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THE
MEDICAL and PHYSICAL
JOURNAL,
CONTAINING THE
EARLIEST INFORMATION ON SUBJECTS
O F
MEDICINE, SURGERY, PHARMACY, CHEMISTRY,
AND
NATURAL HISTORY ;
AND A
Critical Analysis of all New Books
IN THOSE
DEPARTMENTS OF LITERATURE.
CONDUCTED BY
T. BRADLEY, M. D.
Member of the Royal College of Phyficians, London ; Phyfician to the Weftminftsj Hpipital. and to the Afylum for Female Orphans ; Lcdturer on the Theory and Pradtice of Medicine, &c.
BY
R. BATTY, M. D.
Licentiate in Midwifery, of the Royal College of Phyficians, London ; of the* Bntilh Lying-In-Hofpital ; Phyfician to the Infant Afylum ; Fellow of the Linnean Society ; and Lecturer on Midwifery.
AND BY
A. A. NO E HDE N, M. D.
Vice-Secretary of the PJjj^CST^^^^^pqf|^Tg^5*<^rrefportding Member of the
Paris.
Printed for R. PHILLIPS, No. 71, St. Paul's Church-Yard S and fold by all Bookfellers in tiio United Kingdoms. Price Twelve Shillings in Boards. [William Thokxe, Printer, Red Lyon Court, Fleet Street.}
[ OEntcrcU at fetatfonntf H?nH.
ADVERTISEMEN T
Tt is unnecessary for us to enumerate the advantages the World derives from the different branches of Medicine. The state of health enjoyed by most human beings, at some period or other of their lives, impresses this fad too forcibly on their minds te render it a subjetl of doubt. To most of the readers of the Me- dical and Physical Journal, who are probably members of the Faculty, still less need be said on this subjeel, every practitioner being thoroughly convinced that much real benefit is daily arising from those who lose no opportunity of acquiring information, and immediately applying the skill and discoveries of their brethren to the best advantage.
JVe trust that our endeavours in so widely diffusing the ag- gregate labours of individuals have contributed materially to this desirable end ; indeed, if we may be allowed to judge from the flattering testimonies we daily receive from our Correspondents, and from the circulation which the Medical and Physical Journal now universally has through the Navy and Army, we are confi- dent that the benefits accruing to our brave champions and de- fenders ?nust be inestimable, and the improvement in Naval and Military Physic and Surgery incalculable.
In retracing the various subjecls in this Volume, our readers euill agree with us, that very valuable additions have been made to our knowledge of the Cow-pock ; that its discussion in our Jour- nal has extended the benefits of this discovery to the world ; and the minute inquiry into some occasional irregularities attending it, has led to a certain mode of practice, securing the happy effect: mankind are taught to expeel from it.
On the practice of Midwifery, and on the management of the Placenta, we are persuaded that considerable benefit must result from the valuable communications and praclical remarks we have ins-erted on this important branch of medicine.
JVe are glad to observe that Physicians are now adopting the affusion of cold water in the hot stage of fever, a praclice intro- duced by the ingenious and learned Dr. Currie, who is entitled to the thanks of the Faculty for a powerful remedy, and precise rules for its application ; on this head we. have conveyed some ad- ditional
ADVERTISEMENT.
driioual testimonies to its safety and efficacy. — On the subjeel ef Pulmonary Consumption, and the exhibition of Digitalis, we are led to hope for cures in an almost hopeless class of maladies \ and although we may be occasionally disappointed in our expeclations of its certainly fulfilling our wishes, it is undoubtedly a pozverful agent ; and when more experiments and fails shall be colicc~ted> end more precision is observed in its preparation and exhibition, w» are convinced the profession, as well as the community^ will not only reap the fruits of it, but confess their obligation to those who have brought it into notice.
JVe also trust that the public will eventually derive benefit J rem ear communications on Cancery and the discussion it has given rise & — If as yet, ?nany new fails are not added to our stock ; if we are still necessitated to have recourse to palliatives, and the feeble practice of prescribing solely to the most urgent symptoms ; if we have not yet actually established a just theory, or discovered an effica- cious remedy for this dreadful disease, — we are glad to find that bold assertions are received zuith proper caution ; that statements of cases are carefully scrutinized and cross-examined ; that men of sci- ence are eager to unveil mystery, and afford the world and suffering humanity, a fairer opportunity of estimating what degree of con- fidence may be placed on superior pretensions, or on partial and ambiguous representations of fails. However, if it be true that civil convulsions call forth unexampled energies and unexpetled abi- lities, and if the blaze of truth is frequently elicited from the col- lision of jarring opinions, we have a right to hope that a full and severe investigation of the pathology and supposed remedies of this horrible disease will at last reivard us for the search.
The state of science at the close of the eighteenth century gives us a good claim to our expeclations. Deep anatomical and physiologi- cal knowledge are not now confined to one or two Professors at our Universities ; every practitioner ?nr.:st lay a sound founda- tion of the principles of Medicine, to stand in fair competition with his cotemporaries ; and we sincerely rejoice that the very ex- tensive circulation of the Medical and Phyfical fournal so evi- dently facilitates the communication of information, and tends so rapidly and effectually to the improvement of the healing art. London, Dec, 13, 1800.
VOL. IV.] JUL^j 1800. [no. XVII.
To Dr. BRADLE Y. Dear Sir,
Li a former Number of the Medical Journal, you did me the favour to infert a paper, giving an account of a fact rela- tive to the Gloucefte. Militia, which went to prove, that thofe perfons who had been infected with the Cow-pox, could not afterward be infected with the Small-pox. Since that time, there have been fpread many vague reports of cafes, in which it was afferted, that feveral perfons who had been inoculated for the Cow-pox had, afterward; been actually infected with the Small-pox. Prefuming that fome error in the nature of the matter inoculated, or in the conduct of tha operation, mult have been the caufe of fuch oppofite conclufions, ( if there was any foundation for the' reports) I take the libertv of fend- ing you a copy of a letter, with which 1 was honoured, from a nobleman of diftinguiihed worth and refpectability. His Lordfhip could not be miitaken in Jiis obfervation of what paus- ed when his own children were inoculated for the Cow-pox; and yet, the circumftance related, may 'difclofe the caufes of thefe very different opinions and auertions. Nor could his Lordlhip have any other motive for condefcending to make this communication, but what was moft humane and liberal.
When the practice of inoculating for the Small-pox was firft introduced into this country, and even within my memory, many were the objections made to it, for religious, moral, and medical reafons ; and the difputes which arof i between the favourers and oppofers of the practice, were liberally andju- dicioufly fupported. But all the objections being founded in fpeculation or opinion, have yielded to the authority of facts and experience, and they are now almoU forgotten; though the contention taught to medical men, the neccifity of great care and circumfpection in every ftep they took. But with regard to the Cow-pox, for our whole knowledge of which we, are exclufiveiy obliged to Dr. 'Jenner-, I have not heard any reafon, nor fxn or known anv fact, that has induced me to
Numb. XVII. £' change
2
Lord Derby's Letter to Dr. Dcnman.
change my opinion, or to raife any doubt, but that many and great advantages will be derived from the introduction of the practice of inoculating for it; the force of every argument urged, and the fpirit of all the wit employed againft it, lying in the Angle word bejllal. I remain,
Dear Sir, Your very humble fervanr, Old Burlington Street, T. DENMAN.
May 29, 1800.
Lord DERBY to Dr. DENMAN. Dear Sir,
I have great pleafure in fending you as exact an account as I can give, of a circumftance which occurred when my two children were inoculated for the Cow-pox ; and if you think the knowledge of it may prevent any dangerous confequences to others, you have my permiflion to make it public.
April 30, — the children, one of which was fourteen months and the other two months old, were inoculated for the Cow- pox, by Mr. Knight, from the arm of a child which had alfo been inoculated by him. On the next morning, the arm of the elder child was much inflamed, and in a few hours a fmall veficle appeared on the punctured part, which fo nearly refem- bled the appearance we had been taught to expect, that we concluded fhe had received the infection. When Mr. Knight vifited the child, he exprefled many doubts, becaufe, as I un- derftood, the inflammation fo fpeedily followed the operation. Thefe doubts were foon converted into certainty, as in a fhort time the inflammation fubiided, and a flight incruftation was formed on the veficle, which he allured me had not the true cha- racter of the Cow-pox ; though I was, and many others not converfant with the difeafe might have been, mifled by the ap- pearance. On the Monday following, fhe was inoculated in both arms, with matter taken from a different fubject; and this was followed by a fucceflion of precifely the fame appearances as thofe above defcribed. On Wednefday, fhe was again ino- culated from the arm of her brother, in whom the difeafe had gone on fatisfactorily from the firft inoculation. This third inoculation fucceeded completely, the arm obferving the fame courfe as that of her brother. Neither of the children had the fmalleit appearance of fever or indifpofition during the whole procefs. 1 am,
With great regard, &c.
Gropvenor Square, DERBY. May 23, 1800.
( 3 )
T 7 the Editors of the Medical a?id Phyficul Journal. Gentlemen,
Th E pleafure and information derived by the Faculty from your very interesting periodical publication, merits their ac- knowledgement ; and as opinions will fometimes very mani- Feftly differ with refpect to the treatment of particular cafes, and occafionally with propriety, yet, although candour impofes your filence, and in fome fort prevents your animadverfions, a difcriminating public will approve or cenfure fuch as militate againft the founder! practice, and beft authorities : Through the fame medium, I beg leave to offer an opinion reflecting the manual or forcible delivery of the placenta, fo ftrongly recom- mended and enforced by feveral profeffional gentlemen in two or three of your lalt Medical Journals.
Having practifed midwifery for full twenty-five years upon a very exteniive fcale, and, I natter myfelf, with as much fuccefs as molt men, during which period a variety of cafes have pre- fented themfelves, wherein fuch a practice might have been thought expedient ; but, from long experience, I am taught to believe firmly, that in nineteen cafes out of twenty, more danger and mifchief would be induced than obviated by fuch attempts, rather than by fubmitting the bufinefs to Nature.
The following cafe, at an early period of my practice, awakened my apprehenfion of the danger of the manual ex- traction, and influenced my conduct ever after; except in the moll urgent cafe, as it then appeared. — I was called to a gen- tlewoman in labour of her third child, who had for three or four years been fubject to fainting fits, (not of the epileptic or convulfive kind) and had had them occafionally during her former labours, without any farther ill confequences than re- tarding their progrefs in fome degree, having always had long, flow, and very painful labours, though perfectly natural be- fore.. A prefentation of a portion of the funis in this cafe had taken place immediately upon the rupture of the membranes, before I reached my patient, a: fome miles diitance from me, who had a midwife with her. Finding a a;ood puliation, I was induced to return the funis, which I effected, per digitale, (abfente dolore) and a fingle blade of the forceps, with which, in almoft every cafe of fuch prefentation, I have fucceeded, with perfect fafety to the mother and child: the labour advanced fate I y, though flowly afterwards, and fhe was in eight or ten hours delivered of a fine living child j immediately almoft
B a after
4
Dr. Syer, on delivering the Placenta.
after which, a confiderable hemorrhage enfued, but ceafed foon upon the application of cold vinegar and water and brandy, Vv,ih an opiate, together with her fyncopc, which had occurred twice before during her labour. Being extremely anxious for the fafety and prefervation of my patient, under the above prefix- ing circumftanccs, upon her recruiting, an hour after finding no advance, by gentle efforts at the funis during little parox- yims of pain, I was induced (as I then thought juftifuibly), as well as by the intreaty of my patient and by-ffanders, to ex- tracl the placenta, (manus introduaione) which in the moll cautious and gentle manner I feparattd through the hour-glafs contraction of the uterus, as is ufual, with little or no efiuiion ; but a few mhiHtes after, a fudden, though apparently not pro- fufe, haemorrhage took place, which produced the ufual fyn- copc, from which {he never recovered.
The unpleafant fuggeftion upon this occafion, that probably my patient might have furvived, if the bufinefs had been left to Nature, impreficd and reproached me for officious zeal.
The cafe quoted by Mr. Wagft'afF, (no. xv.) although it terminated fafcly, yet, from the circumftanccs therein men- tioned, it appeared officious, and would obvioufly have proved equally fo, if left to Nature, a few hours afterwards.
Mr. Davies's cafe (no. xi.) clearly proves the non-neceffity Ijkewife of manual or forcible delivery; for, if it is ever expe- dient, which may be the cafe, the molt cautious and gradual re- paration ought to take place, not only to obviate haemorrhage and inflammation, but the truly formidable mifchief of inverlio vel prolapfus uteri, which proves too frequently the confe- quence of the rough and rude hand of hafte and ignorance, more efpecially of half-informed women midwives, an occur- rence that I have feveral times met with, to the great forrow and difcomfort of many a valuable woman ever after. How guarded, therefore, ought gentlemen to be, in recommending and fanctioning a practice pregnant with fo much mifchief.
Mr. Peck's advice (in no. XIII. ) feems ftill more excep- tionable than the former, in recommending the practice of for- cible extraction invariably, if a fpontaneous delivery does not fucceed in ten or fifteen minutes.
The fuccefsful termination of Dr. Scott's cafe, (no. xv.) by no means juftified the hazardous attempts, in the extremely reduced ftate of his patient; more time given for her to re- cruit, an opiate, and frigid applications, would in a few hours, moft probably, have induced a fpontaneous reparation, as I have repeatedly experienced.
I was much pleafed to fee in your laft Number of the M*Er dical Journal, fome very judicious and pertinent remarks
lip Oil
Jlfr. Wainvoright-, on Belladonna. 5
upon this fubjedt by Dr. Squire, a refpectable practitioner ancl teacher of Midwifry, wherein he ably combated the arguments advanced by the foregoing advocates for the practice, and in- ftanced a variety of cogent reafon?, as well as the higheft au- thorities, againft it ; at the fame time I was about transmitting thefe remarks, annexing many of the truly refpectable authori- ties he has quoted againft the practice, which how it is needlefs to recapitulate, therefore I fhall only beg leave to corroborate what he has advanced on the fubject, as from confiderable prac- tice and obfervation I am perfectly convinced of the propriety and rectitude of his advice, and lhal! be happy to fee his fur- ther future obfervations on the management of the placentay &c. which he announces is his Intention of giving to the public;
and am,
y Gentlemen,
With much refpect,
Melton, Suffolk, Your obedient humble fervant,
May 29, i2oo. J. S\ ER.
Observations on the Belladonna.
By Thomas Wainwricht, Member of the Royal College of Surgeons in London.
To the Editors of the Medical and Physical Journal. Gentlemen,
ThE account publimed in your journal for April, page 367, of the effects of the belladona applied to the eyes, pre- vious to their being operated on for the cataract, induces me to trouble you with a few obfervations on the medical ufe of this plant. .
Ray has related a cafe, where, from the application of the ^reen leaf of the belladonna to the eye, the iris became fo af- fected, that the pupil would not contract even in the brighteft light. The leaf being removed, the eye was gradually re- ftored to its former ftate ; and this was repeated three feparate times. It does not feem to have been known, that die dilata- tion of the pupil and paralytic ftate of the ins, invariably fol- lowed the free application of the belladonna to the eye.
Twelve
6
Mr. IVainwr'tght) on Belladonna.
Twelve years ago I became acquainted with this fad}, from accidental and perfonal experience; and in 1791, I mentioned this r maikable effect of the belladonna to the Phyfical Society of Guy's, and at the fame time {rated my expectation, that advantage would arife from its application in certain difeafes of the eye. I have been in the habit of applying the juice and the extract of" the belladonna diluted with water, very freely, in many cafes of inflammation of the eye for feveral years. In almoft every inftance where the belladonna has been brought in contact with the cornea, the pupil gradually dilates, and the iris becomes lefs and lefs fenfible to the ftimulus of light. The degree of dilatation can very much be regulated at pleafure, by repeating the application ; in fome instances, the iris has aimoft difippeared, and temporary lofs of vilion enfued : the ufe of the belladonna collyrium has been continued through one and two weeks. When the belladonna is difcontinued, the eye in every inftance is reftored to its natural ftate ; the iris recovers its fenfibility in about twenty-four or forty-eight hours. The application of the belladonna has lefs effect on the eyes of fome ; and in feveral difeafes of the eye, the pu- pil'is not fo readily dilated by it. The ufe of the belladonna does not in any way weaken or injure the fight ; on the con- trary, I have thought that a moderate artificial dilatation has, in my own cafe, rendered my vifion ftronger and more fteady ; and that the glare of fun-mine has been lefs offenfive to me. There is no doubt on my mind, but that the external ufe will be found greatly to facilitate the operations for the cataract. The belladonna collyrium is fcrviceable in acute inflammations of the eye, and in inflammations arifing from external vio- lence ; in the fcrofulous opthalmia it has, with me, had no good effect ; and it has alfo failed in an opthalmia, which afterwards turned out to be venereal. Specks, attended with coniiderable inflammation, were in two inftances removed, by repeatedly infinuating the extract of the belladonna under the eye-lids: the expreffed juice diluted with water, is more effectual than a folution of the extract in water. I have thought the bella- donna lotion more efficacious in cafes where the pupil is to be quickly dilated from its ufe. The beauty of the berries of this plant, has frequently led children to eat them in confi- derable quantities ; and in feveral inftances, twelve and even f.venty-four hours have elapfed before any medicine has been exhibited, and the berries have continued to be voided by ftool during two and three days ; yet, I have not heard of any cafe which has terminated fatally: — the berries do not appear to be fo deleterious as the leaves. From a very free application •f the diluted extract of the belladonna to an eryfipelas of the
leg,
Dr. Dod, on Smail-Pox Inoculation.
7
leg, attended with excoriations, the pupil became diluted, with irritability of the iris, and temporary blindnefs, with pain of the head, convulfive twitchings, and that peculiar idiotic de- rangement of the mind, which arifes from tne belladonna hav- ing been taken into the flomach in improper quantities.
The belladonna has been given internally, joined with calo- mel and tartar emetic, in obftinate cafes of chronic rheuma- tifm, in certain cutaneous eruptions, and in cafes of ulcers and of tumours threatening to become cancerous, with good effe<St. Temporary amendment has followed its ufe in cancer ; half a grain of the extract: is a full dofe, and mould be repeated night and morning, or thrice a day, till the pupil is fomewhat dila- ted : the dilatation of the pupil is an excellent criterion of a full dofe. The medicine fhould not be pufhed further, but this effect: be kept up. It is a great error to give medicine in too large dofes ; and it has been well obferved, that medicines, given in very large dofes, often lofe their peculiar effect:-, and act as mere ftimulants. I am, Gentlemen,
Your very obliged humble fervant, Dudley, >«i4> 1800. T. WAIN WRIGHT.
INOCULATION.
At a time when the Vaccine Inoculation is nearly efta- blifhed in this illand, and when it has made a confidtrable pro- grefs in Ireland and on the continent, it may gratify the cu- riofity of many of our readers to be informed what kind of re- ception the Inoculation of the Small-Pox experienced on its hrft introduction into this kingdom. With this view we pre- fent them with the following account. In the year 1746, a lmall pamphlet was publifhed, intitled,
" Several Cases in Physic ; and one in particular, giving an Account of a Person who was inoculated for the Small-Pox, and had the Small-Pox upon the Inoculation, and yet had it again ; together with two or three other very remarkable Small-Pox Cases, &c. By Pierce Don, M.D. Fellow of the College of Phyiicians, and Phyfician to St. Bartholomew's Hofpical."°
The particular Cafe referred to in the above title-pao-e is given as follows, at page 12 of the pamphlet.
" I did not think to trouble you with any thing more at prefent, but another Small-pox cafe being lately come to my hands, I was unwilling to iofe the opportunity of communi- cating it.
* It
8
Dr. Dod-, on Small-Pox Inoculation.
" It is the cafe of a little boy, fon to Mr. Richards, mem- ber of parliament for Bridport in Dorfetfhirc. He was inocu- lated about three years ago, at the age of about three, and had the Small-pox come out upon him to the number of fifty or fixty, and they maturated and fcabbed, and went off" in the fame mariner that that fort of pock, which was a regular and diftinft one, generally does : But about two years afterwards, i. e. about a year ago,~ he had the- Small-pox again, and there came out between two and three hundred, which maturated and fcabbed likewife, and went through the fame ftages, and in the fame manner that the former did, only he was worfe be- fore the eruption ; but when that was completed, had no man- ner of diforder, except too much of an appetite, as is ufual, every now and then, in and after the Small-pox.
" This is authenticated to me by a letter which I have from a learned and experienced phyfician in thofe parts, Dr. Brao- repp, who is likewife grandfather to the child, and attended him upon both occafions ; and, whatever may be faid in evafion of other cafes, in which perfons that have been inoculated have had the Small-pox afterwards, as, — that the inoculation did not take place, there was no eruption, at leaft no variolous one, and the like,— is certainly an inftance that all is not to be depended upon that is given out in favour of, or is expected from Inoculation ; and thac it is, by no means, an effectual fe- curity from having the Small-pox again.
" But, as it has been oblerved long fince by the inimitable author of Hudibras,
" Suiely the pleafure is as great " In being cheated, as to cheat."
or elfe it is impoflible that Inoculation fhould triumph fo much as it is faid that it does over all its oppofers." â–
This curious pamphlet was anfwered by Kirkpatrick, in the fame year, with great wit and feverity, under, the following title :
u A Letter to the real and genuine Pierce Dod, M. D. aclual Physician to St. Bartholomew's Hospital; plainly exposing the low Absurdity or Malice of a late spurious Pamphlet, falsely as~ cribed to that learned Physician : with a full answer to the mistaken Case of a natural Small-pox, after taking it by Ino- culation."
Thefe two mterefting pamphlets are become very fcarce ; though the latter was afterwards reprinted with the author's real name, and an apology for the feverity of fome of his ani- m^dverfions, which he underftood had diminifhed Dr. Dod's reputation and practice.
On
( 9 )
On the Perspirable Fluids ; by Dr. Mitchill.
From the American Journals we prefent our Readers with the following very ingenious " Speculations concerning the per- spirable Fluids of Human Bodies. In a Letter from Dr. MiTcrtiLL to Dr. Duncan.
« Sir,
u In reply to your laft letter, I have to remark, that, of the fluids afforded by the human body, few have been more talked of, though, perhaps, none to lefs advantage, than thofe exha- lations or effufions from its furface, denominated perfpiration or fweat. The reafon alleged wherefore fo little has been expe- rimentally done upon thefe fluids or humours, is, that they can- not be obtained in fufficient quantity; their volatility being fuch as to prevent the collection of either of them, to fuch an amount, that much certain information can be obtained about their peculiar natures and qualities.
" This is, indeed, in fome degree, the cafe; and, without doubt, the difficulty of procuring, conveniently and frequently, parcels of the matter fecreted from the fkin, has retarded the progrefs of inquiry on this point. While, therefore, the fluids fecreted in the liver, pancreas, kidneys, ftomach, mouth, and almoff. every other part of the human frame, have been exa- mined with great care and exa&nefs, experimenters are yet very much behind-hand in their knowledge of the cuticular difcharge.
" It is not my intention to ftrike the balance between the proportions of fluids fecreted by the kidneys and the fkin, on the one part, nor to adjuft the difference between the exhala- tion by arteries or glands, and the inhalation by lymphatics or r.bforbents, on the other. My object is, to examine, by fuch means as, it appears to me, we are pofleffed of, what fubftan- ces they are which compofe the cuticular fecretion in the time of health, what alterations it undergoes by accumulation and confinement in certain cafes, and how peftilential fluids and fomites may be produced thereby.
** It will not, therefore, be neceffary to give an anatomical defcription of the fkin. All that will be offered will be ca- pable of being comprehended without going into details upon that fubjecl. Almoff all that you need recollect is, that the true Jkin is furnilhed with arteries, veins, glands, excretory duels, and lymphatics, and that it is covered over by a porous femi-tranfparent fort of (heath, called EPIDERMIS, or cuti
Numb. XVII. C cIe!
