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 pur pose, 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 described 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

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 infer, by your criticism on Sir Gilbert Blane's paper in your last publication, that it does not much accord with your own ideas on the subject. 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 affirm, by what, I think, I have witnessed.

May 16, 1816.

VIII.

On Yellow-Fever. By J. B. SHEPPARD, R. N.

A 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 occasionally 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-fever 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.

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, 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 bere 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 epidemic 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 succeed. ing 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.