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he must not trust mainly to his knowledgeof the parts, but must take care that everytouch of the knife is entirely under theguidance of his finger; his finger must

guide the instrument, he must judge of thethickness of the bladder, judge of the ex-tent the instrument has cu.t, and so on,and all that is to be done by his knowledgeof anatomy and feeling, and not by trustingto chance. But it is quite obvious you musttake into your observations that there are

many circumstances to show the danger ofthis operation. There is one I will men-tion : I have never seen a surgeon, after

performing the first part of his operation,and thrusting the gorget in along the groovetill his hand was in the wound up to hisknuckle, without feeling something like

horror ; for 1 once saw a man do this, andconceiving that the instrument was in thebladder, he passed his forceps, withdrewthe instrument, and opened the forceps.Now he had never been into the bladder ;the instrument did not go off the groove ; itdid not go betwixt the bladder and the rec-tum, but it pushed the bladder before it, andwas carried on before the instrument; theinstrument did not cut the prostate, butpushed it on before it, and consequentlythe surgeon did not observe what had hap-pened, that the incision had not been made,and he grasped the bladder and the stonetogether; the stone was in the grasp of

the , forceps, but the bladder was betwixtthe forceps and the stone. Indeed there isa preparation in Dr. Jefferey’s Aluseum inGlasgow, a preparation where the stonewas brought away in this manner : I haveseen it. The patient having died, the bodywas raised from the grave and examined, andit was then ascertained what had happened.There is another thing to be observed,

which is, that the gorget is apt to slip offfrom the groove. It is again said, and witha show of reason with respect to the gor-get-what in the world are all these varie-ties of gorgets for ’1 But, as I stated, theyare so many proofs of the inaccuracy or im-propriety of the operation in former times.Now such an instrument has been found tocut the bladder best; I do not care whetherwhat is used be an abscess lancet, be a gor-get, or a scalpel, but the mode is to feel thecourse with your finger, and to cut with theinstrument which you are most frequentlyin the habit of using ; it may be the scalpel,for you may be most accustomed to use

that in dissection, and cut in the way Che-selden does in his second operation, and Ithink you will do well. But there is a greatdeal more to be said on this subject, andreally, Sir, (addressing the Chairman,) youmust help me to decide whether I must de-vote another half hour to it, or proceed to

something else.

LECTURE ON CONTAGION.

BY

DR. TWEEDIE.

Delivered at the Medical Theatre, Aldersgate-street.

Ir has been remarked by the illustriousSydenham, that fevers constitute two thirdsof mortal diseases, and that eight out ofnine of all who die are cut off by febrile

complaints. It is, therefore, a question ofno small importance, to determine whetheror not fever can be propagated by conta-gion. On this subject very opposite opi-nions have been entertained by medicalwriters.The words contagion and irifectíom are by

many considered as synonymous terms,while by others a distinct meaning has beenattached to each.

Contagion has been defined to be the me-dium by which a disease is communicatedfrom one individual to another, whether byactual contact or touch, or by breathing anatmosphere impregnated with effluvia fromthe human body.

Infection has been restricted to expressthe operation of the poison, or simply theact of communication of a disease fiom oneindividual to another. An epidemic diseasesignifies a disease which prevails at particu-lar periods or seasons, affecting indiscrimi.nately the inhabitants of a district, and is

supposed to arise from a certain condition ofthe atmosphere. The influenza, or epide-mic catarrh, which prevailed during the

spring months of 1762, 1782, and 1803, isan instance of an epidemic disease. It ap-peared at different times in particular partsof the globe ; at one time it was confined tosome parts of the continent of America, andinvaded successively various districts of

Europe, Asia, and America. In this in-stance it is evident that the disease was

produced and propagated by some peculiarunexplained condition of the atmosphere.