10 Dr. Mitchilt, on the pcrfpirahle Fluid;.
CLE, which is infenjible, bibulous-, and exceedingly apt to grcte dirty ; and this to a confiderable degree without the confeiouf- nefs of the wearer.
" A quantity of oil, fecreted into the cells of the adipofe membrane, underlays the true fkln in moft parts of the body; and the veflels and glands concerned in this function combine alfo a portion of the phlogiflon ( hydrogen ) and carbon of the blood, into a febaceous or greafy compofition,. to anoint and* foften the cuticle. A portion of this fatty matter, in the time of health, is fpread over the whole furface, though in greater quantity in ionic parts, and at fometimes, than at others. (Li- quor oleofus — inflammabilis — cutem perungit. Haller^ 5 Ele- ment. Phyfiblog. § 20.) The palms of the hands, the infides of the fingers, and the foles of the feet, are remarked for hav- ing the leaft of it.
" This oily fluid, with which the external furface of the body is fmeared, was found, in the early ftages of fociety, while yet drefs was fimple, and few or no clothes were worn, to be too copious in fome conftitutions, and to colle<5t in greater quantity than the purpofes of comfort required. When this happened, from its adhefive nature, particles of duft, and other things floating in the air, would readily flick to it, and occa- fion fome degree of unpleafant fenfation. To remove this un- pleafantnefs, and the caufe of it, inftindt or accident led to the practice of bathings or of purification with watery which beuig not capable of removing completely the foul and greafy collec- tion, was afterwards quickened in its activity by alkalies and soaps, fubftances which experience proved to be very efficaci- ous in ridding the (kin of its incumbrance. It fometimes hap- pened, too, that the oily liniment of the fkin was too fparingly effufed, or too quickly removed, and did not impart to the cu- ticle (which, it will be remembered, has neither nerves nor fenfibility) that pliancy and fopplenefs which is eflential to plea- faftt and perfect feeling. The epidermis was then prone to be- come horny, to crack, and to induce difagreeable or painful fenfation. To relieve this inconvenience, the cuftom of ap- plying grease or oil over the furface of the body feems to have been adopted by mankind likewife at a very early period ; and in this way the deficiency of the matter of fecretion was fup- plied by art.
« The ufe of water, and of alkaline lotion?, fometimes ren- dered more active by being warmed, and the employment of oil and foft ointments, now and then aided bv manual fricliort> feem to have obtained very extenfivcly, from the mere comfort- able effects they wrought, without any reafoning or theory whatever. Sometimes a perfon employed the watery applica-
Dr. Mitchill, on the perfpirabk Fluids. 1 1
tion only, fometimes the oily, and then again he made ufe of both, in rapid fucceffion.
" But this adipofe fecretion is by no means a pure oil. Ac- cording to circumftances, it is occafionally blended with phos- phoric, sulphuric, septic, and a furplufage of carbonic matter.
" And it is further altered, as far as its nature will permit, by the conftant tranfmiflion of that aqueous fluid, the in- sensible perspiration, through the cuticle, and by the drops of sweat into which it is fometimes condenfed ; both formed by a coalition of a portion of the phlogifton (hydrogen) of the blood, with a parcel of its oxygen, and this liquid (err- ing as a menftruum for certain other fubftances. The exceed- ingly great quantity of perfpired matter inceffantly palling off from every exhalant pore of the fkin, leaves behind, as it eva- porates, fome of its more fixed, faline, and feculent parts, along with, or upon, the greafy covering of the cuticle. A portion of carbon, phofphorus, and fepton, with, fometimes, an over- plus of oxygen, feem to accompany this, efFuiion of the fkin, and, in fome quantity, to remain behind, after the water has evaporated.
" It was remarked before, that the cuticle was infenfible, bi- bulous, and, of courfe, exceedingly apt to grow dirty. How can it be otherwife? The cuticle has neither nerves nor blood-vefiels, and there is little or no reafon to believe that it porTerles organization. It is therefore, in ftri&nefs, lefs a part of the living body, than a kind of tight fhirt, or clofe- fetting tunic, drawn over the whole furface of the body. This fhirt or tunic of cuticle may be confidered as» a foreign wrap- per, or piece of natural clothing; and, like every other foreign thing which enwraps the body, is liable to become charged with fuch fubftances as are excreted froip the true skin within it. The foulnefs of this natural shirt is a fre- quent occurrence. Almoft every body lets it get dirty. When the naftinefs is very confiderable, the poifonous or ftimulant matter entangled there, irritates or inflames the organ of feel- ing, with which it lies in contact, and produces various itch- ings, pimples, eruptions, blotches, tetters, fores, &c. being a principal cause of the diltempers of the fkin. To a cor- rect mind, a dirty cuticle will appear to be a dirty jhirt. If the former could be ftripped off", and cleanfed in the wafh-tub, like the latter, there might poflibly be a convenience in it. This is, however, of fmall moment, fince we know the cuticle can be well cleanfed without being taken off.
" The modern ufe of white llhen and cotton, as articles of raiment, enables us to judge, with tolerable accuracy, what material it is, which Hurts, made of thofe kinds of cloth, and
C 2 worn
J 2 Dr. Mitch ill, on the perspirable Fluids.
worn next the cuticle, receive from the perspiration and sweat. What the garments imbihe muft have pafled firfl: through the cxhalant arteries or excretory ducts, then 'under- gone a further change while remaining in and about the cu- ticle or first shirt, and afterwards have been tranfmit- ted, by rubbing or wiping, to the linen fibres or cotton fila- ments of THE second. The animal matter which befouls the outer shirt is a good indication of that which adheres to the inner. For, as clean linen and cotton become foiled very foon by lying in contact with any part of the human body, what they receive muft be principally derived from the cuticle which they touch and abfterge.
" The uncleannefs of shirts, drawers, and stockings, may, therefore, be deemed to be matter wiped from the cuti- cle, and derived to the cuticle from the venels and du£ts of •the ftibjacent true skin. An examination, then, of the facts relative to clothing grown foul by long wearing next the cu- ticle, may be comldered as virtually an examination of the cur tide itfelf, and of the excreted matters which fticlc to it. ,
" I. One general property of all thefe matters, and of clothes tainted by them, is, that alkaline falts and foaps will feize, neutralize, and extract them ; the garments being thereby rendered wholefome and clean. An unqueftionable effedt of filch applications is to remove the greafy or uncluous matter communicated to them from the cuticle. But this is not all — ; The watery as well as the oily part of the perfpirable matter contains the bases of acids. A portion of oxygen com- bining with this, fat material, imparts to it more or lefs of rancidity. Another portion, uniting to carbon, forms Car- bonic acid, and this, volatilized by heat, is converted into carr bonic acid gas. Another portion of the acidifyin? principle, uniting to the phofphorus, turns it to phofphoric acid : while the fepton (azot), if it happens to combine with caloric alone, flies ofF in the form of azotic air ; or, if it makes a junction with oxygen, conftitutes, with it, septic acid. Oils, being capable of uniting with the ftronger acids, efpecially with the i'eptic, and probably, alio, with the pholphoric and carbonic, there can be little doubt that thefe acids, or fome of them, or fome part of fome of them, join with the adipofe matter into a fort of acid soap, on the cuticle and fhirt. This acidifying procefs, whereby carbon, phofphorus, and fepton, unite to oxygen, tikes place, not before secretion, but after the perfpired matter is depolited on the cuticle, or lodged in the fhirt. The formation of acids, in this cafe, is not the im- jmediate effect of vital movement at all, but refults from che- mical attraction going on among the particles pf the fluids,
At TLB
State of Difeafes in London.
*3
AFTER excretion, as in other inanimate matter; neither the cuticle, nor the fluids which befmear and bedew it, having any living energy to controul or modify the laws of chemical ac- tion. Hence proceeds that sour smell from clothes in, which failors and labouring men have fweated profufely, which, though obvious to the fenfes, and familiar to the wearers and to wafher-women, remains unknown to hardly any body but philofophexs.
[ To be continued. ]
STATE OF DISEASES IN LONDON.
â– Account of Difeafes in an Eajlern Dljtriil of London, from the 20th of May to the 20th of June, 1 800. No. of Cafes.
No. of Cafes.
- - 6
7
2 I
9 4
9 4
4 6
20
3
2
5 4
Cephalalgia - -
Vertigo -
Epilepfia - - - - -
Paralyiis ------
Hyfteria ------
Dyfuria - - - - -
Chronic Rheumatifm
PUERPERAL DISEASES
Peritonitis - - - - - fylenorrhagia lochialis
INFANTILE DISEASES
Ophthalmia purulenta - Aphthae ------
Rachitis - - - - -
Scrophula - - - -
Hooping Cough - - -
4
3
2
6
,1
z 5
2
5 i
4 3
ACUTE DISEASES.
Typhus mitior - - - Sore Throat - - - - Small-Pox - - - - Cough . - - - - Dyfpncea - - - - - Cough with Dyfpncea - Haemoptoe - Phthifis Pulmonalis - - Gaftrodynia - - - • Diarrhoea - - - - Colica - - -
Colica Pidtonum - - Hsemorrhois - Afcites -
Anafarca ----- 6 Hydrothorax - - - - z
Having arrived at that feafon of the year in which thofe dif- eafes, which form a large proportion of the lift in the winter months, ufually decreafe in number, or abate in the violence of their fymptoms, we might expect that this dafs of mala- dies fhould hardly make their appearance on the lift.
The great viciffitude, however, in the temperature of the atmofphere, has protracted fome of thefe complaints to an un- ufual period. Difordcrs- of the bowels alfo, which were taken notice of in the laft report, form an important part of the pre- fent lift.
Cafes of diarrhoea have been uncommonly numerous ; have been protracted to a conhderable length, and have been liable to return upon the leal! irregularity of regimen or diet.
Difeafes
State of Difeafes in London.
Difeafes admitted under the Care of the Phyfuians of the Wefminfler Hofpital, from the zo/h of May to the 2 if of June, 1800.
Continued Fever - - - 16 Hsemoptyfis ----- 2
Pleurify ------ 1 Haemorrhois - - - 1
Sore Throat - - - - i Hyfteria ------ 3
Amenorrhcea - ... 2 Impetigo - - - - - 1
Anafarca - - 6 Jaundice - 1
Angina Pe&oris - 1 Leucoirhoea - - - - - 3
Afcites ------ 2 Lithiafis - - - - - - 1
Afthenia ------ 2 Rheumatifm - - - 5
Catarrh ------ 1 Palpitatio ----- 1
Cephalxa ----- 1 Syncope ------ 1
Cholera ------ 2 Sciatica ------ 1
Cough ------ 4 Struma ------ 3
Diarrhoea - - - - - 5 Syphilis ------ 1
Dyfpepfia - - - - - 1 Tinea ------ 2
Dyfuria ------ 2 Vertigo ------ 1
Enterodynia - - - - 2 Worms ------ 1
MONTHLY REPORT of DISEASES, Admitted under the Care of the Physicians of the Finsbx-'ry Dispensary, St. John's Square, Clerkenwell.
The Diitria, in. which the Patients of the Finsbury Dispensary are visited, com- prehends the Par.ihes of St. James , and of St. 'John, Clerienvjcil ; of St. Luke ; tf St. Sepulchre ivithin and without ; of St. Bartholomew, the Great and the Ltfs ; the Liberties of the Roils, and of Glafs-Uouse Yard ; the Town of I/ling- tin; the Pari she* of St.Pancras; of St. jindrew, Ho/born; and of St. George the Martyr, Queen s-fyuare. This Tract nf Ground may properly enough be term- ed t a North IVcstcrrt District of the Metropolis.
List of Diseases, &c. from May 20, to June 20.
No. of Cafes.
Hsmorrhois - - - - - 4
Worms 7 Prurigo - - - - - -11
Schrophula - - - - 3
jaundice - - - - .2
Paralyfis - - - - - 3
Cough and Dyfpncea - - 14 Dyfpepfis ----- 27
Chronic Rheumatifm - - 12 Acute Rheumatifm - - 2 Lumbago - - - - - 4.
Menorrhagia - - - - 10
Diarrhoea ----- 6
Hiemoptyfis - - - - • 6
No. of Cafes.
Sore Throat - - - 1
Continued Fever - - - 10
Pneumonia ----- 2
Dyfentery ----- 3
Amenorrhea - - - - 13
Leucorrhcea ----- 9
Afthenia ----- 10
Phthifis 12
Hyfteria ------ 6
Dropfy ------ 7
Cephalasa ----- 5
Infantile Difeafes - - - j8
Mania ------ 3
It
Observations cn Diseases in London.
It appears from the above Report, that the difeafes which fcave principally prevailed during the laft month are dyspeptic^ or thofe that originate from fome fault in the organs of digef- tion. This is, in a certain degree, to be accounted for by the alteration that has taken place in the temperature of the air, which, whilft it has proved more favourable to the relief of catarrhal and rheumatic affections, may, by its increafed warmth, have a tendency to relax the tone of the ltomach, and thus pre- difpofe to thofe morbid fymptoms which are more peculiarly connected with that vifcus.
The diforders of the ftomach which have occurred, might, in a large proportion of cafes, be clearly traced in men, to the abufe of fpirituous liquors ; and in women, in addition to the abufe of fpirituous liquors, to which, after they have once paffed over the bounds of fobriety, they are, more than the other fex, completely and irretrievably devoted, an intemper- ance in the ufe of tea. Although this, in a moral view, is furely far iefs dangerous than inebriating ftimuli, is not, per- haps, much lefs fo in its phyfical effects upon the conftitution. Befides, that from the degree of debility and depreffion which it induces, a perfon is naturally led to have recourfe to what are called tonic medicines, or to exhilirating cordials.
A remarkable cafe has occurred of an idiotic girl, about fif- teen years of age, who is uniformly thrown into a ftate of the molt violent madnefs by the hearing of any kind of inltrumen- tal mufic, fuch as the ringing of bells, the notes of an organ, &c. After the hearing thele or any other fimilar inftrument, file, for hours, endeavours to imitate the found with her voice. What makes this cafe itill more fmgular, is, that according to her mother's account, file is not in any degree affected in the lame way by singing.
There was another cafe of mania, which the fifter of the pa- tient attributed to the influence of religious enthufiafm. But whether, in this particular inftance, the religion gave rife to the infanity, or the infanity to the religion, it was not in the power of the medical attendant to afcertain.
One of the inftances of cephalaoa, in the above lift, was re- markable from its alternating with an ulceration of the breaft. W hi lit the latter, either by time, or the application of furgical fkill, gradually got better, the former as gradually came on. This alternation had taken place in repeated inftances. The pain in the head was at its greateft violence at the period of the patient's firlt attendance at the Difpenfary, when the fore was completely healed. As a fubititute for the difcharge thus (topped, an iffue was ordered in the arm, in confequence of which, and partly perhaps in conf-quence of the Peruvian bark,
which
i6
Observations on Diseases in London.
which was alfo prefcribed, and the enjoyment of country air, the patient for fome time paft has not, in any confiderable de- gree, fnffered from either of the complaints with which flie had been before afflicted.
In the cafes of amenorrhcea that have occurred during the period that the drawer up of this report has attended the dif- penfary, the preparations of fteel have exhibited a decided fuperiority over thofe of the Peruvian bark, or indeed, any other remedy taken into the ftomach.
Electricity in one inftance proved almoft immediately fuc- cefsful. It is to cafes like thefe, where a fudden agitation of the fyftem is required, that this ftimulus feems peculiarly adapted. In a cafe of paralyfis in which it was adminiftered, it produced fome appearance of temporary relief, but the pati- ent died on the fucceeding day. Perhaps it may be laid down as a general rule, that chronic difcafes are not to be cured by •violent Jllmull, but rather by the application of thofe gentle re- medies that gradually reftcre the ftrength of the conftitution.
A cafe equally remarkable and melancholy, has remained for a very long period under the care of the difpenfary. It is that of a young woman who, for many years paft, has been confined to her bed in a ftate of universal fpafm. She lies ri- gid and motionlefs, with her eyes more than half clofed, and every other organ of fenfe almoft completely fhut againft ex- ternal impreffion. The phyfician who attended her, by fpeak- ing in her ear as loud as it was poflible for him to do, fuc- ceeded only fo far as to produce a motion of the lips that be- trayed an ineffectual endeavour for utterance. It feems to be a cafe in which there is an habitual abfence of actual fenfation, although, by fome violently exciting caule, the feniibility may, at times, be imperfectly awakened. Lying in fuch a ftate, with fcarcely any fymptom of vitality but a feeble refpiration, ibe can be regarded as little elfe than a breathing corpfe. Upon this curious cafe being ftated to a perfon of diftinguifhed learn- ing and acutenefs, he fuggefted it as a poflibility, that con- fcioufnefs might ftill exijf^ although it was unable to appear^ in coniequence of the voluntary mufcles ufually employed in expreffing it, refufing in this inftance to difcharge their accuf- tomed office. This, it is to be hoped, is not actually the cafe. Nothing is more terrific to the imagination than the idea of being buried alive ; and what mode of being buried alive can be conceived more truly horrible than for the foul to be entombed in the body ! J. R.
Matton Garden, W. W.
To
( 17 )
2o the Editors of the Medical and Phyfical Journal. Gentlemen,
It muft give great pleafure to every lover of, and well-wifher to, the fcience of medicine, to fee that feveral of your Corref- pondents have called the attention of the profeffion to the fub- je£t of Quackery ; which is likely to become more extenfively pernicious, from the public teftimony which a few perfons in exalted ftations have thought it incumbent upon them to bear to the efficacy of certain advertifed infallible remedies. The danger obvioufly refill ting from Empiricifm will be readily ad- mitted by all who have been regularly educated, and are con- verfant with the powers of ample and compound medicines, and the ceconomy of the human fyftem ; but it is not fo eafy to difcover a method of checking the public progrefs of this evil. The plan which your correfpondent, Aliquis, propofes of re- ferring the fubjedt to Parliament, would certainly be effectual, could an act be paffed, forbidding the advertizing any kind of noftrum in any news-paper, hand-bill, or in any other way whatever ; for it is by thefe means that the public attention is conltantly directed to the proprietors, whofe names would foon fall into contempt, if their fkill and reputation were analyzed by the moft proper teft — the number of real cures which they wrought. So well aware of this faol: are thefe infallible doctors themfelves, that they find it neceffary to vary the form of their advertiiements, to obtain even them a reading.
Mr. Bartley has, with probable fuccefs, ( in No. XV. ) brought into view fome facts, to prove the danger, expence, and folly which thofe run into, who are the dupes of Quack- cry. It appears to me, that the frequent expoiurc of fuch fafts would have th ■belt effect : but in order that they might, it is neceffary they ihould be circulated through the fame channel as the do£tors' advertifements ; for. the readers of your excellent Journal are not the perfons likely to be hurt by the ignorant and prefumptuous empyric. It is, generally fpeaking, the mid- dling and lower ranks of people who are the fubjec~ts and dupes of this impofture : And that the public may have the better opinion of the medicines, the proprietors commonly inform them, that, " by the blefiing of God" they undertake, with their powders, potions, or balfams, to cure all difordcrs. Thus ig-* norance and blafphemy unite in picking the pockets and ruin- ing the conftitutions of thoufands. It might be well if the fol- lowing general obi'ervation, amongft others that might be men- tioned, could any way be impreiled upon the public mind: — Numb. XVII. D The
1 8 Mr, Customer on Quackery.
The pretcnfion to infallibility in any one medicine, in curing any one diforder, is abfurd ; much more ridiculous is it to fup- pofe, that any medicine will remove all kinds of complaints : for every medicine poneffes active properties, or it does not. If it be active, it mult be dangerous to apply it, indifcrimi- nately, to perfons of every age, and without regard to their ha- bits ot living. Such an active medicine may be very efficacious in ftrengthening a debilitated conftitution, but would be highly injurious if exhibited for acute rheumatifm, or any other in- flammatory diforder, and, vice versa ; confequently, it is un- wife and unfafe to apply the fame remedy in all cafes. Should the medicine be inactive (which is doubtlefs often the cafe, or more mifchief muft follow) it can be of no other utility than to work upon the imagination; thereby amufing the patient, while his pockets are rifled, unperceived.
It is to be lamented, that while many are robbed of their money and health by mercenary and rapacious impoftors, not a few are led into error and danger by the noftrums of thofe who- are actuated by the pureft motives in recommending them to the public, through the channel of various periodical publica- tions. I allude now particularly to the circumftances of balm, barm, or yeaft, having been, in the moft unqualified manner, held out as a certain cure in putrid fevers. That which is fim- plein its nature, and eafy to be come at, is fure to go down with the multitude. It is not denied, that the fixed air in the balm may occafionally have fome good effect in putrid difeafes ; but I condemn the conduct of thofe who, in contending with fo dan- gerous and powerful an enemy as typhus fever,- place yeaft in the front and heat of the battle, whilft bark, wine, and opium are put in the rear, or, perhaps, ftationed at a diftance as a " corps de referve."
In the Armenian Magazine for Auguft laft, a very brilliant difplay is exhibited of the wonderful effects of this wonderful medicine. Amongft other cafes, " too tedious to mention," a man is ftated to have been " in the laft ftage of putrid fever," when the yeaft was given, " diluted with water," and the *' next morning he was apparently well, and walking in bis garden." So in the Monthly Magazine for laft November, it is afferted, that " a ftrong Dutch girl, brought low with a putrid fever, was ordered fome yeaft, and was immediately tured." 1 have frequent opportunities of feeing and treating putrid fevers, but have never witneffed thefe fudden recoveries from the laft ftage of them to " walking about in gardens." But as people in general are ignorant of the diforder, no won- der if, being iil judges of the moft fui table remedies, they
throw
Mr. distance, on Yeast in Typhus.
1.9
throw out to a finking friend even a rope of fand, that is hand- ed to them by a kind but miftaken neighbour.
I lately attended the fervant of a gentleman, in the laft ftage of typhus ; pulfe 140 ; fubfultus tendinum, Sic. I informed him, I thought the cafe a dangerous one. He faid, he wifhed me to try yeaft, as he had feen it ftrongly recommended in the Monthly Magazine. I told him that, to give it a fair trial, I fhould lay aiide every thing elfe. I did lb; and the f-cond fpoonful of yeaft brought on fuch a purging as had well nigh carried her ofF; but by returning to opium, wine, and bark, fhe happily recovered. About a week after, another young woman, who had been ill nine days, and was covered with pe- techia;, and even vibices, was directed by her mafter to take the yeaft; and if fhe was no better in the morning, to feud for me. In about four hours after fhe took the yeaft, a violent purging came on, which I could not check, and fhe died the next day. There were five others in the family, who were all fuccemvely attacked, and to whom I exhibited opium and vo- latile alkali pretty plentifully; they all recovered excepting an infant two months old, to whom it was impoflible to give any thing. Thus we fee, that however well " a ftrong Dutch girl" may bear working with yeaft, it will not be fafe to have recourfe to fuch means in recovering our fair country- w<5men from putrid fevers, The publisher of this ncftrum, in the Armenian Magazine, tells us, he was firft led to this idea from the fact that a piece of putrid meat is fweetened by being fuf- pended over working beer. But to conclude from hence, that yeaft (that is, the fixed air in it) will correct the putridity of the blood, and other animal circulating fluids, is fallacious ; for it is not generally admitted that fuch putridity actually ex- ifts in the blood: But fuppofe it does; if we allow ourfelves to judge of the effects of any fubftance on the living fibre and fyftem, from its known action on dead matter, we lhall be led into the moft dangerous miftakes. The concentrated vitriolic acid preferves dead animal matter from putrefaction ; but we know that it cannot be fvvallowed with fafety, except in fmall quantities and diluted with water. So, on the other hand, hu- midity is known to promote the putrefaction of dead animals, while water may be f wallowed, and externally applied, not only with fafety, but even with advantage, in putrid fevers. Upon the whole then, it is plain, that uhlefs the public in general were well acquainted with the various difeafes incident to man- kind, it muft be dangerous to commit the treatment of them to fuch unfkilful hands. We do not acl fo in the other profef- llons. Does not the client employ counfel learned in the law to plead his caufe ? Will a wife government entruft the com-
D 2 mand
#
20
Mr. Custance-f on Croup.
mand of its armies and navies to men unacquainted with mili- tary and naval tactics ?
