 
bility  ;  and  its  effect  in  lessening  the  action  of  the  uterus,  in 


380.. ...  ,  Pharmacy i 

these  cases,  tv  here  turning  is  required,  sufficiently  points  out 
its  propriety. 

The  second  is  to  remove  distension  from  the  system  in 
general,  and  particularly  from  the  seat  of  the  disease, 
which  is  best  performed  by  copious  venesection  ;  and, 

The  third  is  to  excite  a  more  powerful  and  sudden  irri- 
tationin  ihej  same  situation.  This  is  best  and  expeditiously 
executed  by  the  appellation  of  cold  water  to  the  face,  ac¬ 
cording  to  the  practice  of  Dr.  Denman. 

I  am*  Gentlemen, 

Oxford  Street j  Yours,  &c. 

March ,  10,  1809.  T.  DEAN, 


IY.  PHARMACY. 

Since  the  renovation  of  the  digitalis,  no  active  vegetable 
production  has  been  introduced  to  excite  experiment,  or  pro¬ 
duce  the  tale  of  wonder.  In  our  last  number  we  stated  hav¬ 
ing  met  with  a  new  species  of  bark.  This  species  has  lately 
been  imported  from  the  Brazils,  under  the  name  of  Cinchona 
rubra  ^Braziliensis,  It  is  paler  than  the  red  bark  received 
from  Peru,  but  very  similar  in  its  appearance,  and  not  less 
powerful  in  its  sensible  qualities.  It  is  very  productive  of 
resin,  and  in  aroma  it  approximates  very  near  to  the  old  pale 
bark.  Dr.  Rush,  of  Philadelphia,  has  lately  published  some 
remarks  on  the  Brazilian  red  bark,  which  tend  to  prove  it 
equal  to  any  species  of  Cinchona,  and  very  superior  to  most 
employed  in  Europe,  in  consequence  of  which  the  expensive 
species  of  Peruvian  bark  are  very  rarely  prescribed  by  the 
American  physicians.  A  quantity  of  this  species  of  Cinchona, 
in  the  hand  of  Reece  and  Co.  is  now  supplied  to  tbe  faculty, 
in  order  that  it  may  undergo  the  trial  to  which  its  sensible 
qualities,  and  the  testimony  of  Dr.  Rush,  entitle  it. 


t‘,1  * 

381 

MEDICAL  INTELLIGENCE. 

The  Professors  of  the  University  of  Edinburgh  have  this  season  not  less 
than  two  thousand  Students, 

A  tea-plant,  three  feet  high,  in  the  possession  of  Mr.  Cape!  Lofft,  of 
Troston-hali,  hear  Bury,  blossomed  in  the  parlour  of  that  Gentleman's 
house  on  the  18  th  December  last,  notwithstanding  the  thermometer,  in  a 
southern  aspect,  was  at  28  degrees.  The  buds  appeared  early  in  September. 
The  scent  of  the  flower  was  delicate  and  evanescent,  resembling  that  of  fine 
green  tea  dried. 

A  Gentleman  has  discovered  a  vegetable  product  of  British  growth, 
which,  by  particular  management,  may  prove  an  excellent  substitute  for 
foreign  coffee. — This  is  the  iris  pseudicorus ,  flower  de  luce,  or  common 
yellow  water  flag;  the  seeds  of  which,  being  roasted  in  the  same  manner 
as  coffee,  very  much  resemble  it  in  colour  and  flavour,  but  have  something 
more  of  a  saccharine  odour,  approaching  to  that  of  extract  of  liquorice. 
Coffee  made  of  these  seeds  to  the  proportion  of  half  an  ounce,  or  an  ounce, 
to  a  pint  of  boiling  water,  is  extremely  wholesome  and  nutricious. 

DIED.— On  Thursday,  Feb.  1 6,  at  Andover,  in  Hampshire,  Dr.  John 
Hemming,  formerly  Physician  to  the  Oscutton  Dispensary. 

»■  \  - 

Means  of  cleansing  Houses,  &c.  of  Rats  and  Mice.  A  plant,  which 

grows  in  abundance  in  every  field,  the  dog’s  tongue,  the  cynoglossum  offi¬ 
cinale  of  Linnaeus,  has  been  found  by  M.  Boreux  to  possess  a  very  valuable 
Quality.  If  gathered  at  the  period  when  the  sap  is  in  its  full  vigour,  bruis¬ 
ed  with  a  hammer  and  laid  in  a  house,  barn,  granary,  or  any  place  fre» 
quented  by  rats  and  mice,  those  destructive  animals  immediately  shift  their 
quarters.  The  success  of  this  method,  M.  Boreux  says,  is  equally  speedy 
and  infallible. 


