Imatges de pàgina

period were later, as from 12 to 24 hours after the attack, he could not promise success, though he deemed it the only efa fectual remedy. Mr. Hey justly maintains that no such precise limit can be laid down in all cases; for while one of his cases terminated fatally in less than 18 hours, in some others bleeding was successful, when a delay of more than 24 hours had occurred. Nor does he admit any similar limitation of the quantity of blood to be drawn: he thinks, indeed, that there is scarcely any other limit than the removal or considerable di. minution of the pain,“ provided all that is requisite be drawn within twelve hours of the first evacuation.”

“If the disease is clearly ascertained, no other consideration is of much importance. The state of the pulse affords little information either as to the propriety of bleeding, or the quantity of blood proper to be taken away; and if we are de. terred, either by the apparent weakness of the patient, by the frequency and feebleness of the pulse, or by any other symp- . tom, from bleeding copiously, we shall generally fail to cure the disease." p. 161.

Immediately after bleeding the most speedy and most effectual means of purgation were resorted to, and continued, so as to produce an evacuation once in three or four hours, which was maintained for two or three days, or longer if necessary. This accords with Dr. Gordon's precept, that “the purging is to be early excited, and to be contioued without intermission, till there be a complete termination of the disease." Mr. Hey always found opiates destitute of any advantage, affording but an insidious truce, and rather tending to prolong the disease. Circumstances may render purgative or emollient injections useful; fomentations, if properly applied, are soothing, and never did harm; but blisters are inconvenient, and seldom necessary.

If these means fail to cure the disease, from being employed too late or in an improper manner, the mischief produced in the cavity of the abdomen, whether by extravasation, suppuration, or gangrene, is beyond the reach of medicine; and nothing can be done, save to alleviate distressing feelings; cordials and tonics can afford no other advantage. Purging, however, is proper in every stage of the disease, unless gangrene has actually taken place; and should be excited, if possible, whea bleeding has become inadmissible.

The success of this practice, then, was as follows. Before the plan of bleeding was adopted, of fourteen patients only three recovered; but after the 15th case, which occurred in the author's practice, of thirty-three patients only three died; and the last twenty-six recovered in uninterrupted succession. Yet this was an epidemic puerperal fever, which has been said by most of the writers to be of a low or typhoid character. This is at least the third example of an epidemic fever of this sort, which was combated effectually by copious and active evacuations only; for those of Aberdeen and Sunderland, described by Drs. Gordon and Armstrong, were of the same species. When we consider what a general bugbear typhus, (i. e. debility, putrescency, &c.) was, at the time when most of the books on this subject were written; how distinctly in some cases the general opinion has veered round in that respect of late; how very much like low fever are many of the abdominas inflammations after the acute stage is past, where they have been neglected or maltreated; and how injurious we find the use of cordials, bark, and other excitants in the common fevers of this country at present; we are disposed to agree with the author before us, that the puerperal fever is always essentially the same disease, “inflammatory at its beginning, and putrid only in its progress;" and that the distinction between the sporadic and epidemic disease is so far only important in practice, “that the epidemic disease requires more prompt attention, and more vigorous treatment;” for that “ the means of cure are precisely the same in both; but in the latter their measure is greater and less limited, and the period within which they must be employed is far more circumscribed.” p. 182.

Whatever may be the general inference upon this subject, this little treatise will be deemed a perspicuous and judicious history of a severe and dangerous epidemic, characterized by sound pathological knowledge, clear arrangement, and great correctness of composition, and worthy to be classed with the best monographs of modern medical literature,



On Re-infection in the Ship Fever of Tropical Climates.