Permit me to embrace this opportunity of tranfmitting to you two cafes of Croup fuccefsfully treated with the Digitalis, which, 1 think, promifes to be a very efficacious remedy in that dreadful and generally fatal diforder. I fhould have wait- ed to fee its effects in a greater number of cafes, before I had fent you the refult, but am defirous of throwing out the hint to practitioners in general as early as poflible, and (hall be happy to fee it has been improved upon with the defircd fuc- ceis in tluir future treatment of the croup.
Mary Eell, four years of age, was brought to me about twenty-four hours after being attacked with the ufual fymp- toms of croup. The hoarfenefs, fhrill voice, and dyfpncea were very confiderable. I ordered five drops of tinct. digi- talis to be given her in water every four hours; and the next day {he was quite free from the complaint, which never re- turned.
Mary Millard, a year and half old, was attacked on the I ith of this month with hoarfenefs, a barking cough, and great dyfpncea. I faw her about twenty hours after the firft appearance of thele fyinptoms, and found her extremely reft- lefs, with a very quick pulfe. I ordered five drops of the tincl. digitalis every four hours. 12th, Symptoms relieved; p. ftill quick ; has had one ftool. Increafed the dofe to fix drops: — at night p. lefs frequent; three ftools ; hoarfenefs and barking almoft gone. 13th, Still fome barking, but coughs lefs frequently : — 8 o'clock at night, very reftlefs ; hoarfenefs and dyfpnoea increafed; p. very quick. Cont. tinctura. 14th, Slept well ; frequent ftools ; dyfpncea and hoarfenefs much re- lieved. Adde tinct. opii gt. ij. ling. dos. digitalis. 8 o'clock at night, five ftools fince morning ; p. much lefs frequent ; dyfpncea and hoarfenefs ftill better. 15th, A good night; two ftools ; pulfe calm ; dyfpncea quite gone ; fome hoarfenefs re- mains. 16th, Symptoms of the croup quite gone. 21ft, Con- tinues free from complaint. I am,
Gentlemen,
Kidder minjfer, Your moft obedient fervant,
May 22, 1800. GEO. CUSTANCE.
To
( 21 )
To Dr. BRADLEY.
Sir,
If I had waited for the prefent increafing numbers of im- partial reftimonies and indubitable facts in favour of Vaccine Inoculation, I need not have troubled you to infert this letter in your ufeful Publication; but as, in the onfet, I did (with more seal than prudence) oppofe, what I then confidered an innovation in practice, (by confounding the uncertain effects of the cafual, and, perhaps, fpurious cow-pox, with the real advantages evidently arifing from this difeafe when inoculated) I now think it right, in juftice to Dr. Jenner and the medical public, to declare,
That, in the courfe of my practice, I had occafion to make trial, and do approve of vaccine inoculation ; yet, I think it fhould only be conducted by practitioners who have taken proper care to afcertain the genuine difeafe.
I remain, with great refpect, Sir,
Your obliged and conftant reader, Cfocefler, May 29, 1800. CHARLES COOKE.
To the Editors of the M edical and Phj/Jical Journal, Gentlemen,
Fr OM my not having been in the habit of reading your Phyfical Journals, I remained till this day, (when a friend put the whole of them into my hands) nearly ignorant of the va- riety of debates which have taken place upon the important fubject of Vaccine Inoculation. Dr. Jenner's two firft pub- lications, a paper of Dr. Pearfon's, and an early one of Dr. Woodville's, comprehended the whole of my reading on the difeafe; but, I have been by no means an idle practitioner in the bufinefs, and I have not failed to endeavour to fatisfy my- felf completely in every doubtful point regarding it : and I find, in that refpect, I have fuccecded quite as well as my bro- ther inoculators. If you can afford me a page or two in your next Pamphlet, I will mention a few particulars which, I hope, may not be unfatisfactory. Early in laft Spring, Dr. Pearfon (of whofe acutenefs and indefatigable perfeverance too much cannot be faid) fent me fome vaccine virus, with which I ino- culated feveral perfons -} in two inftances only it took effect ;
on
Mr. Kelson, on Vaccine Inoculation,
on a man and a little girl : The former about the ninth day be- came ill, and fo continued for feveral days, when a few pink% flery -looking hlijlers appeared on his body, and then followed a very numerous eruption, exa6r.lv like fmall-pox of the diftindr. kind ; they took the ufual courfe of variolous puftules, and the man did well. From one of thofe pink vefications, I inocula- ted his wife, and fhe had the true cow-pox, with only local pujlules : the man's fon, who never had the frftalT-pox, remained with his father the whole time, but did not catch the diforder. From the woman I inoculated three children, and they all had eruptions of the variolous kind, and were very ill during the eruptive fever. From thofe I inoculated a few others, fome of whom had eruptions, and fome had not. At this time, I was alio ufing mattar which originated with the little girl, who took it when the man did, and which I foon learnt to prefer, fhe having the difeafe in the mildeft form poffible ; and from this, in no one inftance did eruptions occur, in upwards of a hundred patients, from two weeks old to eighty years, whom I inoculated laft Spring. During the Summer I wholly dis- continued it; in the Autumn, through the kindnefs of Dr. Pearfon, I again obtained fome virus, and have inoculated as many more, without having one eruptive cafe. The fails I can irate to be" clearly demonftrated by my extenfive inocula- tion, are thefe: That the difeafe, when unattended with erup- tions fimilar to variolous, (which, by the bye, notwilhitanding fuch high authority as Dr. Pearfon's, I believe to make no part of it) is a thoufand tunes more trifling than fnall-poxy icarcely having had a patient fufficiently ill to prevent amufe- ment or labour : — That the local inflammation of the arm is not to be dreaded; I never had occaiion for any other application than a bit of rag, when the puft.ule has been rubbed off ; that rag has been finged : — That it is not an infectious difeafe; to de- termine which, L H-lecied about forty people in our workhoufe, and inoculated half of them, fome in both arms, and fixed them to fleep with thofe who had not had it; but in no in- ftance was it communicated to the others. I broke the puf- tules, and frequently made them fmell the parts, but to no effect. After giving the difeafe to the remainder, I, beyond cavil, afcertained it to be a perfe:? fecurity againjl the fnuill pox, For I immediately inoculated the whole party with the moft virulent variolous matter I could procure; but nothing enfued, except local fuperficial inflammation for the nrft fix or feven days. I then introduced a wretched family, juft recovered jfrom very bad final' -pox, their dirty clothes unchanged, and divided them in different beds among them, but to no pur- pofe. I then inoculated with cow-pox an infant, and as foon
as
Mr. Kehcri) on Vaccine Inoculation.
^3
as I was fatisfied it had taken, I put it, and kept it in th * b.d with its filler, who had the moft dreadful conflue t fm; i p x, but no inconvenience enfued. Moft of thef wo.-khoife children I have this fpring inoculated again, both with vario- lous and vaccine matter, but nothing happens : this fliews the vaccine effect to be a lajling fecurity againft itfclj\ as weL as the J/nall-pox. I have inoculated feveral people with it, who have had the fmall-pox, but it has only proved, they are not fufceptible of the difeafe. If a perfon be inoculated with vac- cine lymph, and the operation be repeated a few days after, if the firft have taken, as that advances, the fecond, though taken alio, difappears. Befides the cafes above noticed, molt of the others whom I have inoculated, have had variolous matter inferted afterwards, for the fatisfaction of themfelves or friends.
I muft now fay fomething refpe£ting the cafes where pujluks appear. I believe they are to be accounted for this way: — Ori- ginally, fome how or other, the vaccine virus gets inter- mixed with variolous ; in this ftate it is inferted into the arm together ; they are both acting on th'j furrounding parts, lo*- cally and dijlinftly : if, perchance, the vaccine fermentation goes on the fafteft, that gives the ftimulus to the conftitution, and the cow-pox is produced ; if the variolous do, the lir.all- pox is the confequence. Should they happen to keep toler- able pace with each other, I think both get into the habit, as in the cafe of my firft patient. Now, in drawing a. thread through this mixed local puftule, if you iuppofe it to be merely mixed, and not, if I may ufe the expreflion, chemi- cally combined, (which by no analogy we can allow) one part of that thread may have particles of variolous, the other of vaccine virus adhering to it; and, thus account for my firft little girl's cafe, and thofe who followed, &c. All the local puftules I ever faw in thefe eruptive cafes, contained a fluid of a different confijhnce and appearance from the true vaccine lymph, approaching very nearly xto pus. - If the thing could have been procured from gveafy-beeled borj'es, I fhouid have had the,means of propagating the difeafe fome months fooner than I had, as I left no experiment untried upon my poor cows to produce it. As to its calling out fcrofulous complaints^ I never knew an in- ftance of it; and unlets it be' in cafe of puftules, I fhouid think it cannot be expected. I never knew any cutaneous dif- eafe follow it; and during my practifing this new 'mode, I have never thought it necefiary to give a dofe of phyfic either after or before inoculation. I muft not conclude without noticing a circumftancc which has frequently happened to me when I have been neceffitated to tife jlalt matter^ and which, at the
* time
24
Dr. MitcbiH, on Nitrous Acid.
time oP my being lefs experienced, would moll probably have led me into fatal errors. Upon introducing a bit of thread, which has been impregnated with vaccine lymph only a few days, inflammation has quickly followed, and, to a hafty obfer- ver, not very unlike the true inflammation ; this runs on five, fix, and feven days, then it fuperficially fuppurates, and for the mod part leurfs over ; but occafionally it has continued a fore fome time longer, producing a degree of illnefs, &c. but never the genuine cow-pox. This fhews, that the fpecific powers of the vaccine fluid are foon loft by putrefaction, and that the part is afFe&ed in the fame manner it would be by any other putrid animal fubftance placed under the cuticle; and all thofe inftances enumerated by practitioners, as having been fufcepti- ble of fmall-pox after inoculation with the vaccine, are to be traced to this lburce of deception. I am, Gentlemen,
Your obedient humble fervant, Seven Oaks, May 19, 1800. T. M. KELSON.
The Mitchillean Theory defetided.
[Extiafted from a Letter of Profeflbr Mitchill, of Mew York, to Mr. Perkins, of Leicefter Square, Proprietor of the Metallic Tractois. Dated Columbia College, April 3, 1800.]
I Think the nitric acid is fufficiently proved to be a mixture of three acids, in the pureft form in which it is obtained by chemifts.
Firft, There is a quantity of fea-falt mingled with the pu- reft fait petre, of which it is rarely or never divefted. This affords muriatic acid, which comes over firft in the diftillation, and mingles with the product in the receiver. The exiftence of this acid is proved by adding nitrate of filver, which is immediately rendered turbid, and precipitated in a white mu- cilaginous fediment.
Secondly, A portion of the fulphuric acid employed to de- compofe the nitre, is volatalized by the heat, and rifes in va- pour too ; and thus a portion of fulphureous acid is blended with the diftilled fpirit in the receiver. This is proved by adding nitrat or acetat of lead, which falls down in the form of the fulphat of lead. Thel'e precipitates are formed in all the forms and famples of nitrous acid that I ever favv.
Thirdly, it being known that the fulphuric and feptic acids
are
Mr. Schaw, on Cold Affusion.
55
are mixible with each other, it muft often happen that they .combine before the mixture meets with potafs to neutralize it.
Fourthly, As it is equally well eftahlifhed, that feptic and muriatic acids will enter into union, it follows that thefe two, very commonly indeed, are blended together, before they are con- nected with the fixed vegetable akaii. It is therefore ordina- rily impoffible to procure one drop of pure and naked feptic acid, by any decorrvpofition of nitre that can be inftituted. The acid obtained is always an aqua regia, or fome fuch thing; and the afiertion that aqua forth diftolves filver, and aqua regia gold, is not correct. Both thefe acids are modifications of aqua regia; or, in- other words, mixtures cf various things with the original acid of putrefaction.
Fifthly, Such being the conftitution of nitrous acid, the nitric acid muft be equally a mixture or farrago of things; and thus, of courfe, is nitrous air, nitrous acid vapour, nitrous oxyd, and every thing of the fort, procured by art, or by the procefies in the laboratory. I with the gentlemen who pre- scribe and publifh fo much about thefe fubftances, would con- fider a little more attentively the compoiition of the things they employ ; we Ihould then have lefs contradiction and ob- ferity on the fubje£t.
Sixthly, You may rely on it, therefore, that the analyfis of nitrous acid into azote and oxygen, is not correct — There never has been fuch a pure fpecimen of nitrous acid in this world, ob- tained by diftillation from fait petre. I wifh that the true com- poiition of thefe forms and mixtures of feptic acid might be properly enquired into and underftood.
Your's, with the higheft confideration and regard, - SAMUEL LATHOM MiTCHILL.
To the Editors of the Medical and Pin/fical Journal, Gentlemen,
If the following, in your opinion, can be of the fmalleft lupport to the ufe of cold affufion in fevers, and be deemed worthy a place in your truly valuable Journal, its infertion will oblige,
Gentlemen, His Majeffs Ship, Tourterelk, Y°ur vei7 obedient fc vanr, Spithead, May 12, 1800. JAMES SCi.iA\Y, Su geon.
Numb. XVII. E * The
26 Mr. SchatVj on Cold Affusion.
The affuficn of cold water on the furface of the body in typhus and other fevers, fo ably treated of, and recommended, by Dr. Currie, appears to me a Subject dcferving much atten- tion, both as a fnnply efficacious remedy, and for the eafe with which it may always be procured ; it therefore becomes a duty incumbent on every practitioner who has experienced its ef- fects, to communicate the refult of his practice to the public.
From various opportunities which I have had of obferving this method of treatment, and from having frequently put its effects to the teft myfelf, I feel fully warranted in aliening that, in every cafe where it is judicioufly employed, its efficacy will invariably be evinced. In country practice, when the general afrufion could not be ufed on account of the preju- dices of the lower order of men, I have feen different instan- ces, where even the partial application of cold water to the (ace, neck, brcaft and arms was of infinite fervice, and, in- deed, I hardly ever faw it ufed without fome very palpable ad- vantage ariling.
In the Medical Journal for lafl March, I obferve a paper from fome perfon, aSTuming the appellation of Viator, where- in the author feems to qaeftion the propriety of the practice, and fuggefts that it may be productive of obftinate diarrhoea when unfuccefsful. Without entering into controverfy with your anonymous correspondent, I Shall only recommend to him to give it a fair trial, ere he Starts any more objections, when, I may fafely prognosticate," he will find his theoretical infinu- ations quickly vanifti before the peremptory and uncontroul- able evidence of fact and experience. A late traveller, who feems to differ a little in this opinion with our Viator, informs •us, the practice was by no means an uncommon one in Abyf- finia; and, if I miltake not, he fays, the water was copioufly thrown over the patient as he lay in bed, in all Stages of high- ly putrid and other fevers, with, I believe, manifeft advantage. Its good effects are very well known to many who vifit more Southern climes. A meritorious practitioner of my acquaint- ance, who has made repeated voyages to Africa, affured me that he found the moft beneficial confequences refult from a copious ufe of it. He ufed to place the patient under a pump, and allow the water to play over him in a full Stream, or dalh it over his body in buckets full, with admirable effects.
Mr. Martineau, in a paper inferted in the Medical Journal for January laft, feems to approve its application in cafes of internal inflammation, and fays, that no inconvenience arofe from it even where pneumonic complaints were prefent. With all due deference to Mr. M's opinion, and without any inten- tion to implicate in the kaft the accuracy of his observations,
Mr. Schaw, on CM Affusion.
1 b;g leave to remark, that, in three cafes which fell under my own infpection, where catarrhal fymptoms attended the fever, the cold ablution appeared to do evident mifchief, by increafuig the cough, and confequent irritation, to fuch a pitch as almoft totally precluded reft ; which, of necefiity, compelled the re- medy to be abandoned.
The beneficial effects of cold lavation in febrile diforders, may, perhaps, be farther exemplified by an inftance that oc- curred in the Royal Infirmary at Edinburgh. The difeafe was fmall-pox ; the fubject a Negro Jad about 17, He was brought into the Infirmary with all the fymptoms of a pretty acute fe- ver. No eruption was prefent, and the afFufion of cold water was directed by, I believe, Dr. Home. This, to the belt of my recollection, was performed twice, when the eruption ap- peared, and put a ftop to its further ufe. The puftules were extremely few in number, and the attendant fever fo exceed- ingly mild, that the patient walked about the ward during the whole continuance of the difeafe. — But to relate a cafe:
A. M. a failor, a^tat. 30, of a robuft healthy conftitution, was attacked, on the 22d of October laft, with all the ufual fymptoms of fever, which he attributed to cold. He had an emetic given, which operated very well as fuch, but produced no other fenfible effect. On the 23d, in the morning, his pulfe was 116 in the minute, his fkin very hot; he had great thirft, and complained of fevere head-ach; had a ftool during the night. My hand acted the part of a thermometer, and I directed the application of cold water, which was performed while I felt his arm with one hand, and held my watch in the other to mark the change I expected. The afFufion was fcarce finifhed when his pulfe fell to 90 ; he was then dried and put to bed. I vilited him in half an hour, when his pulfe was 92, and regular, fkin cool, head-ach much relieved, and he felt wonderfully refrefhed. Six o'clock, P. M. pulfe joo, heat above natural, head-ach increafed fince the afternoon. The operation was repeated with the fame effect as in the morning, reducing the pulfe to 70. In an hour afterwards, when I again vifited, he faid he felt " very eafy," his head-ach was nearly removed, and the heat of his fkin was very little, if at all, above natural ; I ordered an opiate to be given at bed-time.
24th. Eight o'clock, A. M. pulfe 76; flept well tluring the night, has little head-ach, fkin very little above natural heat -t had a ftool this morning.
Rep. AfFufio aquae frigid.
7 P. M. Pulfe 72, fkin of natural heat, no head-ach; has been walking about great part of the afternoon, and fays he feels " quite itrong." No farther application was necellary.
E % V. L.
Mr. Schaw-, on Cold Affusion.
D. L. retat 25, of a healthy and ftrong confritution, was tittacked, in the night of the 21ft of February laft, with cold fhivering, followed by increafed heat, head-ach, naufea, and flight vomiting. I faw him about nine next morning. The vomiting had ceafed; the naufea was likcwife gone; pulfe 112, and ftrong; fkinhot; faccflufhed; breathing a little hurried, but without. pain of breaft, or cough; head-ach very acute; tongue clean, of a bright red colour ; much thirft. I ordered, and faw performed copioufly, the cold affufion. The fhock Was confiderable, but the effecT: almoft inftantaneous. The pulfe immediately fell to 80, and the head-ach was greatly re- lieved.
At one' the pulfe was 90, and the heat above the natural ftandard; I repeated the remedy; which fucceeded fo well, that in the evening the head-ach was removed, the fkin of natural heat, and he recovered without farther application.
Thefe two cafes, I think, fhew pretty pointedly the ad- vantage of an early employment of this fimplc and ufeful re- medy. I have made ule of it too in the more advanced ftages of typhus, and, I think, with very happy effects. It evidently mitigated the violence of the febrile fymptoms, and appeared to fupprefs the tendency to delirium; and although the dif- eafe generally ran out its courfe, yet it feemcd to affume a milder form, and to be attended with lefs danger, when this treatment was adopted.
I might have related other cafes of the fame nature, but as the events in all were pretty fimilar (allowing for a flight va- riation in circumftance), and as I am fearful of exceeding the limits of a fheet, I defer, till fome future period, faying any farther on the fubjech
Should this be honoured with your notice, I (hall be fti- mulated to renew my efforts in the fame caufe, or any other which chance or opportunity may place within my reach.
The inaccuracy and want of connexion which may appear above, I doubt not will be liberally excufed, when it is con- fidered how ill calculated a nautical life is for application or ftudy.
ft
( 29 )
To the Editors of the Medical and Phyfical Journal. Gentlemen,
.A. S it has been the opinion of moft medical men that Small- pox and Mealies could not exift, and go through their differ- ent ftuges, at one time, in the fame perfon, I am induced to tranfmit you the following cafe (that came under my care verj- lately) to be inferted in the Medical and Phyilcal Journal, if you think, it fufHciently interefting. I am,
Gentlemen,
Very refpectfully, Eafi Street, Manchejler Square. EDW. LEESE.
APRIL 19th, 1800. The infant of Mr. W. in Padding- ton Street, about five months old, at the breaft, without any appearance of teeth, had been ever fince its birth a very fine and healthy girl, though it had in the fkin eight or ten little fpots fomething like flea-bites, but fo very trifling as not to produce in me the leaft hefitation to inoculate it, it being otherwife quite lively, and in good health; I therefore in- ferted into the arm fome variolous matter, recently taken from a healthy girl that had the difeafe by inoculation.
On the morning after the inoculation, a powder, compofed of caloin. ppt. and p. rhei, was given ; and afterwards, for a few days, pulv. antim. and calom. in very fmall doles, every night and morning.
On the 4th day it was evident the virus had began to acl; in the arm, the little fpots before obferved had disappeared? and the child was in its ufual ftate of health.
About the 9th day fome little (pecks appeared in the fkin, which it was fuppofed would become variolous puftules, but they difippeared, though about ten or twelve in the arm, around the inoculated part, continued to ijicrtafe, and advance to fup-< Duration.
10th day, Much as yefterday, but the child rather feverifl; and uneafy.
nth day, Uneafy as yefterday, with fome little fever; a very few fpots about the hpdy1 that promifed tq be variolous pufhdes.
1 2th day, Rather more fever, puflulcs more advanced, bow- els open ; ordered a faline febrifuge mixture ; feemed alfo a jittle heavy, and ituffed at the nofe. The weather being to- lerably
Mr. Hill, on Angina Pectoris.
lerably fine, it had been carried out almoft every day; was therefore fuppofed to have caught a flight cold.
13th day, The variolous puftules advancing, the heat of the fkin rather lefs ; but was fomewhat furprized to find it filled in every part with an eruption exactly refemblmg mea- lies, accompanied alio with much rednefs of the eye-lids, and difcharge from the eyes; the breathing a little impeded from the ftoppage in the nofe. As I fuppofed the variolous and mor- billous eruptions could not appear together, but that one would be retarded till the other had taken its courfe, I was in fome doubt whether to pronounce it mcafles or not.
14th day, The variolous puftules increafing, and filled with fome matter ; a good deal of inflammation in the arm, and the puftules there very prominent, though not very large; the morbillous eruption general, and very diftinctly marked, with watering of the eyes, fneezing, cough, and flight oppreflion in refpiration. I took a medical friend with me, who, like myfelf, had never feen fuch a cafe, and he perfectly agreed with me that there was not the leaft doubt but the eruption Was the meafles.
15th day, Lefs ill than yefterday, meafles disappearing, fmall- pox advancing, cough and fneezing lefs frequent than yefter- day.
1 6th day, Called, but the child was carried out ; the mother informed me it was better than yefterday ; the meafles nearly gone.
17th day, Meafles nearly or quite gone, the variolous puf- tules dying away alfo ; they were fmall, and contained but lit- tle matter; the inoculated part drying, and black in the centre.
1 8th day, The meafles entirely difappeared, and the fmall- pox going very faft. From this time the child continued to be in perfedt health.
