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muscles. For it is evident, that if the fibres had been straight or perpendicular to the ribs, they would have been not only much more numerous than in the oblique position, but would have acted upon the ribs with greater force."* "Quanquam," as Mayow expresses it, “ iisdem sursum aut deorsum movendis recta insertio melius conveniret;" that is, if the intercostals had been placed in their situation with perpendicular fibres, the ribs would, during their action, provided the nature of the articulations allowed of it, have been moved during inspiration in the same straight line, consequently the dilatation of the chest would not have been affected by their movements; but to obviate this difficulty, which one set of oblique fibres would also have produced, two sets have been formed, which, acting together, not only directly raise the ribs, but, assisted by the double articulation at the spine, and the oblique one at the sternum, cause them, during their ascent, to form the parabola of a projectile, or to describe the arc of a circle, and thus of course, considerably to increase the diameter from one side of the chest to the other. It is evident, from the double articulation of the ribs at the spine, and from the obliquity of their attachment at their cartilaginous extremities, that, if the muscles had been straight, they would have pulled the ribs directly against their articulatious, and thus they would not have been raised at all ; but the obliquity of the insertion of the muscles enables them to act out of the perpendicular, and thus to draw them not only upwards, but to throw them outwards, considering the nature of the articulations, and thus to form the arc of a circle ; the muscles were therefore placed obliquely in two decussating layers; but had it been the object merely to raise the ribs without throwing them forward to dilate the chest, “ iisdem sursum aut deorsum movendis recta insertio melius conveniret.” This appears to me to have been Mayow's meaning, and which will be more evident, if the reader will take the trouble to consult his plates, either in the original work, or in my publication, where he is largely quoted, and the plates transcribed. I may, therefore, very safely conclude, that Mayow is fully entitled to the merit of having proved that both layers of intercostals raise the ribs, and that, in raising them, they are also thrown outwards during inspiration, and thus contribute to enlarge the chest for very evident purposes. Mayow, indeed, was a genius of no ordinary cast; his works prove him to have been a man of great activity, perseverance, and penetration. His mode of reg
Anatomy, p. 109.
soning was apposite and instructive. He was the discoverer of oxygen, of the nitrous and azotic gases, and he applied the name of fire-air to the first, as Scheele has since done in Sweden by the term feuer-luft, signifying precisely fire-air, without knowing of Mayow's discovery. His explanation of the analogy between respiration and combustion-his doctrine of the former, viz. that it was to warm and not to cool the blood, as was then the received opinion-his explanation of muscular motion, and of the co-operating action of the intercostals in particular ;-his invention of an excellent chemical apparatus for experiments on gases, form altogether a mass of anticipating information, which the reader, dazzled by the brilliancy of modern science, would probably be surprised to find so far back as 1674, and in the works of one who died at the early age of 32. It is not, indeed, of any beneficial consequence to the public who is the discoverer of any particular fact, and it would be a good rule to follow, not to enter into any speculative discussion upon points of no essential benefit to mankind : but it is gratifying to trace the progress of science, to mark the dawn and the completion of discoveries, and to award the palm of merit to those ingenious minds whose exertions have partly dispersed the clouds of darkness over which subsequent labours have spread a broader effulgence of light King-Street, St James's Square,
March 22, 1816.
On the Use of the Poultice in Internal Inflammations. By
WILLIAM ENGLISH, Surgeon, London.
Æsculapius himself is not, I believe, more
antique than in the simple remedy I now offer to your attention. A poultice,-a few observations on a simple warm poultice, are what I beg leave to intrude on your good nature for a few moments. Do not the surgeons too exclusively monopolize this remedy to themselves ? I am much mistaken if it is not found as effectual in a variety of internal inflammations (which sur, geons are not often consulted about), as it is known to be in those externally situated, particularly such as pleuritis, enteritis, hepatitis, peritonitis, cynanche, &c. of course no one will suppose that I contend for attempting to combat such dangerous diseases, armed merely with external applications. All I mean to urge from strong conviction is, that this is an auxiliary when called early into action, which will be found availing in a degree not generally imagined ; and, I am given to understand, that, on the Continent, especially in Spain and Portugal, this is an application which physicians resort to very generally, and with great confidence.
About two years ago, I was seized with pleuritis ; my cure was confided to the very kind and skilful management of two eminent physicians; the most approved treatment was resorted to, bleeding, both generally and locally, and blistering, were not spared ; but, in defiance of all that was done, for six days the pain and misery remained unabated, when, on the seventh day, a poultice was suggested, and applied in the way I have always seen it the most speedily effectual : a large blistering plaster was laid on for two hours, and a warm poultice succeeded, which was repeated about two hours afterwards. This happily soothed me to sleep, the first time I am sensible of having had that comfort for a week. By the continuance of this remedy, aided solely by a little aperient medicine, in a day or two I was enabled to lie on my side, which hitherto was impossible ; expectoration became copious and easy, and in a short time I recovered.