Dr. W. Pym, inspector of British hospitals, published, in the Edinburgh Medical and Surgical Journal for April 1816, a paper entitled “Proofs of the Bulam Fever attacking the Human Frame only once.” This publication forcibly attracted my attention. The doctor asserts, that the disease called yellow fever in our country, but which he has specifically named Bulam fever, never attacks the same person twice. Dr. Fellowes, in his account of the pestilential fever of Andalusia, fully confirms this fact. It is well to compare the opinions enter. tained by medical men in different parts of the world, and more especially the facts related by them. Concerning the fever in question I have no desire to revive controversy. After a long and painful acquaintance with it, I am well convinced that its proper character is, the ship, or jail, or hospital fever of tropical climates; that it is, of course, a disease sui generis, distinct from the endemic or indigenous yellow fever of the West Indies, and from the bilious remittent fever of hot climates. I have seen it, and carefully attended to its nature and progress, in Philadelphia, in the years 1793, 1797, 1798, 1799, 1802, 1803, and 1805; having, during all this time, been absent from the city only two weeks in 1793, after a severe attack of the disorder. My attention was arrested in 1798 by observing that persons who had had the disease before, were then exempted from it, although few others escaped. I mentioned the fact, and was much ridiculed for my remark. This could not hinder my continued attention to the subject; and

my opinion being confirmed by succeeding observations, I can now safely assert, that during the seven years of its appearance amongst us, I did not meet with one instance of the same person's being infected with this disease the second time. I observed the fever pass through large families, attacking those only who had not been before infected. These facts were too powerful not to have their proper weight.

I acknowledge my having attended persons in this fever, who said they had had it before. This I do not mean to controvert; I only give my own experience, as to never having myself seen it twice in the same person. I know that several of my medical friends, who regard the Bulam fever or ship fever of tropical climates, as a different grade of the bilious remittent, differ widely from me as to facts and theory-and with their ideas of the fever in question, it cannot well be otherwise. I merely wish to give the result of my own observations; believing that a fair and correct account of interesting facts, as they occur, should be collected and spread before the medical world. And perhaps such collections will be more valuable by being unaccompanied with theoretical remarks. They will serve to give us more correct ideas of diseases; and as to the present one, may assist in solving the ques tion, so much agitated, whether it be contagious or not—or in other words, communicable from one person to another: a most important question; on the right decision of which, the comfort and safety of those exposed to it in a great degree depend.

As an additional fact in favour of this fever not attacking the same person a second time, it will be well to remark, that none of the physicians of Philadelphia, who were infected with it in 1793, have since died of this disease-and it may not be foreign to observe, that those who have once suffered from attacks of bilious remittent or intermittent fevers, are much more liable than others to be again affected by them when exposed to the same causes; another striking discrimination between the remittent bilious fever, and the Bulam or ship fever of tropical climates.

Philadelphia, 8th mo. 13, 1816.


Case of Hernia.


ANDREW PATEN, a coloured man, about 30 years


age, strongly built, and of a large stature, having always enjoyed good health, had been subject to a scrotal hernia on the right side for the last five years, but which being well maintained in its situation by a truss, had never occasioned the least inconvenience. On Friday, August 10, while raising his carriage, (he being a coachman), he made an effort, which was succeeded by a sudden pain in the left groin, but which appears, however, not to have been sufficiently acute to excite alarm, or even to induce him to examine the spot, which was the seat of the pain. This occurred at about three in the afternoon, and in the evening, as usual, he returned home, complaining merely of fatigue, and went to bed without any examination, although the pain had not abated. At about eleven, however, he was roused by the increase of his sufferings, which were now so violent as to make him cry out; vomiting and hiccup made their appearance simultaneously, and the pain, extending throughout the abdomen, but more particularly below the navel, became excruciating. His sufferings had alarmed him and medical assistance was requested at about half past one. Upon examining and questioning the patient as to the probable cause of his colic, (for thus it appeared to me at first sight) no satisfactory information could be obtained. After some further investigation, however, he recollected having felt in the afternoon a small lump upon the left groin, and added, that his most violent pain had been at that spot. This tumour, about the size of a goose egg, proved upon examination to be a scrotal hernia of the left side, strangulated. Attempts had already been made by the patient to effect the reduction of the tumour, and I repeated them my


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