To the Editors of the Medical and Phyfical Journal. Gentlemen,
Dr. Black, in his inftrucliye paper on the Angina Pectoris, Art. XX. Vol. IV. of the Memoirs of the Medical Society of London, obferves, " DilTeftions have fhewn this difeafe to be connected, either with fome organic degeneracy of the heart or great veflels, or with fome mechanic prefTure upon them, arifing either from an aftufion of fluids^ or an accumulation of
Mr. Hi//, on Angina Pefiorls.
fat;" 2nd concludes with the following query, " Are women exempted from this difeafe ? I do not recoiled: any decided in- iiance on record of its occurring in the female fex ; and fome of the oldeft and moft experienced phyficians in this part of the kingdom have made the fame remark."
The following cafe, recently under the care of Dr. Arden, of this city, and myfelf, will, I hope, be acceptable to the readers of your ufeful Journal.
Your obedient fervant, Cbe/er, May n, 1800. G. N. HILL.
Mrs. E. B. from infancy up to the age of twenty-two, of a fpare habit of body, fubject. to few complaints, excepting a periodical hemicrania of the left fide, accompanied with co- pious bilious vomitings; from a change of her fituation in life, which had hitherto been very abftemious, to full living on animal food, and the liberal ufe of malt liquors, became fud- denly very' fat ; to obviate which, recourfe was had to fevere labour, acids, and ftarving, with a total abftinence from all drinks heretofore ufed. An increafe of the hemicrania, violent dyfpeptic fymptoms, irregularity of the menfes, and confider- able emaciation, were the confequences : Removal to a more healthy air, change of diet, and moderate labour, removed thefe affections ; and, excepting occahonal recurrence of the affecTion of the face, Mrs. B. enjoyed tolerable health, until the age of thirty-three ; at this period, from the concurrent caufes of eafe, indolence, full meals of animal food, particu- larly late fuppers, the ufe of malt liquors, indulgence in fleep after dinner, and almoffc total neglect of exercife, obelity re- turned with quick fteps, and produced an alarming change. One day, after eating a hearty dinner very eagerly, whiift at- tempting to walk to a neighbouring village, fhe was in a mo- ment feized with a violent pain under the left breall, extending acrofs the fternum, tov/ards, but not quite reaching, the right fide; it compelled her to ft op inftautly, when refiing on a (tone, it went off in a few minutes. Though very much frightened, yet, being a woman of great refolution, fhe periifted in com- pleating her walk, notvvithftanding three or four fimilar at- tacks before reaching home; but, owing to the precaution of walking very deliberately, and retting often, none of thefe equalled the firlt in violence or duration. She defcribed the pain as attended with great and inconceivable diftrefs at her breail, as though her heart gave a violent ftroke upward to- wards her throat, and then fell down again, at which inftant the anxiety wa* indelcribable, but commonly relieved for a mo- ment
3*
Mr. Hi//y on Angina PeSIoris.
ment by cxpulfion of wind from the ftomach, and a deep lengthened figh. The pain for fome months, or near two years, never recurred but upon ufing fudden or violent exercifc ; and then, if any friend urged her to come on, and ftrive againft it, her apprehenfions were, that death muft be the confequence of the attempt. The obefity continued incrcafing, with the addition of a troublefome incubus; at length, the pain occur- red after eating heartily a favourite dinner and lying down on the bed, and often about midnight ; hence, it became neceflary a friend fhould watch the approach of both thefe unhappy af- fections, and awake her ; when (he would inftantly get up, la- , bouring under the apprehenfion of immediate diflblution. The rather fudden death of her hufband one morning very early, on receiving the intelligence, was fucceeded by the pain, like a fudden ftroke or blow received on the left breaft, and the firft fainting fit; on recovering from which, {he complained of pain down her arm, and numbnefs in the hand, particularly the thumb, the whole limb being cold and covered with a clammy moifture, as, indeed, was the whole body. 1 was prefent when this happened ; on examining the pulfe, I found it very feeble and irregular, giving one weak ftroke, and then two fcarce perceptible ; it was fome time before it became regular, and remained feeble and fluttering all day. I prefcribed the cam- phor julap, made with peppermint water and a portion of aether, which ftaid on her ftomach, notwithftanding a deadly licknefs, though not amounting to vomiting, being prefent. The medicine occafioned the efcape of much wind, and thereby afforded relief; a large blifter to the breaft, faline aperient medicines, thin weak liquids for drink, and an abftemious diet for a few weeks, rendered her free from the faintings, and perceptibly reduced the corpulency. Neglect of this falutary plan, towards the latter end of laft year, was followed by a fe- vcre attack in the night, foon after eating a hearty improper fupper near twelve o'clock, after having juft dropped afleep ; about two o'clock, a fecond; and during my attendance with Dr. Arden, (now called in) a fucceflion of paroxyfms at irre- gular periods for feveral weeks : fome of thefe were flight compared to others. Univerfal coldnefs, clammy fweats, lofs of all fenfe, and the power of voluntary motion, accompanied the more fevere fits; and I often obferved, that immediately on recovery from one, our patient would ftretch herfelf up- wards, ftrive to yawn, throw her head back, and fay, fhe wifhed fhe had a rope fixed to a beam to pull at, believing it would expand her cheft, and give her heart more room to bear. Saline, fudorific, and gently aperient medicines were pre- fcribed, with low diet, though indeed, little now fufficed, the
conftant
Mr. Hill, en Angina PeBoris.
33
conftant diftrefs of mind, labouring under continual apprehen- lions of death, fcemed to fufpend appetite : the tendency to become thinner loon evinced itfelf. Two large ifTues were now cut, one beiow each knee, the difcharge from which being copious, afforded confiderable relief; occafional moderate eva- cuations, with this conftant drain, have reduced Mrs. B's fize very confiderably ; her health has proportionally amended, but Ihe is ftill fubjeef to returns of the pain upon any fudden ex- ertion of body, or particular emotion of mind, although it is now but rarely accompanied by fainting.
Dr. Parry, in his recent treatife on this formidable difeafe, when enumerating its fymptoms, fays, " And is altogether fo free and diftintSt from any difficulty of breathing." Now, in the cafe I have recited, though not before mentioned, this fymptom was moft urgent, but only prevailed when Mrs. B. was ufing exercife : in thofe attacks of the difeafe which oc- curred when at reft, this fymptom never appeared ; but the deep fighing peculiar to fuch patients was now moft confpicu- ous, accompanied with a lifting up of the arms, and an into- lerable defire to expand the breaft. From all which has now been faid, permit me to add, I think there can be no doubt, but fudden increafe of fatnefs is capable of proving a very alarming caufe of angina pectoris ; it is probable, that the four cafes mentioned by Dr. Darwin in his Zoonomia, as cured by iilues, abftemioumefs, and antimonials, were of this defcrip- tion ; an encouraging circumftance to thofe who fliall be fo unfortunate as to be afflicted with this difeafe in early life ; I argue thus, becaufe the complaint, when occurring in perfons at a more advanced period, feems, from the clear deductions of Dr. P. to arife from omfication of the coronary arteries ; and, unhappily, thefe curative means cannot merely be but little relied on, but, perhaps, would have a tendency rather to ag- gravate than relieve, inafmuch, as from our knowledge of the functions of the abfoibent fyftem, evacuating remedies tend powerfully to promote abforption ; hence, may quicken, rather than retard the progrefs towards oflification. Diheitions feem to have proved, that perfons liable, or who have fallen victims to angina pectoris, are peculiarly inclined to fatnefs of the heart ; in thofe, therefore, who acquire fudden, enor- mous, and diftreffing obefity, can we wonder the difeafe mould occur fo formidably? I have never met with a cafe of angina in advanced life, as defcribed by authors on the fubject; but I have fome reafons to believe, it has occurred in very corpu- lent fubjects, and been over-looked; one perfon in particular, a woman, I remember to have been fo fimilarly arretted to Mrs. B. as, that the deicription of the one cafe might ferve
Numb. XVII. F for
34 Mr. Leeson^ on Croup.
for that of the other, with this difference only, as to the evenf, that this patient perfifted in rejecting the ule of all means pre- ferred for her relief, and continuing to grow fatter daily, was one morning found dead in her bed, after having eaten a hearty fupper of animal food.
To the Editors of the M cdical and Phyfical Journal, Gentlemen,
ShOULD the following obfervations appear worthy you? attention, you will much oblige me by inferring them in your ufeful Journal. I am,
Your's,
Grantham, May 10, 1S00. B. LEESON, jun.
It is much to be lamented, that, in the narration of medi- cal facts, an unjuft preference is given to fuch as have had a favourable iffke ; while unfuccefsful cafes, however interesting in their progrefs, or important in their event, feldom are brought before the public eye. The felf-gratification which occafions this partiality to fuccefsful cafes, leads alfo to ano- ther error, ft ill more injurious to found practice and medical improvement, — to the publication of fortunate cafes, the very exiftence of which is doubtful. Not that I can fuppofe any medical practitioner fo void of principle, as wilfully to im- pofe upon the public, fictitious cafes; but, I doubt not, it will be granted, an attachment to a preconceived opinion will fre- quently prevent a proper attention to the difcrimination of dif- eafe. Hence, complaints of the moft ferious import are fre- quently reported to have yielded to remedies of trifling effi- cacy; which, if again employed, on the authority of fuch re- ports, are only productive of difappointment. I have been led to thefe reflections by fome accounts I have lately feen, of the fuccefsful treatment of the croup. Judging from thefe defcriptions, a perfon would naturally conclude the croup to be a difeafe of long duration and eafy management. As by one author we are informed, that mercury employed, fo as to produce falivation, effectually cures: another is confident of the fuccefs of a lotion made with the fpiritus aetheris vitriolici compoiitus ; while a third relies upon a decodtion of feneka.
No
Mr. Leesori) on Croup.
35
No doubt, all thefe remedies might be productive of good ef- fect, if the rapid progrefs of the complaint allowed them to be fairly tried. But I am afraid, fuch is the celerity of the dangerous fymptoms, that few prac"titi oners have had the plea- fure to experience a recovery from the true croup. It may be right, I mould define what I underftand by the true croup : By this term, then, I would exprefs a difeafe, arifing from an extravafation of coagulable lymph within the trachea and bron- chial tubes, which occafions that peculiar found in inspiration •,vc ihould expect, was the breath drawn through a narrow pipe. This is preceded by a flight inflammatory ftage, of which the fymptoms are fo little troublefome, as feldom to be obferved.
In confidering the cynanche tracheaiis, it is neceffary to pre- mife, that two diftinct difeafes appear to have been clalTed- by writers under the fame name. The one arifing from a fpaf- modic ftricture of the parts furrcunding the trachea; the other depending on extravafation, the confequence of inflammation. In the nrft, the exhibition of an emetic feldom fails to re- move the complaint, while the fecond bids defiance to every effort of art. In the fpafmodic croup, the attack is fudden, generally commencing lome time after the patient has been in bed ; it is accompanied by remarkable anxiety, and oppreflion about the breaft ; a hoarfe, fhrill voice ; great rednefs of the countenance; (which expreffes moft grievous uneafinefs) quick and difficult refpiiation, and a foft pulfe. Upon the operation of an emetic, thefe fymptoms gradually fubfide ; the patient finks into a flurnber, and awakes with little remains of the complaint. I am acquainted with a family, in which this complaint has attacked more than once, each child of a nu- merous offspring, and has never failed to difappear upon the operation of an emetic.
Very different is the progrefs of the inflammatory croup ; in this, the firft appearance of difeafe is of fuch an infidious nature, as feldom to create any alarm, being confidered by the attendants as a flight cough accompanied with hoarfenefs. By degrees the roughnefs of the voice becomes more remark- able, the breath is drawn with difficulty, as if through a nar- row pipe, occafioning a peculiar fhrill found;* there is a con- ftant feverifh heat upon the fkin, together with a profufe per- fpiration about the head and face, in fo much that the fweat ftands in drops upon the countenance, which exhibits the greateft anxiety ; the pulfe is quick and foft; the lips are pale,
F f 2 frequently
* Ftbris excitatur ad liberandum corpus a muco, & membrana extra vafa.
Home de Suffocation? StrUula.
Mr, Leesori) on Croup,
frequently livid ; the changes of countenance are fudden and frequent; at one time it is red, in an inftant it is pale as a corpfe. The progrefs of this difeafe, from its commencement to its termination, as far as you may depend upon the in- formation of nurfes, never exceeds more than four or five days : from the fir<f appearance of danger, the patient feldom continues more than thirty-fix hours, rarely fo long. I have been obliged to refer to nurfes, as I believe few medical men have witnefTed the firft attack of croup, it being too inconfi- derable to merit their attention.
Having endeavoured to enumerate the pathognomonic fymp- toms of the croup, I (hall farther intrude by detailing two cafes which have lately occurred to me.
G. M. eleven months old, naturally of a full habit, recently weaned, and now about his teeth ; as he has generally had a cough and fluffing while cutting his teeth, the nurfe was not alarmed at this circumftance, which had occurred for a day or two before I faw him. I was firft called about eight o'clock in the evening; the great anxiety, difficulty of breathing, and peculiar found in refpiration, clearly indicated his complaint to be the croup : his gums were lanced, an emetic mixture, compofed of four grains of emetic tartar, one drachm of oxy- mel of fquills, and an ounce and a half of water, was given in dofes of two tea fpoons full every ten minutes until it oper- ated ; a lotion, compofed of fp. aetheris vitriolici campofttus, and the aqua ammoniae acetata, was applied to the throat. At nine o'clock, the fymptoms continuing equally urgent, I had the affiftance of an eminent phyfician relident in this town j by his advice, leeches were applied to the throat, and the pa- tient put into a warm bath; blifters were likewife laid on each iide the neck : from thefe means fome relief appeared to be gained. At eleven o'clock, the child being more reftlefs, was again immerfed in warm water; an oily mixture was given oc- cafionally. At four o'clock in the morning, the violence of the fymptoms increafing, an ounce of ipecacuanha wine was given, in fmall quantities, before it produced any effect ; the warm bath was again ufed ; about feven o'clock tie child ex- pired.
April 2C, J. L. aged twenty-two months, yet flill at the breaft, has had a flight cough for a few days j it has increafed much during the night ; the child has been very reftlefs, and fweats much about the face and head ; fwallows with tolerable eafe; breathes with much anxiety, and with a peculiar fhrill found. It was nine o'clock in the morning when I firft faw this child; being aware, from the fatal termination of the former cafe, of the neceffity of powerful means to arreft the
progrefs
Mr. Ward, on the Treatment of Hernia. 37
progrefs of the diforder, I immediately opened the jugular veins, and obtained from thence between fix and feven ounces of blood ; after which a folution of fix grains of emetic tartar in an ounce and a half of water, with a drachm of oxymel of fquiils, was given in dofes of two tea fpoons full every ten minutes ; the whole mixture was given before any vomiting was produced; the child was then placed in the warm bath for feven minutes. For a ihort time it appeared to be more compofed, and to breathe with lefs difficulty ; but, about twelve o'clock, the former fymptoms returned. A tea fpoon full of- the decoction radicis feneka was then given every half hour, which excited great thirft, and additional reftleflhefs ; the pa- tient grew worfe, breathed with more and more difficulty, and expired about three o'clock P. M.
It has generally been obferved, that the croup is moft pre- valent during a wet feafon, or in damp fituations; thefe twd cafes occurred when the weather was more than ufually dry.
It will be obferved in the above cafes, that there was con- fiderable diminution of the fenfibiiity of the ftomach ; as ap- pears from the quantity of emetic medicine necefiary to pro- duce vomiting. May not this arife from an increafed deter- mination of blood to the trachea, diminilhing the influx in the veflels ©f the ftomach ?
Remarks on the Treatment of incarcerated Hernia1, with Cases: By M. Ward, Surgeon to the Manchefler Infirmary.
Having feldom feen the taxis fuccefsful as it is generally conducted, in cafes of incarcerated inguinal and fcrotal her- nia, I was induced, feveral years ago, to place the patient in an inverted po/it ion * whilft I applied the taxis; and am con- vinced it poflefles fome important advantages over the pofi- tions in common ufe.
The
* By this plu afe is'meant, the patient being held by the legs on the fhould- ers of an afliltant; his body being allowed to lung down : another afliftant. is ihen to fupport his head and Ihouldeis, and to incline them a little for-. W3r4s3 & *s t0 ie'ax the abdominal mufcles,
3S Mr. Wardy on the Trettment of Hern-a.
The following are all the cafes of this kind which have been under my care fince the period alluded to.*
Firft. May 25, 1795, Wm. Bellows was admitted into the Infirmary with a fcrotal hernia, which had been in an incar- cerated (late twelve hours. He complained of great pain, and had vomited frequently.
He was bled copioufly, and had a clyfter given, which pro- duced a trifling evacuation only.
While the warm bath was preparing, an affiftant was di- rected to fit upon the bed with his back towards the patient, and to grafp his legs (which were put upon his fhoulders) juft above the ancles, and to rife up with him upon his back ; another affiilant was then directed to fupport his head and fhoulders, and to incline them a little forwards, principally •with a view to relax the abdominal mufcles, but in part to prevent the weight of the body from falling wholly upon the legs. He was held in this po'ture ten or fifteen minutes while the taxis was applied, and, by repeating the fame procefs three or four times (allowing him to reft at intervals) the hernia was reduced, without having recourfe to the warm bath.
Aperients and a trufs were directed for him, and he was difcharged cured on the 30th.
Second. January 15, 1796, Wm. Howarth was admitted with an inguinal hernia, which had been incarcerated twenty hours. The mod urgent fymptoms were fingultus, vomiting, and pain.
After fixteen ounces of blood had been taken from his arm, he was placed in the inverted pofrcion, and the taxis was ap- plied, at intervals, till the warm bath was ready; fcveral ef- forts were alfo made while he was in the bath to reduce the hernia, but were ineffectual. He continued in the bath till he began to grow faint ; he was then removed to bed, and, in about an hour after, the reduction was compleated, by again having recourfe to the inverted pofition and the taxis.
Third.
* I was not aware until I had arranged my notes on this fubje£t, that the late Mr. Pott, and Mr. Beni. Bell, had recommended in their Treatifes on Hernia, the pofition which I have called the inverted pofition. The former, after having given directions for applying the taxis, adds, " The pofition ot the body, and the difpohu'on of the lower limbs, may be made veiy affiftant in this operation, when the difficulty is confiderable ; the nearer the pofition approaches to what is commonly called (landing on the head, the better, as itcaufiss the whole packet of interlines to hang, as it were, by the ftrangu- lated portion, and may thereby dilcngage it, &c. &c." Pott's Works, ( Earls' s edition) Vol. II. p. 67, 6?.— See alfo Bell's Surgery, Vol. I. p. 2,3^ 3d edition.
Mr. Ward, on the Treatment of Hernia.
Third. March 4, 1796, Job Morton ruptured himfelf by endeavouring to Hop- a reftive horfe. Several hours had elapfed when he fent for me.
The hernia was an inguinal one, in a tcnfe and painful ftatc.
He had vomited feveral times. The means made ufe of were venaefection, the inverted pofition, and the taxis, which were happily fuccefsful.
Fourth. Jan. 20, 1798, Richard Parry, setat. 40, was ad- mitted with an incarcerated inguinal hernia.
The fymptoms, mode of treatment, and the refult, were ex- actly fifnilar to the firft cafe.. He was difcharged cured in a few days.
Fifth. Wm. Bellows was admitted the fecond time, (fee Cafe 1.) About fixteen hours had elapfed fince he found him- felf unable to return ,tKe hernia.
He was bled, an(f the warm bath was ordered ; but before it was ready, the complaint was removed, by placing him in the inverted pofition, and applying the taxis.
Sixth. Owing to the following cafe having occurred in the night, it devolved to the care of Mr. Jenkinfon, Houfe Sur- geon to the Infirmary, who has favoured me with the follow- ing particulars :
" March 17, 1799, Wm. Bellows was brought to the In- firmary at three o'cbck, A. M. About fix hours had elapfed fince he found himfelf unable to reduce his hernia.
" He complained of great pain, and hiccuped at times.
" I attempted, but in vain, to reduce it by applying the taxis, having previoufly raifed his hips by placing pillows un- der them. About a pint of blood was then taken from his arm; a purging clyfter was injefted, which brought away a ftool in about half an hour ; a cold folution of fal ammoniac was applied to the part affected, and caftor oil was ordered in- ternally, which procured him feveral, evacuations.
" Between feven and eight o'clock he was put into the warm bath, and felt eafier afterwards, though the tumour con- tinued of the fame fize, but felt rather fofter. About two hours after he left the bath, he was held by the legs on the flioulders of an affiftant, and the taxis was applied nearly a quarter of an hour, but the hernia was not reduced ; he v/as then laid down in bed, and a ficknefs came on, and during the continuance of the ficknefs it went up."
He was difcharged cured on the 22d, with a new trufs, his old one having been ufelefs for fome time.
Seventh. May 13, 1799, James Taylor had experienced the molt excruciating pain four hours, from an incarcerated inguinal hernia.
The
40
Mr. Tfardy on the Treatment of Hernia.
The inverted pofition was not reforted to for want of proper afliftants ; but the patient's head being lowered, and his hips elevated as much as poflible, brought him nearly into that po- lition; and the hernia was fpeedily reduced by applying the taxis.
If we admit the propriety of placing the patient, when the taxis is to be applied, in fuch a pofition as may mod effectu- ally co-operate with the furgeon, the inverted pofition feems in every point of view fairly entitled to a preference, not only in the inguinal and fcrotal, but alfo in the congenital and fe- moral hernia; and whoever will reflect on the connexion which fubfifts between the parts above and below the ftrieture, will be inclined, I think, to draw a fimilar conclufion.
But this is a matter which does not reft on theory entirely; the experience I have already had of its utility, enables me to fay, that more benefit actually takes place from the taxis when the patient is placed in an inverted pofition, and with lefs violence or injury to the difplaced vifcera, than when any other pofition is made ufe of ; an equal degree of preflure being ap- plied in both cafes.
The alarming fituation of Wm. Howarth (Cafe a) induced me both to repeat the taxis oftener, and alfo to apply a greater degree of preflure before the refiftance could be overcome, than* I had ever done before; and it is to thefe caufes, and having availed myfelf of the moft favourable pofition, that my fuccefs is to be attributed, not only in this but in the three fucceeding cafes.
I fhould be forry to be wanting in that refpect which is due to the opinions of men defervedly eminent in their profeflion ; but I mult beg leave to withhold my aflent from the injunction which would limit the furgeon to gentle preflure in every in- Itance. " A little time and pains {pent in this manner will fre- quently be attended with fuccefs, and obtain a return of the part; but if it fhould not, and the handling of it, (which I muft repeat fhould alwavs be gentle) becomes painful and very fatiguing to the patient, we are advifed to defift for a few hours, and try the effe£tof other means."*
w But this muft always be had in view, that any preflure that is applied muft be of the moft gentle kind ; for every thing of this nature that creates much pain, is very prejudi- cial, and ought by all means to be avoided. "f
Whoever regulates his practice by the above rules, will, I
believe,
* Pott's Works, Vol. II. p. 68. •f Bell's Surgery, Vol. I. p. 287.
Mr. Ward, on the Treatment of Hernia.
4*
believe, rarelv fucceed in reducing thofe hernia that are ac- companied by a confiderable degree of ftridture.
I truff, however, it will not be imagined I am an advocate for a rude or violent method of applying the taxis ; every ad- dition to the preffure applied, fhould certainly be made in a cautious and gradual manner; but at the fame time it will be incumbent upon us to remember, that fhould we fail in re- ducing the hernia, the patient muft either fubmic to an opera- tion, which often terminates fatally even when performed un- der the moft favourable circumftances, or to the almoft inevit- able alternative of a gangrene taking place, with all its attend- ant evils.