Non-contagionists deny that any diseasecan be propagated from person to person,except such as are communicable by theinoculation of a specific animal poison;they divide contagious disorders into theacute and chronic, and enumerate amongthe former, small-pox and measles; amongthe latter, syphilis, psora, porrigo, andsome others. They disbelieve, or affect todisbelieve, in the possibility of plague, ty-phus, and scarlet fever, spreading from oneindividual to another, and insist that the

propagation of these diseases depends on at-

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mospheric causes ; or should they be tracedto any other origin that they cannot spreadby contagion. Now I contend, and am pre-pared to prove my assertion by facts, that

the common fevers of this country, howeverthey originate, do spread from person toperson, either by actual contact, or from

breathing an infections atmosphere. Dowe not frequently observe small pox andmeasles, about the contagious character ofwhich all are agreed, prevailing so exten-tensively in particular districts, not to men-tion the impossibility in many instances oftracing their origin ; that it is most philoso-phical to explain their rapid extension overa certain portion of the community on theprinciples of an epidemic. It is also anundoubted fact, that diseases strictly andunquestionably contagious, prevail more

extensively at one season than another, andthat, in general, one distemper only of anepidemic character prevails at a particulartime. Thus small-pox is more common atone season, measles at another; and al-

though typhus and scarlet fever are metwith at all seasons, yet it is remarked thatin certain conditions of the atmosphere, andat particular periods of the year, they aremore extensively prevalent ; but do not

all these diseases, although intimately de-pendent on atmospheric causes, spread byby contagion And where is the difficultyin believing, although the plague prevailsin certain countries at particular seasons,and thus obeys the laws of an epidemic,that it does also spread from person to per-son ? 1 We are, however, told by the non-contagionists, that an epidemic disease cannot be thus propagated, an assertion contra-dicted by reasoning, as well as by wellauthenticated facts.On the principle, therefore, that an epi-

demic disease may and does, under cer-tain circumstances, propagate a like diseasefrom person to person, many difficulties,in explaining the propagation of plague,are removed. The many absurd and almostfabulous modes which have been inventedto account for the appearance of this dis-ease in certain places, have given greatscope for the ridicule of the non-conta-

gionists, and this has been a powerfulcause of the late more general belief in thenon-contagious nature of plague. This dis-ease, I repeat, may have a local or an epi-demic origin, precisely in the same man-ner as typhus fever, however generated, iscommunicable by contagion. You mustalso bear in mind, that a combination of cir-cumstances is essentially requisite to favourthe propagation of plague ; thus, for in-stance, the extremes of heat and cold areboth equally favourable, or even necessary,to its extension, and the disease has alwaysbeen remarked to commit its ravages most

extensively during a season of moderateheat. Hence the reason that plague morerarely occurs in the northern climates, coldbeing unfavourable to its progress. It hasalso been observed in the tropical regions,as those of Persia, Japan, India, and China,that its existence is almost unknown. Evenin those countries, as in Egypt, Syria, andthe Mediterranean, where it occasionallyprevails extensively, it is always observedto moderate considerably, and often altoge-ther to disappear during the hot months.You may readily also conceive, that plaguespreads most extensively in the crowdedand filthy parts of the population, wherelittle or no attention is paid to ventilationand cleanliness. Thus, during the ravagesof plague in this and other cities in for-mer times, the abodes of the more re-

respectable classes were comparatively freefrom the disease ; and it is an establishedfact, that poisonous or contagious effluviamay be rendered almost innoxious by plen-tiful dilution with pure atmospheric air.This comparative immunity of the betterclasses may also in some measure be attri-buted to their more regular and generousmode of living, dearth and famine beinggenerally noticed to precede or accompanyplague and pestilential diseases.

It would lead me too far into digression,were I at present to enter into the variousremote and predisposing causes of plague ;but the history of the disease as it occurredin the 17th century, and the minute ac-counts we have from those who have been

eye-witnesses of this scourge, prove that itobeys in many places the laws of an epide-mic ; hence it is stated to appear over a

large territory or district at one and thesame time, that it suddenly appears, and asrapidly disappears in particular localities,and from causes that are not very evident toour senses. All this has been observed overand over again, and can only be referred tothe influence of some unknown and inscru-tahle principles in the atmosphere or soil,the elucidation of which, in the productionof pestilential diseases, has hitherto eluded,and perhaps will for ever elude, the re-

searches of man. We can as little explainthe particular states of the atmosphere un-der which various epidemics, as hooping-cough, measles, small-pox, or scarlatinaoccur. These diseases suddenly spread overa district, and again disappear precisely inthe same manner as plague has been ob-served to do ; but whoever doubts the pos-sibility of these diseases being communi-cated from person to person, although theymay have an epidemic origin. Every prac-titioner mnst have observed one or other ofthe diseases allowed by all to be contagious,

attacking such numbers, and in placeswhere no communication with the sick

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c9ud be traced, that contagion alone couldnot account for its general diffusion.

