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that the old practice was discontinued in consequence of its counteracting an hypothesis that was altogether unfounded, respecting the proximate cause of the disease, and that, as experience gradually gained the ascendency over theory, the original treatment was revived, and is now generally adpoted.
We have next a case of Angina Pectoris, by Dr. Black of Newry. On dissection, the coronary arteries were found completely ossified through their whole course. -The 3d article contains a case of Hydrocephalus Internus, by Mr. Edmund Pitts Gapper, Surgeon at Ewell, cured by profuse salivation.--Dr. 'Thomas, of St. Kite's, next gives an account of a Child who, when about 5 months old, became of a blue color, resembling that which is observed in those instances in which the respiratory organs are defective: the color gradually disappeared. We cannot agree with the author in supposing that it depended on a bilious fever which attacked the mother while she was suckling the child.
Dr. Lettsom furnishes a history of an obstinate hepatic disease, which, after having resisted a great variety of remedies, was removed by the occurrence of a smart feverish attack. In the 6th article, Dr. Lee, of Jamaica, relates the case of a Negro, who, after an operation for strangulated Ilerma, was left with an artifi. cial anus in the groin. He remained in this state for about 12 months, when an ioflammation came on in the part, the opening was closed, and the fæces were again carried off by the natural canal.-In articles 7 and 8, Mr.Smith, of Philadelphia, presents an account of the cure of Croup by emetics; and of the removal of Telaruis, succeeding to a wound in the tibia, by reproducing a discharge from the part by caustics.--In the ioth article, Dr. Marshall adduces a fact in support of the supposed origin of Cow.psx from the grease of the borse.
A very ingenious dissertation next occurs on the Paws, by Dr. Adams; being one of the papers which obtained the Society's medal. The symptoms that occurred in a case which fell under the author's notice, while at Madeira, are minutely detailed, and the effect of remedies on them is correctly related. The quantity of mercury given in this case was so small, that it cannot be supposed to have any influence on the cure Dr. Adams enters into a disquisition on the leprosy with which the Jews were affected during their abode in the wilderness ; and from the nature of the symptoms, he concludes that it must have been the yaws.
In the Ith paper, we have an account of an extra uterine Fæetus, by Dr. Fothergill of Bath. The symptoms were at first supposed to proceed from dropsy in the ovarium, although the real nature of the case was ascertained for some time before
the period of pregnancy was accomplished. It ended in the death of the mother, which event was preceded by a discharge of putrid matter from the intestinal canal; and on dissection, the skeleton of a dead child was found behind the uterus. Dr. F. concludes with some judicious observations in favour of the long controverted point, how far it may be proper, in such instances, to have recourse to the Cæsarean operation.
Mr. Dyson gives a case of inverted Ulerus after delivery; which was safely returned into its natural state, and at a subsequent period again performed its usual functions.---Mr. Carden, of Worcester, rather vaguely relates the history of a fatty Tumour in the Ikorax, together with a large cyst, containing serum and coagulated blood, which had produced pectoral complaints that terminated in dropsy.--The 14ih article is by Mr. Field; detailing a case in which, after the patient had experienced great bodily hardship, together with a scanty supply of food, the health gradually declined, and death was produced, as the symptoms seemed to indicate, from a disease in the stomach. On dissection, however, the malady was ascertained to be in the ileum, 18 inches of which were found in a cancerous state.--We have next an account of a mal.conformation of the Heart, in consequence of which the blood could not become properly arterialized, and that blue color of the skin ensued, which is known to exist under similar circumstances. -Mr. Carn, of Bath, relates an instance in which the Peroneal Artery was wounded in a part that lies so deeply between the bones of the leg, that it could not be taken up until a portion of the fibula had been removed ; amputation, the usual resource on such occasions, was thus rendered unnecessary, and the limb was restored to its former sound and healthy state.
The 17th article, communicated by Dr. Marcet, is of considerable importance. It contains a recommendation of the white Oxyd of Bismuth for chronic pains of the Stomach. Dr. Odier, of Geneva, has for some sime employed this mineral with success, but we believe that it had never been before used in this country. The paper relates some cases in which its good effects seem very apparent; and we think that it promises to be a valuable addition to the materia medica,
We now arrive at what we consider as the most valuable communication in the whole volume, an Essay on the Use of the Bath Waters in Ischias, by Dr. Falconer. The Docter begins by giving a full account of the symptoms of this disease, through all the stages of their progress, from their first commencement, when they are so slight and transient as to be little noticed, until their termination in an abscess of the hip joint; one of the most painful affections to which the human frame is inRev. FEB. 1807.
cident, and in which the patient is either carried off by hectic, or, if he survive, is left with his limb shortened, and almost useless. The paper tends strongly to corroborate the idea that has been long entertained respecting the good effects of the Bath waters in this complaint; which are the more useful the earlier they are employed, and, after the suppurative stage has commenced, are no longer admissible. Leeches and blisters are sometimes found necessary to be employed together with the water; and occasionally opium and Dover's powders are beneficial adjuncts.—Dr. Falconer gives, in the form of a table, the result of all the cases which have been treated in the Bath Infirmary during a space of 16 years. The whole number, deducting those that were not deemed fair subjects for a trial, is 415; 103 of these were entirely cured, 168 received considerable benefit, iu were materially relieved, and 33 only were dismissed without gaining any advantage. For this paper, Dr. Falconer received a silver medal from the Society.