In the treatment of a complaint fo dangerous in its nature, and fo rapid in its progrefs, that the fate of the unfortunate fufferer is frequently decided in a few hours, it appears highly injudicious to allow a confiderable portion of that precious time (which ought to be appropriated to the ufe of the moft efficacious remedies) to be occupied in applying cold liquids, or ice, to the part affedled.*
Where cold topical applications are fo managed as not to divert the attention of the furgeon from meafures of more ef- fential importance, my objections will not apply; but having reafon to believe that great confidence is fometimes repofed in them, and being convinced of their general inutility, I cannot help thinking it would be a happy circumftance were they to- tally difcarded in the treatment of every fpecies of incarcerated hernia.
In the intervals, when patients of the above defcription are not undergoing the taxis, or ufmg the warm bath, might it not promote the object in view (or' at leaft retard the progrefs of inflammation) were they to be laid in bed with the head
* Mr. Pott's remarks in his Treatife on Hernia, when cautioning his readers againlt employing fomentations, cataplai'ms, and embrocations, are very forcible, and appear to me not very inapplicable in the prelent inltance. '« I know that in this I differ from the majority both of writers and practi- tioners ; but having (as I think) truth on my fide, I do again venture to fay, that I verily believe, that the confidence which has btfcn placed in fuch kind of applications, lias destroyed many more lives than it lias faved. A hernia, with painful ftri&ure, and ftoppage of Itools, is one of thofe cafes in which we can feldom ftarid (.till even for a fhort fpace of time ; if^ we do not get for- ward, we gen rally go backward; and whatever does no good, if it be at all depended upon, certainly does harm, by occalioning an irretrievable lofs of time : of this kind I take the cataplafm and embrocation to be ; while the former is applied, or the latter nfed, no other more powerful means are made life of; and though it has the appearance of doing fomething, yet I fear it is little more than lpecious trifling ; efpecially if the cafe be at all prcifino-."
Works. I'd. II. p. 69," 70.
Numb. XVII. G and
4* Mr. Woodward^ on Infantile Diseases.
and fhoulders lowered, and the hips elevated confiderably, in- ftead of being allowed to lay in the ufual horizontal pofition ?
However trivial Inch a circumftance may appear, nothing ought to be confidered beneath notice, which may in any degree tend to promote eafe, or diminilh danger.
Mancbejhr, May 29, 1800.
To the Editors of the Medical and Phi/fical Journal. Gentlemen,
If you think the following Effay has fufficient merit to be ad- mitted into your ufeful Publication, I will thank you to infert it.
Your's, &c.
May 22, 1800. W. WOODWARD.
By the mod accurate calculation,* half of mankind die under eight years of age. The extraordinary havock made by difeafes among children, is much owing to the unnatural treat- ment they meet with, which is ill fuited to the fingular deli- cacy of their tender frames. This mortality is greateft among the moft luxurious part of mankind, but gradually decreafes in proportion as the diet becomes fimpler, the exercife more frequent, and the general method of living more hardy; and .as it doth not take place among wild animals, the general foun- dation of the caufe is fufficiently pointed out. The inftin&s of children, and the conduct of Nature in rearing other ani- mals, are never attended to, and they are incapable of helping themfelves, particularly in the moft early period. When they are farther advanced in life, the voice of Nature becomes too loud to be ftifled ; and then, in fpite of the influence of cor- rupted and adventitious tafte, will be obeyed.
Many reafons have been affigned why the ftate of infancy is the moft iickly; and why fo great a proportion of the hu- man fpecies is cut off at that early period. Phyficians have infifted largely on the unavoidable dangers arifing from the
fudden
* Since the practice cf inoculation has become fo general, this may have fomewhat decreafed ; and the introduction of the vaccine difeaie bids fair even to leflln tint : To the honour of thofe gentlemen, who, in the cauls cf humanity, brought this difeafe forward, be it ever remembered.
Mr. Woodward^ on Infantile Diseases.
43
fudden and total change of the animal ceconomy of infants, that commences immediately on their birth ; and on the dan- gers that are cauled by the free admiffion of the external air to their bodies at that time : they have expatiated on the high de- gree of irritability of their nervous fyftem, the delicacy of their whole frame, and the accefTency of their food. A little re- flection, however, may fhew us, that this account of the mat- ter, though plaufibleat firft view, is not fari'sfec-iory : This lin- gle confideration refutes it, that all thefe alleged caufes of the licknefs of infants are not peculiar to the human fpecies, but are found among many other animals, without being attended by fuch effects; that the difeafes molt common to children are not found among the lavage part of mankind ; and that they prevail in exact proportion to the effeminacy and luxury, and as people forfake the plain dictates of Nature, to follow what they are pleafed to term, the light of reajon. There is, in truth, a greater luxuriancy of life and health in infancy, than in any other period of life. Infants, we acknowledge, are more delicately fenfible to injury than thofe in advanced life ; but to compenfate this, their fibres and veffels are more capable of diftenlion, their whole fyilem is more flexible, their fluids are lefs acrid, and lefs difpofed to putreflence; they bear all evacuations more eaiily, except that of blood; and, which is an important circumftance in their favour, they never fuffcr from the terrors of a diffracted imagination: their fpirits are lively and equal; they quickly forget their pad fufterings, and never anticipate the future.
Children recover from difeafes under fuch unfavourable cir- cumftances as are never furvived by adults ; if they wafte more quickly under licknefs, their recovery is quick in proportion, and generally more compleat than in older people, as difeafes feldom leave thofe baneful effects on their conftitutions, jb frequent in thofe of adults: in fhort, a phyhcian ought never to defpair of a child's life while it continues to breathe.
In human parturition, the moll known and fuccefsful prac- titioners, if they are candid, will own, that in common and natural cafes, Nature is fufHcient; and, that their bufinefs is only to aflift her efforts in cafes of weaknefs of the mother, or an unnatural polition of the child. As ibon as an infant comes into the world, our rirft care is to cram it with phyhc : There is a liquor in the bowels of infants, and many other animals, when they are born, which is neceffary to be carried off"; the medicine which Nature has provided for that purpofe, is the mother's firff milk ; this, indeed, anfwers every purpofe, and effectually; but we think fome drugs forced down the child's throat will do much better — the compofition of which varies,
G 2 according
44-
Mr. Wood-ward, on Infantile Difeafes.
according to the fancy of the good woman who prefides at the birth. It deferves to be remarked, while on that fubjcct, that calves, which are the only animals taken under our pecu- liar care in thefe circumftances, are treated in the fame man- tier; they have, the fame fort of phyfic administered to them, and often with the fame fuccefs ; manv dying under the opera- tion, or of its confcqucnces : and we have the greateft reafon to think, that more of that fpecies of animals die at this period than of all others. We fee in thefe circumftances put together, that notwithitanding the many moving calls of natural inftinct in the child to fuck the mother's breaft, yet the ufual practice is to deny that indulgence till the third day after the birth ; by that time, the fuppreflion* of the natural evacuations of the milk, ufually brings on a fever, the confequence of which is often fatal to the mother, or puts it out of her power to fuckle her child at that time. The fudden f welling of the breafts, which commonly happens about the third day, is another bad confequence of this delay. When the breafts become thus fuddenly and greatly diftended, a child is not only utterly un- able to fuck, but, by its cries and itruggling, fatigues and heats both itfelf and the mother: this is another caufe which prevents nurfing. I believe it was the gentlemen who had the care of the Lving-in Hofpital in London, who firft had the honour, in this inftance, to bring us back to Nature and common fenfe ; and by that means have preferved the lives of thcufands of their fellow creatures. They ordered the chil- dren to be put to the mother's breaft as foon as they (hewed a defire for it, which was generally within ten or twelve hours after birth ; this rendered the ufual dofe of phyile unneceflary; the milk fever was prevented; the milk flowed gradually and eafilv into the breafts, which before were apparently empty ; and things went on in the natural way. I am ferry, however, to obferve, that this practice is not yet become general. If a mother is determined not to nurfe her own infant, fhe fhould, for her own fake, fuckle it at leaft three or four weeks, and then wean it by degrees from her own breaft; in this way, the moie immediate danger arifing from repelling the milk, is prevented. When a mother does not nurfe her own infant, ihe does open violence to Nature; a violence unknown among
the
* It is, perhaps, unneceflary to remind our readers, tint in puhiifliing the communications of our 1,'oirefpondents, vye by no means wifh tc be un- derltcod, as adopting or appioving their opinions. We believe that ieve- lal opinions contained in this paper, have originated in a want of oppoi tu- 1 i'.y to acquire the latefl mfmrmatiofi, refpecting fume of the prafhees which the writer cendemns. Edit.
On Human Combustion.
45
the inferior animals, whom Nature intended to fuckle their young ; a violence unknown to the moft barbarous nations, and equally unknown amongfl the moft polifhed in the pureft ages of Greece and Rome.
[ To be continued. ]
From An Effay on Human Comhujiion from the Alufe of Spi- rituous Liquorsy by Pieree-Aimee Lair, Paris, i Vol. duodecimo, we prefent our Readers with the following Ex- tracts.
The bodies of living perfons have been known to catch fire from the flame of other bodies, and continue to burn alinoft to afhes. 1
On this aftonifhing and little known fact, the author ven- tures, as he fays, to make fome obfervations, which are the fubftance of his effay.
He begins by remarking, that the fact itfelf may be diffi- cult to be believed, and will find the more opponents bccaufe of its rarity; and becaufe there are examples of parts of the hu- man body, to which this fatal accident has happened, that have not been confumed when they have not been abfolutely fub- jected to the action of the fire. But he adds, this phenomenon has been afferted, as true, by too many learned men, of un- doubted veracity, for it to be called in queftion. The names of thofe he cites are Bianchini, MafFei, Rolli, Lecat, and Vicq-d'Azyr.
He enters on his fubject by obferving, that he fhall have re- courfe to facts ; which are much more fatifactory than fuppo- fitions. Moft of thofe he cites, which are not a few, are ex- tracted from the journals of various nations ; and, with fome fhades »f difference, offer much the fame refults, which are thus enumerated by the author:
t. The perfons who have been fubject to combuftion, have been long accuftomed to drink lpirituous liquors.
2. None but women have been confumed.
3. Theie women were old.
4. The body has not burned fpontaneoufly, but accidentally.
5. The extremities of the body, fuch as the feet and hands, have generally been fpared by the fire.
6. Water
46
On Human Combustion.
6. Water, inftcad of extinguifhing the fire in tliofe parts that were in a ftate of cornbuftion, has fome times only given it greater activity.
7. The fire has little injured, and fometimes not at alL, thofe combuftiblc things that were in contact with the body when it was burning.
8. The cornbuftion of thefe bodies has left a refidue of greafy and fetid afties and fat, that were unctuous, oftenfivc to the fmell, and very penetrating.
It is proper to add, that often, while the fire was in the height of its action, it fent forth little or no flame.
Having cftabliihed this feries of facts, he examines each, individually, and begins with the abufe of fpirituous liquors, to which moft of the victims of this horrible death had been fubject. In order to fhew how this practice may render the body combuftiblc, he remarks, it is generally known, that peo- ple who drink much eat little; which little is of high-feafoned viands; that their urine is aqueous, and that the alcohol c parts, like all volatile fubftances, are but little decompofed, penetrate the mufcles, and as it were, faturate the whole mafs. In proof of this he cites different cafes; of which it has been remarked, that the bodies of perfons who have died drunk, fend forth a vinous odour long after death. But, without fuppo- fing fo much, there are few who have not been fenfibie of the alcoholic vapours which drunkards exhale. Two conlequ-.tvcs refult from a body being thus impregnated with alcohol; one is, that the vinous fpirit dries the fleih, foftens the fat, and fits them both for cornbuftion; and the other, that this kmd of interna! and highly inflammable vapour-bath is ever ready to catch fire, and to communicate it to the body that is already thus prepared,
Cornbuftion has only been obferved to take place in women ; which does not prove that men are wholly exempt from it, but that they are Jejfs. fubject to it than the other fex. This pro- peoflty the author attributes- to the delicacy of the female fi- bres, and the iefs compadtnefs of the parts of the body, which :s natural to them, and their fedentary life, rendering both the .fiefh and the fat more proper to abibrb fpirituous fubftances, and diipofe them to inflammation.
The women were old : the love of liquors is the fuccefior of the pailions of youth, and is moft manifeft, particularly in women, in an advanced age. The little exercife of which this feafon of life admits, encourages the increafe of inflammable Srbftances in the body, and thus gives place to the accident V queftion.
Was the fire fpontaneous ? or .was it communicated by an
ignited
On Human Combustion.
47
ignited body ? The latter cafe is admitted by the author in iupport of his opinion. He obferves, it is poflible that thefe inflammable vapours, which emanate from the bodies of drunk- en people, may catch m e, and communicate it to the bodies by which they are exhaled. Perfons are cited who had drunk brandy, and whofe breath, kindled by the flame of a candle, had communicated the fire inwardly, in confirmation that the fire had caught by accident in all the cafes he quotes, it was obfcrved, that the remains of moft of the perfons were found near the fire.
The author then returns to the poflibility of fpontaneous combuftion in the human frame; admitted by fome enlightened obfervers. Having noticed, that thefe kind of conflagrations take place in the mineral and vegetable kingdoms, he cites cafes of men, after drinking much brandy, that have breathed flames : but fuppofing thefe fadts confirmed, he does not ima- gine fuch inflammation could totally deftroy the body. To this it may be replied, according to the author's own dodlrine, that fince he fuppofes bodies may take fire from a pipe, a light- ed candle, or burning coals, there is no evident reafon why it might not, in like manner, take fire from a fpontaneous flame, in contact with it over a great extent of furface.
Of the fifth remark, relative to the parts fpared by the fire, the author fuppofes the cauf; to be in their lei's propenfity to burn.
In proof of the fixth, he cites a familiar example of water thrown on greafy and fpirituous fubftances, which does but augment the activity of the fire.
He attributes the little damage done to the combuftible cloth- ing of the dead body to the nature of the flame, fimilar to that of the alcohol. Befide which, it is obferved, that the com-' buftion is performed almoft without flame, the body being ilowly confumed like the pyrophore, and the nature of the aihes and greafe that remain, being the fame as thofe of all animal parts, the emanation of which has not been excited to the utmoft.*
Thefe explanations being given, the author yields to fuch reflections as rcfult from, and are the end of, his inquiries. The firft is, that accidental human combuftion might be fup- pofed the work of the guilty ; aod the innocent might thus be involved in great misfortunes. He cites, in proof, the ex- ample of a man condemned to death, in confluence of fuch an accident. He thence very judicioufly obferves, that thefe
' facts
* Dont l'cm <nat'on n'a pas etj! poitle au dcrr.ier dc^ie.
48
Mr. Shau!, on Spasmodic Jffeclion.
facts are as necefFary to be known by the lawyer as the natural hiftorian.
He concludes with prefuming, that the terror which acci- dents fo dreadful mufl infpire, were they fufficiently known, might perhaps deter many people from the vice of drunkennefs.
However plaufible the reafons given in this work may be of the propenftty of certain living animal bodies to catch fire, and be thu;> confumed, it rauft be owned, that were they merely hypothetical, the poflibility of an event fo aftonifhing mull be doubted ; and that nothing lefs than experience could deftroy the incredulity felt at the recital of thefe ftrange combuftions : but this authority of experience is fo well fupported by the number and agreement of the facts, and by the character of the perfons who teftify their veracity, that none but the obfti- nate can doubt of their exiftence.
The work is written with perfpicuity and method, is rich in well-felecred quotations, and the arguments it contains are jdways fupported by facts, and ftated with fagacity.
To the Editors of the Medical and Phyfical Journal. Gentlemen,
If the following fingular cafe, from its fuccefsful termination, (which appears to have been effected principally by the exhi- bition of the Digitalis, and may, probably, merit the attention of practitioners in fo dreadful a malady) fhould be deemed worthy a place in your periodical publication, I offer it to your iervice ; and am,
Gentlemen, . With very great refpedt,
Your moft humble fervant, Docking, Norfolk, EDMUND SHAUL.
June 6, .1800.
S. O. a young women aged twenty-one years, of low fta- ture, and of a feeble, florid habit, having over-exerted her- felf in waiking or running ten miles in a Ihort fpace of time; in confequence of which, fhe fainted, and became extremely languid and debilitated, b.ing three months advanced in preg- nancy. Symptoms of irritation, with great tendency to abor- tion, immediately fupervened; but, upon examination, theje was no apipearance of dilatation of the os tincae } and the va-
Mr. Shauly on Spasmodic Affection.
49
gina was very much contracted, fcarcely admitting the intro- duction of the fingers. She was ordered to keep herfdf in a horizontal pofition, and to abftain from all heating liquors ; an anodyne mixture was alfo adminiltered, com poled of the mixtura camphorata. tinct. caftor & tinct. opii ; a dofe of which was ordered to be taken every three hours. But the pains recurring at times, accompanied with a general hyfteria, I was fent format twelve o'clock at night, and found her labour- ing under an increafe of fymptoms, but Hill there -was no di- latation of the os tineas. I then gave her a draught with tinct. opii. gts. 40, and aether, vitriol, increafing the tinct opii. gra- dually. This affording a temporary relief, fhe took fome'nou- rifhment, and was difpofed to fleep; but in an hour afterwards fhe became v iolently convulfed, and every fymptom of the moft dreadful fpafmodic affection, ever witnefTed by any medical practitioner, now came on. The opisthotonos and emproi- thotonos alternately fucceeding each other, the head and extre- mities were bent backwards fo as almqft to meet: foon after an action the reverie of this took place ; her chin and knees were contracted together, the mufcles of the face and her eyes were violently diftorted, the latter being almoft protruded from their fockets ; and during the paroxyfms fhe frequently attempted to bite herfelf. In Ihort, every mufcle of her fyftem appear- ed more or lefs to labour Under fpafmodic action.
In this defperate ftate I repeated the tinct. opii with fome aether ; but no relief being obtained, I ordered it to be given to her every two hours, and an emollient clyfter was alfo in- jected. This mode of treatment not anfvvcring my expecta- tions, I fent for a medical friend to fee this lingular and de- plorable cafe ; and as our p relent plan feemed to afford fo un- fucccfsful a profpect, another expedient was adopted : Twelve ounces of blood were taken from her arm, and I ordered the abdomen and extremities of the body to be rubbed with an em- brocation, con fitting of the linimentum faponis and tinct. opii aa. ; and locrdrops of the tinct. opii to be given internally, witli ;ether. vitriol. Twenty grains of the pil. gummofie
were alfo adminiltered every three hours, and I recommended her to go into a warm bath for ten minutes. The fpafms ft ill continuing, but with a lell'er degree of violence, Dr. Redfearn, a phyfician at Lynn, was fent for to vifit her. After fome deliberation, and having communicated to him the different remedies 1 had made ufe of, he ordered me to give her in- ftantly 100 drops of the tindt. opii, and the following medi- cines were prefcribed:
R. Emulfionis camphorat. ^iv; tinct. opii, tinct. caftorei aa *fs. Mifce. fiat enema ftatim injiciendum.
Numb. XVII, H R. Tinci
SO Jjr. Charles Darwin > Experiments.
.JUL . Tinct. opii?r>ethcrjs vitriol, aa £j ; ol. fuccini 35 i j - Hat
ibrocatiu toto'corpori applicand. poft balneum tepidum.
The following draughts were alfo prefcribed :
R. Emulfronis eamphorttf: -gifs ; tin£t. digitalis purp. gt. xl;
tincVc>pii gt. foo; aediAs/vitriol. -^j. M. Fiat hauftus tcr-
tiaquaque hora Ilnj&enuu*^'
S^ft^ tinctura digitalis was increafed gradually to 70 drops at>o'r»e^c&.~~Aflaft more favourable fymptoms appeared ; the fpafms were mitigated, and fhe palled a tolerably eafy night without being affected by them. However, on the following morning, a return of the former fymptoms feemed to be ra- pidly coming on j her eyes were very much diftorted, and the DocStor ordered the enema to be repeated with 3 1 j of the gum affafcetida added to it ; and a bolus, compofed of the different articles fubjoined, to be inftantly given.
R. Opii purif. gt. vij ; zinci calcinat. gt. ifs ; pul. digit, purp. gt. ij ; piperis cayenfis gt. iij. Syrup, s. s. Fiat bolus ftatim fumendus.
Soon after the above medicine was given, a general relaxa- tion of the whole fyftem fucceeded, attended with naufea, and a total ceffation of fpafmodic action. Being extremely debili- tated, a diet of wine, eggs, and coffee was prefcribed, with as much nutriment in various forms as could be got down. The tin£t. opii was now diminifhed gradually, and vegetable and mineral tonics were adminiftcrcd. By continuing this regimen her health became perfectly eftablifhed, and fhe has ever fince remained entirely free from any return of fpafmodic action.
The quantity of the tinct. opii, taken internally at different time^, in the courfe of three days, was two thoufand two hun- dred and ten drops ; one ounce was injected per anum, and two ounces and a half applied externally.
Experiments, by Dr. Charles Darwin.
As the attention of medical practitioners has been for fome time directed to the treatment and diagnofis of Phthilis Pul- mojialis ; and as the diftinction of the complaint, and its feveral Itages, depend in a coniiderable degree, upon the matter ex- pectorated, we believe our readers will be gratified by the fol- lowing Extracts from the fcarce work, Dr. Charles Dar- win'* Experiments ejlablijhing a Criterion between mucilaginous and purulent Matter. An additional motive for reviving the fubject at this time, is the great improvement which has been
mads
Dr. Charles Darwin's Experiments.
5*
made in Chemiftry fince the year 1780, v/hen that work was publifhed; and the hope that fome of our Correfpondents will be induced to favour the Public with their fentiments on the diftindtion between aerated pus and the matter of tubercules.
Experiment I. To a drachm of very foetid purulent mat- tery obtained from a common abfcefs, fifty drops of vitriolic acid were added. The acid funk to the bottom, while the pu- rulent matter kept in the upper part of the glafs ; but, on the addition of about two ounces of water, the whole formed a turbid white uniform mixture.
Exp. II. About fifty drops of vitriolic acid were added to a drachm of mucus, coughed up from the lungs, and diicharged from the nofe ; the acid foon diiTolved the greatcft part of the mucus, but, on a proportion of water being added to the mix- ture, the mucus, which had been diiTolved, fjuam on the top of the fluid.
Exp. III. To fifty drops of vitriolic acid-, diluted with about an ounce of water, were added about two drachms of pure mucus, coughed up from the lungs, and collected from the nofe ; notwithftanding repeated agitation, they could not be made to unite; — almoit the whole mucus continued afloat at the top ; and the watery fluii below loft very little of its tranfparency, acquiring only a f:ight bluifh caft.
Exp. IV. On the addition of about two drachms of foetid purulent matter, to fifty drops of vitriolic acid, diluted with about an ounce of water, an uniform turbid fluid of a whitilh colour was formed, and which exactly referable d that mention- ed in the firft. experiment.
Exp. V. About two drachms of very foetid purulent matter were combined by agitation with as much mucus. Thefe two fluids were fo blended together, that no difference could be perceived. To this was added a mixture of fifty drops of vi- triolic acid with two ounces of water, In a Ihort time the fluid in the under part of the glafs had the fame turbid appearance as in Experiment firft and fourth, while the mucus apparently deprived of purulent matter fwam on the top.
Exp. VI. All the five glafTes mentioned in the preceding experiments, were allowed to remain at reft about half an hour, during that time the glaffes mentioned in experiments fecond and third, which contained the mucus, remained unchanged. But the firft, fourth, and fifth depolited each a white coloured fediment in confiderable quantity; the fluid above the fediment in firft and fourth had become lbmewhat more tranfparent, but ftill continued of a white colour. In the fifth the mucus con- tinued to float on the luiface as before
H 2 Exp,
52
Dr. Charles Darwin's Experiments.