Extract  of  a  Letter  from  a  Regimental  Surgeon  stationed  on  the  coast— 
<c  At  present  lam  so  much  engaged,  that  I  have  not  time  to  take  down  a 
tenth  case  out  of  the  many  I  am  obliged  to  attend  from  morning  to  night,  in 
the  fever  lately  imported  from  Spain.  We  Regimental  Surgeons  here  are 
half  dead,  two  entirely  from  fatigue  and  fever.” 

X>  D 


VOL.  II, 


382 


Medical  Intelligence . 


[April, 


Society  for  the  Relief  of  the  Ruptured  Poor,  No.  52,  Wood  Street,  Cheap - 
SiVfe,  Instituted  1796. — A  special  general  meeting  of  the  Governors  of 
this  charity  was  held  at  the  London  Tavern  on  Wednesday  the  22d  of 
March,  when  His  Royal  Highness  the  Duke  of  Sussex,  (pursuant  to  hi 
polite  offer,)  was  elected  Patron  of  this  institution. 

Mr.  Troughton  also  attended  at  this  meeting  as  the  executor  of  the  Will  of 
Mr.  Kempenfelt,  (brother  to  the  late  Admiral  of  that  name,)  and  paid  a 
legacy  of  three  hundred  pounds  bequeathed  by  that  gentleman  to  the  charity, 
in  aid  of  its  benevolent  intention. 

On  Wednesday  the  8th  of  March,  the  Medical  Society  of  London  held 
their  Anniversary  Meeting  at  their  house  in  Bolt  Court,,  when  the  following 
Officers  and  Council  were  elected  for  the  year. 

President. -—Dr.  Lettsom. 

Vice-Presidents. —  Dr.  Bancroft,  Dr.  Babington,  Mr.  Norris,  Mr.  Ware. 

Treasurer.— Dr.  Saver  Walker. 

Librarian.— Dr.  Cluttcrbuck. 

Secretaries.— Mr.  I.  M.  Good,  Dr.  Hamilton,  Dr.  Poignand.  Foreign- 
Correspondence. 

Registrar. — Mr.  A.  B.  Turnbull. 

Members  of  the  Council. — Mr.  Andrew,  Mr.  Field,  Mr.  Chambef- 
laine,  Mr.  Hooper,  Mr.  Hurlock,  Mr.  Haighton,  Mr.  Abernethy,  Sir  John 
M.  Hayes,  Bart.  Dr.  Adams,  Mr.  Ring,  Dr.  Bradley,  Mr.  Seaton,  Dr. 
Thornton,  Mr.  Griffith,  Mr.  Heaums,  Mr.  Robinson,  Mr.  Astley  Cooper, 
Air.  Taunton,  Mr.  Macdonald,  Mr.  Hopkins,  Mr.  Young,  Mr.  Platt,  Mr. 
Addington,  Dr.  Lidderdale,  Mr.  Ramsden,  Dr.  E.  N.  Bancroft,  Dr.  Lavf- 
rence,  Dr.  Shearman. 

To  deliver  the  Anniversary  Oration  for  1800. — Dr  Birkbeck. 

After  the  election,  Dr.  Sayer  Walker  delivered  the  Anniversary  Oration 
on  the  best  means  of  promoting  medical  science.  A  numerous  body  of  the 
Fellows  of  the  Society  afterwards  dined  together  at  the  London  Coffee* 
House. 

The  Council  of  the  Society  have  lately  come  to  the  resolution  of  pub¬ 
lishing  at  short  intervals,  and  with  as  much  regularity  as  circumstances  will 
admit,  a  selection  from  the  communications  laid  before  the  Society,  instead 
of  waiting  as  heretofore  for  materials  to  complete  a  volume.  This  cannot 


1809.] 


Aledical  Intelligence . 


383 


fail  to  be  of  great  advantage  to  science  and  to  the  community,  by  the  more 
rapid  diffusion  of  those  practical  improvements  which  the  inquiries  of  indi¬ 
viduals  are  daily  bringing  to  light. 

Dr.  Ramsbotham  will  commence  a  Summer  Course  of  Lectures  on  the 
science  and  practice  of  Midwifery,  and  on  the  diseases  of  women  and  infants, 
<2U  Monday,  May  8  th,  at  ten  o’Clock  in  the  morning,  at  his  house,  No.  p, 
Old  Jewry. 

The  descriptive  and  physiological  parts  of  these  Lectures  are  elucidated 
by  a  reference  to  appropriate  specimens  of  anatomical  preparations  from  a 
very  celebrated  collection ;  and  the  practical  parts  are  taught  upon  a  well 
constructed  machine,  and  by  attendance  upon  cases  when  the  pupil  is  proper¬ 
ly  qualified. 