Dr.Smith, of New Hampshire, has contributed some remarks on the Position of Patients during Lithotomy. He objects to the present plan of binding down the hands to the ancles; by which posture the abdomen must be compressed, and the intestines forced towards the bladder, and thus rendered more liable to be injured. - In the 20th memoir, Dr. Broadbelt of Jamaica relates a case of great Enlargement of the Scrotum, which took place in a negroe, apparently in consequence of a stricture of the urethra.-On the next paper, by Dr. Bostock, of Liverpool, the Society bestowed their honorary medal. It contains an account of two cases of Diabetes. After an accurate enumeration of the symptoms, the author relates the result of a number of experiments which he performed on the diabetic extract, which he appears to have examined with much care: but he does not enter into any detail of the remedies employed.
Nearly all the remainder of the volume, consisting of more than 300 pages, is occupied with remarks on the Influenza which was so prevalent in the spring of 1803. The Society issued to their correspondents a set of queries, to which they received answers from 58 medical gentlemen in different parts of Great Britain and Ireland ; and these communications are all published, without alteration : forming a valuable but confused mass of information, which we regret that the Society did not take the trouble of analyzing and arranging. One of the most characteristic symptoms of the disease was debility, which eame on from the commencement of the attack, and was frequently the first circumstance that arrested the attention of the patient. It has been a subject of discussion how far the disease was con. tagious; for the most part, the correspondents of the Society seem to consider it as not of this nature, but some very respectable practitioners adopt the contrary opinion, and support it by plausible arguments.
Art. VI. A Clinical History of Diseases, Part First, being, 1. A
Clinical History of the Acute Rheumatism. 2. A Clinical History of the Nodosity of the Joints. By John Haygarth, M.D.
F.R.S. &c. 8vo. Pp. 168. 58. Boards. Cadell and Davies. T is generally admitted that in no science is it more dificult
to convey information by means of books, than in practical medicine. In some degree, this difficulty depends on the nature of the science, but a part of it must certainly be attributed to the mode which has been usually pursued by those who have attempted to instruct mankind on this subject. Most of the older authors, and many of the moderns, whose works are in the highest estimation, have been writers of systems; they have undertaken to treat of the whole circle of diseases on a regular plan ; and this plan has always involved an hypothesis, which has perverted their description of the phænomena of disease, and influenced their method of cure. Another mode has, of late years, been more in fashion ; viz. that of publishing single cases. At first view, this might be considered as much less exceptionable ; it professes to be the simple relation of facts, and, as such, must necessarily have its due weight in the formation of opinion and the advancement of knowlege : but, unfortụnately, the publication of cases has not been productive of all the advantage that might be expected from it. This failure is owing to several circumstances; perhaps the most important of which, and the only one that we shall now specify, is the fondness which every one naturally possesses for presenting something extraordinary to the world. In consequence of such a feeling, practitioners are induced not to give an account of their experience in diseases that are of free quent occurrence, or of great fatality, but of such as are uncommon; and to the same cause we may attribute an irresist
propensity, even among men of veracity, of magnifying the importance of these rare occurrences, and of placing every thing in that point of view which may excite surprise rather than impart information. The work now before us is executed on a plan in which the advantages of both the former modes are in a considerable degree combined, while their disadvantages are equally avoided. We have in it the benefit which is to be derived from generalization, united to the minuteness which is found in the relation of single cases.
Dr. Haygarth informs us in his preface, that since the year 1767, he has constantly recorded, in the patient's chamber, a 'full and accurate account of every important symptom, the remedies which were employed, and, when an opportunity offered, the effects which they produced. After an extensive range of practice, for nearly 40 years, he has resolved to lay the result of his observations before the public; and the method which he has adopted is to analyze all his records concerning each particular disease, and to deduce from them a series of facts respecting it. Perhaps no medical writer ever proceeded on a basis of observation at once so accurate and so extensive. The present volume contains the account of two diseases, acute rheumatism, and the nodosity of the joints ; and we shall briefly notice some of the positions which Dr. H. has established on these subjects.
Out of 10,549 cases, in the higher and middle ranks of society, of which Dr. Haygarth has kept records, 470 are Theumatism, and of these 170 were attended with fever, exhibiting that form of the disease which is called acute. The common cause of the complaint appears to be cold, particularly when conjoined with moisture ; more males are attacked than females, probably because they are more exposed to the exciting cause; and for the same reason, it is more frequent in winter and spring, than in summer and autumn. from 5 to above 60, are subject to it: but it occurs more generally between 15 and 20. The latent period, i. e. the period between the application of the cause and the appearance of the symptoms, is shorter than is commonly imagined, and sometimes there was no perceptible interval. Dr. Haygarth has not been able to perceive that any other disease precedes the acute rheumatism, or is united with it, so constantly as to imply any connection between them. The pulse is commonly above 100, and the blood when drawn exhibits a strong inflammatory crust.
With respect to the method of cure, the strict antiphlogistic plan is the one which is commonly adopted : but, as the author observes, although the disease is seldom or never fatal, it is under this treatment exceedingly protracted, and sometimes scarcely ever entirely removed. In an early period of Dr. Haygarth's professional life, he received from the late Dr. Fothergill the idea of employing bark as a remedy in acute rheumatism; and on trial he found it so beneficial that he has ever since employed it, with the greatest success. The manner in which he administers the bark we shall state in his own words: