Imatges de pàgina

çause certainly occasions an essential and specific difference, for á venereal or schrophulous ophthalmy is very distinct from one occasioned by cold or irritation. The second distinction our author considers as the least important, though in a practical view, it is of great consequence; for no one would give the purgatives in peripneumony, which are absolutely effential in phrenitis, or the opium in hepatitis, which is so particularly adapted to enteritis. The third division we suspect is not an accurate one. The inflammation of the skin is styled erysipejas, of the cellular membrane phlegmon; the inflammations of the diaphanous membranes, as the p', ura, peritoneum, &c. are supposed to be different from those of the mucous membranes, or the muscular fibres. That the erysipelas is a peculiar disease of the skin, may be admitted to a certain extent; but there are inflammations, which in their symptoms come so near to erysipelas, though the feat is different, that by common consent they have obtained the name. Thus, the peritonæal inflammation in puerperal fever, is styled erysipelatous: the peripneumonia typhodes has had a similar appellation. We mean not to affert that this is correct; but those who have attended the progress and termination of these complaints will be prepoffcfied in its favour. There are, however, facts on the other hand; and a peripneumony, decidedly from cold, has sometimes, under our own eyes, assumed a putrid appearance, when a putrid fomes has been present in the system. The erysipelatous sore throat is on a more certain foundation, though, while the ephelion is a continuation of the skin, it can scarcely be adduced in opposition to our author's system, which we mean not to oppose: we have only suggested these doubts for future elucidation. That erysipelas is always the eficct of acrimony, another of the positions which Dr. Smyth oppofes, may also occasion fome difficulties. Heat and cold will undoubtedly induce it; but restrained or hurried perspiration may be as certainly accounted acrimonious as any poison introduced. In the third article of this volume, eryfipelas came on, by the puncture of a tendon; and though we suggested doubts of its cause, we thought, if our recollection was not inaccurate, that other instances of a similar kind might have been adduced. We ought however to add, that, on tracing the supposed facts, we have not been able to discover them; and the instance which occurred to us may have been a solitary one; or symptoms of general irritation, with which the skin will occasionally sympathise, may have been the foundation. That there is generally an acrimony, may be shown from the spreading nature of the disease, and the utility of dry pouders. "Our author's conclusions, with the answer to one hbjection, we shall select.

De ! Do not the preceding facts naturally lead to the following conclufions? ift. That the erysipelas is an infammation of the skin only. 2dly. That the peculiarity of this inflammation depends solely on the nature and texture of the skin. 3dly. That acrimony, though a frequent cause, is by no means the only one capable of producing it. And 4thly. That though the difference of the cause cannot in this instance alter the nature, yet it has confiderable influence on the appearance and symptoms of the disease.

• To the first conclusion it may be objected, that as the erysi. pelatous inflammation sometimes recedes, or is repelled from the kin, and attacks other parts of the body, particularly the brain and lungs, those parts, as well as the skin, must be subject to this affection. The observation is certainly just, but not the inference. I admit, that the same cause which produced inflammation of the kin may equally excite it any where else: but it does not follow, that those inflammarions, though arising from the same cause, should be of a similar nature, when the part aff Eted is so extremely different. I affirm on the contrary, that there is not the smallett resemblance between the symptoms of the erysipelas of the head, and the delirium or coma which is brought on by this inflammation receding and affecting the brain: nor, to invert the proposition, is the peripneumony occasioned by the retroceslion of the measles (an inflammation analogous to the erysipelas) in any respect different from the same disease produced by other causes."

These cases of retroceding erysipelas are different from the erysipelatous affections we just now mentioned. Dr. Smyth is strictly accurate in his remarks; but it may be questioned how far these inttances are truly metastases. We have often seen delirium supervene on erysipelas, as well as peripneumony; but they have either seemed new attacks, accidentally varied, or concomitant affections. In the other parts of the paper our author is sufficiently correct; and, if he fails in explaining the nature of critical abscesses and their connection with fever, he fails with every other pathologist; and no one will succeed, till the nature of fever is better ascertained. The acute rheumatism is probably not so much a disease of the muscular fibres, as of the coats of the vessels.

XX. A Case of Inversion of the Uterus. By Robert Cleghorn, M.D. Professor of Materia Medica in the University of Glasgow.-This unfortunate woman survived the accident, and the uterus remained inve d. Dr. Cleghorn's remarks on this and similar cases are judicious and practical. His reading on the subject is also extensive. The following circumstances are very properly pointed out, as necessary to be kept in view.

• ift. The quantity of blood discharged. Whenever that is uncommonly copious, efpecially when the strength finks speedily,



the patient ought to be examined most carefully without losing a moment.

• zdly. The nature and degree of the pains which remain afa' ter delivery. Fatigue, diftention of parts, and ocher obvious, causes, always do, and always must leave a sensation of soreness after the pains of labour. This sensation, however, which often gives way to a gentle fleep, is not only inferior in degree, but is different in kind from the horrible pangs which accompany the invested uterus. The back, the loins, the fore-part of the belly and the thighs, are all exquisitely painful, while the uterus is thrown into convulfive contraction, so that the patient imagines the is about to bear a second child, or to lose some part of her bowels. Hir ítrength finks apace; the extremities grow cold ; a clammy fiveat bedews the forehead and breast; the pulse stops; excess of fatigue procures no rest; the patient falls into a syncope, from which she is never roured, or roused only by convul. fions and delirium.

"If, therefore, after the delivery of the placenta, violent expulsive pains, equalling or exceeding in severity those which attended birth, hall attack the patient, the ought to be examined in. fantly. Such an examination, unless the operator be deficient in kill or tenderness, can do no harm, and it may save life. That it is so frequently neglected in the bzginning of such melancholy cafes, is unpardonable: for, when the bottom of the uterus at fisit falls through the os uteri, it can be for the most part easily replaced, if no spasm has come on.'

