PART III.

MEDICAL INTELLIGENCE.

Account of Diseases treated at the PUBLIC DISPENSARY, (near Carey Street,) London, from 30th November 1807, to 29th Feruary 1808.

The month of December was cold and frosty, on the whole, and the atmosphere generally turbid, and almost constantly depositing moisture, during the day; but it was calm until the end. The air was more generally clear in January, but still frosty; the frost alternating, however, with frequent thaws. The same state of weather has continued through the month of February; but appears to be changing, as the temperature is at present milder. The period, from the last days of December to the middle of February, has been marked by several tempestuous gales; the last of these, on the 10th of February, being accompanied by an extraordinary fall of snow. There was also a heavy fall of snow on the 8th of December, and slighter showers of it on the 11th of the same month, as well as on the 20th and 21st of January. On the latter day the thermometer descended to 12°; and its minimum was at the freezing point or under, on a majority of the days in each month. Its medium has been about 36°.

From the prevalence of severe and changeable weather, catarrhal, and other affections of the lungs, have been very general, among all ranks of people, and in many of the instances, which came before us at the Dispensary, they were combined with other disorders, which originated from the same common source, exposure to cold; namely, in some with diarrhoea; in others with chronic rheumatism, dysentery, ophthalmia, sore throat, &c. It will be observed, in perusing the foregoing list, that, of twentyone cases of pulmonic inflammation, only one appeared in the acute form, which is denominated pleurisy. In the other instances, the pulse was never full, strong, nor hard; a sense of

load,

load, tightness, and stuffing, rather than actual pain, was complained of; the fur of the tongue was of considerable thickness, and of a brownish colour; the skin moist, and its temperature scarcely increased. In the old or infirm, and particularly in those who were subject to habitual catarrh, still more decided marks of debility occurred; and these oppressing symptoms continued their course for several weeks; the effusion or secretion in the lungs gradually extinguishing life, or as gradually diminishing, leaving the organs of breathing for a considerable time unable to perform their functions well. On the whole, those who were bled, either before or after they came to the Dispensary, seemed not to do so well, as those from whom that evacuation was not made.

The measles have continued to prevail through the winter; but as they have latterly not been so severe, nor followed by such frequent and severe pulmonary attacks, the number of applications to the Dispensary has been less. Besides those in the list, however, under the title Rubeola, two of the cases of catarrh, and one of dysentery, were sequelae of measles.

Two of the cases of anasarca were sequele of scarlatina. In one of these an unusual circumstance occurred, which appears worthy to be noticed. The fever had left the patient (a boy of 12 years) five weeks before I saw him. He was in a state of debility, with slight anasarca of the lower limbs, and some accumulation of water in the scrotum. Three or four days afterwards, I found these anasarcous symptoms had altogether disappeared; he complained of some slight headach, the pulse was about 90, and the skin a little warmer than before; a dull appearance of the eyes led me to examine them, and I found that, although the pupils were not greatly dilated, and contracted on the approach of a candle, yet he was totally insensible to its light, when within three inches of his face: In short, he was quite blind. blister was immediately put over the scalp, and some mercurial pills, with digitalis, was given. It may be remarked, that he had not taken the latter medicine before. His sight was partially restored on the next day, and perfectly on the day following. The use of these medicines was not pursued, and he speedily recovered his health, without any return of the anasarcous symptoms, under the use of tonics. Whether a sort of metastasis had actually taken place, it might not be easy to decide; nor is it more evident, whether the operation of the blister contributed to remove the disease.

