Imatges de pàgina

It is not at present my object to controvert the contagious nature of those diseases, or to discuss their identity; but I may remark in passing, that if their identity be admitted, my experience of the laws of the legitimate tropical yellow-fever, having convinced me abundantly of its origin in strictly local causes, I should be compelled to withhold my assent to their possessing any contagious properties. The investigation of the supposed sources of introduction of the Bulam contagion into the various ports and garrisons, is necessarily, from the nature of the inquiry, involved in obscurity, and peculiarly liable to fallacious deductions; an increased value is therefore stamped on the simple and clear evidence furnished by the negative facts in favour of domestic origin. The daily familiar examples in the West Indies of the promiscuous introduction amongst the healthy, of men labouring under the yellow-fever in its various stages, without the communication of the same, although no means of prevention are practised, present an accumulation of facts in favour of local origin, which, divested of hypothetical research, or oral reports, rest on the obvious truth, that, if contagion formed any part of the character of the tropical endemic, the effect would be manifest, in those instances of unrestrained intercourse, in the due production of the disease; and the truth of such contagious propagation would, from the multitude of the examples, have speedily received unequivocal confirmation. Such effect not succeeding, it would be an unphilosophical conclusion to admit the agency of contagion among the causes of the tropical endemic.

But, to proceed to the consideration of the more immediate object of this communication,-the opinion that the human frame is liable only once to an attack of the Bulam fever, which may be here kept distinct from the question of contagion. If the assertion be limited to the disease which has caused the mortality in Gibraltar and Spain, having no personal experience of that disease, I have no observations to offer thereon; but if, as appears to be intended in the term " Bulam fever" is included the disease called the yellow-fever of the West Indies, I must then express my dissent from the proposition of absolute immunity after one attack. Every one who has attended to the laws of the tropical endemic, will have had occasion to observe the varied extent of unsusceptibility of yellow-fever, which the European acquires by the combined or separate effect of duration of residence, degree of habituation, to the remote cause, and severity, and number of febrile attacks; it will be obvious, that, if the unsusceptibility depends on the above causes, (which I believe few will dispute), its degree will be liable to variation, and

the immunity of the individual will therefore be in no case absolute, but always relative; a condition widely different from the exemption acquired by the system having once undergone the disease produced by the specific contagion of the small-pox, to which it has been compared. The unsusceptibility of yellowfever thus acquired, although merely relative, is, however, always sufficiently distinct, and confers, in many instances, the appearance of absolute non-liability; the deception is confirmed, from time to time, by instances of a body of subjects, who have undergone an attack of the yellow-fever (and have consequently received the advantage of habituation to the other means of acquiring relative non-liability) in former situations, where the remote causes of fever are more powerful than where they may be subsequently exposed to a prevailing epidemic, of which they have proved to be unsusceptible: as was exemplified in the exemption of the French West India refugees, in the North American epidemics, and in the immunity of part of the garrison from the fever of Gibraltar, who had previously served in the West Indies. If the identity of the epidemic of the West Indies, and those of Gibraltar and Spain, be admitted, the superior energy of the tropical remote causes of the disease will not be denied. The transition of a ship or regiment from the West Indies to the south of Europe, as Gibraltar or Spain, will therefore, as far as concerns yellow-fever, be obviously one of relative security, and we have a right to expect what happens, that they would enjoy exemption from an epidemic in the latter places, where the intensity of the remote causes is inferior to that they had been previously habituated to endure in a tropical climate. A preceding residence and attack of the epidemie in Gibraltar, will also lessen the susceptibility of yellow-fever in the West Indies, but in an inferior degree to the former case; nevertheless, those men in a regiment or ship's company who had not undergone such assimilatory process, would, on their arrival in the West Indies, from greater predisposition, in all cases suffer the first attacks of yellow-fever; and in those instances where the remote causes of fever were not peculiarly active, would be probably the only subjects of the attack.

It may perhaps be urged as an objection, that, in all succeeding attacks of yellow-fever, the original one was improperly considered as such, when, in fact, the disease was only what is termed the continued, or remittent bilious fever. Such a saving clause would, no doubt, be useful in support of the opinion of non-liability; but even admitting the force of such objection in its general application, (which I am not disposed to grant), it must not be forgotten, that variety does not alter the

species, and except a specific difference be established between those forms of disease, which I have yet seen no reason unconditionally to allow, either from observation or description, the argument is invalid; for there is no difficulty in shewing, that the criterion of the legitimate yellow-fever demanded by the author, is inapplicable to diagnosis, as well as to practice. The black vomit is considered in his publication as the peculiar test of the real disease, and it is inferred, that where that symptom is absent, the existence of yellow-fever is doubtful, and liable to denial. If this test of black vomit were to be exclusively admitted, and all other cases rejected as spurious, I should be willing to subscribe to the truth of the doctrine, that no second attacks take place, because, after that concluding symptom, constituting the test, has unequivocally appeared, I do not recollect to have witnessed any recoveries, which will necessarily preclude the possibility of future attacks; but having, on the other hand, seen recoveries effected in cases of this fever, which, uncontrolled, would, in all human probability, have terminated in black vomit and death, I cannot admit the propriety of the creation of black vomit into the criterion of the true disease, but am satisfied with viewing that symptom as the mere mark of a destructive degree of disorganization. The diagnosis of this disease is in general sufficiently obvious to a moderate share of experience, without waiting for the supervention of a symptom, the usual precursor of death, to ascertain the character of the attack. The utter inapplicability of this test to practice, is proved by the treatment directed by the author in the specific disease, being totally different from that enjoined in the spurious class, the latter requiring early depletion, while in the former the use of the lancet is said to be destructive. Although my views of the cure of yellow-fever do not coincide in the prohibition of early depletory treatment in any case of that disease, yet even, on the author's own remedial principles, the inconsistency of ranking a concluding symptom as the criterion of a disease, in which an early diagnosis is most important to the cure, is too conspicuous to escape notice.

