Imatges de pÓgina
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pleted the operation, his body was bedewed with a warm perspiration. After some convulsive sobbing, his respiration was completely relieved ; and, in a few minutes after his arm was bound up, his pulse was 76, and continued full and regular. He complained of thirst, and was supplied plentifully with bar. ley-water.

He was sent to Plymouth hospital early next forenoon ; but, at that time, though he had had no stool, he was nearly free from uneasiness. His respiration was perfectly natural ; his skin dry, but not hot; hus pulse 80, and soft; and the power of using his arm quite restored. He took, early in the morning, an ounce of Epsom salts.

As we quitted Plymouth almost the same day, I must regret that I have had no convenient opportunity of rendering the case complete, by relating its final result ; but, from the im. proved state in which I left him, after conveying him more than a mile from the ship, and from experience in similar cases, I have every reason to believe that nothing more was wanting to render him a decided convalescent than the free evacuation of his bowels,-an event that probably took place within a few hours.

Case VI. WILLIAM MACKENDRICK, private marine, ætate 32, complained, on Sunday 6th August 1815, of headach, giddiness, and sickness. His eyes were red; his tongue moist, but tremulous, and much furred; his skin hot; his pulse quick and full; and his hands and lips affected with nervous agitations. He had come on board the preceding day from Plymouth, where he had staid several days indulging in intoxication.

He was bled to thirty-five ounces; took five grains of calomel with fifteen of jalap, and was furnished with plenty of bar. ley-water. By 6 P. M. he had had several stools, and was much better, His tongue had become steady, and - nearly clean. He took an effervescing draught of magnesia. The same medicine was likewise repeated next morning and evening.

On the 8th, he complained of general uneasiness and shivering, with cold perspirations. His bowels were loose ; his pulse quick and full; and his tongue white and moist.

He was bled to thirty ounces, and had an effervescing draught, as before, three times a day. The bleeding almost immediately relieved all his complaints; and, by the evening, he was free from every uneasy feeling.

On the 12th, feeling some slight return of shivering, he took a drachm of cinchona, with fifteen drops of diluted sulphuric acid, three or four times a-day; which medicines were repeated daily till the 15th, when he returned to duty quite well.

The subjects of the two following cases, as well as those of the three first, were young men, of rather sober habits, and will readily be admitted as fair specimens of common uncontagious fever.

CASE VII. William Hartshorn, seaman, ætate 20, who had under. gone an attack of the yellow-fever at Jamaica in November last year, complained, on Friday 18th June 1815, of sickness, pain in his loins, and cold shivering; which symptoms had come on the preceding evening.

He took six grains of calomel, with three times the quantity of jalap. At 6 P. M. he fainted on losing eighteen ounces of blood. He afterwards took two grains of calomel, with six grains of pulvis antimonialis.

On the 17th he was better, and the medicines were both repeated. On the morning of the 18th he had no complaint of consequence, and took a scruple of rhubarb ; but, at 3 P. M., he was distressed with headach, vertigo, vomiting, and thirst, which had gradually come on.

Twenty-eight ounces of blood were immediately taken from his arm, with striking relief; and the antimonial was repeated at bed-time.

His bowels afterwards required several pretty strong purga. tive medicines, especially some doses of calomel; and he had two or three slight shivering fits, for which he took half an ounce of bark daily; and, on the 28th of the month, he resumed his usual duty, perfectly cured.

CASE VIII. ROBERT SAYER, seaman, ætate 24, complained, on Monday 26th June 1815, of headach, giddiness, and general uneasiness, which bad begun the preceding night, with shivering and nausea. His tongue was slightly furred; bowels regular; skin hot; pulse 80, and full.

On attempting to bleed him, he was seized with a fit of shivering, so that not more than six ounces could be procured. He then took seven grains of calomel, with twenty of jalap. At 3 P. M. a vein was again opened; when the approach of syncope prevented more than sixteen ounces being abstracted. At 5, having experienced no relief, eighteen ounces of blood

were taken away without much difficulty; and, at 7, he took five grains of calomel.

He had only one loose stool that evening; and, on the 27th, complained of severe pain across the epigastric region. His dose of jalap and calomel was repeated; and, at bed-time, he took four grains of calomel.

On the 28th, he had no complaint remaining. On the 29th, he took a strong purgative, and, without any other medicine, he resumed his usual duty, on the 2d of July, in perfect health,

It is unnecessary to load this paper with more cases, as they were all treated on the same principles. Those who were ill, when we were near an hospital, had the advantage of being sent there ; but the disease generally had previously received such a check, that they were either actual convalescents at the time, or became so immediately after being received ; so that scarce one was above a fortnight, some not more than ten days, at the hospitals ; and those who were entirely cured on board recovered equally well.