NEW  MEDICAL  PUBLICATIONS. 

A  Practical  Materia  Medica,  in  which  the  various  articles  are  fully  de» 
scribed  and  divided  into  classes  and  orders  according  to  their  effects.  Their 
virtues,  doses,  and  the  diseases  in  which  they  are  proper  to  be  exhibited, 
are  fully  pointed  out,  interspersed  with  some  practical  remarks  and  some 
select  formulae.  To  which  is  added,  a  general  physiological  table,  intended 
principally  for  the  use  of  Students  and  Junior  Practitioners,  12mo.  price  5s. 
in  boards. 

A  Dictionary  of  Practical  Surgery,  containing  a  complete  exhibition  of 
the  present  state  of  the  principles  and  practice  of  Surgery,  collected  from 
the  best  and  most  origiual  sources  of  information,  and  illustrated  by  eritica.i 
remarks.  By  Samuel  Cooper,  8yo.  price  15 s.  in  boards. 

The  First  Lines  of  the  Practice  of  Surgery;  being  an  elementary  work  for 
students,  and  a  concise  reference  for  Practitioners,  with  copper  plates ;  a 
new  edition  corrected  and  enlarged.  By  Samuel  Cooper,  ]  Is.  in  boards. 

Observations  on  the  Utility  and  Administration  of  Purgative  Medicines  in 
several  Diseases.  By  James  Hamilton,  M.  D.  The  third  edition  revised 
apd  enlarged,  8vo.  price  9s.  in  boards. 

JN  THE  PRESS. 

Blair’s  Grammar  of  Chemistry,  ]2mo.  price  3s.  6d.  bound. 


The  paper  on  Medical  Education,  in  our  last  Number ,  by  Dr. 
John  Reid ,  we  are  desired  to  slate,  was  not  his  own ,  but 
the  production  of  a  friend.  Coming  inclosed  from  Dr. 

Reid  led  to  the  mistake. 

.>  .  >.  «■  * 


D  I)  2 


INDEX. 

i->  V  * 


A. 

ABERNETHY,  Mr.  45,  49.  254. 284 

Abstinence,  remarkable  case  of,  10-— 
extraordinary  instance  of  in  North 
Wales,  293. 

Aikin,  Dr.  258. 

Air, dephlogisticated  nitrous, ,202. 

Air,  fixed,  or  carbonic  acid  gas,  202. 

Air,  hydrocarbonic,  203. 

Air,  vital,  202. 

Alkalies,  S.  T.  on  the  use  of,  in  medi¬ 
cine,  281. 

Allen’s  Pectoral  Balsam  of  Liquorice, 
100. 

Andrews,  Dr.  57. 

Aneurism,  143.  operations  by  Mr.  Cline 
and  Mr.  Astley  Cooper,  144.  often 
mistaken  for  a  tumour  of  another 
description,  285. 

Animal  Heat,  120. 

Antiphthisical  Specifics,  98. 

Archer,  Dr.  his  letter  on  Vaccination 
as  a  remedy  for  hooping-cough,  216. 

Areka,  cr  Be  .  nut,  8. 

Arsenic,  175. 

Arsenic  Acid,  77  • 

Armstrong’s  Art  of  preserving  health, 
194.  ; 

Arnold,  Dr.  212. 

Ash,  Dr.  C.  92. 

Astruc,  Dr.  255. 

Atony  of  the  bladder,  183. 

B. 

I  - 

BABINGTON,  Dr.  89. 

Bache,  Dr.  268. 

Bandana  soap, 

Eaillie,  Dr.  127. 135.  147.  173. 

Baillou,  31 1. 

Baker,  Mr.  on  the  remuneration  of  me¬ 
dical  men,  364. 

Barbel,  ill  effects  attending  the  eating  of 
this  fish,  83. 

Barbosa,  Dr.  J.  A.  first  practises  vacci¬ 
nation  at  St.  Salvador  in  1804,  198. 

2927' 

Barclay,  William,  Antibilious  pill,  2. 

Bark,  hew  species  of,  267. 

Bardsley,  Dr.  35.  85.  87.  212. 

Beddoes,  Dr.  17 — character  of,  198, 
201.  203. — his  tables  of  airs,  203. 

Beer,  Mr.  the  celebrated  oculist,  140, 

Bell,  Mr.  Charles,  298, 

Bell,  Mr.  John,  340. 


Bill,  General,  of  Christenings  and  Bu¬ 
rials  within  the  Bills  of  Mortality, 
94.  •  ! 

