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mation of the greater size of the liver before birth than after that period, and are consequently to be considered as the purposes intended by nature to be effected by that peculiarity in the fetus.
Remarks on the Fever which occurred at Gibraltar in 1813. In
a Letter from Joseph D. A. Gilpin, M. D. Inspector of Army Hospitals at Gibraltar, to COLIN CHISHOLM, M. D. F. R. S. &c. &c. [From the Edinburgh Medical and Surgical Journal, for July, 1814.]
MY DEAR SIR, I HAVE received your letter of the 11th November, and am happy, and not a little flattered that mine to you, on the subject of the contagious fever of 1793, has met your approbation. During the months of September, October, and November last, a disease in every respect similar to that, was prevalent in this garrison; and had we not thinned our population, by turning eight thousand persons out of it, it no doubt would have proved as destructive as it was here in 1804. I am the only medical man that escaped the contagion; and what was more extraordinary not a member of my family, six in number, caught it; and I know not another family of which that can be said. We all of us took four or five doses of bark every day, by way of keeping up the tone of the stomach. I do not pretend to say that we owed our safety to that, but I did the same at Martinico, and escaped infection there also. When the disease ceased, the lieutenant-governor called upon all the medical men to give in a statement of their opinions, as to the nature, cause, and treatment of it. I enclose you the slight sketch which I gave, together with a statement of the deaths, &c. and an authentic document sent me by a well-informed Spanish physician, who volunteered his services in the civil lazaretto, established without the walls of the garrison, and which clearly, in my opinion, proves that the fever was imported. In the statements of fifteen medical men, two only seemed to be undecided as to its being contagious; the rest were staunch contagionists. In the street where it first appeared, the houses on each side were speedily affected. I had, with others, many numerous families under my care, the members of which were almost progressively attacked. I attended the governor, his lady, and three children, with servants, in all amounting to upwards of twenty; the servants indeed were sent, at least most of them, to the military lazaretto. I have had some correspondence with Sir James Fellows, the inspector at Cadiz. From his account, the disease there was highly contagious, and he mentions a curious circumstance,—that a body of people who were situated in a marshy situation entirely escaped the infection. I cannot at this moment lay my hand on his letter, or I would give you his own words. The disease at Malta is the true plague, with buboes, carbuncles, &c. By the last accounts from the governor, it is now confined to one village, which they have walled round, and have placed a cordon of troops. I should be glad to have Dr. Haygarth's work; I have no doubt of its being a valuable one. lour book, my dear sir, we have in the library, and it has been pretty well turned over lately, I assure you. I give you an extract of a letter to Earl Bathurst, I am certain it will give you pleasure, although it i so flattering to my feelings. The packet is about sailing, and I have returns, &c. to transmit to the Board. This must be my apology for this very hasty scrawl. Should you have any other commands, lay them freely upon me, being most sincerely and faithfully yours, Gibraltar, March 1814.
Jos. D. A. GILPIN.
By publishing the extract from Governor Campbell's letter to Earl Bathurst, mentioned in the foregoing, I may perhaps commit a breach of confidence; but it is so honourable to the character of my friend, and does so much justice to his merit in the faithful discharge of his most arduous duty on this very trying occasion, that I cannot resist the desire to make the reader acquainted with it.
« Extract of a Letter from his Excellency Lieutenant-General
Campbell, to the right honourable Earl Bathurst, dated Gibraltar, 25th December, 1813.
“ In having the honour to make this communication, I feel it incumbent on me to notice particularly to your lordship, the great professional abilities, zeal, and attention, manifested by Dr. Gilpin, deputy-inspector of hospitals, as the head of the medical department. The able manner in which he has conducted the arduous duties of his situation, during one of the most trying periods that could have occurred, claims my warmest approbation; and for which I trust, together with his claims for long service in the West Indies, your lordship will have the goodness to submit the doctor's pretensions to promotion, to the favourable consideration of his royal highness the Prince Regent."
OFFICIAL STATEMENT. “During the months of August and September last, I saw some cases of fever, which appeared to me to be the usual autumnal bilious remittent; but on visiting two men in City Mill-lane, I found them labouring under a fever, apparently of a still more serious type; but as I saw them only a few hours previous to their death, I had not sufficient grounds on which I could found a decided opinion as to the nature of the disease.