If you refer to the historical details ofthe plague, you will find ample proof of itsspreading by contagion. I shall not detain

you by going into these various statements,but confine myself to the proof of the ques-tion from the mortality among those mem-bers of our profession who have exposedthemselves to hazard, and in many instanceshave fallen a sacrifice to the humane dis-

charge of their professional duties. WhenDr. Bancroft took charge of the pest-housesSt Aboukir, in 1801, he found that everymedical officer who preceded him in that

dangerous service, had caught the disease,and that of the twelve officers seven haddied ! The nurses, and other attendants onthe sick, shared a like fate; though, as Dr.Bancroft remarks, if there be any spot onearth exempt from the operation of marshmiasmata, it would have been that uponwhich these pest-houses were placed, thesurrounding country being dry, barren, andsandy. The medical officers of the French

army had previously experienced the effectsof contagion to a much greater extent: nofewer than eighty medical officers had fallena victim to plague within a year. In thetwo following years it was thought expe-dient to dress buboes, carbuncles, and blis-ters, as well as to bleed and perform otherminor offices, under the direction of theMedical Staff. From these precautions onlytwelve medical officers died in two years ;but more than one-half of the Turks, who Iwere thus employed in assisting the Frenchsurgeons, took the plague, which in severalinstances proved fatal. ,

When the plague raged at Moscow, in1771, a physician, who offered his services Ias chief surgeon, relates that in three of the

principal hospitals at Moscow, all the assis-tant surgeons who were employed underhim (fifteen in number) took the disease,three of whom only recovered ; whilst thephysicians who walked among the sick, butcarefully avoided all contact with them,generally escaped.During the campaign in Egypt, in 1301,

the French lost nearly 2000 men by plague,and it was thought politic for a time to denythe existence of the disease. Buonaparte,at that time a general in the French army,and Desgenettes, the chief physician, ex-posed themselves to considerable hazard, inorder to allay, in some measure, the appre-liension of the soldiers, fear being, as youall know, a powerful predisposing cause ofdisease, The doctor attempted to inoculatehimself with the disease, but in order to

secure himself against the danger he washedthe part in which the matter was insertedwith soap and water. For three weeks thetwo little points of inflammation, corres- j

ponding to the two punctures, were visible,and to prove himself free from the disease

fie bathed in the presence of the army.-Desgenettes candidly acknowledges himselfthat this incomplete experiment, whichmade considerable noise at the time, proveslittle, and does not refute the transmissionof contagion demonstrated by a thousand

examples, and only shows that the circum-stances necessary to ensure inoculation tak-

ing effect are not well determined. Besides,how often does inoculation for small-pox,and even vaccination, fail on the applicationof the morbid virus ? This experimentseemed to mislead Dr. White, an Englishmedical officer, who, under the belief thatplague could not be communicated eitherby contact or inoculation, submitted him-self to the test of experiment ; he enteredthe pest-house of the Indian army, and soonafter he rubbed some matter from the buboof a woman on the inside of his thighs. Thenext morning he inoculated himself insidethe wrists with a lancet dipped in matter dIs-charged from the bubo of a Sepoy; he con-tinued in good health on the fifth day, buton the evening of the sixth he was attackedwith rigors and other symptoms of febrileaction ; to these succeeded much affectionof the head, tremors of the limbs, a dryblack tongue, weakness and anxiety, andother unequivocal symptoms of plague.Even now he persisted that the disease wasnot plague, and would not allow his groinand armpits to be examined. He becamedelirious on the ninth, and died on the af-ternoon of the tenth day.

These, Gentlemen, are facts, and one factis worth a thousand unsupported assertions ;the conclusion, therefore, I conceive to beirresistible-that plague is a contagious dis-ease. At the same time, I freely confessmy conviction, that the disease would less

readily spread in a pure atmosphere, ifthere be at the same time proper attentionto personal cleanliness and diet. Whenthese precautions have been disregardedduring a visitation of plague, the disease hasnot only attacked greater numbers, but thegeneral character of the malady has beenremarked to be more malignant and fatal.It is on this principle that the immunity ofOxford from a visitation of the plague, whileit raged in London, in 166.5, is accountedfor. About a century before, the inhabi-tants of Oxford had begun to improve thestreets and dwellings, and to establish re-

gulations for securing greater cleanliness ingeneral.An important question arises as to the

necessity of quarantine restrictions andenactments, with the view of gnardingagainst the introduction of plague from fo-reign countries. On this point I would