In March last, a particular friend of mine was seized with an acute inflammatory attack ; the pain was entirely confined to the left side. He placed our fingers where the appendix of the diaphragm arises from the lumbar vertebræ, as the part where the most excruciating pain was felt. He was in excessive mi. sery; the least movement or cough was torment to him. Dr Babington attended this patient with me, and of course every thing likely to subdue the complaint was resorted to. One peculiarity in the symptoms attracted our attention, viz. a considerable expectoration of a beautiful yellow bile, unmixed with the glairy phlegm he was perpetually coughing ap. He declares all our remedies were ineffectual until the application of the poultice on the fifth day, which gave him great relief. This was kept constantly warm to the part affected for two days, when the pain was so far abated that he requested permission to lay it aside, its weight being oppressive. He recovered very slowly. I have seen cases that put on all the characters of peritonitis and enteritis, where the stomach was so irritable, that medicines could not be retained for an instant, which did well by the application of a very large blistering plaster, succeeded in two hours by poulticos kept constantly hot, after which, medicines could be administer,
ed effectually. I was called lately to a gentleman who was seized in the night with low muttering delirium, frightful groaning, and excessive shivering ; he complained of no very particular pain, but looked suspicious and fearful. On pressing my fingers on the region of the stomach, in the direction of the diaphragm, he started, and almost jumped out of bed, and it was with difficulty I could prevail on him to suffer me to examine this part again, which was tense and unusually hot. He had vomited two or three times, and was purged; his thirst was insatiable. In the evening he had noticed a slight disposition to a bowel-complaint, which prevented him from going out as intended; otherwise he was very well.
I wished to bleed him, and took out my lancet for that purpose, but he expressed such extreme horror at the sight of this instrument, and such dreadful apprehension at being bled, that I was deterred from performing the operation, and for the present contented myself with giving him four grains of calomel, and as much James's powder, with the constant application of a hot poultice. In five hours after, when I again visited him, all the alarming symptoms had abated, and he could bear me to press on the scrobiculus cordis without fear or pain. He de. scribed the effect of the poultice as a charm, and he very soon recovered.
I consider the warmth and moisture of a poultice to be much superior to fomentations, and it is attended with less inconvenience and trouble. The only objection is its weight, but this, however, is seldom complained of, until the cause for which it is applied be removed. A bladder, half filled with warm water, is a very good substitute for the poultice; but this is even more complained of for its oppressive weight, and I think less efficacious in all respects. The application of a very large blistering plaster, for an hour or two previous to the poultice, certainly facilitates the beneficial effects thereof; but as blisters, when applied large, are apt to give trouble and pain by the strangury they cause, about one-third of the emplast. lyttæ, with two-thirds pix Burgundica, forms a plaster less liable to this objection, and is even more stimulating to the skin ; of course, more efficacious, when applied for this purpose.
Mark Lane, London, November 1815.
N. B. On completing this letter at the time it is dated, I chanced to take up a newspaper, a paragraph in which announced, that, in Liverpool and in the neighbourhood, inflammation of the bowels, and bowel-complaints, were alarmingly prevalent; owing, it was supposed, to the abundance of hazel
VOL. XII. NO, 47.
nuts which that season produced, and were eaten.--A certain cure, however, was to be obtained by the application, to the part affected, of a hot poultice, as soon as the pain commenced. This was enough for my purpose, as I only wished to call the attention to that, which I consider of more importance than is commonly attached to it, in internal inflammatory complaints, I therefore did not forward the letter to you ; but now I am induced to present it, in consequence of an allusion to the same subject in the last number of the Medico-Chirurgical Transactions by the president; although I may inter, by your criticism on Sir Gilbert Blane's paper in your last publication, that it does not much accord with vour own ideas on the ubject. I am free to confess that I do not understand Sir Gilbert to urge the application of topical remedies, as excluding the lancet and other more powerful means; he only seems to imply, that even those means are known but too often to fail, which may possibly be aided by the former, and such is what I wish to aflirm, by what, I think, I have witnessed.
May 16, 1816.
On Yellow-Fever. By J. B. SHEPPARD, R. N. SELECTION of alleged proofs in favour of the Bulam fever
attacking the human frame only once, having been inserted in the last number of this Journal, with an accompanying claim to the discovery of such peculiarity, I am induced to offer some observations on the subject, which I beg to be understood as referring more strictly to the legitimate yellow-fever of the West Indies, than to that form of disease which has occasional. ly appeared in some parts of the south of Europe, and to which the name of the Bulam fever has been applied. The former disease it has fallen to my lot to treat, occasionally, on an extensive scale, during a service of more than eight years of the late war in the West Indies. I may also be permitted to add, that my opportunities of observation were extended beyond the usual sources of information, in the situation I held as secondsurgeon of the Naval Hospital at Antigua, at a period when yellow-lever prevailed in an unusual degree in several of his Majesty's ships under repair in English harbour. The epidemics of Gibraltar and Spain I have no knowledge of, beyond what I have derived from description.