“ I was soon after called by the late Mr. Pigoli, to see some of his patients; and in their cases I recognised the symptoms and appearances of a fever which has been denominated typhus icterodes, and of which I had seen numberless cases in the islands of Grenada, Martinique, and Guadaloupe, when physician to the forces to the late Lord Grey.
“ In the month of October, I attended different families, the numerous members of which were attacked in succession, and with a fever of the same type. Many of the symptoms were similar to those which accompany bilious remittents, such as anxiety, listlessness, alternate chilly and hot fits, white tongue, yellow skin, nausea, vomiting, &c.; but those symptoms and appearances which I considered as characteristic of the dis
case above named, were the protruded red eye, and exquisite pain at the bottom of its orbit, and of the forehead, back, and limbs; and, as the disease advanced, the dilated pupil, excessive irritability of stomach, hæmorrhage from the mouth and nostrils, dark vomiting, skin of a dingy yellow hue, unlike the bright yellow suffusion of the bilious remittent, and in many cases a fatal total suppression of urine. To this catalogue I may add, that insidious cessation of symptoms, which almost always occurs about 60 hours from the first attack, raising hopes in the patient and his attendants, that are speedily quelled by an aggravated recurrence of every fatal symptom. This deceitful calm I have often witnessed in the general hospital at St. Pierre's, in Martinique.
“ In the general mode of treatment, the medical officers of the garrison are, I believe, agreed. Calomel given at first, in rather a full dose, and afterwards in smaller ones, at the distance of three or four hours, seems to be the measure pursued; and it has been observed, that if the bowels be thoroughly opened, before the third or fourth day, the disease frequently proceeds with few untoward symptoms, and generally does so if the remedy affects the mouth. In the West Indies we hailed that effect as a very favourable one. In many cases, however, whatever might have been the previous treatment, a succession of alarming symptoms occur, and few more so than the extreme irritability of the stomach. Various remedies have been recommended, with a view to calm its violent action; the application of a blister; a table-spoonful, given at short intervals, of an equal mixture of lime-water and milk; solid opium in doses of half a grain or more, every two or three hours; pills made of Cayenne pepper, brandy, &c.; but it has been observed, that a repetition of purgative injections, and the patient's refraining for some hours (should his strength admit of it), from swallowing medicine or food, has had a good effect.
“ The authorities for bleeding, in incipient cases of this fever, with a view to prevent congestion and subsequent topi. cal inflammation, are no doubt very respectable; and, in some cases, when the patient was vigorous and plethoric, the practice has been successful. But we are now, I
presume, possessed of a remedy in the cold affusion of water, which more
speedily produces a solution of fever, and checks the inordinate action of the heart and arteries, from the continuance of which arises the congestion and topical inflammation, so much to be dreaded. It is a mode, too, of removing fever, which possesses one great advantage over that of the lancet; for though it should not produce the complete effect intended, it certainly does not diminish the patient's strength, but leaves him in a state that may enable him to bear the operation of any other energetic remedy that may be thought necessary: on the other hand, should the loss of blood fail in its effects, we may easily conceive how ill the subject of it would be prepared to struggle against a disease so frequently rapid and fatal in its termination. I cannot say, however, that I saw many cases here, in which I would have recommended the cold affusion; neither the state of the pulse, nor the heat of the body were such, as, in my opinion, to warrant the application of it. I preferred, therefore, frequent tepid spongings with vinegar and water. Children, indeed, were much benefited by the cold affusion.
“ That the disease in question is contagious, (or more properly speaking, infectious, as actual contact does not appear to be necessary to its transmission), I entertain not the least doubt, though an opposite opinion has been held by some highly respectable characters. I have witnessed, both abroad and in this garrison, too many melancholy instances of the disease being communicable from one person to another. At Martinique, in the year 1793, we suffered dreadfully from the ravages of a fever, in every respect similar to that which lately appeared here; and, in numberless instances, its infectious nature was ascertained, by its attacking those who were in attendance on the sick; and it is a melancholy truth, that very few of the medical officers survived the pestilential duty in which they were employed. But as, in this statement, I am only called upon to give my own opinion, I do not think it necessary to combat further the opinions of others. I shall merely add, that innumerable circumstances have brought a degree of conviction to my mind, that is not to be shaken by any arguments or reasonings on the side of non-contagion, that I have hitherto heard of or read.
“ In endeavouring to account for the production of the dis