simply remark, -that es we have such in-

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contestible proofs of the propagation of

plague by contagion, it is the duty of go-vernments to impose cer tain precautionary re-strictions on vessels arriving from countriesin which the plague is known to be preva-lent ; such regulations, however, should beas little obnoxious as is compatible withthe safety of the community, more espe-cially as it has been allowed that the plaguehas never been communicated at the Laza-rettos, and quarantine establishments, to

those persons who are employed as inspec-tors of goods imported from plague coun-tries. This is pretty demonstrative evi-dence of the improbability of plague beingimported with goods. There is not, how-ever, equally conclusive testimony, that thedisease may not be communicated to theinhabitants of towns by personal communi-cation with those labouring under plagues,and while there is the slightest possibilityof the introduction of plague from onecountry to another, I do not think that thelegislature ought to abolish wholesome andsalutary regulations enacted for the wisest ofpurposes-the securitv of the people againsta disease attended with such lamentableconsequences.The similarity of the symptoms of plague,

and the common continued fever of this

country, has been remarked by all who havehad an opportunity of witnessing true

plague in those climates where it prevails,and if swelling and suppuration of the pa-rotid inguinal or other glands, or the occur-rence of carbuncles, are to be regardedas pathognomonic characters of plague, Ihave treated many such cases in the FeverHospital. The difference appears to me toconsist, chiefly in the uniformity of the

swellings in plague, and the rapidity withwhich the disease runs its course. This

may depend, in some degree, on the climatein which plague is engendered, as we ob-serve how rapidly fatal the cholera morbusof tropical climates is compared with theepidemic cholera of this country.

It evinces a very limited notion of thecircumstances under which fever is gene-rated to assert that contagion is the onlyprinciple capable of producing the disease.I venture to affirm, however, that it is one,and a very frequent source, which may bepowerful or not, according to many circum-stances into which I cannot at present en-ter, but more especially according to theattention that is paid to pioper ventilationand cleanliness. It is a fact now provedbeyond the possibility of doubt, and it oughtto be known to all local authorities, thatfever is readily produced by the accumu-lated effluvia from the human bodv ; andthe atmosphere of an apartment, or district,may be so contaminated from this cause, asto prove a source of fever to the majority,

who inhale it. It is not necessary that theeffluvia thus productive of fevers, shouldarise from persons labouring under disease,the concentration of exhalations from healthyindividuals, crowded in a single apartment,being, in many districts of this and otherlarge cities, perhaps the most commonsource of fever, aud it is utterly vain andhopeless to attempt its extermination inthis metropolis, while so many ill fed, illclothed, and filthy individuals are huddledtogether in chambers of small dimensions.No one but those accustomed to visit thecrowded districts occupied by the lowerclasses in many parts of London, could con-ceive the destitution and wretchedness ofan immense number of the labouring classes.It is not uncommon for twenty to thirtyhuman beings to be accommodated, day andnight, in one small apartment ; and whilegovernments are busily engaged in legisla-tive enactments for supplying the wants ofthe poor, it is surely an object of nationalimportance to guard against the risk of pes-

tilence, by insisting on the local authori-ties adopting a more rigid system of police,and enacting some regulations with the viewof preventing, as much as possible, dangerfrom this source. I can point out districtsin many parishes of this metropolis whichare never free from fever, nor can they everbe so until this source of the disease ismore generally known and the causes re-moved.

It is this concentration of human effluviawhich is so productive of fever in crowded

prisons and workhouses, and during thesummer and autumn, more especially, a cer-tain number of persons only should be per-mitted to reside in one apartment, or ward.From inattention to this principle, fewparisli workhouses, when over-crowded withpaupers, escape the occasional occurrenceof fever. The most remarkable instance of £the production of fever by contaminated airoccurred at the Old Bailey Assizes, in 1750.At this period the system of prison disci-

pline had been very much neglected, and’ therefore ventilation and personal cleanli-ness among the prisoners disregarded. At. the sessions in N-1-ay, there were a greaternumber of prisoners for trial than usual,and consequently the prison was over-

crowded, but whether any of the prisonerswere labouring under fever at the time or

not is uncertain. The prisoners were ar., raigned in the court, and those persons whol were placed in the course of a current ofi air, passing from the prisoners to an openL window, were seized with fever, but theother people in the court who were notl exposed to this draught escaped. The Lord, Mayor, and those who sat on his left hand,; were infected, while the Lord Chief Justice,, and the Recorder who sat on his right,

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escaped. Many also of the Middlesex jury,on the left hand of the court, died of it,while the London jury, who sat opposite tothem, received no injury.

