Imatges de pÓgina
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then, in the form of decoction, with an aromatic: wine was also allowed in small quantities according to the strength of the patient.

· This was the usual method we followed throughout the month of September ; but in October and November we had occasion sometimes to use the lancet ; and, in the cases of relapse particularly, the best effects seemed to follow the loss of blood.

• As we had reason to suspect that these attacks of fever were connected with abdominal inflammation, cupping-glasses were employed in preference, and after fomenting the parts, they were applied either to the region of the stomach, liver, or spleen, where the pain was most complained of, and great relief invariably followed from this topical bleeding.' p. 363.

When Sydenham complained that he knew of no successful method of treating intermittents, as the bark, which had always had the appellation of a specific, rather checked their progress than moved the cause of the disease; those congestions were not suspected which have been shown to exist to a great degree in consequence of the strong determinations to the viscera, which very early take place; and it was not likely that the disorder could be radically cured, until the irritation which they occasion in the system was entirely removed.

• It is not however by throwing in mercury, and pouring in the bark, that this effect is to be produced: these are terms to be met with in some late writers, and they are not less improper than the indiscriminate and empirical manner in which those invaluable medicines have been employed.

* The smallest quantity of mercury will often (as it is well known) affect some constitutions so speedily, that it is impossible to lay down any rule for its administration in these fevers.

I have generally found great advantage to result from its being introduced gradually into the habit, and its action to be rendered more certain by being given in small dozes, and at distant intervals.

• In the distribution of the extra diets, or what are termed medical comforts, a discretionary power was given to the medical officer in at tendance; but one general principle was admitted by all, and acted upon throughout the establishment; that wine and spirits were not found to be absolutely necessary to the removal of the Walcheren fever, as it was called; and that, during the progress of convalescence, the management and quantity of diet was to be considered of the highest importance in effecting a perfect recovery. A very contrary opinion had long prevailed, and it is the popular one in the army, that the British soldier required more nourishment and more animal food than those of other countries; and hence arose the profuse and liberal allowance of every article that could be thought of, which tended rather to satiate, than to satisfy the appetites of persons reco. vering from acute disease.' p. 332.

p. 283.

PART III.

MEDICAL INTELLIGENCE.

REPORT of DISEASES treated at the PUBLIC DISPENSART,

near Carey-Street, London, from August 31st to November 30th 1815.

ACUTE DISEASES.
No. of Cases.

No. of Cases, Febris 32 Dysenteria

25 infantum remittens 8 Peritonitis puerperarum

1 Apoplexia 1 Variola

9 Hydrocephalus 1 Rubeola

14 Otalgia 1 Scarlatina

30 Cynanche

Varicella

2 Catarrhus 80 Erysipelas

2 Pneumonia 22 Arthritis rheumatica

5 Pertussis 5 Rheumatismus

4 Hepatitis

2 Abortus Cholera

4

15

Cephalea
Vertigo
Asthma
Catarrhus chronicus
Hæmoptysis
Phthisis
Dyspepsia
Gastrodynia
Pyrosis
Vomitus -
Hepatalgia
Icterus
Enterodynia
Colica pictonum
Tenia
Ascarides
Hæmorrhois
Marasmus
Diarrhæa

Chronic DISEASES.
No. of Cases.

No. of Cases. 21 Hæmaturia

1 6 Dysuria

1 1 Nephralgia

2 - 32 Hysteralgia

10 Amenorrhea - 21 Menorrhagia 25 Leucorrhæa

8 14 Anasarca

9 4 Hydrops

3 7 Rheumatismus chronicus - - 46 2 Pleurodyne

3 6 Paralysis 16 Asthenia

11 1 Hysteria

2 1 Chorea

3 1 Epilepsia 4 Melancholia

1 8 Struma

2 Lichen

2

25

Lepra
Psoriasis
Urticaria
Erythema
Purpura -
Impetigo
Porrigo

CHRONIC DISEASES continued.
No. of Cases.)

1 Ecthyma
4 Scabies
3 Herpes
2 Rupia
1 Eczema
8 Aphtha
12

No. of Cases.

2 8 1 2 2 1

The warm and dry weather which had prevailed during the summer, was protracted to the latter part of October ; so that the whole season was remarkably uniform, dry and fine, yet temperate. It was a general observation, in the month of October, that so long a series of fine weather had not occurred for many years. This steady temperature and dryness appears, however, to have been peculiar to the south-east portion of the island ; for in the north-west the autumn was unusually wet, and in the north in general showery and cool. In the second week of November, however, the temperature suddenly altered during a hail-storm, and became 20 degrees lower at night than it had been in the morning. From this time, a steady frost, unusual at this early season, has prevailed, until to-day, the 30ih, when the thermometer has again suddenly mounted to 50°, having been as low as 26° last night.