Exp. VII. The mucus collected from the top of the fifth was put into another glafs, and an ounce of water impregnated with fifty drops of caujlic alkaline lixivium* was added; but no union or folution could be produced even by the aid of triture.
Lxp. VIII. Fifty drops of the alkaline lixivium were added to each of the phials No. i, 2, 3, and 4; when 1 and 4 were agitated, the white fediment was again diffufed in them; hut, in a fhort time it fubfided, leaving the liquor above of the fame v/hitifh colour as before, the addition; the agitation of 2 and 3 had no eff'ecT: in producing any union farther than before, the mucus in both ftill continuing to float on the furface.
Exp. IX. The mucus ufed in 7 and 8 was again put into a glafs by itfclf, and about two drachms of c a ujlic alkaline lixivium added to it. In this, by the aid of agitation, it was foon com- pletely dijjolvecly loling entirely its vifcidity, and leaving a froth on the top.
Exp. X. Two ounces of water added to the folution of mu- cus in alkali, No. 9, produced no decomposition; and had the efFeiSt only of giving the fluid a greater tranfparency; no change was produced on this fluid, when allowed to remain at reft for the fpace of half an hour, except that the froth on the furface difappeared.
Exp. XI. To half the liquor of 10, about a drachm of ni- trous acid was added ; the mixture became of a more turbid and white colour, but no depolition took place.
Exp. XII. A fimiiar change of colour took place on the addition of a certain quantity of the muriatic acid to the re- maining half of No. 10. But, even after the mixture had flood for half an hour, no fediment had fallen to the bottom of the veiTel.
Exp. XIII. When the white coloured liquor on the furface was poured cfr' from No. 1, 4, and 5, each of which depofited a fediment refembling pus-, the fediments were again obferv - ed to emit a very ftctid fmell. To thefe fediments, collected in one glafs, about two drachms of nitrous acid were added. The mixture for a little time appeared uniform, but in a few minutes a thick white cloud was obferved on the top of it, the liquor below being of a wheyifh colour.
Exp. XIV. To the liquor, No. 13, was added about two ounces of water : The cloud which before fwam on the furface, was, on flight agitation, uniformly diffufed through it; and when the mixture was allowed to remain at reft for a fhort time, a
fediment
>
* Phaimacop. Edinenfi
Mr. Uwins, on Febrifuge Medicines.
53
fdiment fell to the bottom, exactly refembling that which had appeared in Obfervation 6, to have happened in Experiment i, 4, and 5; and this fediment, when the fluid above was poureji off, had alfo a foetid fmell.
[ To be continued. ~]
To the Editors of the Medical and Phyjical Journal. Gentlemen,
1 HEORETICAL difquifiti ons and controverfial commu- nications are, perhaps, in fome meafure, foreign to the defign, of your publication, as tending to the exclufion of what may be conceived more immediately important and beneficial to the medicinal art : Encouraged, however, by former indulgences, and fully confeious of the extreme liberality which has hitherto characterized the Medical and Phyfical journal, I have taken the liberty of again intruding on your notice, by making fome Obfervations on the modus operandi of Febrifuge medicines ; or, rather, of fuggefting a few hints on this fubject, and fubmit- ting them, with the utmoft deference, to the A4edical Public, through the medium of your ufeful and initruclive Mifcellany. — To this I am more particularly induced, in confequence of a mifreprefentation of a few remarks of mine, inferted in one of your former numbers. That Dr. Huggan Ihould conftrue my obfervations on his opinions into an oblique imputation of Enthufiafm to his encomiums on opium in the cure of febrile diseases., or a recommendation of venccseLlion in inflammatory fevers, appears altogether unaccountable; as I confidently main- tained and afferted, on the authority of my own experience, the extreme utility of the former, and the baneful tendency of the latter, in fevers of every description ; and I have not the leaft doubt, that the Doctor's practice in thefe complaints is in exacl conformity with my own, though the principle and theory upon which fuch practice is conducted, may in fome degree differ.
The fcicncc of medicine has, within a few years paft, re- ceived very confiderable and important improvements, in con- fequence of a greater attention having been lately paid to the causes than the mere phenomena or symptoms of difeafes ; and in no inftance, perhaps, has this alteration in medical practice been more manifeft or beneficial, than in the treatment of thofe complaints which, from their generality and frequency of ap- pearance,
54
Mr. Uwins, on Febrifuge Medicine!.
pearance, may be confidered as tndemics in this climate, viz. fevers. I humbly conceive, however, that, notwithftanding the improvements which have been already made, and the compar- ative amplification which has obtained, we are far from having arrived at a ftate of perfection, either in this or in any other department of the healing art.
A derangement of the nervous fyftem, occafioning general debility, is an invariable attendant on fevers of every denomi- nation ; and to this fingle caufe, debility, are all the fymptoms which occur, under different circumftances of constitution, si- tuation, habit, &c. of the patients to be referred : for, notwith- ftanding the minute divifion and extenfive claffification which have been adopted (and, doubtlefs, with great propriety) by nofological and fy Hematic writers on febrile affections, there appears to be no fpecific or abftract difference in the difeafes thcmfclves, the variety of appearance which they affume being totally dependent upon the ftate of the conftitution receiving the affection. Thus, the fame caufes operating upon a perfon of a fanguine temperament and plethoric habits, ftiall occanon the difeafe which has obtained the appellation of inflammatory fever, with fymptoms of vafcular excitement ; which, on a pa- tient of a contrary defcription, will be productive of a typhus or nervous fever.
. In what fpecific manner the malign powers exert their influ- ence on the fyftem, fo as to occafion that deviation from the healthy ftate, which gives rife to the phenomena of fever ; or, in other words, what is the proximate caufe of fever, is not my intention here to enquire; as I conceive it to be a matter of flight confequence to afcertain ; the minutiae of theory be- ing more calculated to difplay ingenuity, and amufe fpecula- tiits, than to afford any material information; and an attention to rational principles and conduct in praclice, is far pre- ferable to thofe theoretical refinements, and fanciful hypothefesy which are, in the prefent day, by far too prevalent. I do not mean, by this aflertion, to give the fmalleft encouragement to that empirical mode of practice, which pretends to preclude the necejfity of all peafoning a priori in medicine — far from it. No one, who judges impartially from premifes, will accufe the Poet of advancing any thing in favour of Free-Thinking, when he afferts, with refpect to modes of faith,
*' His can't be ivrcng nvhofe life is in the right.'"' his defign being merely to fhew the fuperiority of practical piety over dolrinal diflinclions, theological difputations, or reli- gious fanaticifm. — But, to return, the counteraclion of nervous debility being the principal objects to which the attention ftiould be diiected, in the treatment of febrile complaints, the
utility
Mr. Uwins, on Febrifuge Medicines.
55
utility and abfolute necefiity of proceeding upon a Jibnulant flan of cure becomes obvious ; and thus is the equal benefit derived from the exhibition of opium (one of the molt power- ful of all nervous ftimuli) in inflammatory, typhus, or any other fever to be explained; this important and truly valuable medicine decreafing the ftrength and number of pulfations, in thofe fevers which are characterized by fymptoms of arterial Itxength and vafcular excitement, and producing effects ex- actly oppofite, where occafion requires.
That the advantageous effe&s of opium are to be referred folely to its Jlimidating quality, is alfo evident from the equal fuccefs attending its adminiftration in the cold and hot ftages of an intermittent; which is a fact I have fully afcertained from experience.
Nothing can poffiblv be more erroneous in theory, or irr- jurious in practice, than the antiphlogijlic plan of treatment in febrile diforders; and depriving the animal machine of its only fupport, at a time when its functions are impeded, or rendered irregular, folely in confequence of debility, or deficiency of ex- citement, has been productive of incalculable mifchief !
How then, it may be urged, are we to account for the un- deniable benefit which has attended the exhibition of antimonial preparations, nitre, and other medicines of the refrigerant clafs? — A very general mifunderftanding feems to have ob- tained with refpect to the action of thefe medicines ; for a mi- nute examination into their effedts, will fhew the propriety of ranking them in the clafs, not of antiphlogijlics, or refrigerants^ (which, by the way, are indefinite terms) but of Jlimulants. To illuftrate this doctrine, it will be only nccefiary to recol- lect the confequences frequently produced by the adminiftra- tion of antimonials in the incipient ftate of a nervous fever. When the quicknefs, fmallnefs, and irregularity of the arterial pulfations, diftrefling pains in the head, extreme oppreffion of the mind, and other fymptoms are prefent, denoting the high- eft ftate of nervous debility, a dofe of pulv. antim. in fuch quantity as to create a flight naufea of the ftomach, will often reduce the pulfe to its proper ftandard, and, by inducing a re- gularity and due proportion between the action and re-action of the fyftem, will effectually arrcft the further progrefs of the difeafe. Can thefe effects be accounted for upon any other prin- ciple than a fympathetic excitement of the nervous fyftem, from the temporary derangement in the functions of the ftomach ?*
With
* Would not mercurial oxyds, or any other mineral preparations, admi- niflered with care and attention, be productive of equal advantages with- antimonial medicines ? and is not the benefit derived from the exhibition oF Mi'jenic. alb. in levers, to be referred to its operation on the ftomach ?
Dr. Bosquillon, on Hydrophobia.
With refpect to nitre, its ufe in fcrophulous and other dif- eafes, originating in debility, and an inactive ftatc of the living powers, as well as the experiments of Dr. Percival and others, prove it to pollefs a Itimulating property, which is alfo further corroborated by the extraordinary fuccefs attending its admini- ftration in typhus, as related by Dr. Wood ; and a cafe is fome- wfaere mentioned, of an inflammation of the ftomach fuperven- ing upon an over dofe of this medicine, which is contradictory to the fuppofition of its acting as a refrigerant. I am moreover informed, that people who are in the habit of taking a large quantity of acids, and fubftances containing much oxygen, are conftantly found to have their blood in a sizy state.
The above remarks are by no means intended as a recom- mendation of an indifcriminate and invariable mode of practice in all kinds of fevers ; fuch a doctrine could only be founded in abfurdity, and dictated by phrenzy; but are merely for the pur- pofe of endeavouring to limplify the curative indications, and thus to improve the treatment of thofe difeafes, which, on ac- count of their univerfality, and frequent danger, demand the particular attention of the medical practitioner, and in which an erroneous practice has been productive of more mifchievous conlequences, and fatal effects, than probably the difeafes them- felves would have occasioned, had they been left entirely under the guardianfhip of Nature. I am, Gentlemen,
With the greateft refpect, GttteviUt Street, London, Your obedient fervant,
>»i3, x8co. DAVID UWINS.
56
Reflexions on the Case of a young Girl, who died with Symptoms of Hydrophobia.
â– By C. Bosquillon, Phyfician to the Chief Hofpital, (Grand Hofpice) at Paris.
I HAVE proved (fays the Doctor) in my Commentaries on the Elements of Practical Medicine by Cullen, that terror alone may determine the fymptoms of hydrophobia or madnefs, in thofe who had been bitten by an animal fufpected to be at- tacked with this diforder. Numbers of perfons have been feen to labour under fymptoms of this nature, and to recover on being informed that the dog that had bitten them was not mad. There are oth ers, on the contrary, have become fuddenly hy-
drophobial
Dr. Bosquillori) on Hydrophobia.
57
drophobial on learning, at the end of a confidcrable time, that the perfons bitten at the Tame period with thcmfelves had died with lymptoms of hydrophobia. The informations which I have received on the cafe of the young perfon in queftion, have con- vinced me that terror alone produced' all the terrible effects which lhe had experienced. She was bitten the nth Frimaire, (Dec. I,) by a little dog of fix months old, naturally fuappifh ; it had, however, never ceafed to obey the orders of its matters, nor did it appear to know them lefs than ufual ; its eyes had nothing menacing in their look, nor was there any froth about the mouth. The family was juft informed of a perfon recently dead by madnvfs; it was imagined that this little dog was at- tacked by the fame malady ; they refolved to drown it, and this they did without alluring themfelves of the apprehended fa6t.
What an impreffion might not this be fuppofed to make upon a girl of fourteen years and a half, extremely fenfitive, and of a very lively imagination ! From this moment (he be- came deeply thoughtful ; about forty days afterwards (he hurt the finger bitten, in attempting to cleave a piece of wood; the cicatrice of the wound where (he was bitten opened again, and her uneaiincfs greatly increafed. During the periodical eva- cuation incidental to her fex, fhe had occaiion to put her hands in coid water; a fuppreffion took place, and that was followed, the 30th Nivofe, (January 19,) fifty-one days after the bite, with a violent head-ach accompanied with fever, a contraction, of the throat, a frequent fneezmg, and unquenchable thirft. Fumigations were made ufe of to relieve the head-ach, but prefently univerfal tremblings and convulfions took place. She drank with perfe£t eafe till the 2d Piuviofe (Jan. 21), when (he let fall a glafs of water which her mother offered her; her hand and her whole body, her countenance efpecially, were at that inftant greatly agitated by convuliive movements. Thofe about her, being greatly frightened, occafioned her to be con- veyed that fame evening to the Great Hofpital. She was much affected to find they tied her in her bed, which it is the cuf- tom to do with hydrophobial patients. She parted the night in a difturbed condition ; the next morning lhe pufned back a glafs of water they offered her, and fell into convulfions; fhe was, neverthclefs, very thirlty. They made her drink out of a biberon ; lhe fwallowed the liquid with precipitation, and complained even that they did not pour it out faff enough. She preferred water tinctured with red, or mixed with a little fwcet orange-flower water; but at every time fhe fwallowed, the convulfive movements returned : neverthelefs, fhe endured the fight of a large vcfTcl which was brought to her for the purpoie of bleeding her in the foot. Her feet were left in it a Numb, XVII. I lonz
58 Dr. Bosquilloriy on Hydrophobia.
long time, and ftill fhe did not fall into convulfions. Her ima- gination became greatly inflamed; fhe talked with much volu- bility, and bitterly complained that fhe had heard nothing but of madnefs fince fhe was bitten. 1 faw her the 4th Pluviofe (January 23,) an hour before her death ; fhe was greatly de- jected and iunk down, and had a pale, wafted countenance ; every thing announced that fhe was out of the reach of all re- lief. Hydrophobial patients, on the contrary, generally die in itrong convulfions, which come on even frequently at the inftant when v/e think them better. Their colour changes but little ; which, without doubt, has given reafon for the world to be- lieve that they have been ftifled to death ; moreover, the con- vulfions have only appeared the third day of the diforder ; they have been preceded by fever, and a contraction of the throat, apparently the cfFect of inflammation in the cefophagus and the trachea artcria; indeed, it can hardly be doubted but that is the cafe, when we confider the extraordinary quantity of faliva, and of mucus, with which we find thefe parts filled after death, and of the rednefs throughout them. In fhort, the true hy- drophobia, as well as other convuliive idiopathic diforders, is never preceded by fever; it comes on at once. All this proves therefore that terror alone threw this young girl into the fright- ful ftate which occafioned her death.
It was neceffary, in order to preferve her, that thofe who furrounded her fhould have taken quite a contrary courfe to that which they obferved, and have compofed and comforted her mind; and, above all, have perfuaded her that the animal was not mad. Tranquillity of the mind alone may keep off this cruel difeafe. It becomes eiTential then, as well for thofe who have been bitten, as for the progrefs of the art, to keep the dogs, or other animals, fuppofed mad, fhut up lately in a con- venient place for five or fix weeks; the madnefs always fhows itfelf in the courfe of this time, and they die in a few days when the hydrophobia comes on. When they are attacked by any other diforder, the proof of -what it is is foon obtained. By fuch a procedure we may avoid creating a great many tor- ments or appreheniions, at leaft in thole who have been bitten by fuch animals ; we fhould not be obliged to keep them, for two months together, tied down in their beds, as is the com- mon cuftom, fubjecting them to a treatment which may Well augment their fears, and determine or fix that diforder which it is our defign to prevent. It is proper alfo that the public fhould know, that it is proved that in all thofe who have been bitten by animals with the hydrophobia, a twentieth part at molt experience the fymptpms of hydrophobia, and that thefe are generally perfons of minds the moll fenfitive, and fubje£t
to
Mr. Bell, on Scrofula. 55
to alarm. I do not know that children, who have not attain- ed the age of reafon, have ever experienced thefe fymptoms. Paris, zotb Pluviose. BOSQUILLON,
To the Editors of the Medical and PJiyftcal Journal, Gentlemen,
In looking over Profeflbr Hufeland's defervedly celebrated Treatife on Scrofula,* I was ftruck with the following cafe, which he confiders as an uncommon one, and fays, that he had never heard of any thing fimilar, except fome cafes related by Hillary in his Ot/arvations on the Diseases^ &c. of Barbadoes. I have been induced to translate it, as I do not know that the; original work has yet appeared in an Englifh drefs, and hope you will do me the favour to infert it in your excellent Journal. I have added a cafe, which I had an opportunity of obferving a few years ago, fo nearly fimilar that they may be conlldered as analogous. I am,
Gentlemen,
His Majeflfs Skip, Pelican, ^^W&V^ Plymouth, June 10, 1800. JOHN JjL-LL, burgeon.
u A Species of Eiephantiafis from a Scrofulous Caufe, '
" A girl of a fcrofulous habit, who had frequently running ears, fore eyes, and other fymptoms of a fcrofulous ftate dur- ing her infancy, had patted very favourably through the fmall- pox in her eleventh year, and had enjoyed a good ftate of health for the two fucceeding years, v/as attacked in her thirteenth year with a fwelling in the left foot, which foon extended to the caif of the leg. After fome general internal and external re- medies had been ufed, the tumefaction difappeared, but re- turned in a fhort time, and increafed to fuch a degree, that it extended from the toes up to the hip: the leg was more than double the fize of the other, rather cold than warm, pale, and the fwelling fo hard, that no imprellion could be left on it with
I 2 the
* See Hufcland Ucber die Natur, Erkemituifmittel, urid Heitart der Skro. felkrankhcit, &c. zd edit. 'Jena, 1797.
6o
Mr. Bell, on Scrofula.
the finger. The patient was in other refpects apparently healthy, had a blooming hue on her countenance, and a cheer- ful temper, but had fometimes pain and reltlefsnefs ; the na- tural and vital functions were good.
u After having thus pafled a period of fix months without ufing any medicine, a phyfician was confulted, who treated her chiefly with evacuants and laxatives. From this time fhe be- came very languid, loft her colour and appetite ; the foot got no better, and the idea of curing her being abandoned, fhe in a few months acquired her former ftrength and cheerfulncfs.
" Some time afterwards a veficle appeared on the infide, a little above the knee of the difeafed leg, from which a yellow- ifh watery fluid was difcharged. This difcharge ceafed fpon- taneoufly, but returned in a fhort time, when the matter took on the appearance of curdled milk, and became fo corrofive, as to excoriate the furrounding fkin. The leg became ftill larger and harder, and the fkin in many places felt knotty, and as firm as leather ; the other leg remained perfectly found. About this time fhe was attacked occafionally with violent fe- verifh paroxyfms, attended with anxiety, delirium, and con- geftions of blood in the' head, which were caufed by the near approach of the natural period of menftruation.
" Some months afterwards, when fhe had attained her fix- teenth year, and the difeafe had been of three years {landing, fhe was ordered to take fpongia ujia, radix ferpentaria:, pilules fcillce, and decotlum ligni guiaici; fomentations of herbs, with campker and volatile alcali, were applied externally to the leg, and aqua lyiharg: acet. comp. to the fore.
Thefe medicines caufed diarrhcea, and fometimes vomiting, and increafed the urinary difcharge, but the leg got no better, except that the fore was dried up : the medicines were con- tinued. A few weeks afterwards fhe had another attack of the feverifhnefs mentioned above, with anxiety, delirium, and dil- ordered circulation,- which continued for fome days ; and im- mediately afterwards, the difeafed leg was fomewhat fofter, and acquired a red and purplifh colour. A fhining and very tenfe tumour arofe under the calf, in which the patient com- plained that there was a violent and painful pulfation.
" She continued the fame medicines, with the addition of Hoffman's fublimate pills. A fortnight afterwards the tumour under the calf of the leg inflamed greatly, burft, and difcharged a yellow-coloured pus, and the fore above the knee alio broke out again. In a little time the let? became fomewhat fmaller.
" For a whole year after -his, the moft adtive medicines, as hydrarg. muriat. puivis plummerl, arnica, assafcetida, zinc. vi~ triolat, cicuta, fri&ion with ungt. hydrarg. fort, fumigations
with
Mr. Bel^ on Scrofula. 6 1
with hydrarg. sulpburat. rub. warm baths and fliower baths, with chalybeate and fulphurcous waters, were made ufe of.
" The iize and hardnefs of the leg were not diminished by thefe means, but rather feemed to become more conficierable. Befide the fores already mentioned, feveral hard glandular tu- mours appeared, which inflamed, fuppurated, and difcharged an acrid lymph, which often caufed great pain in the furrounding parts. She had feverilh attacks from time to time, which con- tinued a few days, and generally left the leg much worfe. Her menfes appeared in the middle of the year, without in the lealfc changing this dreadful evil.
" At the clofe of the year, the leg was of a monftrous cir- cumference, felt hard and fcirrhous quite up to the hip, and was in many parts covered with fcabbed, fuppurating, and in- flamed places. What is very remarkable, the growth of the patient went on ; her menfes were regular, fhe ate and drank with an appetite, and all her functions were natural. The difeafe remained entirely topical.
" In this way Ihe remained for three years longer, during which the difeafe ftill increafed, and died at laft from hectic fe- ver and atrophy.
" I take this, which is certainly a very remarkable cafe, from the papers of my late revered father. From every fymp- tom, and from the whole tenour of the difeafe, it is evident that it was nothing more than a difeafe of the glands and lym- phatic veflels of the part, and therefore a fcrofulous difeafe ; and hence it is apparent to what a dreadful height it may ar- rive, and likewife for what a length of time it may remain merely topical.
** With refpect to the appearance which the difeafe here took on, I have read of nothing umilar, except the cafes which Hil- lary defcribes under the appellation of Elephantiafis, the dif- ftinguifhing fymptoms of which were a monftrous hard glan- dular fwelling of one leg, a totally indurated cellular mem- brane, :ind a rough, irregular, and fcaly furface, with which the patient often lived, for twenty year", without any other func- tion being dilturbed by it. He alfo remarks feverilh attacks from time to time, which invariably increafed the evil, and threw frefh metaftafes on the difeafed iej."
A girl of thirteen years of age was feized with general fwelling of the left leg, from the knee to the ancle; and it was fo painful that Ihe could not bear to have it touched. It look- ed a little red for a few days, and afterwards became pale ; but without any diminution of pain, though the fv/eiling rather de-
creafed.
62
Mr. Bell, on Scrofula.
creafed. A week afterwards fhe was attacked with feverifh- nefs, thirft, reftldsnefs, and great heat of the (kin, for which fome laxative medicines and antimonials, with opiates at night, were ordered ; and the leg was rubbed, whenever fhe could be prevailed upon to fubmit to it, with ungt. cera and calomel. About a month after the firft attack, the pain became more vi- olent; fhe could not be prevailed on to lay down in bed, but conftantly fat in an elbow chair, with the foot refting upon a pillow on the floor. She could not now bear to have it rub- bed, or even to wear a loofe flocking or bandage, and was afraid to let her petticoats touch it. In this way it continued about fix months with little variation, except that the whole leg became aedematous and greatly fwelled, fo as to be of more than three times its natural Tito.
The fkin and cellular membrane foon became indurated from below the knee down to the toes, polVelfed very little feeling, and felt hard and firm like leather ; yet ftill fhe complained of violent deep-feated pain, and fcreamed out in great agony if any one attempted to move her. At the end of a year, feveral fcirrhous-like tumours, of the fize of a filbert, appeared on different parts of the leg and foot, which inflamed, fuppurated, and difcharged a thin, curdled ferum j they were not very painful.