Sir John Pringle states, that he has ob-served the hospitals of an army, not onlywhen crowded with sick, but at any timewhen the air is confined, and especiallyin hot weather, produce fever of a peculiarkind, which was often mortal, and he adds,he had observed the same thing to arise infull and crowded barracks, and in trans-

port ships when filled beyond a due number,and detained by contrary winds, or whenthe men have been kept at sea under closehatches in stormy weather. Fever is; how-ever, much more likely to spread in con-fined situations, where cleanliness is littleattended to, and still more rapidly whenpatients, under disease, are crowded toge-ther. The late Mr. John Pearson told me,that he had observed, when more than acertain number of patients were placed inthe wards of the Lock Hospital, fever be-came prevalent in the house, and that sinceonly a certain number of patients were ’,placed in each ward according to its dimen- i

sions, he had never known fever to occur.I would, however, strongly impress on yourminds, that whatever be the primary sourceof fever, the disease, under certain circum-strnces, spreads from person to person.My appointment of physician to the Fever

Hospital has given me most ample proofsof the contagious nature of the common con-tinued and typhus fever of this country.I am aware that an enlightened physician,who holds a different opinion on this sub-ject, has had the same advantages, havingpreceded me in that situation-I allude toDr. Armstrong. The Doctor, in the earlypart of his professional life, and even tillwithin a very short time, was a firm believerin the doctrine of contagion, and in his

writings has given so many evidences ofthe truth of this point, that I cannot ima-

gine how he reconciles the facts he has

given with the opinions he now holds andpromulgates. These opinions are the more-dangerous as they are sent forth to the worldwith the authority of experience, and withthe enthusiasm for which he is remarkable.But let us not be led away by speculativedoctrines on a subject involving so muchresponsibility. Let us look to facts, and

weigli them in the balance, free from pre-judice or the dictates of cuthority, and I donot fear the result, which must be a con-viction of the contagious nature of fever.I shall endeavour to prove my positions byan appeal to facts, for the truth and accuracyof which I pledge myself.The late Dr. Gregory, of Edinburgh, in

his lectures on fever, entered somewhatinto the question of its contagious nature, in

which he firmly believed. While he in-structed his pupils as clinical professor, heconstantly warned them against too near

approach of the patients labouring underfever, and with all the precautions he couldinculcate, he always had some of his pupilsunder his care with fever.

One of the cases admitted into the clini.cal wards, was a very beautiful youngwoman. She received no ordinary share ofattention from one of the pupils, who wasunremitting in his visits, and frequently re-mained for some time close to the bed onwhich she was placed. He was repeatedlycautioned by the doctor to avoid unneces-

sary exposure and risk, but he contended

against the wiser opinion of his teacher,and broadly questioned the doctrine of con-tagion. A few days after, Dr. Gregorywas requested to visit him, when he foundhim labouring under unequivocal symptomsof fever, which, in spite of every attempt tosave him, proved fatal. This is a fact whichdoes not require comment, and a more pal-pable illustration of cause and effect cannotbe required.During the prevalence of an epidemic

fever in Edinburgh, in 1817, it was neces-sary to open an additional hospital; and alarge building, which had been used as

government barracks, was converted into afever hospital. The situation was remark-

ably open and exposed, and, in the imme-diate neighbourhood, fever was less prevalentthan in any other district of the town. Whenthishospital,became crowded, all the medicalattendants who resided in the establishment,including the medical attendants and nurses,were successively attacked with fever. Noris this a solitary instance : the same occur-rence I mentioned to you, has been repeat-edly noticed in pest-houses into which per-sons attacked with plague are received.Besides, the Fever Hospital alone furnishesevidence sufficient for our present purpose.This hospital, as many of you may know, issituated in an open somewhat elevated dis-trict, abundantly free from malaria. I canstate, from incontrovertible evidence, thatwith one exception, every physician whohas been connected with this establishmenthas been attacked with fever, and that threeout of eight have died since the establish-ment of the hospital in 1802; and since myappointment, five years ago, 1 have beentwice attacked. The domestic establish-

ment, too, have one and all passed throughfever ; including matrons, apothecaries,porters, domestic servants, and all the

nurses ; and to show that the contagiousprinciples may be engendered by fomites inclothing, the laundresses, who wash the pa-tients’ linen, are constantly attacked, so thatit is with difficulty that women can be found