The diseases of the patients of a Dispensary who are much exposed to the influence of the weather, are observed to vary much in correspondence with its changes. Accordingly, during the months of September and October, the disordered states of the stomach and bowels, and other affections usually termed bilious, which are connected with them, continued to prevail to an unusually late period. Several severe cases of dysentery, especially, presented themselves, accompanied by much abdomi. nal pain and tenesmus, and a very irritable state of the bowels, which appeared to require more soothing, and to bear less evacuation, even when moderated by anodynes, than usual. Opiate enemata were very serviceable, in some cases, in quieting the irritability of the rectum, which sometimes suffered considerably from the acrimony of the discharges.

Most of the exanthemata, but especially the scarlet fever, which generally assumed rather an unfavourable character, have been prevalent during the autumnal months. The measles, th gh frequently cccurring, were not generally attended by those formidable pectoral symptoms, which indeed are always Jess liable to be severe in the milder seasons. But the smaile

pox, in some cases, were of the confluent kind, and lamentably prevalent, considering the facilities which are offered to the poor of rescuing their children from this calamity. The variolous inoculators, being chiefly practitioners conversant with the lower classes of the people, seem to have left the minds of these people in a state of confusion, on this subject, almost approaching to stupor. They have scarcely any reason to offer in excuse for their omission to secure their offspring from the contagion ; but in the state of doubt into which they have been thrown by contradictory assertions, they neither variolate nor vaccinate, but wait in apathy the casual operation of the contagion. The scarlet-fever was generally accompanied by a severe affection of the throat, which, in many cases, continued to harass the patjent after the usual terın of the fever had elapsed, and, in several children, appeared to be the principal cause of the fatality of the disease. The simple rash, which yields readily to the cool treatment with litile medicine, was seldom seen during this epi-, demic; and the period, when cold washing seemed to be essentially remedial, was soon over ; but laxatives and acids appeared to be more beneficial than the cinchona or cordials. We witnessed only one or two cases of dropsy supervening upon the disease, although the convalescence was in many cases slow.

The only case of hydrocephalus in the list, which exhibited symptoms of the commencement of pressure, when it was first visited, terminated in recovery. The child, an intelligent boy of eight years of age, with light hair, and large blue eyes, had been ill ten days with fever and headach, the latter of which had considerably increased, and had been accompanied at first with intolerance of light and noise. When he was visited from the Dispensary, he was lying in bed, with a rapid pulse, partially flushed countenance, dilated pupils, and extreme pain in the head, so that be screamed upon being moved, or even upon the apprehension of being moved. He was nearly, if not entirely blind, and there was a perceptible disposition to strabismus. The bowels had been slightly opened by medicine. A purge of calomel and jalap was ordered immediately; the head to be shaved, and cloths instantly wetted with water and a little aether to be applied to the scalp; the temples were bled with leeches; and as etfusion appeared to have commenced, balf a drachm of mercurial ointment was ordered to be rubbed in twice a day. On the following day, a very marked amendment was perceptible ; the boy could bear to be moved gently, and said his head was better. The leeches were a second time applied, and the purgative repeated, and the friction was continued about ten days; during which there was a progressive and rather rapid diminution of the symptoms; the sight returned about the third day,

with the cessation of the headach, and soon became perfect ; and he was discharged in a fortnight in complete health. The speedy relief to these formidable symptoms, which ensued upon the adoption of this treatment, is obviously to be ascribed exclusively to the evacuant and refrigerant remedies, and not to the influence of the mercury, the operation of which was necessarily too tardy to produce so rapid a change; and it may serve as an intimation, not to omit the use of evacuants, even when we are called to treat hydrocephalus at a period when the stage of effusion appears to have commenced.

T. B. Bloomsbury Square, November 30, 1815.

By

Observations on the Generation of the Guinea. Worm.

GEORGE Thomas Heath, late Surgeon of his Majesty's

Ship Psyche. As it appears by Dr Chisholm's paper on Guinea-worms, published in your last Number, that the mode in which those animalculæ obtain admission in the human frame, is by no means clearly ascertained, I beg leave to submit the following facts, which may, perhaps, somewhat elucidate this obscure subject.

His Majesty's ship Psyche had been in Bombay dock and harbour during the first three months of the year 1808. In April she sailed from thence, and in three months afterwards, being then in the Persian gulf, two of the men were found affected by Guinea-worms; others also complained at various intervals ; and, in the course of a twelvemonth from quitting Bombay, eight men in the whole had them.

From this period (April 1809) to the end of the year, 74 persons were put on the sick. list with those worms, some of whom had them two, three, four, and even five times, the worms issuing at different periods from various parts of the trunk and limbs. The length of the worms varied from nine to forty-two inches. Not one of the officers was at any time affected by ihem.

The alarming prevalence of those worms, the very distressing effects and long confinement in many instances induced, excited considerable interest on board, and caused every inquiry to be made, in order to obtain information on a subject of such importance.

As officers and men had been equally on shore while the ship was in dock at Bombay, had drank of the same water there, and of the same stock taken to sea, we could not believe that the worms, or their embryos, were introduced through the medium of the water drank. The only way in which we could account for their introduction and exclusive confinement to the seamen, was by supposing that the worms, in a minute or em

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