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309 MR. VAN BUTCHELL.-SIR A. COOPER.-DR. EADY. That the Bill may extend to Ireland, and thus place the schools of anatomy in that country on the same footing as those in Eng- land, as the exclusion of Ireland from the penalties of the law, would go to sanction the exportation to Dublin, of exhumed and even of murdered bodies from England and Scotland. That the Royal College of Surgeons may not be entrusted with the powerof grant- ing licences or certificates for dissection, and that the Court of Examiners be re- quired to examine all candidates for the di- ploma without the production of any certifi- cates whatever, regarding the knowledge dis- I played by the candidate in the course of his examination, as his only claim to be en- trusted with the health and lives of his Majesty’s subjects; thus giving to talent and industry their due reward, whether found in the humble tenement of a village, or in the gorgeous mansion of a city. And your Petitioner, as in duty bound, will ever pray, &c. We again repeat, that there can be no security for the public against murders simi- larto those committed by BURKE, until the SALE of a dead body be interdicted by the severest penalty that the law can impose; and that the prejudice against dissection cannot be dissipated, so long as the legisla- ture shall deem the operation, an appro- ptiate mark of punishment and degradation for the vilest of felons. Mn. E.M.VAN BUTCHELL has been libe- rated from Newgate, on bail. His trial will be one of very great interest, and we shall be much deceived if any portion of the evi- dence that will be elicited, should go to a justification of a verdict of manslaughter. Suppose Mr. MARTIN VAN BUTCHELL had performed the operation of lithotomy on " a healthy countryman"-that the man had died twenty-nine hours after the operation, and that Mr. CALLA WAY, on dissection, had dis- covered that there was some eechymosis be- hind the peritoneum, at the posterior part of the left iliac region ;—that there was a free division of the prostate, and a clean cut into the bladder,-a small tongue-shaped body immediately behind the meatus urina- rius, composed of a portion of bladder and prostate, formed by another incision com- municating with the first, and a third of an inch behind the opening of the -meatus,- that the edges of the incision from the ex- ternal opening to the bladder, were ragged, and that there was a passage at the side of the bladder. Furtlier, suppose Mr. CAL- LAWAY had been informed that the operation lasted an hour, that gorgets and scoops, and scoops and gorgets, knives and staves, and staves and knives; forceps and fingers; and fingers and forceps, had been thrust into the patient’s body, the whole of the time, and that Mr. Van Butchell had re- peatedly declared, he could not explain the cause of difficulty ,-what, we say, would be the evidence of Mr. CALLAWAY at the trial of the operator on a charge of manslaughter ? ? Mr. LLOYD would do well to reflect on this. Let it not be said that the balance of Justice is held with a partial hand in England, even between quacks, whether of advertising Oê of hospital notoriety. DECENCY AND NO QUACKERY. THE following advertisement, or what else shall we call it, has frequently ap- peared in the morning and evening papers, within the last fortnight. This Day is published, ILLUSTRATIONS of the DISEASES of the FEMALE BREAST. By Sir Asr LEY COOPER, Bart. Serjeant-Surgeon to the ! King. In the Press, and very shortly will be pub- lished, by the same Author, ILLUSTRATIONS of the DISEASES of the TESTES. Sold, &c. Dr. EADY, of Church-street, Soho; ortho- dox Dr. EADY ! continue to chalk the brick walls, old doors, and lamp posts, with thy name and address simply, and thus show nit example, worthy of speedy imitation, to the SERGEANT-SURGEON of our KING.
Transcript

309MR. VAN BUTCHELL.-SIR A. COOPER.-DR. EADY.

That the Bill may extend to Ireland, andthus place the schools of anatomy in thatcountry on the same footing as those in Eng-land, as the exclusion of Ireland from

the penalties of the law, would go to sanctionthe exportation to Dublin, of exhumed andeven of murdered bodies from England andScotland.That the Royal College of Surgeons may

not be entrusted with the powerof grant-ing licences or certificates for dissection,and that the Court of Examiners be re-

quired to examine all candidates for the di-ploma without the production of any certifi-cates whatever, regarding the knowledge dis- Iplayed by the candidate in the course of hisexamination, as his only claim to be en-

trusted with the health and lives of his

Majesty’s subjects; thus giving to talent

and industry their due reward, whetherfound in the humble tenement of a village,or in the gorgeous mansion of a city.And your Petitioner, as in duty bound,

will ever pray, &c.

We again repeat, that there can be no

security for the public against murders simi-larto those committed by BURKE, until theSALE of a dead body be interdicted by theseverest penalty that the law can impose;and that the prejudice against dissection

cannot be dissipated, so long as the legisla-ture shall deem the operation, an appro-

ptiate mark of punishment and degradationfor the vilest of felons. ’

Mn. E.M.VAN BUTCHELL has been libe-

rated from Newgate, on bail. His trial willbe one of very great interest, and we shallbe much deceived if any portion of the evi-dence that will be elicited, should go to a

justification of a verdict of manslaughter.Suppose Mr. MARTIN VAN BUTCHELL hadperformed the operation of lithotomy on " ahealthy countryman"-that the man had diedtwenty-nine hours after the operation, andthat Mr. CALLA WAY, on dissection, had dis-covered that there was some eechymosis be-hind the peritoneum, at the posterior partof the left iliac region ;—that there was afree division of the prostate, and a clean cut

into the bladder,-a small tongue-shapedbody immediately behind the meatus urina-rius, composed of a portion of bladder andprostate, formed by another incision com-

municating with the first, and a third of aninch behind the opening of the -meatus,-that the edges of the incision from the ex-ternal opening to the bladder, were ragged,and that there was a passage at the side of

the bladder. Furtlier, suppose Mr. CAL-LAWAY had been informed that the operationlasted an hour, that gorgets and scoops, and

scoops and gorgets, knives and staves, andstaves and knives; forceps and fingers;and fingers and forceps, had been thrust

into the patient’s body, the whole of thetime, and that Mr. Van Butchell had re-

peatedly declared, he could not explain thecause of difficulty ,-what, we say, would bethe evidence of Mr. CALLAWAY at the trial

of the operator on a charge of manslaughter ? ?Mr. LLOYD would do well to reflect on this.