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to undertake this loathsome, and frequentlydisgusting duty.Now let us compare these facts with ‘

what occurs at the adjoining establishment,the Small Pox Hospital, which stands withina few feet of the Fever Hospital-the twobuildings forming two sides of a square. Iam informed by the present attending phy-sician, Dr. Gregory, that for the last sevenyears he has been either the attending, oractual physician of that establishment ; andthat during this period, no case of fever hasoccurred among the domestics, their com-plaints being catarrhal affections of a veryslight kind, or some accidental surgical ail-ment-so trifling, indeed, that not one ofthem has been confined to bed above one

day. The physician, apothecary, or matron,have never had fever ; and, according toDr. Gregory’s report, fever is unknown inthe establishment. If, as Dr. Armstrongasserts, our hospital is placed on a marshysoil, why do the inmates of the ’Small PoxHospital, and the inhabitants of the imme- Idiate neighbourhood, escape ? The medical !,attendants, nurses and servants, of the FeverHospital, are not exposed to more severeduties than those who hold similar appoint-ments in other hospitals. I have known oneof the nurses. during the examination of the

discharges from a fever patient, immediatelysicken, and afterwards pass through fever.This does not happen when the evacuationsof patients labouring under other diseasesare examined, and shows that there is someprinciple in the secretions of fever patients,which is capable of producing the disease.Dr. Bateman mentions, as an illustration ofthe contagious nature of fever, that one ofthe nurses of the hospital was attacked withfever, from imprudently sleeping in a bedwithout changing the linen, just quitted bya convalescent who had left the house.The following most striking example, is

upon the authority of the same respectedand talented physician :-

Dr. Bateman visited a poor family of fourpersons laying in the same bed, in a closedirty apartment, ill of fever. He alwayshad the precaution of throwing open thewindow on entering the room, and to sta-tion himself between the window and thebed, while he examined the sick. He re-

peated his visits daily for a week with im-punity ; he was at length accompanied byanother physician, who designed to admitthe patients into the Fever Hospital then justopened. This gentleman took no precau-tion, but examined the skin of the sick

closely and minutely, standing on that sideof the bed towards which the air from thewindow impelled the contagious effluvia,and so near as to receive these effluvia andthe breath in the most concentrated state.He immediately after took the infection,

and his fever proved fatal. In this case the

disease followed what may be termed a fulldose of the poison, to which incautious zealhad exposed him.

I attended, some time ago, a medicalfriend during a severe attack of commonfever, produced evidently from arduous at-tendance on fever patients. He resided inan open elevated situation ; and, at thecommencement of his illness, his family andservants were all in full health. He wasnursed, at the commencement of his disease,by a faithful servant, who never evinced theleast dread of free exposure. She had con-tinued her attentions, however, for a veryfew days, when she became ill with the ordi-nary symptoms of fever, and passed throughthe disease. She was succeeded in her du-ties by a second servant, who very soonshared a similar fate; both servants weretreated at the same time, having caught thefever evidently from their master. Now it

happened that, besides those who were at-tacked with fever, there were in all seven

persons in this family, but none of themwere permitted to enter the sick chamber ;and what was the result of this quarantine ?my friend was afterwards nursed by a per-

son accustomed to this occupation, and noother individual took the disease.

A very short reflection on this case, mustconvince any one, that if there existed alocal cause, such as malaria, in the dwellingin which this family resided, and whichsome sceptical minds might assert to be thecause of the disease in those who took it, Iwould ask why did the other members

escape, and why were those only selected,as it were, who visited the sick chamber,and personally nursed the first individual ?The answer is plain and logical, that theformer escaped, because they were not ex-posed to any source of infection, and thelatter were attacked because they inhaledthe contaminated atmosphere of a fever pa-tient. Those who oppose the doctrine ofthe communicability of fever by contagion,inquire, how can the doctrine explain thesimultaneous attack of many individuals, orthe occurrence of the disease in a single in.stance, or in places remote from each other ?It cannot be disputed that fever occurs epi-demically, or from the influence of localmalaria, but will fever thus produced, bepropagated to individuals at a distance fromsuch causes ? The following case provesthis question in the affirmative :-

Dr. Pritchard attended a child labouringunder a very severe attack of fever in PaulStreet, Portland Square, which according to acommon though not well founded opinion, isone of the most unhealthy parts of Bristol.Another child of this family had been sent,as soon as the disease appeared, to thehouse of a relative in Kingsdown, a hill of

782

considerable elevation. This child, how-ever, sickened of-fever, and a servant of thefamily on the hill was soon afterwards sentinto the infirmary under the same disease.The latter had never gone into Paul Street,and therefore cannot have been subjected tothose local miasmata, which have been sup-posed so closely to imitate contagion. Dr.