Black,  Dr.  198.213. 

Blair,  Mr.  9.  his  grammar  of  chemis¬ 
try,  383. 

Bland,  Dr.  267. 

Bleeding,  serious  consequences  of,  51. 

Blegborough,  Dr.  his  case  of  a  boy  who 
swallowed  a  half-penny,  251. 

Bloom  of  Venus,  2. 

Brodum’s  Specific,  2. 

Boerhaave,  147.  311.  . 

Booth,  Mr.  109- 

Bostock,  Dr.  173. 

Bourne,  Dr.  10. 

Brown,  Mr.  on  rigidity  of  the  mem¬ 
branes,  259.  on  bleeding  in  slow  la¬ 
bours,  271. 

Buchan,  Dr'.  233.-— his  fatal  case  of 
passion,  234. 

Buchoiz’s  process,  78. 

Burke,  Mr.  155. 

Burns,  Miss,  experiments  in  consequence? 
of  her  death,  173. 

Burns,  50.  - 

Buxton,  Dr.  95. 


C. 

C2ESARIAN  operation,  69,  70,  264. 
C'alderwood,  Mr.  84.  86.  180. — on 
medical  electricity,  184.  279. 
Calculus,  145. 

Cancer,  96. — Revieyr  of  Dr.  Lambe 
on,  132.  226. 

Cantharides,  168 

Capon,  Mr.  swallowed  a  crown-piece, 

252.  ' 

Carditis,  Dr.  Davis’s  inquiry  into  the 
treatment  of,  96.  125. 

Carlisle,  Mr.  58. — chosen  professor  of 
anatomy  to  the  Royal  Academy,  9S. 
122.  ' 

Carmichael,  Mr.  96. 133. 

Carwardine,  Mr.  45. 

Cataract,  Dr.  Reece’s  treatment  of,  53. 
Mr.  Wardrop’s  mode  of  cure  in,  139. 
— admiral  Henry’s,  249. 

Catarrh,  343. 

Caton,  Dr.  his  reply  to  W.  Y.’s  criti¬ 
cism  on  Dr.  Powel’s  case  of  hydro¬ 
phobia,  27.  197.  his  communication 
on  cutaneous  diseases,  234.— pn  hy¬ 
drophobia,  326. 


INDEX. 


Chandler,  Ann,  Dr.  Power*  sequel  of 
his  case  of  hydrophobia  in  regard  to 
her  child,  14. 

Cheston,  15Y,  158. 

Ching’s  worm  lozenges,  298. 

Christie,  Mr.  his  report  of  the  progress 
of  vaccination  at  Ceylon,  207, 

Chamberlayne,  Mr.  300. 

Clarance,  Mr.  48. 

Clarke,  Dr.  71.235. 

Clarke,  Mr.  16. 

Cline,  Mr.  operates  for  aneurism  of  the 
carotid  artery,  142. 

Clutterbuck,  Dr.  95. 

Consumption  of  the  lungs,  122. 

Contagious  mania  in  animals,  334. 

Convulsions  in  pregnancy,  376. 

Cooper,  Mr.  Astley,  his  operation  for 
carotid  artery  r  143.  150,  165. 

Co  wage,  300. 

Cramor’s  balsam  of  Iceland  liverwort, 

99. 

Cretinispa,  observations  on,  by  Dr. 
Reeve,  116. 

Croatz,  Mr.  70. 

Crown-piece,  Mr.  Capon  of  Lowestoffe, 
swallowed  one,  252. 

Crowther,  Mr.  on  Diseases  of  the  Joints 
156 — continued,  252. 

Cullen,  Dr.  168.  302. 

Cundeil,  Mr.  103. 

Cutaneous  diseases,  214. 

D. 

DALBY’s  carminative,  2. 

Dancer,  Dr.  17. 

Daran,  57. 

Darwin,  Dr.  131. 

Davis,  Dr.  96. — Review  of  his  book  on 
Carditis,  125. 

Day,  Mr.  cured  of  gout  by  a  new 
mode,  188. 

Deafness,  256. 

De  Graaf,  330. 

Downman’s  poem  on  Infancy,  194, 

Dixon’s  antibilious  pill,  2. 

Diabetes, new  practice  in,  20. 

Diseases,  Dr.  Nisbet’s  letter  respecting 
monthly  reports  of,  21 — in  London 
in  1808,  200 — Cutaneous,  214.  234. 
of  the  eye,  255.  hereditary,  309 
spasmodic,  320. 

Dispensaries,  Dr.  Herdmrn’s  proposal 
for  the  improvement  of,  121. 