Besides those deplorable cases of uterine disease, which medicine can scarcely even mitigate, (the scirrhus and cancer of the uterus), instances of pain referred to that organ, and its appendages, are not unfrequent among the poor. These pains some

times

times come on in a few weeks after delivery in married women, and are often referred to the last childbirth; they are most commonly accompanied by some irregularity in the menstrual dis charge, generally by an increase of it, or by alternations of a bloody, with a thinner, less coloured, and offensive evacuation, according to the accounts of the patients. The symptoms vary a little, apparently according as the uterus itself, or its particular appendages, are disordered. In general, the patient complains of pain in the loins, extending round the margin of the pelvis to the groin, on both sides, and shooting down the thigh to the knee, or, in more severe cases, even to the foot. Sometimes the pain is more strictly referred to the uterus itself or its neck, and the loins are scarcely affected; and sometimes it is fixed in one side, above the ilium, as if seated in the ovarium. The stomach is frequently disordered by sympathy, and the patient complains of nausea, flatulence, and other dyspeptic symptoms. Some degree of febrile action occasionally attends these complaints. They are in some instances, without doubt, the signs of incipient scirrhus; but in others they seem to be connected with a degree of chronic inflammation, and diseased secretion, consequent on the irrications of childbirth, or produced by causes suddenly interrupting or deranging the menstrual discharge In one case the slow inflammation, which appeared to be confined to the ovarium and ligaments of the left side, was the consequence of recent marriage. The round ligament appeared to be particularly affected, as the part through which it passes to the pubes was extremely tender. It was relieved by the application of leeches to the groin, and laxatives of neutral salts; but it continued from one period of menstruation to the next. Among the narcotic medicines, which, like all that have been used, occasionally give relief in uterine diseases when others have failed, the tincture of the hop, or humulus lupulus of Linnæus, is not one of the least efficacious. There are no medicines, however, which exert any peculiar action on the uterus; and in the diseases of this organ, just alluded to, we often succeed by employing general constitutional remedies; such as laxatives and diaphoretics, when there is fever on the one hand; or cordials and tonics, when weakness on the other; soothing the pain, in the meantime, by cicuta, opium, humulus, and other anodynes.

A case of severe bilious vomiting occurred on the 15th of February, when the weather was excessively cold, and smart vomiting of bile took place in another patient about the same time

The small-pox has been, on the whole, less prevalent and less severe, than in the autumnal season; it would probably have disappeared during the cold season, according to its usual course, had not the poison been extensively circulated by inoculation. London, Feb. 29th 1808. T. BATEMAN.

On Ear-Trumpets.

(Vide Nicholson's Journal, No. 79. for December 1807.)

Mr GOUGH has lately made some ingenious observations on the theory of ear-trumpets, with a view to their improvement. This has hitherto been neglected by philosophers, and we are uncertain at present in what manner an ear-trumpet acts on the auditory organs. We may conceive the sonoriferous pulses to be collected in the cavity of the vessel, and to pass thence into the meatus auditorius in a state of increased condensation; or we may suppose, that the same pulses strike the sides of the trumpet, and excite similar vibrations in this metallic shell, which imparts them to the orifice of the auditory duct. The latter theory is most plausible, and seems confirmed by experiments. Solid conductors are of no advantage to the partially deaf; and trumpets of a parabolical figure are liable to serious objections. Mr Gough recommends an instrument constructed on the principle of a drum, and he has made some experiments which induce him to hope for beneficial consequences from a contrivance of this kind. By a drum, he means a circular box or funnel, furnished with an earpipe, and having its mouth or widest aperture covered with a thin elastic membrane, which must be stretched with an uniform force in every direction, like the vellum of a military drum. The pulses which fall from the atmosphere upon this membrane, will be immediately transmitted by it to air confined in the box, and their escape from this cavity must evidently be through the eartube, because the covering of the mouth will not permit them to return by that aperture. The further prosecution of this subject is well worthy of the attention of persons partially deaf, who may reasonably expect some relief from the improvement of acoustic instruments.

Abstract of the Answers of Counsel to Queries respecting the Jurisdiction of the London Royal College of Physicians.

First." Have the London College of Physicians any real or effective power (under the act of 14th and 15th Henry VIII.) of controuling generally the practice of physic in England, at a greater distance than seven miles from London ?"

Second." If they have such power, does it extend to doctors of physic, (not graduates of Oxford or Cambridge), or merely to persons practising without a diploma?"

9

Answer.