In this way fhe continued for another year, the leg increas- ing in thicknefs, and the fkin and cellular fubftance growing Hill harder; and during this period fhe was fubjeel to frequent feverifh attacks, which reduced her ftrength greatly, and wore her down to a mere fkeleton.
Towards the clofe of the year, an abfeefs, of confiderable fize, appeared on the trochanter ?najor of the left thigh, which burft, and difcharged at firft a large quantity of good pus, which was foon changed to a thin ferum ; and after having been ill above two years and a half, fhe died during one of the feverifh attacks, already mentioned, without ever having lain down in bed during that period, after the fir ft month.
It was thought from the firft, and during the progrefs of the difeafe, to be a cafe of Necrosis Ostium; but on examining al- ter death, no fuch difeafe was found, for the bones of the leg and foot were found, but rather fofter than ufual. The adi- pofe membrane, which contained a great quantity of ferum in its cells, and the fkin, were found to be the fole feat of the difeafe.
A variety of medicines were tried in this cafe, but without the leaft good effect, and fhe only experienced relief from large doles of opium.
( 63 )
To the Editors of the Medical and PhpJZcal Journal. Gentlemen,
Through accidental delay, your Journal for April has but juft reached me ; in that Number is a paper from Dr. Sher- wen, in which he complains, in an epithet not lefs harjh than mi/neritedy of my having unncceflarily reflected on the correct- nefs of his experience in the medicinal efficacy of Fox-glove.* Your indulging me with a few words in explanation, will probably adjuft the mifunderftanding, by convincing even the Doctor himfelf, that the remark alluded to, was not (to bor- row his own language) " unneccjj'ary^ and therefore not imperti- nent"
I repeat that the Doctor has, apparently, with the moft hu- mane intention, cautioned againft the free ufe of Fox-glove; but that the ground of his dread, refpecting its producing finifter effects, exifts in his having not employed it fo extcn- fively as has occuied to me to do in numerous inftances, with- out having witneffed any pernicious confequence to acrue from it.
With whatever benevolence of defign a medicine may be objected to, as being ** in/uUous" in its operation, and pojjijfmg u deleterious and poifonous properties^' the caution cannot be admitted as founded on accurate experience-, when it is well known, that it may be adminiftered in all ages and tempera- ments, and in much larger dofes than many articles of the ma- teria medica, e. g. corrofive muriate of quickhlvcr, arfenic, tartarifed antimony, &c. without inconvenience.
The molt falutary medicines, by abufe, may indifputably prove the moft deadly poifons ; but, for that reafon, to decry them as poffefling poifonous properties, and unfit for popular employ, might ferve injurioufly to check a due inveftigation of their powers, by thofe even who might be fully competent to the refearch.
The fubjec~t of difpute then centers merely in, whether it be neceflary to denounce a medicinal fubftance of acknowledg- ed falutary powers as poifonous, becaufe it might prove fo by injudicious ufe ? or to rank it among the moft efficient agents, capable of being employed within certain limits, without any rifk of producing deleterious eftecls ? In the latter cftimation I am inclined to hold Fox-glove, as molt conducive to the ul- timate
* Vide Medical and Phydc3] Journal, Vol. III. p. uz.
6+
Dr. KinglakC) in Explanation.
timate eftabliftiment of its real powers. Nor, in my appre- henfion, is much to be feared from the popular ufe of this re- medy, under the reftriclions ufually promulgated relative to a powerful medicine. I can feel no alarm for a dropfical or con- sumptive patient infufing the leaves of Fox-glove in the form of tea, and beginning with a table fpoon full of it, gradually incrtaling the doL to a common tea-cup full. The naufea in- duced by a flight excefs of this medicine, will operate as a fafe- guard to its undue adminiftration. It requires, indeed, no fmall addrefs to prevail on a patient who has been feverely fickened by an over-dofe of Fox-glove, to recur to its ufe ; hence it may be prefumed, that fewer inftances of its proving poifonous in domeftic employ would occur, than of its arreft- ing and curing deftructive difeafes.
Dr. Sherwen's avowed experience of the fuccefsful ufe of the feeds of Fox-glove, is implicitly credited by me ; the trial was judicious, and, to my knowledge at leaft, original. It deferves to be repeated, on the Doctor's Statement of their fuperior effi- cacy. No opportunity fhall efcape me of fubjedting them to the tell of experiment j yet, a poltcriori, it muft be confefled, that much identity between the feminal Structure and the or- ganic development of vegetable fubftances, cannot be reafona- bly expected. The various fecretions, depofitions, and arrange- ments which obtain in the fully evolved vegetable, do not pre- fent in the germen ; a fufceptibility only for thefe effects, un- der fuitable agency, exifts in that embryon ftate.
The medicinal efficacy of plants is probably referable to the constitution of principles, relulting from the peculiar or- ganic actions of the different parts of the vegetable fabric.
I his remark is not intended to difparage the authority of Dr. Sherwen's experience ; it would appear from his teftimony, that the powers of the Fox-glove were really concentrated in the feed. This fact would lilcewife warrant me in making trial of the roots of Fox-glove, as probably pofTeffing alfo the native energies of the plant in fuperior perfection.
I cannot approve of Dr. Sherwen's propofal of drying the Fox-glove in a ftrong expofition to the fun. Are not the fen- fible properties of all plants leaft diminifhed in drying, when the procefs of exficcation has been carried on in fecluiion from folar light ? And, on parity of reafon, are not the remote and proximate arrangement of principles (on which medicinal ef- ficacy muft efTentially depend) alfo liable to be more deranged by the decompoiing power of light, than by flow exhalation produced by moderate temperature in a dark fituation ?
It appears to m; that a preferable mode for drying Fox- glove, in comrnon with all other plants intended for medxinal
ufe
Dr. Kinglake, in Explanation.
65
ufe, is, to ftrew the recent leaves cn the furface of tin plates, and introduce them into an oven previoufly heated, and k.pt to about the temperature of eighty degrees of Fahrenheit's ther- mometer. If the mouth of the oven be (topped during the procefs, every adventitious influence from light and air v. ill be fufHciently precluded, in this heat the humidity of the plant will be fpeedily, equally, and uninterruptedly detached, leav- ing the elementary and conftituent principles in as near a ftate of native arrangement, as the cefiation of organic life can ad- mit.
A cafe of haemoptyfis, of three weeks ftanding, in a mar- ried lady, aged about twenty-five, under circumftances of ftrong conftitutional tendency to pulmonary confumption, has been lately cured by the tincture of Fox-glove under my di- rection; it afforded fpeedy relief; was taken during three weeks; more than thirty drops could not be borne without naufea. The pulfe occauenally intermitted under its influ- ence; was raifed from a fm.aU, hard vibration, to much com- parative foftnefs and fullnefs, but uniformly exceeded in fre- quency the natural ftandard.
It has alfo been fuccefsfully employed by me, within thefe few weeks, in two other inftances. One, an elderly man, fuf- fering under habitual afthma, with urgent cough and rapid ema- ciation. Not having any of the tincture at hand, the powder was fubftituted, in dofes of one grain three times a day. Its efficacy was Itrongly felt in the courfe of a week, in the abate- ment of cough, return of appetite, and other convalefcent changes. No naufea nor fenfible impreffion on the pulfe was produced, it fteadiiy retained a morbid hardnefs and frequency. The pctient is now perfectly free from cough ; refpires with tolerable freedom, but complains of undiminilhed debility.
The other was a boy, about fixteen years of age, who had been afflicted nearly two months with febrile paroxyfms, re- curring every evening, cough, dyfpnoea, mucous expectoration, preternatural tenfion of the abdomen, and an icteric difcolour- ation of the whole fkin. The tincture was taken upwards of three weeks ; not more than twenty drops could be endured ; its operation was moft ftrongly fopoi ific; the patient was ren- dered fo extremely and diltinctlv comatofe by its agency, that, in a few minutes after taking it, he would irreliltibly fall afleep, and that fo foundly, and durably, as to require at times to be actually roufed from his lethargic ltate. His difpolition to (lumber, after the firft week of employing the Fox- glove, was fo infuperably ftrong, that he could not, without much effort, either raife his chin from his cheft, or open his eyes, to relate how he felt. He defcribed his fenfations, however,
Numb. XVII. K as
66
Dr. Kinglakc, In Explanation.
as being agreeable, and expreffed his firm perfuafion that he gained ground daily. The recurrence of the febrile paroxyfms was foon obviated, and every other fymptotn progremvely amended, excepting the fallow hue of the fkin. The pulfe did not intelligibly correfpond with the effects produced, it was neither fenfibly retarded, nor ftrengthened, but continued morbidly quick and feeble. The friends of the patient defift- ed from profecuting the ufe of the medicine, from a belief that his recovery was fufficicntly advanced.
An additional proof of the infufficiency of Fox-glove, in the cure of the lajl Jlage of pulmonary consumption, has been re- cently afforded by the fatal termination of the cafe of a young man under my care, to whom it had been freely exhibited in every variety of form, and under the moft approved collateral regulations, during three months, with no farther benefit than temporary alleviation; latterly, it became quite inert, unlefs given in dofes of fixty drops, when noxious ficlcncfs occafi- onally enfued. It was at length relinquifhed as ufelcfs, when the fubftitution of fmall dofes of opium, in a diluted folution of fulphuric acid, taken at fhort intervals, produced the moft gratifying palliative effects. I am,
Gentlemen,
Chilton, fupcr Peldon, Your's, very refpeafully,
June 19, 1800. R. KINGLAKE, M. D.
CRITICAL
( <7 )
CRITICAL RETROSPECT
MEDICAL AND PHYSICAL LITERATURE. [foreign and domestic]
f ranfafiions of a Society for the Improvement of Medical and Chirurgical Knowledge, llluftrated with copper-plates. Vol. II. 8vo. pp. 380. London, Johnlbn. 1800.
The defign of this work is fimilar to that of Duncan's Annals of Medicine, or Dr. Simmons's Medical Fads. It appears to be the intention of the editors to admit original papers only; and while they are fupplied by fuch names as ornament the prefent volume, there can be no doubt that the work will maintain its popularity.
This volume contains twenty-nine papers on fome of the mofl interefting fubjefts of medicine and furgery, from which we feleffc the following extracts.
Account of a Cafe in which Death nvas brought on by a Haemorrhage from the Liner. By G. Blane, M. D. F. R. S. &c. Read May 6, 1794.
" A boy, aged eight years, of a delicate conftitution, final] Ma- ture, and pale complexion, whofe family on the father's fide had been extremely fubjeft to phthifis pulmonalis, but he himfelf having no fymptoms of fcrofula or rickets, or any external blemifli or de- formity, except that his belly had always been too large, and he had been fubjett to complaints of the ltomach and bowels through life, began to complain on the 12th of March, 1794, of languor, lofs of appetite, and flight pains, which he referred to his breaft and ftomach. Thefe fymptoms continued the fame next day, but became more fevere on the 14th, and remained fo the three fol- lowing days, on the laft of which he became feverifli, and there was an eruption of red fpots on the neck and breaft, which lafted only a few hours. On the 1 8th and 19th, the fymptoms were milder, and he was thought to be recovering ; but in the night between the 19th and 20th, he was feized with a fevere pain, which he referred to the left hypochondrium. This continued between five and fix
K 2 hours,
68 Dr. Blane, on Hamorrhagc from the Liver,
hours, and he then became fuddenly faint, and lofing all fenfe ani motion was thought to be in a fwoon, but from this he never re- covered.
"■This is the account which I received from the family and the medical gentleman who attended, for J did not fee him during hisi illnefs ; and not having been fent for till he was in extremities, \M had died before I arrived. •
'* Leave was obtained to examine the body, and the following appearances were obferved. Upon laying open the abdomen, a large quantity of coagulated blood was difcovered, covering the whole left fide of the interlines. In exploring the fource of this, feveral hfiures were obferved in the left lobe of the liver, which were about two-thirds of an inch in length, whence the blood had undoubtedly flowed, for they were found to lead to a cavity in the fubftance of the lobe of about the fize of a pigeon's egg, and full of blood. The peritonaeum, on the furface of that part of the liver which was near one of the fifiures, was raifed from the liver like a blifler, full of coagulated blood. Thefe appearances were on the lower furface of the lobe, but on the upper furface of the fame lobe there was one fifiure, round which was a fimilar collection of blood between the peritoneum and the fubitance of the liver, and it led to a fmall bloody cavky near the furface of the liver.
'* There was no external livor, or other mark of injury either on the adjacent parietes, or on the fpleen or inteftines.
" It feems moft probable therefore, that the rupture and con- fequent hemorrhage were owing to the weak ftructure -of the liver, which correfponded with the general weaknefs of this young per- fon's frame.
'* It would appear that it is this weaknefs, proceeding from a too great tenuity of the coats of the veffels, that chiefly conflitutes the fcrofulous habit, of which the principal fymptoms feem referrible to a rupture of the fmaller l'eries of veflels either circulatory or lymphatic, and the confequent efrulion either of red blood or co- lourlcfs fluids, occafioning fometimes haemorrhages, but more fre- quently interftitial or glandular depofirs. The fine flcin and filky hair obfervable in fuch habits are farther in proof of this.
" As far as my reading goes, I have not met with any morbid af- fection of the liver fimilar to that above defcribed, or have I ever feen or heard of fuch a cafe, which has made me think that it might deferve a place in lbme regitler of fafts. It has indeed been alleged, that there is not much utility in recording extraordinary and anomalous cafes, as they are feldom the objects of practice. But if there is any juilice in tins remark, it applies rather to unufual combinations of fymptoms, thnn to morbid appearances detected by direction; for as the number of bodies ttiat are infpecled is comparatively fmall, there is reafon to prefume, that, in the num- berlefs others which are not examined, there may be many among them funilarly affected."
Ths
Air. Ru/nfey, on Croup. — Dr. Rujpl, on the Small Pox, &c. 69
The third paper contains an elaborate
Account of the Croup, as it appeared in the Toivn and Neighbourhood of
Chejhcim, in Buckinghamfljire, in the Tears 1 79 3 and 1794. By
Henry Rumsey, Surgeon at Chefham. In this account the author fees reafon fl>r admitting the exigence \f fpafmodic croup as well as inflammatory; and he fays,
" It apoears to me that the croup is an inflammation of its own kind. If it confided in common inflammation, we might expect to find the fame appearances (that is, the fame kind of concretion on the furface of the trachea) every day, as its mucous membrane is fo frequently the fubjedt. of inflammation attended with an increafed fecretion. The matter, however, of which this fubftance is formed, poflefles different properties from thofe of the mucous which is thrown out upon the membrane of the nofe, or of the trachea in common catarrhal affections.
" I think it probable, that the film which we find in the croup is not formed by a fecretion from the mucous glands, but is an ex- fudation from the exhalant arteries. Upon this principle we can more eafily account for fuch film not being found in common ca- tarrhal affections, in which the mucous glands are perhaps more the feat of the difeafe. It is, therefore, analogous to the inflammatory exfudation in the inflammation of other internal membranes nrft defcribed by the late Dr. Hunter.
" The croup has been fometimes thought infectious, but I have not been able to form a decided opinion upon this point. Some circumftances render it probable, as two and fometimes three chil- dren in the fame family have been feized with it. But on the other hand, I have at different times feen two or three in a family efcape, while one or two of the others have died of it, without any pains being taken to keep thofe who were in health from the nek. When a difeafe is epidemic, it is fometimes difficult to determine whether it be communicated by infection, or whether feveral people have the difeafe in confequence of their being cxpofed to the fame exciting caufe. It is rather remarkable, that although there were between twenty and thirty children in our workhoufe, only one had the difeafe."
In the treatment the author thinks that calomel, in alterative dofes, as recommended by Dr. Rufh, proved a ufeful remedy.
Au Account of tvjo Cases, Jheiving the Existence of the Small-Pox and the Measles in the same Person at the same Time. By P. Rus- sel, M.D. F.R.S.
The Meafles and the Small-pox were epidemical at Aleppo, in the year 1765. They both made their appearance about the fame time in December of the preceding year, and gradually increafed through January, February, and part of March. The Meafles dif- appeared in April, while the Small-Pox lingered till the fummer folftice.
" Till the month of March, both difeafes were, in general, of a favourable kind. The eruption in the Meafles commonly hap- pened
JO P. Russell, on the Small-Pox and the Measles.
pened on the evening of the third, or morning of the fourth day. The eruptions were firft vifible on the face ; and began to fade every where on the fixth or feventh day, but fe/dom difappeared entirely (boner than the tenth. They were rather more prominent than thofe which I had obferved in Europe, and the branny fkurf left on the (kin was coniiderably lefs : in other refpedts there wad no material vaiiation from Sydenham's Accurate Defcription of th» Meafles epidemic at London in the Year 1670.
" After the beginning of March, the difeafe became more for- midable. The eyes were more inflamed, the coryza, the cough, and the febrile fymptoms were in a greater degree than in the former months. The eruption appeared irregularly from the fe- cond to the feventh day of the fever. The eruptions often ap- peared on the breaft before they were feen on the face ; they were of a fainter colour, and the branny fkurf was, in general, lefs. A vomiting and diarrhoea were common fymptoms from the be- ginning; the latter continued throughout the difeafe ; the former nfually ceafed as foon as the eruption was complete: but very young fubje&s continued to be harrafl'ed by retchings, excited by the irritation of fneczing or coughing. — About the height of the difeafe, the fick were fubjeel; to lhort exacerbations of the fever, accompanied with difficulty of breathing, and flitches in the cheft, which recurred feveral times in the twenty-four hours. On the whole, the Meaflcs, after the month of February, approached nearer to the anomalous fpecies defcribed by Sydenham under the year 1674.
" From the end of February, the Small-pox, which hitherto had been of a mild diftindt kind, became irregular and much more fatal. The puftules were confluent on the face ; on other parts diftinft, but generally flattilh, and indented at the top. In many cafes they fuppurated imperfe&lv ; in others, they remained dry or hufky : and fome inftances occurred of their turning black about the feventh day. A diarrhoea and tenefmus frequently attended from the beginning to the end.
" Though a large proportion of the infe&ed (till recovered, they continued long in a fickly ltate. Children were not only re- duced by the diarrhoea, but were often attacked with the hooping- cough, or with erratic fevers, both being at that time epidemic in the city. In the more malignant kind of Small-pox, many died between the feventh and ninth day ; fome lhuggled to the ele- venth ; very few recovered.
" When the Small-pox and the Meafles prevailed in the fame feafon, many of the children fufFered both difeafes in fucceffion, as ufual. The Meafles were rarely obferved to fucceed the Small- pox in lefs than twenty days, reckoning from the eruption. The Small-pox commonly fucceeded the Meafles fomewhat earlier in the third week ; but feveral cafes were met with, in which the puftules of the Small-pox were difcovered on the face, before the total difappearance of the Meafles 011 the limbs ; that is, on the eleventh or twelfth day.
Mr. jfenner's Addrefs on Vaccine Inoculation. J I
rc It has already been remarked, that few of the infected in either lifeafe died before the month of March. But from that time th â– mortality in the Small-Pox was confiderable; as thofe who had juit before -urfered from the Meaflcs, ar.d were reduced by the diarrhoea to a ftate unfavourable for the reception of a fatigu- ing diltemper, generally perilhed ; unlefs the fupervening Small- pox was of a mild kind. The danger appeared to be rather lefs where a bad kind of Meafles fucceeded the Small-pox.
" The recior^cal influence of the two difeafes in the fame fub- jeft was carefully attended to in above three hundred cafes ; and fo little did the quality of the firft difeafe leem to influence that of the fecond, that a mild, diftindt Small-pox was often oblerved to follow the word: kind of Mealies, and vice verfa.
" In the month of March, an inftance occurred where both dif- eafes were conjoined in the fame patient. The fubjefl was a fe- male child two years old, of a pale, delicate complexion. The rednefs of the eyes, the coryza, and the cough which accompa- nied the f-ver, led me to expect the Mealies. On the fourth day, the eruptions of the Mealies were vilible on the face, the neck, and the back ; but at the fame time a few eruptions of a different kind were interfperfed on the face and neck, which, if they had been the fole eruption, I fhould without hefitation have declared to be the Small-pox. The progrefs of the puftules on the fifth proved them to be variolous. Both eruptions were of a favourable kind, and diftinitly purfued their regular courfe. On the eighth day, the Mealies were fiding fall, while the variolous puftules on the face were near their height. The pultules were not numerous, were very diftinft, and ripened perfectly. The cough continued to be a troubkfome fymptom, efpecially in the fecond week. A diarrhoea fupcrvened about the fourteenth day, and contributed to render the child's recovery very flow.
" In the month of April I met with a fimilar cafe. A healthy boy, three years old, was attacked with the ufual fymptoms of the eruptive fevers, at that time epidemical. The cough rather feemed to indicate the Mealies. On the third day, the eruptions of the Small-pox and Mealies made their appearance together. The variolous puftules were of the fmall, round kind, and came to perfect maturity; but were more numerous than in the former cafe. The Meailes were of a fainter colour, and left behind them ftill lefs of the branny (kurf, agreeing in both circumltances with the difeafe then prevalent.
" On the fixth day of the fever, a diarrhoea and tenefmus were joined to the harafiing cough, and reduced the patient fo low in the fecond week, that his life was defpaired of. The flux, how- ever, leaving him towards the end of the month, he recovered."
An Addrefs to the Public on the Advantages of Vaccine Inoculation: with the Objeclions to it refuted. By Henry Jenner, Surgeon. F. L. S. &c. 4to. pp. 20; London, Cadell and Davies.
The author commences his addrefs by ftating, ** in the way of
companion,
72
Mr. 'Jcnner's Address on Vaccine Inoculation.
comparifon, the peculiar differences which mark the Small-pox and Cow-pox;" and he affirms that the (Ltement is " in every particu- lar, confirmed by very extenfive experience."
After the comparifon of the advantages which are to be derived from the fubftitution of the Vaccine Difafe for the Small-pox, the author obferves, ** It is perfectly confident with my prefent defign, briefly to notice the mod popular objections which have been urged againft the introduction of Cow-pox.
" It has been called a beilial humour, and by a fallacious afToci- ation of ideas, it is fuppofed to introduce an unnatural difeafe into the conftitution.
" If this very weak and futile obje-lion were worthy of reply, we might obferve, that the cow is of all others the mod healthy and the mod cleanly of our domeftic animals, and might alfo remark, that no females are fo healthy as our dairy maids, whofe morning and evening hours are fpent amongft the cows; and we fhould not forget that eminent phyficians recommend invalids to avail them- felves of the falubrioa; effects of the breath of the heifer. How void of foundation then mull be the objection to the infertion of an atom of matter taken from the teat of the cow, once in the life only, when every perfon is in the daily habit of introducing into his ftomach various parts of the fame animal. The human ftomach. revolts not at beef, butter, cheefe, and cream ; yet every one, ac- quainted with the animal economy, mud know, that thefe aliments are quickly mingled with the conftitution.
" Another grand objection (which indeed is the only one that firikes at the foundation of our theory) is, that perfons are liable to be affected with fmall-pox after having been inoculated w ith the Cow-pox.
" A very extenfive practice, and an equally extenfive communi- cation of the experience of medical friends of the firft reputation, would almoft warrant a Ihort, abrupt anfwer to this queftion ; an anfuer conveyed in terms unaccommodated to the feelings of the prefent age. After this objection, which has been refuted as often as it has been urged, a laconic reply, conveyed in no polite lan- guage, would by no means be improper, as it would harmonise with the general mode of fuch objections; and by all laws, the iinfwer ought to be of the colour of the qucilion ; but what is not owing to cavilling individuals, is a juft debt due to a candid and judicious public.