XXI. The History of a Contraction of the Fore-arm and Fingers, with some Remarks and Reflections on Bleeding in the Arm, By Mr. Henry Watson, F.R.S. Senior Surgeon of the Westminster Hospital. The contraction arose from the irritation of the tendinons fascia, and was removed by dividing the biceps longitudinally, and continuing the division from the flesh into the tendon, below that part where it sends off the fascia. The relief was almost instantaneous.

XXII. A singular Case of Abscess of the Liver which terminated favourably. By George Sandeman, M. D. Physician to the General Dispensary.—The cure was not effected by art: the abscess burst into the intestines or into the ducts, and the matter was discharged by stool. The recovery was rapid and complete. If the application of a blister had occurred, it would have saved much trouble, for, in That way, the matter might have been perhaps drawn off.

XXIII. A Case of a Rupture of the Bladder, from a Fall. By Mr. Charles Montagu, Surgeon of the Western Dispenfary.---The accident was occasioned, as the title imports, by a tull, probably when the bladder was diltended. It is however surprising, that though the rupture would admit the hand to pass through, eight ounces of water were drawn off by the catheter the morning after the accident, and, at another time, a pint of urine of the natural colour.

XXIV. A Case of Hydrophobia. By Mr. John O'Donnel, Apothecary in London.--An instance of a dreadful disease, but in no respect a peculiar one.

XXV. On the Medicinal Properties of the Muriated Barytes. By Adair Crawford, M. D. F. R. S. Physician to St. Thomas's Hospital. - Muriated barytes, probably a metallic salt, in a large dose, is certainly injurious : in a small one, it promotes a flow of urine, warms and apparently stimulates the stomach, and seems to be a powerful alterant. When any fever is present in the system, it is found to be injurious. The best effects were produced by it, in doses of from three to seven drops, in schrophula, incipient cancers, and schirri. In the last stages of cancer, and in consumption, it did no service. Dr. Smyth describes the method of preparing the medicine, and ascertaining its purity; but these directions cannot be given in an abridgment. The barytes of Stronteam in Scotland, seems to be an earth, in some essential respects differentifrom the earth commonly distinguished by this name in chemical authors.

XXVI. A Case of Dropsy, in which the Water. has been twice drawn off by tapping the Vagina. By Sir William Bishop, · Knt. Surgeon at Maidstone in Kent.-The operation, in the way prescribed, was peculiarly easy, as the vagina was protruded by the weight of the water.

XXVII. Two Letters from John Collins, Esq. of the Island of St. Vincent, addressed to Benjamin Vaughan, Esq. of London, on the Subject of a Species of Angina Maligna, and the Use of Capsicum in that and several other Difeases. - In these instances, as well as in some epidemics, when the disease prevails in Europe, the affection of the throat was the primary complaint. The recipe we shall transcribe :

• Take iwo table spoonfuls of small red pepper, or three of the common cayenne pepper, and two tea spoonfuls of fine falt, beat them into a parte, and then add to them half a pint of boiling water. Strain off the liquor when cold, and add to it half a pint of very sharp vinegar. Let a table spoonful of this liquor be taken every half hour, as a dose for an adult; diminishing it in proportion for children.'

From the earliest period of our practice we have seen common pepper eaten with great advantage.

XXVIII. Account of an Exfoliation of the internal surface


of the Tibia, removed by the Application of the Trephine. By Mr. Thomas Whately, Surgeon. This account is not very singular in any respect, nor does the operator's address de. ferve any very particular encomium. , XXIX. Some Account of the Invention and Use of the Lever of Roonhuysen. By Robert Bland, M.D.-Dr. Bland's history of the lever is curious, and his directions for the use of this instrument are judicious and proper. It is an unsuitable subject of discussion in a popular work; nor will the directions admit of an analysis. We do not, however, perceive the ad. vantages which Roonhuysen's lever poflefles over the single blade of Dr. Leake's forceps.

XXX. An Account of a very uncommon Blindness in the Eyes of newly-born Children. By Mr. Samuel Farar, Surgeon at Deptford. - A fingular occurrence, where the three successive children of the same parents were born with the cornea opaque, but gradually acquiring pellucidity. In the last child the recovery was very slow,

XXXI. Three Instances of sudden Death, with the Appearances on Diffection. By James Carmichael Smyth, M.D. Fellow of the College of Physicians, and of the Royal Society; and Physician Extraordinary to his Majesty. In the first in'. ftance, there was an occasional pain of the stomach, though Bight: the death was sudden, by the internal coats being corToded, and the peritoneal coat at last bursting in consequence, probably, of the exertion of vomiting. There was an inflammation of the peritonæum seemingly occasioned by the stimua lus of the fluids escaping through the wound. In the second case, the sudden death was subsequent to a fever with aphthæ, in which there had been some affection of the lungs : it was owing to a sudden effusion of blocd, or of bloody serum, into the lungs : the blood was in a dissolved state, and hæmorrhages after fevers had not been uncommon. The third was an inftance of croop, less acute than the usual disease of children, owing to a humour in the back part of the larynx, seemingly of a conglobate gland, which had partially and incompletely suppurated.

XXXII. Of the Danger of wounding the epigastric Ara tery in the Operation of Tapping for the Ascites. By the same.-The accident of wounding some considerable branch of the epigastric artery seems not be so uncommon as has been supposed. Perhaps the inflammations in the bowels, and other unexpected accidents, which sometimes happen after tapping, may be owing to the artery leaking internally.

XXXIII. Of the Aphonia Spasmodica. By the same. In the three cases of aphonia spasmodica here related, the two last are seemingly paralytic or apoplectic. That the disease


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