Distilled  water,  the  use  of  preferred  in 
the  Middlesex  hospital,  198. 

Dunn,  Mr.  77. 

E. 

ELECTRICITY,  its  effects  in  sup¬ 
pression  of  urine,  84.  180. — in  de¬ 


ranged  secretion  of  the  kidneys,  181 
— in  spasm  of  the  urinaryorgans,  182 
— in  atony  of  the  bladder,  1 83. 

Empiricism,  1.  97.  201,  297. 

F. 

FEMALE  pill  of  JTooper,  of  Wir 
dow  Welch,  ib. 

Fprguson,  Dr-  301. 

Fearon,  Mr.  185. 

Eernel,  Dr.  309.311. 

Fish-poison,  Mr.  Kiernan’s  communi¬ 
cation  on,  83. 

Fordyce,  Dr.  George,  77. 

Fowler's  Mineral  Solution,  77. 

Fowler,  Dr.  175.  179. 

G. 

GALEN,  311. 

Galvanism,  85. 

Gardner,  Dr.  299. 

Garthshore,  Dr.  288. 

Godbold’s  Vegetable  Balsam,  98. 

Gout,  new  mode  of  curing  by  Dr. 
Reece,  187. 

Grant,  Dr.  17. 

Grice,  Mr.  on  the  use  of  the  lever, 
262. 

Gonorrhoea,  Mr.  Kiernan’s  letter  on 
some  alleged  cases  of,  254. 

Guest,  Mr.  Barnet,  103. 

H. 

HAEN,  Dr.  17. 

Hamilton,  Dr.  21.  167 — appointed 
Physician  to  the  London  Dispen¬ 
sary,  199. 

Haighton,  Dr.  150. 

Hardwicke,  Mr.  his  case  of  hydropho¬ 
bia,  104. 

Hawes,  Dr.  93. 

Haller,  311. 

Haygarth,  Dr.  21 1. 

Hayton,  Mr.  187,  188, 189. 

Haslam,  Mr.  96. 

Harding,  Mr.  his  new  mode  of  saving 
life,  187. 

Harrison,  Dr.  222. 

Half-penny,  case  of  a  boy  who  swal¬ 
lowed  one,  251. 

Herdman,  Dr.  his  proposal  for  the  im¬ 
provement  of  Dispensaries,  92.  12 1, 
122— appointed  physician  to  the 
Duke  of  Sussex,  193, 

Henderson,  Dr.  96. 

Henry,  Dr.  William,  93. 

Henry,  Admiral,  his  case  of  cataract, 
55 — his  mode  of  curing  the  gout, 
55,  155.— his  letter,  249. 

Hippocrates,  146, 311 , 312, 


INDEX. 


Dill,  Sir  John,  called  the  Linnaeus  of  centrated  solution  c£  ditt  o,  ib. 
Britain,  102.  ’  ’  Lawrence,  Mr.  156. 


Hill,  Mr.  175.213. 

Hodgson,  Air.  15, 

Hoffman,  312. 

Home,  Mr.  57.  60.  135.  137.  154. 
Howship,  Mr.  cases  of  lock-jaw,  320. 
Hogejp  hectic  pills,  103. 
Hooping-cough,  vaccination  a  remedy 
for,  216. 

Hospitals,  237.  * 

Hunter,  Mr.  John,  52. 61.  337.  338. 
Huy,  Mr.  55. 

Hunterian  Museum,  135. 

Huy,  Mr.  55. 

Humbold,  Air.  304. 

Hydatids  of  the  urethra,  359. 
Hydrophobia,  14 — sequel  of  Dr.  Pow- 
el’s  case  of,  ib. — Dr.  Bardsley’s  case 
of,  35.  92. — Meeting  of  the  College 
of  Physicians  on  the  subject  of,  93. 
104. — Air.  Hardwicke’s  case  of,  ib. 
— Dr.  Pinckard’s  case  of,  106  — 
Latin  verses  on,  195.  211. — Dr. 
Turnbull's  case  of,  213. — Dr.  Nisbet 
and  Air.  Alorris’s  case  of,  217.  320. — > 
Dr.  Caton’s  observations  on,  326. — 
ease  of  David  Hale,  328. 

L  , 

JAAIES’S  antibiiious  pills,  2. 
Instruments,  obstetrical,  a  new  im¬ 
provement  on,  293. 

Indian  pink,  301. 

Ingrassius,  311. 

Iris  pseudicorus,  or  flower-de-luce,  381. 
Jones,  Air.  288. 

Ives,  Air.  his  treatise  on  diseases  of  the 
eye,  255. 

K. 