Haviland, in an account of the fever whichoccurred at Cambridge during the springof 1815, states, it became a very interestingquestion to determine, whether or not thefever was infectious ; at first he was dis-

posed to think it was not-latterly, how-ever, he had reason to doubt the correctnessof this opinion, and the following circum-stance confirmed those doubts :-A servant girl who was ill, was sent home

from a family in the town to her friends, wholived at a cottage distant about ten milesfrom Cambridge, at Stretham Ferry. Herdisease proved to be fever, of which she re-covered ; nearly all the family became after-wards ill of the same complaint, of whichthe father died.

Dr. Armstrong, in his lecture on con-tagion, states, that some years age he at- iltended an individual who had an inter-mittent fever or ague, which, in a few days,lost the intermittent type, and became asdistinctly remittent for a few days, and thenthis remittent changed its character, and be-came continued, and assumed the most ma-lignant symptoms of typhus. This case

made a deep impression on his mind, andwas sufficient to upset all his preconceivednotions about contagion, and to lead him toconclude that malaria was the primarysource of typhus fever; that this fever hasa remittent, intermittent, and continuedform, and that each of these forms do passand repass into each other, as to show thatthey are really modifications of one affection,so far as their remote exciting cause is con-cerned. It is too much, however, to at-

tempt with one solitary case to overturn allformer doctrines. That continued fever fmay succeed to intermittent or remittent Itfever, has been long known ; and also thatcontinued fever does occasionally assumethe remittent character, is one of the oldestfacts in physic ; but that common continuedintermittent, and remittent fever, are onlymodifications of each other, because theyhave been occasionally traced to arise fromthe same cause, is an assumption by no imeans warranted by facts. I have latelyattended some members of a family undersimilarcircumstances, but the results which II shall detail have led me to an oppositeconclusion with my friend Dr. Armstrong.

Last autumn I was requested to attendan individual in a family residing in one ofthe open airy squares in town. I was in- I :

formed by her mistress, that during a short

residence at their seat in Essex, she be-came ill, and symptoms of tertian ague were

soon distinctly marked. As the fit was ofshort duration, and not remarkably severe,she was not put under medical treatment,but returned to London, and resumed hersituation in their establishment in town.

The fever, by and by, assumed the form ofquotidian ague, which shortly lapsed intomild continued fever. At this period of thedisease I was consulted, and found her withsymptoms of acute cerebral excitement.She was removed, after a few days delay,into the Fever Hospital, the wards being atthat time unusually crowded. During thefew days I attended her in the house of thisfamily, one of the daughters was particu-larly kind in her attentions to this servant,frequently visiting, and partially nursingher. A day or two after this young ladywas attacked, and passed through mild con-tinued fever. She had slept with her motherfor a few mights, till, by my request, shewas placed in an adjoining room. Themother was also seized with fever, and bothwere ill at one time. I gave. particulardirections that the mother and daughtershould not be visited by the other membersof the family who had now returned to town,and the servant was removed to the Hospi-tal. No other individual of the family tookthe disease. The servant, after a long andtedious illness, eventually recovered; but

during the cold easterly winds of spring, shehad another attack of tertian ague, which

proved unusually obstinate.With this single case I am not prepared

to assert more than the facts warrant, but it

apparently leads to the conclusion, thatwhen malarian fever assumes the continuedform, it does spread from person to person.I could adduce volumes of additional casesfrom the records of the Fever Hospital, toprove the contagious nature of fever. Ineed not adduce the every day instances ofevery individual of a family becoming suc-cessively attacked-the one after the other,spreading from floor to floor. and from roomto room, sparing neither the young nor theold. It is also by no means unfrequpnt, tofind relatives and friends who attend, or

only occasionally visit persons in fever, be-coming themselves the subject of the dis-ease on returning to their home, often at adistance from the place where they caughtinfection, and then communicating the dis-ease to others, who have not been exposedto any other possible source, except con-tagion from their bodies.