The success of the treatment employed on the present occasion, which consisted almost solely of bleeding and purging, seems a decisive proof of the inflammatory nature of the disease ; and it is useful to shew, that a continued fever may be of that character, and may absolutely require that treatment, though externally marked by such feebleness of the pulse, and by such languor and prostration of strength, as, according to many systematic books, ought to be considered inconsistent with such measures. I formerly found it necessary, in defiance of all such rules, to adopt the same practice in the yellow-fever ; and, having witnessed its indispensable necessity and great utility then, as well as in the fever which gave occasion for the present observations, I should consider myself much to blame if I neglected the first opportunity of extending a cautious trial of the same practice to the most malignant of contagious fevers. Convinced, from experience, that the yellow-fever is not contagious, I cannot say that I have seen any fever of that nature since I was capable of forming a judgment for myself; and cannot help feeling some of that awe which the descriptions of them are apt to inspire ; but, without pretending to say that contagious fevers ought to be universally treated upon the same principles as those which have a different origin, I may look forward, with what, I trust, are well founded hopes of success, to the result of the trials I have mentioned ; and I believe, that that debility must be frightful indeed that shall deter me from making so justifiable an attempt.

Without entering into any refined theory about the peculiar modifications of the inflammation undeniably existing in various organs of the body during fever, I go upon the broad and tangible principle, that the commencement of continued fever affects, with inflammation, some of the organs essential to life. Dissections continually prove this to be the case in every part of the world ; and the immediate violence of vascular action, or its effects, are always admitted to be the cause of the most dreadful symptoms, and even of death, in fever. Every consi. deration ought, therefore, to yield to the means of subduing it at its very commencement, while in its active stage, and before organic changes of structure have begun. Then is the time for employing blood-letting to advantage, when a judicious use of it may almost ensure, in a few hours, a successful result to our labours, while the neglect or delay of that practice beyond the proper period, may leave to us weeks of painful anxiety, and to our patient, if he survive at all, months of debility and helplessDess.

October 1st, 1815.

II.

Case of Mortification of the Appendix Vermiformis Caci, occa

sioned by a Human Tooth found in its Cavity. By WILLIAM

Briggs, M. D. Liverpool. G.

• tic temperament, had for several weeks laboured under a seyere cold, but had not been wholly confined by it; and on Saturday 7th January 1815, he had walked from his house to his office, a distance of three-fourths of a mile, and back again, and had transacted business for some hours. On the Sunday morning, about seven o'clock, he sent for his family surgeon, Mr Bickersteth, and complained of having had grinding pains in his belly during the greater part of the night, for which he had taken a dose of ol. ricini, which had operated, but had not removed the pain. Mr B. states, that " at that time the pulse was quiet, and the pain by no means urgent, so that he merely ordered calomel gr. iv. and a draught of infusum sennæ with magnes. sulphas; that when he called in the evening, the physic had operated with rather more relief than the oil; that, in

fact, so slight was the pain, and so little was the patient apprehensive of danger, that, on that same evening, he wrote notes of invitation to several of his friends to dine with him on the next Tuesday. But Mr B. finding the pulse at 120, and hard, took about Zxx. of blood from a large orifice, with great relief.”

Monday, 9th, half-past 6 A. M. I was called to him for the first tinie. He had had a severe rigor between 5 and 6, which lasted about ten minutes, but, when I arrived, he was in a copious perspiration. Pulse 136 and small. The blood taken on the preceding evening had a thick buffy coat, with uncommonly large floating masses of albumen, but the crassamentum was tender; he had vomited some yellow bile. On pressing strongly on every part of the abdomen, I found neither tension nor soreness till I came to the right iliac region, where there was manifestly a circumscribed tenderness ; but still the pain was so inconsiderable, that any person, judging from this symptom alone, would hardly have suspected any serious mischief.' Indeed, I remarked to Mr B. that, though there could be no doubt of the existence of peritoneal inflammation, yet, both from the absence of more acute symptoms, and from the remarkable expression of atony in the countenance, it had more the character of puerperal fever, than of peritonitis in a male subject in the prime of life. But the practice to be adopted was evident. Mr B. immediately took from the former orifice near 30 ounces of blood, which had the same appearance as that drawn the night before. We remained with our patient till nine; he was languid after the bleeding, but did not faint ; and though the pulse did not abate in frequency, or improve in strength so de cidedly as we had hoped it might, yet there was no return of the pain, rigor, or vomiting, and we left him in a copious perspiration, with directions to take repeated small doses of ol. ricini or magnesia.

We saw him again at 1 P. M. when he felt generally better ; the pain had not returned; he had perspired freely; the stools, though very scanty, were feculent, of good colour, and tolerable consistence; the pulse was more distinct, and did not exceed 120; once, when it was counted by Mr B., it did not amount to more than 114. We advised him to continue taking the oil.

On calling again at 7 P. M. we were grieved to find him in every respect worse; he had had no stool; the skin was dry ; the pains bad returned, shooting across the abdomen, and there was soreness over the whole hypogastrium; the pulse was again at 136, and small; and on our proposing another bleeding, he immediately replied, that," from his own feelings, he had

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