KEMPENFELT,  Air.  362. 

Kentish,  Air.  50. 

Kiernan,  Mr.  on  Fish-poison,  83 — case 
of  three  children  at  a  birth,  166 — 
Jus  observations  on  some  alleged 
consequences  of  gonorrhoea,  254. — 
singular  case  of  contagious  mania  in 
animals,  334. 

Kidneys,  deranged  secretion  of,  181. 
Kilpatrick,  Mr.  on  schirrus  of  the  ute¬ 
rus,  260. 

Kinglake,  Dr.  on  pulmonary  consump¬ 
tion,  323. 

Korfum,  157. 

Kotzebue,  287. 

L. 

LACERATION  of  the  perinscum, 
274 — of  the  urethra,  345. 

Lardner’s  prepared  charcoal,  8 — con- 


Lazare,  311. 

Lambe,  Dr.  on  cancer,  review  of,  13£. 
— his  letter  to  the  Editors  respecting 
his  reports  on  Cancer,  223.  261. 

Le  Gassier,  Dr.  36. 

Leyden  jar,  185. 

Lever,  on  the  use  of  the,  262 — Obstitor 
on  the  use  of,  372. 

Lectures,  by  Dr.  Buxton,  95. — by  Dr* 
Clutterbuck,  ib. — by  Dr.  Reid,  ib. — 
by  Mr.  Taunton,  ib. — by  Dr.  Squire, 
96.  by  Dr.  Reid,  295.  by  Dr.  Rams- 
botharn.  295.  383. 

Leucorrhcea,  168. 

Lind,  Dr.  3. 

Lieutaud,  147.  154.  311. 

Liver,  Scrutator  on  the  functions  of, 
153. 

Lloyd,  Mr  106. 

London  Hospital,  lecture  at,  by  Dr, 
Buxton,  95. 

Lock-jaw,  Mr.  Howship’s  cases  of, 
320. 

Lowndes,  Mr.  on  electricity,  in  sup¬ 
pression  of  urine,  84.  180.  184.  hi$ 
reply  to  Mr.  Calderwood,  279. 
Lubbock,  Dr.  Richard,  199. 

Lues  bovilla,  327. 

Lues  venerea,  327. 

Luxmore,  Mr.  on  Tinea  capitis,  150, 
Lumbago,  169. 

M. 

MARCET,  Dr.  87. 

A'lainwaring,  Mr.  case  of  successful 
delivery  in  extreme  distortion,  26$, 
288. 

Medicine,  9.  104. 206.  review  of  Reece’s 
Dictionary  of  Domestic,  229.  301. 
Medicus  on  vaccination,  138, 

Mead,  Dr.  311. 

Mellisj  Mr.  on  rupture  of  the  parturi¬ 
ent  uterus,  67-- oh  retroverted  ute¬ 
rus,  257. 

Aledical  Intelligence,  90.  197.  292.  381. 
Medical  Education,  Dr.  John  Reid  on, 

289.  ‘ 

Medical  department  of  the  army,  Dr. 

Nisbet’s  letter  on  the,  236. 

Medical  Board,  a  hint  to  the,  90.  92. 
Aledical  Lectures,  see  Lectures. 

Medical  Publications,  see  Publications. 

- - —  Police,  A'ledicus  Politicus  on 

the  neglect  of,  285. 

Aledical  Reform  at  Edinburgh,  220. 
Alembrane,  rigidity  of  the,  259. 
Menorrhagia  chlorosis,  168. 

Metallic  substances,  their  influence 
the  human  body,  268. 


Index. 


Mercury,  Its  powers  in  various  dis¬ 
eases,  2 56. 

M\’s  remarks  on  Dr.  Lambe  on  Cancer, 
191. 

Midwifery,  63 — London  practice  of,  71 . 
162.  257.  371. 

Mineral  poisons,  172. 

Mineral  preparations,  on  the  extensive 
use  of  in  medicine,  1 92. 

Morgagni,  48.  147.  311. 

Morrison,  Mr.  109— cure  of  tinea  ca- 

-  pitis,  361. 

Morris,  Mr.  his  case  of  hydrophobia, 
217. 

Morand,  Mr.  313. 

Montaigne,  310. 

Munchausen,  Baron,  299. 

N. ‘ 

NATIONAL  Institution  for  promot¬ 
ing  vaccination,  officers  of  the,  198, 

Newell,  Dr.  91. 

Newton,  Sir  Isaac,  269. 

Nisbet,  Dr.  his  opinion  respecting 
the  teeth  and  tooth-powders,  3 — on 
monthly  reports  of  diseases,  21 — case 
of  four  children  at  a  birth,  167 — his 
case  of  hydrophobia,  217.  his  letter 
on  the  medical  department  of  the 
army,  236. 