'* Every cafe that has been brought forward to undermine the theory we defend, we can prove to a demonftration was not one of the genuine kind. There are three difeafes which have indifcrimi- nately been termed Cow-pox, only one of which is the real preven- tive of fmall-pox. In the fpring fcafon particularly, cows are fre- quently fent to market for fale : the farmer omits to milk them in the morning, previous to their fetting out, that their udders may appear full, and the animals on that account become more va- luable. The frequent confequence is, that inflammation enfues, which terminates in eruptions on the teats and udder, and affects
Prof. Dumas? on the Muscles of the Human Body. 73
the milker with a loathfome difeafe on the hands, arms, and mould- ers. The forehead fometimes does not efcape, from the circum- ftance of the fervant's leaning i-gainft the udder in milking. This difeafe may afreet the fame perfon feveral times, but it will never prove a preventive for Small-pox: a cafe of this kind occurs in the city of Briitol; a Mr. Jacobs, attorney at law, was extenfively affected tvjice with this difeafe (which, from hib total ignorance of real Cow-pox, he has called by that name,) but it did not prevent his being airlifted with a fubfequent fevere Small-pox.
Syjlcme Methodique de Nomenclature, iffc. — A Methodical Syftem of Nomenclature and Clarification or the Mufcles of the Human Body, with Deicriptive Tables, lhewing their Old and New Names, Situations, Attachments Direction, Compofition, Fi- gure, Connexion, and their Ufes: To which is added, a Dic- tionary, containing the Synonyms of the Mufcles. By C. L. Dumas, ProfefTor of Anatomy and Phyfiology, Sec. Sec. Montr pelier. \XO. 200 pp. It is almoft univerfally allowed that the anatomical terms which are at prefent in general ufe, are very imperfect, and by no means correfpond with the numerous and ufeful difcoveries in this fcience; an attempt to correct tlicfe defects will not now be confidered fo daring an innovation as it might have been formerly. Mons. Dumas, as profelTor of anatomy, was conflantly remarking the dif- ficulty of teaching this fcience from the crowd of abfurd names given to various parts ; and has undertaken in this work, the very arduous and ufeful talk of rectifying them; and though he may not have fully anfwered our expectations, yet we think a tranflation of this work, with fome alterations that would occur on a careful pe- rufal, would be a very acceptable prefent to the ftudents of anatomy of this country.
In the third chapter, the author confiders fome of the defects of anatomical language in general, and the mode of correcting it; and we tranflate the following as a fpecimen of his manner of treating the fubject.
" A flight examination of the moft common anatomical terms will be fufheient to fliew the incorrectnefs and impropriety of a great number of them. There are fome which are ftrictly arbitrary, and others which have no determined fignification, and which any anatomift may change at pleafnre. Urder this clafs may be ranged all thofe denominations drawn from numerical orders, &c. which exprefs neither fituation, form, figure, nor connexion, but only the number of parts, which does not define any thing anatomically. Of courfe, we reject the names of firft, fecond, and third phalanx, &c. terms givc;i to bones which have no agreement or relative fize. Vefaliuds terms of firft, fecond, third, fourth, fifth, fixth, &c. mufcles of the arm ; Columbus's firft, fecond, and third mufcles of the tnceps; lVinJlouj's firft, fecond, and third cdduclors of the thigh ;
Nums. XVII. it and
74 Prof. Dumas, on the Muscle; of the Human Body.
and firfr. and fecond externpl radial ; and ftmilar names given to mufcles which differ in fituation, attachment, and figure, muff at once appear ridiculous.
" If anatomical terms have fometimes a vague and arbitrary fignification, there are fevcral that have no meaning at all. What fenfe can be annexed to blind hole, of/a innominata, acceffary mufcle, fublime mufcle, humble mufcle, profound mufcle, pudendal artery, l£c. &c Turks faddle, par vagum, recurrent nerve, nates, tefles \£ •vulva cerebri? How is it poliible to affociate fuch ridiculous expref- fions with any true and clear ideas of anatomy?
" There are other names perhaps lefs abfurd, although not more regular, which actually tell us what they do not mean — fuch are the names of vena cava, which is not the only vein that is hollow, and duclus arterinfus to diffinguifh a dudl, which is actually liga- mentous in the adult. — Arbor vita, to characterize the ramifications which the internal furface of the cerebellum prefents when cut verti- cally, and in which nature has not exclufively placed the feat of life, Sec.
" The frequen*' ufe of terms in an abfolute fenfe, which are only relative, is an efleniial defett in anatomical language. The adjectives, great, little, vajl, thin, fuperior, inferior, Jkort, long, right, left, are examples of this impropriety. When we talk of the great and little wings of the fphenoid bone, the great and little condyles of the humerus, the great and little trochanters of the thigh, the great and little angle of the eye, and the great and little bones of the tarfus, it is impoffible to comprehend them. The epithets of great bone, grand artery, great and little faphena, great and little fympathetic, great and little meferaic, can never be con- fonant to a proper nomenclature, and ought to be abolifhed, lince great, little, long, fhort, &c. are not eflential properties, but only qualities relative to a part, and can only ferve in the defcription of one part."
It would occupy more room than we can poflibly allow in our Journal to follow the author in his cenfures on all the abfurd names that are in general ufe, as well as the idle vanity of denominating parts after the difcoverers cf them ; who, the author juffly oLk ferves, have no occafion for fuch auxiliaries to render their names immortal; not to mention the pofCbility of attributing a difcovery to one perfon, when it actually belongs to another.
The author's plan is to divide the human body into forty-feven different regions, all of which have particular names, and under which all the mufcles may be ranged in a natural order, and immediately found as indicated by their proper heads and clafles ; and he thinks this method will facilitate both the ftudy and in- veltigation of anatomy, by afTembling together what ought to be united, and feparating what ought to be divided, as putting each mufcle in its proper place, and circumfcribing its limits ; and, al- though he fays the fame idea has been adopted by Chaufier, he thinks his own an improvement upon it.
To
Prof. Pfaff and Dr. Scbeel's Magazine.
75
To illuftrate his mode, the author has given us tables of the rau.cies, arranged under cUftind columns according to their regions, with their old and new names, fituation, firlt attachment;, fixed points, direction, laft attachments, points of infertion, compolition and figure, connexion, and ufes. And at the end of the work he has added an ufeful dictionary of fynonyms of all the mufcles of the human body from the belt authors.
Nordifoes Archiu. i. e. Northern Archives of Natural ana" Medical Sciences or, Magazine for Medical and Natural Science of the North. Edited by Prof. Pfaff, of Kiel, and Dr. Scheel, of Copenhagen. Firft Volume, firft Number, 1799. pp. 192, 8vo. Price i6gr. or about 25. 6d. Copenhagen, Brummer.
The Editors of this new periodical publication propofe to coi- led all contributions relating to natural and medical fcience, bv which both are, as well in general as in their lingle parts, illus- trated, enlarged, and corrected, and the practical application of them, for the prefervation of health, and cure of difeafes, really improved ; but merely as far as this is owing to the indullry and genius of northern (Swedilh and DaniO:, &c.) phyficians, furgeons, and naturalills. We Ihall be enabled, by this ufeful publication, to get acquainted with the itate and progrefs of medicine in the North, of which we have had hitherto but little knowledge ; and the well known talents of the Editors, and the interefting content* of the firft number, give us reafon to hope, that this undertaking- will anfwer their views, and fatisfy the expectations of the learned. We find here, amongft the Original Papers, I. Net*) Experiments on Rejpiration and its ufe, by Prof. Abilgaard, with Remarks cf Prof. Pfaff. — Thefe experiments are directly oppofite to the generally adopted dodrine of refpiration, and Mr. Abilgaard attempts no- thing lefs than to prove by them, that very little air, or none at all, enters into the lungs during inspiration ; againft which Prof. Pfaff defends in his remarks the general opinion. 2. Diffedion of a drowned horfe, by J. Kuhn, niith fome phyf.ological remarks of Mr. Herholdt and Rapt. — The objed of this paper ii chiefly concerning the air bladders that are found in large drowned animals. ?. Ex- periments on Galuanifm, are contributions to Mr. Humboldt's work on the fame fubjedt. 4. Contributions to the hijlory cf lur-vated and contagious intermittent fe vers, contain iome interefting obfervations. 5. On Small pox Inoculation, by Prof. Pfaff', where he relates iome obfervations made in inoculating a great number of children in fe- veral villages at once. 6. D~fcri(>tion of a hooked forceps, and a perforator, <witb a Jheath, by Dt*. Scheel. — Short reports and extraitt from letters, include a ihort account of the mineral waters of Swe- den, by Hedin, Sec. Literature of Northern Medicine and Natural Hijlory, A review of fome differtations of Kiel and Copenhagen, and of feveral pamphlets relating a dyfentery prevailing in the neighbourhood of Kiel.
Encyclopedic,
76 Prof. Hildebrandt, and Dr. Van Heckeren's Books.
Encyclopedic, i. e. Encyclopedia of the whole Chemijiry, comfrfed by
F. Hildeer andt Prof, at Eilangcn. Firft Vol. Theory.
Firft Number, 1799. pp. 219. Price 14 gr. or about 2s. Er-
langen, VValther.
cannot but approve the excellent plan which the author has adopted itere, in propofing the element" of chemiftry; and we arc fully convinced that it is perfectly calculated to fati-fy the requifites wh'ch the vail progrefs of that fcience entitles us to expect from a Philosophical Syflcm of Chemiftry. Mr. Hildebrandt intends to include the whole chemiftry in a fyftematical, and, as far as pof- fible, in a mathematical order; with fuch a combination of theory and practice, that it may pr ive a very ufetul manual, not only for the philolophic and profeffxnal chemiit, but alfo for a common reader, and for the ufe of life. With reflect to this, the prefent v ork is to comprehend as well all parts of appiicated as of pure chemiftry, to the former of which a proper ieftion is to be de- voted. The theoretical part is to precede, to which the practical will follow, in fuch a manner that its rules may be derived from the theory, and the refults in the different operations explained by it. The whole is written with as much concifenefs as pofhble, and the paragraphs are therefore but aphorilUc, and the quotations but few.
How far, however, the author has fulfilled this difficult and in- tricate tafk, which he has planned to execute, we fhall not be able to judge till more numbers have made their appearance. In the prefent number we find, according to the plan, the theory of the different elements in general, of heat, light, oxygen, azote, at- mofpheric air, of hydrogen, and of water.
J. Fan Heckcreti, M. D. de Osteo genesi prretematurali, cum Tabula aenea; \K.o. pp. 125. Lugduni, Batavor. 1797. Price 2 rixd. 6 gr. or about 8s. The Author of this learned Differtation treats, firft, of the mor- bific of.fication which takfs place in the preternatural fwelling of the bones themfelves, and afterwards of the ofilfication in the car- tilage, in the membranes, and other foft parts of the body. From his inquiries and ftrict obfervations of the procefs which Nature follows in forming fuch bony fubftances, it appears, Naturam in ofteogeneii prsternaturali, habita p^rtium, quibus contingit ratione non minus ac in aliis aberrstionibus censtantes fequi leges atque wertum in agendi modo ordinem femper fervare.
In the accurate explanation of thefe laws the Author fhows with much acutenefs, how conftant they really are, notwithftanding the appearance of irregularity with which the morbid accumulation of bony matter feems to ifTue ; and it appears that Nature acts here, likewife, according to eftablifhed organic regulations ; and thus, what has been otherwife called a concrementum inorganicum, ought properly to be confidered as a regular production of Nature. The Author then proceeds to difcufs, copioufly, upon the exuber- ance of callus; and having examined the late opinions of the non- exiftencs of callus, he gives his own opinion, which he illuftrates
Dr. Hecker' 's .and Dr. Brandis's Theories on Dentition. 77
by a very good figure of a morbific bone. His definition of the callus luxurians is the following : " Callus luxurians vocatur, qui niajora copia formatus eft, quam ad deperditam non folum offis fub- ilantiam reitaurandum fed etiam ad debitam fanitati convenientem firmitatern toti offi tribuendam 'requirebatur." In accurately fur- veying a bone, where luxuriant callus has been formed, it is appa- rent that plaftic Nature never performing any thing Superfluous, does not produce an exuberance and deformity of callus from mere luxuriance, but that it is always occafioned by certain external and internal caufes, by which the formative a<ft of Nature is difturbed and rendered irregular ; how they aft and influence upon the form- ation of the callus is amply explained by the Author.
Critical Sur-vey of the Latefl Theories on difficult Dentition in Children. (Partly extracted from the Journal of Invention, Theories, &c. in German. Numb. XXXI. 1800.)
Dentition has been always considered as a matter of great im- portance in difeafes of children, and all the different and Sometimes dangerous affections incident to the infantile age at the time they are cutting their teeth, have hitherto been fuppofed by almoit every practitioner to originate from the irritation of the gums by teeth breaking through; and the appellation of cicntitio diff.cilis com- prehends a feries of fymptoms, that, however they may differ in their external appearance, are derived from the fame fource. A fwelling and inflammation of the gums, with a great falivation and violent pain, and even Spontaneous hydrophobia, a collection of pituitous matter in the breaft, a laborious breathing, coughs, or concinual vorr.ition of bilious matter, vehement diarrhoeas, con- vulfions, and other fpafmodic affections; fevers with acute exan- themata, a fuppreffion, or a fuperabundant excretion of urine, or a preternatural fharpnefs of it ; an inflammation of the urethra and prepuce, with a kind of gonorrhoea; all thcfe are mentioned by medical writers as immediate fymptoms of teething, however in- creafed and changed by other concomitant caufes, as colds, fmall pox, worms, &c.
Such was the prevailing opinion of dentition, and the fymptoms that fometimes attend it, till of late it has been made a matter of inquiry and difcuffion. Three of the molt refpectable authors and phyficians of Germany, finding great difficulties in explaining thofe fymptoms according to the opinion which was generally adopted, made an attempt to eftablifh new theories on dentition, by which alfo the practice in thofe affections is greatly influenced Although they agree, that the mere irritation of the gingiva cannot be allow- ed to be the immediate caufe of thofe fymptoms, yet they differ very much in the explanation and theory they refpectively give of their nature and origin.
It is certainly undeniable that the idea of difficult dentition has been too far extended ; but whether, on the other fide, it ought to be confidered of no immediate influence at all, is ftill a matter of dif- putej as will appear from the obfervations annexed. It is proper
now.
7# Dr. Heckers and Dr. Brandis's Theories on Dentition.
now, however, to proceed to give a concife account of each theory ; of which we ftiall firft relate,
I. Dr. Heckers Theory, (contained in his Magazine for Pathological
Anatomy and Phyfiology. Numb. I.) The common opinion of the aft of teething in children is fubjeft to fbmc difficulties, as it cannot be well explained, how it is poflible a part, as the gums, not poffeffed of much fenfibility and irritability, only by being irritated from the teeth cutting through, fhould pro- duce fuch violent fymptoms, as are obferved fometimes during the period of firft dentition. Another caufe ought, therefore, to be fought for, that will prove more fatUfactory in explaining, and more ufeful in directing a proper practice and cure of thofe fymp- toms, to which fo many children fall a facrifice.
It is a general law founded upon facts and experience, that as foon as the organs of fecretion are difeafed or affected in a morbid manner, they fecern fuch humours as are alfo morbid and preter- natural. Thus, an irritation of the liver will produce a (harp and corrupted gall ; paffions often render the milk venomous ; and the mildeil faliva of an irritated and angry animal becomes very malig- nant and poifonous. Now, in a child that is cutting teeth, many circumftances take place, which are fufficient to turn the faliva into a very powerful, malignant, and even deadly poifon. We obferve a great colbftion of faliva and an irritation in the mouth of a teething child ; it fuffers a great deal of pain; reftlefs and fleep- lefs, it is continually crying, irritated, and in a degree of paffion. This, already, may lead us to conjecture, that the faliva acquires fuch a malignity as to be able to "caufe many and very dangerous fymptoms of difficult dentition.
It will, however, be ftill further proved by the following argu- ments : That a corruption and acrimony of the fali-va, almoji Jimilar to that in the canine madnefs, is the principal caufe from --which all the m'jjl dangerous fymptoms of dentition are to be derived.
1. Many fymptoms of dentition admit of a more natural and eafier explanation from this faliva than from the irritation only, viz. the coughs, laborious breathing, the collection of pituitous matter in the breafl, fuftocation, &c. j fwaliowing it caufes vomi- tion and diarrhoea. When it poffeffes a high degree of acrimony, or when its excretion is by any means obftructed, it produces in- fenfible and irritable conftitutions, hydrophobia, locked jaw, epi- ieptic fits, &c. The acrimony being imp.utcd to the humours, gives rite to fevers and exanthemata. The inflammatory and go- iiorrhoic a flections of the genitals are owing to acrid faliva having thrown itfejf upon the urinary fyftem ; a complication of dyfentery anJ dentition is confequently very dangerou.-, because the bowel; sre thus likely to be doubly affected.
2. Dentition has been obferved to be flight and eafy whenever the falivation was confiderable, or falival humours evacuated by- other emunctories of the body.
There is a great nmilarity between the fymptoms of difficult
dentition
Dr. Heeler's and Dr. Brandts'; Theories on Dentition. 79
dentition and thofe of real hydrophobia, apparent from the impe- diment in fwallowing, and other fpafmcdic affections.
4. Several children, who died of difficult dentition, had bloody ftools, attended with a tenefmus, as in dyfentery. Upon differing the body, erofions and inflammations were found in the throat, ftomach, and interlines, which were moil probably caufed by the acrid faliva ; fomething fimilar has been noticed in the ftomach of perfons who have died of hydrophobia.
5. The cure conliits in diminiihing the irritation in the mouth, in removing the inflammation of the gums, of the falival glands, and the tonfils. To evacuate the (harp faliva, and to render it lefs noxious, are indications to which we are led by Nature itfelf. The mcft difficult dentition becomes lefs dangerous when there is much faliv.ition, vomition, and moderate diarrhoea.
Tne principal remedy is the fixed caujlic alkali, or the 'volatile alkali, which has been already recommended by Fred. Hoffmann. When this is given early enough, before the nervous fyftem is too much affected, or before too vehement fpafmodic or even apopletic fymptoms have arifen, it certainly is able to fave the life of many children. It moreover, in general, is a very ufeful remedy, when- ever the organs for the fecretion of lymphatic humours being irri- tated and inflamed, fecern morbific fluidities ; for inftance, in gonorrhoea, in fome cafes of dyfentery, catarrhous inflammations of the throat and breaft, hydrophobia, Sec. Blifters applied be- hind the ears are of great fe, vice. The incifion of the gums can only ferve to mitigate the violent inflammation, but does by no means promote the cutting of the teeth. Opium fhould be avoided, or ufed at leaft with great caution, as apoplectical fits, of which many children die in dentition, are frequently brought on by it. Extra&um hyosciami may be given inftead of it ; warm baths have likewife great effect in removing the fpafms and pains, and in pro- moting ialutary excretions. Emetics and cathartics are alfo fome- times very ufeful.
II. Dr. Brandis's Theory. The intelligent Dr. Brandis, of Brunfwick, known by feveral excellent publication";, and Tranflator of Darwin's Zoonomia, ad- vances his opinion about the nature and origin of the dangerous fymptoms fometimes obfervable at the time of firft dentition, in his book on Metafiases, 1798, in German. Although he agrees with Armftrong and Hecker, that they are not to be derived only from the irritation of the nerves of the teeth, yet he rejects their theo- ries, and rather thinks, that a suppression of sahval secretion has the principal fhare in producing thofe fymptoms. The fecretion of fa- liva is much incr afed by the topical irritation in the mouth, and becomes very neceffary to the conftitution of the child. When the topical irritation is too vehement, in a difficult dentition, it ex- tends to the falival glands, and caufes a fuppreflion of the fecretion of faliva. It may be obferved, therefore, that the mouth and lips become dry and cold, in bad cafes ; meanwhile, there is a great
degree
8o Dr. Hecher\ and Dr. Brandies Theories on Dentition.
degree of febrile heat in other parts of the body, which is a dia- gnoftic fign of this dangerous difeafe.
When the fapprefled action of the falival glands is replaced by that of the pancreas, a diarrhoea comes on, which, as it generally continues as long as the difficult dentition is accompanied by thofe iymptoms, contributes very much to diminilh the violence of them, and of the concomitant fever. But, on the contrary, when this does not take place, nervous fymptoms, convulfions, and a nervous fever arife, which having a great fimilarity with Hydrocephalus Internus, is very well described by Armltrong under the name of hectic fever. That thefe nervous fymptoms cannot be afcribed to the nervous irritation anfing from the teeth cutting through, may be farther proved by the following confiderations :
1. Nervous fymptoms, arifing from a re-action of the fenforium caufed by the pain, are never removed by any material excretion, as this manifeitly happens in difficult dentition by falivation and a diarrhoea of watery humours.
2. All anodynes and antifpafmodic remedies, opiates particular- ly, which in convulfions proceeding from pain, prove fo very effi- cacious, are without any avail here, of which circumftance Dr. B. had frequent experience,
3. The incifion of the gums ought to remove the caufes of the difeafe at once, according to the theory generally believed ; but in four cafes, where he faw it ufed, it was not only of no immediate utility, but in fome inftances, by additional irritation, it increafed the nervous fymptoms. A healthy child, fifteen months old, hav- ing fuffered a flight degree of coid, was fuddenly feized with all the fymptoms of difficult dentition. Emetics, mercurial purgatives, fomentations of the mouth, &c. were applied in vain. It lay fenfelefs, with its mouth open, and cold ; the pulfe was hardly per- ceptible, and vehement convulfions came on from time to time. The gums were cut in on both fides to the teeth themfelves, after which it feemingly recovered a little ; but foon after, the mouth and the lips remaining dry, pale, and the cheeks cold, the fever and convulfions returned ; and though the operation was repeated, and ointments rubbed in, outfide and infide, it died the next day. The gums were found divided by the operation, and the teeth free and vifible, but no inflammation could be traced on the margin of the incifed gums. The operation flinuld have certainly faved the child, if the difeafe had been dependent from the cutting of the teeth, and a falivation would have had that effect.
In examining thofe theories, the arguments ftiould firft be confi- dered, by which they have attempted to prove that the fymptoms derived from difficult dentition are not owing to the irritation of the gums, on account of their being lefs fenfible, and not provided with nerves, as to bs able to caufe thofe fymptoms ; that the inci- fion of the gums is of no utility, and, confequently, that the nature of the fymptoms themfelves is by no means correipondent with the quality of the caufe they are fuppofed to be occaiioned by. Al- though the theories jurt, propofed are partly grounded upon thofe
confiderations,
' Dr. Hec&er's and Dr. Brandts' s Theories on Dentition, Zt
confiderations, yet it may be proper to defer reviewing them till we relate Dr. Wichmann's Theory, as it is particularly urged by that gentleman.
Both Theories are certainly very ingenious and plaufible, feveral doubts, however, may be raifed againft them, to which they feem to be expofed. In the firlt place, Dr. Brandis objects to Dr. Heck- cr's opinion, that, as the fymptoms of difficult dentition do not arife before the falivation is entirely fuppreffed, and confequently before the fecretion of any faliva is flopped, they cannot owe their origin to its acrimony, of which quality he never could perceive any figns in a teething child. But mould not the exigence and ac- tion of fuch an acrid humour be proved by the erofions and inflam- mations that have been found in the throat, ftomach, and inteftines of children dying in a high degree of difficult dentition ? How- ever, even when this is allowed, it may be fuggelted, that it Would be more proper, and agree better with our improved knowledge of animal ceconomy, to derive primarily the morbific fecretion of the faliva, and the fymptoms of difficult dentition, from the fame proximate caufe which confifts in the nervous irritation, and to confider both as the congenial effeft of it, and not the morbific fa- liva as