I would, however, in conclusion, haveyou to bear in mind the vatious predis-posing and exciting causes of fever, and torecollect under what circumstances fever isfrequently generated. I trust I have shown

you satisfactorily that fever spreads by con.

783

tanion, which may he a frequent cause or act,according to many individual circumstances.It is also certain, that the noxious principlecapable of generating fever, may be so di-luted by a fresh and pure atmosphere, as to

be incapable of spreading the disease-verymuch in the same way, as concentratedacids may be so diluted as to destroy theiracrid caustic properties. The importance,therefore, of keeping the chamber of a feverpatient thoroughly well ventilated, is tooevident to be overlooked-fresh air provinghighly beneficial to the patient, and diminisli-ing, in a very great measure, the proba-bility of the spreading of the disease.

FOREIGN DEPARTMENT.

Passage of a licetus by the Anus..

THE subject of this paper is a woman whohad been pregnant four times ; once shewas delivered of a child, come to the fulltime, and thrice she miscarried. Towards theclose of her fifth pregnancy, in the course ofwhich nothing extraordinary was observed,slie felt pains resembling labour pains, at firstthey were slight, soon became strong, butceased altogether in two days. After expe-riencing a sensation in the abdomen as if

something had burst, the waters ceased, andat the same time a small quantity of very foetidblood. A midwife accurately observed theflow of the waters, but found the neck of theuterus still very much elevated and comple te-ly shut. A physician was called, who was ofopinion that the time of labour was not yetcome, the more especially, because the pa-tient thought she had not been pregnantmore than six or seven months. The ex-

pulsive pains returned no more, the breastsenlarged, and peritonitis declared itself,accompanied with very intense nervous

symptoms. The belly was very painful onthe right side, and presented a hard andimmoveable tumour. The fever, however,left her, and the pain of the belly greatlydiminished. A few days after, some green-ish bloody matter, of a mouldy odour, passedout through the vagina. The passage of thissubstance and the pain lasted neaf-ly threemonths. Then the patient, after menstru-ation, passed by the vagina some folds ofrotten and putrefied flesh in a blackish li-

quid. Three months after this, she again

* Nouvelle Bibliotheque, Juillet, 1827.

felt the pains of the side, which soon distip4peared.About nine or ten months later, the pa-

tient again felt the pain, and it increased inthe same degree as her pregnancy. Lastly.the exit of a dead and putrefied foetus, iiOctober, 1820, put an end to the symptoms,the tumour of the belly still remaining. Thepatient being troubled with colic, was in-duced to take an enema. She thought thatshe could distinguish in the faeces a frag-ment of bone, and a few days after, thereappeared at different times a temporal anda parietal bones, ribs, thigh-bones, &c. Aa recto-vaginal fissure was established, butin July, 1821, the tumour on the belly, toge-ther with the fissure, had disappeared, her ap-petite and strength returned, and the patientappeared to be in a fair way for recovery.

lJfonst1"ositYAThis case consisted of two embryos form-

ing only one body, which had been born be-tween the second and third months of preg-nancy. The two trunks were united to eachother throughout the whole extent of theiranterior surface. Both of them had a verylengthened head, and adhered to the sameplacenta by one common umbilical chord,which was thick and short, and grew nar-rower before it penetrated the abdomen.

The mother, 30 years old, had three veryhealthy children, and at their full time ; butshe was subject to hysteric symptoms andderangement during menstruation. The

miscarriage had been preceded by violentconvulsions.

Pores of the Skin.

It is well known that Leeuwenhoek said,that he counted 14,400 pores on a squareline of flesh, so that a square foot wouldcontain 20?,:i60,000. The whole surface ofa middle-sized man is 14 square feet, which,according to the Dutch, anatomist, wouldgive 2,904,040,000. pores. M. Henry Ei-chorn Goettingen, wishing to be convincedof the accuracy of this assertion, lately in-vestigated the subject, and found that thereare only 5,000 pores on a square inch of flesh,and consequently 10,080,000 in a man.

GIRAFFE.*

* Revue Medicale, August, 1827.

I2ztiitcte if ’rance.-Sittirzg of the 2d of Jtl,lyI M. G. St. Hilaire entertained the Aca-demy with an account of the giraffe which

; the Pacha of Eypt presented to the King