Nomenclature,  new  chemical,  280. 

O. 

ODIER,  Dr.  87. 

Officers  of  the  Medical  Society  of  Lon¬ 
don,  382. 

Opium,  the  produce  of  Porto  Santo, 
equal  to  Turkey,  and  superior  to 
East  India,-  82. 

Ophthalmia,  Egyptian,  Mr.Ware’s  opi¬ 
nion  respecting,  96.  143.  255. 

Osborne,  Dr.  267. 

Oxyd  of  bismuth,  86. 

Oxygen  gas,  201. 

P. 

PATENT  Medicines,  British,  not  al¬ 
lowed  to  be  imported  into  Russia, 
98. 

Paracelsus,  a  saying  of,  104. 

Passion,  fatal  case'  of,  related  by  Dr. 
Buchan,  224. 

Paregoric  Elixir,  2. 

Purton,  Mr.  50. 

Parry,  Dr.  116. 

Parr,  Dr.  Bartholomew,  199; 

Pathology,  general  principle  of,  206. 

Percival,  Dr.  211, 

Perrin’s  Balsam  of  Lungwort,  101. 

Pectoral  Balsam  of  Honey,  101. 

Pennington,  Sir  Isaac,  9. 


Pearson,  Mr.  Surgeon  to  the  British 
Factory  at  Canton,  10.  his  treatise  oh 
cancer,  133.  260.  * 

Phosphorus,  Clinicus  on  the  medical 
effects  of,  287. 

Pharmacy,  77.  168.267.  380. 

Physicians,  College  of,  their  meeting 
on  the  subject  of  hydrophobia,  93. 

Pinckard,  Dr.  his  £ase  of  hydrophobia, 
104.  219. 

Pills,  Vital,  201. 

Pliny,  118.  , 

Pneumatic  Pulmonary  Practice,  103. 

Powel,  Dr.  sequel  of  his  case  of  hydro¬ 
phobia,  14.  93.219. 

Pott,  Mr.  151.  152.330. 

Publications,  Medical,  96.199.  296.383.^ 

Pulteney,  Sir  James,  Dr.  Nisbet’s  letter 
to,*  236. 

Puerperal  convulsion,  64.  162, 

Pulmonary  consumption,  323. 

PurpUra,  116. 

R. 

RAMSBOTHAM,  Dr.  383. 

Rats  and  mice,  mode  of  driving  them 
from  houses,  &C.381. 

Reid,  Dr.  23.  95.  on  medical  education, 
289  intends  discontinuing  his  month¬ 
ly  reports  of  diseases,  295. 

Review  of  Dr.  Bardsley’s  Medical 
Reports,  35 — of  Dr.  Uwins’s  modern 
medicine,-  44— of  Mr.  Wadd,  on 
stricture  of  the  urethra,  57 — London 
practice  of  midwifery,  71 — of  Dr, 
Davis  on  carditis,  125. — -of  Dr, 
Lambe  on  cancer,  132 — of  Mr.  Crow- 
ther  on  the  joints,  156 — continuation 
of  Dr.  Lambe  on  cancer,  226. — of 
Dr.  Reece’s  dictionary  of  domestic 
medicine,  229 — continuation  of  Crow- 
ther  on  the  joints,  252 — of  Burns  on 
diseases  of  the  heart,  337.  of  Hooper’s 
physician’s  vade-mecum,  342— -of 
Watt’s  Anatomy,  369. 

Reece,  Dr.  Richard,  on  white  swelling 
of  the  joints,  53— on  cataract,  ib.— 
his  cure  of  cataract  by  pounding  the 
eye,  55 — -on  vaccination,  137.  155. 
review  of  his  domestic  medicine,  229 
—his  explanation  of  his  mode  of 
curing  cataract,  249 — on  the  ma¬ 
nagement  of  the  teeth,  367. 

Reeve,  Dr.  his  observations  on  creti¬ 
nism,  116. 

Regnault’s  syrup  and  lozenges  of  Ice¬ 
land  liverwort, TOO. 

Report  of  the  small-pox  hospital,  2D€ 

Ring,  Mr.  9. 

Riviere,  311. 

Roberton,  Mr.  168,  289, 


INDEX. 


Roonhuysian  lever ,•  263. 

Ruspini,  Chevalier,  his  tooth-powder, 
7 — tincture,  8. 

Russell,  Mr.  James,  199. 

Rupture  of  the  parturient  uterus,  67. 
Rumbold,  Mr.  109. 