Notwithstanding the parallel which has been drawn between the present assumed discovery, and that of the cow pox, as regards the inattention of the profession to a known fact, the analogy between the two cases appears to me to be remote indeed. The knowledge of the preventive powers of the cow-pox, previous to Dr Jenner's publication, was confined to a class of persons, whose pursuits and habits of life were foreign to philosophical research, and who were therefore unable to institute the inquiry which Dr Jenner conducted to so admirable a termination.

The suggestion of non-liability to a recurrence of attacks of yellow-fever, so far from possessing any appearance of the nature of a discovery, must have naturally often presented itself to the mind in the early stage of acquaintance with that disease, like one of those illusions, which, because we fondly wish, we almost persuade ourselves to be true, until checked by further experience. From the interest excited by its extensive ravages, a fact of such vital importance in the laws of the disease, instead of escaping the notice of even common observers, or of being treated with neglect by those entrusted with the public health, would have been seized with avidity and confidence by all classes, and long since established by volumes of confirmation, affording to those exposed to the destructive sphere of its operation, indemnity for the past, and security for the future. The reverse is, however, daily exhibited in those islands, in a manner so conspicuously free from ambiguity, that the person who should at this day hazard such an opinion, would be exposed to the negative of every one who had passed a few years within the tropics.

For these reasons, I trust I am justified in concluding, that the doctrines which have called forth these observations are untenable, because they are so far irreconcilable and at variance, that one position cannot be maintained without abandoning the other; for either the Bulam and yellow-fever are not the same disease, and consequently, all the analogical reasoning derived from the latter falls to the ground; or if, as I believe, they are the same, then what has been called the Bulam fever may, and does, attack the human frame more than once; but the name thus assumed must be erroneous, because the yellow-fever is not an imported, or, in other words, a contagious disease. Witney, Oxfordshire, June 2, 1816.


Case of violent Contraction of the Uterus, threatening Abortion, cured by copious Bleeding, and enormous Doses of Opium. By EDWARD LLOYD KNOWLES, Surgeon, Soham, Cambridgeshire.

THE THE difference of opinion existing amongst medical practitioners, in regard to the treatment of disorders, is not an unusual occurrence; but any thing that leads to a successful

mode of treatment, even if it should be extended beyond the general practice, probably may not be unworthy of your obser vations. Under these circumstances, and impressed with the importance of the case, I beg you will give it insertion in your excellent Miscellany.

On the 5th of June last, I was summoned, in a great hurry, to visit Mrs F. of this town. On my arrival, I found her in the most excruciating pain, arising from a violent contraction of the uterus, as she was far advanced in pregnancy, being in her seventh month; the pulse very full and quick, beating 98 in a minute. She was of a robust constitution, bowels regular, and frequently an inclination to vomit. A considerable heat was excited from the violent action the system was thrown into. On examination, not the least dilatation of the os uteri presented. Under these circumstances, I thought the most advisable plan to pursue was, to deplete the system, and alleviate the distressing action of the womb, by opiates to a large extent; as it is observed by most teachers on midwifery, and indeed in almost all treatises on that subject, that where the abortion endeavours to arise from a disposition of the uterus to contract, the plan to be adopted is depleting, and opiates given in considerable quantities. Having so many respectable authorities to support me in this instance determined me to proceed boldly on the following mode of procedure. Immediately, on my arrival, after asking the dif ferent questions to decide my mode of treatment, I ordered sixteen ounces of blood to be drawn at 8 o'clock in the morning, with the draught below:

B Tinct. opii, gtt. xl.

Spt. æther nitrosi, ss.

Aq. Menth. pip. q. s. M. ft. haust. omni hora sumendus. These were persevered in for four hours without the least perceptible benefit, the pain continuing unabated, and the contraction in the uterus increasing. At mid-day she was bled, and an addition of gr. iss. of opium made to each of the draughts, which were to be repeated every half hour. They were continued for four hours, without any alleviation of pain, notwithstanding the quantity of opium administered, and two pounds of blood abstracted from the arm. The pains came on exactly as they do in labour, at an interval of about five minutes, and that in a manner of the most violent nature. At this time, a bye-stander would most certainly have concluded, the force being so great, that the contents of the uterus must every minute be expelled. When I called again, which was at 4 P. M. it forcibly struck me, from the excessive straining pains, that abortion was rapidly advancing; but, on examination, not the least probability of it present

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