Rymer’s  cardiac  tincture,1  2. 

*  Si 

&ENNERT,  312. 

Senac,  311. 

Selle,  126. 

Seares,  Dr.  }62. 

Sequiera,  Dr.  181. 

Shadwell,  Dr.  312. 

Sharp,  Mr.  61. 

Sibly’s  solar  tincture,  2. 

Sicilian  bloom,  2. 

Sigault,  operation  of,  in  retroverted 
uterus,  259. 

Small-pox,  prevalent  in  Staffordshire, 
93 — extinct  at  Ceylon  since  the  in¬ 
troduction  of  vaccination,  209. 

Soda  Water,  87. 

Solomon’s  balm  of  Gilead,  2. 
iSfihacelus  of  the  toes  and  feet,  151. 

Spina  bifida,  165. 

Spasm  of  the  urinary  organs,  182; 

Stahl,  311. 

Surgery,  46.  139.  248.345. 

Suppuration  in  tumours,  an  hospital 
surgeon  on,  283. 

Swiss  remedy  for  worms,  300; 

Swieten,  Van,  311. 

Swediaur,  Dr.  255. 

Sylvester,  Mr.  Charles,  on  the  effeet3 
of  carbonate  upon  cancer,;  96. 

T. 

TATTERSALL,  Dr.  voted  physician 
to  the  Surrey  dispensary,  93. 

Taxed  medicines,  letter  on,  87. 

Taunton,  Mr.  95. 

Tea-plant  in  blossom  at  Gapel  Lofft’6, 
Esq.  381. 

Temperaments,  doctrine  of,  301. 

Teeth,  Dr.  Reece  on  the  management 
of  the,.  367 

Thomson,  Mr.  Henry,  his  reply  to  Dr. 

W.Y.  on  hydrophobia,  31. 

Tinea  Capitis,  letter  on,  56.150.  case 
of,  by  Mr.  Morrison,  361. 

Tin-filings,  301. 

Tooth  specifics,  3. 

Tumours,  46— a  remarkable  chronic, 

__  ib. — encysted,  148. 

T  urnbull,  Mr.  his  case  of  hydrophobia, 
313. 

Typhus,  specific  contagion  of,  335. 


T.  W.  on  the  peculiar  structure  of 
certain  parts,  329. 

T.  S.  on  the  prognosis  in  labour,  66* 

■  V‘ 

Velno’s  Syrup,  2.  _  , 

Vaccination,  9 — its  introduction  into 
China,  ib. — Essex  Report  of,  90— 
116.  137.  138.  197— officers  of  the 
National  Institution  for  promoting, 
198 — 207 — progress  of  in  Ceylon, 207 
- — number  of  patients  Vaccinated  at 
Ceylon  in  1807,  210 — a  remedy  for 
hooping-cough,  216. 

U  win’s,  Dr.  Modern  Medicine,  44.' 
Verulam,  Lord,  269. 

Uterus,  case  of  inversion  of  the,  by  Mr. 
Merriman,  162 — retroverted,  257, 
Mr.  Kilpatrick  on  schirrus  of  the9 
260. 

*W.  ..  • 

WADD,Mr.  on  stricture  of  the  urethra9 
57. 

Ware,  Mr.  respecting  the  sameness  of 
infection  in  venereal  gonorrhoea  and 
Egyptian  ophthalmia,  96. 

Wardrop,  Mr.  his  proposal  for  conduct¬ 
ing  the  incision  of  the  cornea  in 
cataract,  139. 

Ward,  Mr.  294. 

Watt,  Mr.  his  new  practice  ih  Diabe¬ 
tes,  120 — Chirurgical  views,  199 
Whatel-y,  Mr.  58.  62. 

Wollaston,  Dr,  W:  H.  93. 

Woolcombe,  Dr.  on  consumption  of  the 
lungs,  122. 

Wood,  Dr.  211. 

Worm-medicines,  298 — Ching’s,  ib.— 
Gardner’s,  299. 

Wheeler,  Mr.  16. 

Willan,  Dr.  137.  2S5. 

Watts,  Mr.  his  apparatus.  202. 

Ware,  Air.  55. 

Wine,  Vital,  201. 

Wenzel,- baron,  55. 

Washbourne,  Mr.  on  spina  bifida,  165* 
Wasp,  new  species  of,  293. 

Wiseman,  151. 

Y. 

YELLOW  fever,  17.— Dr. Henderson’s 
suggestions  for  the  prevention  of,  96. 
Yellow  Fever  remedy  reprobated  in 
Spain,  98. 

Young,  Dr.  69.  258. 

« 

Z, 


Zeller,  311.