Let it not be said that the balance of Justiceis held with a partial hand in England, evenbetween quacks, whether of advertising Oê

of hospital notoriety.

DECENCY AND NO QUACKERY.

THE following advertisement, or what

else shall we call it, has frequently ap-peared in the morning and evening papers,within the last fortnight.

This Day is published,

ILLUSTRATIONS of the DISEASES ofthe FEMALE BREAST. By Sir AsrLEY COOPER, Bart. Serjeant-Surgeon to the! King.In the Press, and very shortly will be pub-

lished, by the same Author,ILLUSTRATIONS of the DISEASES of

the TESTES.Sold, &c.

Dr. EADY, of Church-street, Soho; ortho-dox Dr. EADY ! continue to chalk the brick

walls, old doors, and lamp posts, with thyname and address simply, and thus show nitexample, worthy of speedy imitation, to theSERGEANT-SURGEON of our KING.

310 REVIEW OF DR. MACKINTOSH’S

Elements o/ Pathology and Practice o/’Elements of Pathology and Practice ofPhysic. By JOHN MACKINTOSH, M.D.Acting Surgenn to the Ordnance, N. B., i

and Lecturer on the Practice of Physicin Edinburgh. Edinburgh, Carfrae.London, Longman. 1828. pp. 484.

THE reputation of Dr. Mackintosh, whichlias for many years stood deservedly high inthe profession, has latterly been greatly en-hanced, by his bold and successful innova.tion upon the established treatment of one

of the most perplexing disorders with whichthe art-of medicine has to contend. Disre-

garding immemorial custom, and despisingprinciples which wanted the support of bothfacts and reason, Dr. Mackintosh was thefirst to deviate from the beaten path in inter -mittent fever, and to set a strong example ofthe importance of attacking with the lancetthe cold stage of this difficult disease. Heis now extensively known as the author ofa remedy which has, in a multitude ofcases besides those in his own immediate

practice, proved at once decisive and valua-ble.

In the course of the last volume of this

Journal, we published, as our readers areaware, a series of cases in proof of theefficacy of Dr. Mackintosh’s plan of treat-ment, and with the impression, that in

noticing his present work, we cannot ren-der those of our readers who have not yetseen it, a more acceptable service, we shallendeavour to present them with the views ofthe author on the subject of intermittentfever. Our extracts will necessarily occupya considerable space, and we shall refrain,therefore, from giving a general analysisof the work, which, however, could wend room to do it justice, it would amplydeserve. Before inserting the extracts, wemay observe, that the present is the first oftwo volumes which are intended to containthe whole of the theory and practice cf me.dicine, which Dr. Mackintosh LaJ been

teaching in Edinburgh for several years.The second volume, we believe, is upon theeve of publication, and, if we may judge bythe first, the two will form, both a valua-ble text-book to his pupils, and a work ofinterest to the profession at large. The

present volume is distinguished by clearand sound pathological views, originality

and independence of thought, a fearless ex.posure of wig and gown classifications andabsurdities, whenever they interfere withtrue principles, and contains evidence in

every page, of the acute and experiencedphysician.

Intermittent fever forms the first of thosedivisions into which the subject of fevers ingeneral is separated, and the definition, phe.nomena, causes, pathology, treatment, andpost-mortem appearances of intermittents,are the heads under which it is discussed.Dr. Mackintosh defines intermittent feverto be

’, " A complaint of very frequent occur.

rence in all warm countries, and one of the

! purest specimens of a disease dependingupon an irregular determination of blood,in which the system is generally relieved bythe unaided powers of the constitution."

He objects to the usual classification,Instead of three kinds,

" They ought all to be regarded as thesame disease, with a longer or shorter inter.vol ; the one frequently runs into the other.The longer the interval, the more severe theparoxysm, and vice versa."

Under the head of phenomena, Dr. Mac.kintosh has not, as he could not well have,any thing new to add. He observes, how-ever, in speaking of the tremours of the body,"If I can trust my own sensations, and

the accounts I have subsequently heard fromothers, these affect internal as well as ex.ternal parts."We apprehend, that a contrary opinion

would be a very irrational one. It would berather difficult to draw the line between

any external and internal portions of the

body or its organs, with a view to determine

which parts are, and which are not, con.

cerned in that convulsive effort which na.ture is making to recover the equilibrium ofthe blood, when the human frame is said toshiver.On the subject of the causes, we need not

dwell longer than to remark, that Dr. Mac.kintosh’s opinions are decidedly and very

rationally opposed to the doctrine, that expo-sure to marsh miasm will of necessity occa-sion ague. He is also opposed to the opi-nion, that it is ever contagious. A sum.mary of his views are pretty nearly con.veyed in the following passage" From personal observation, sLoquire4

311ELEMENTS OF PHYSIC.

during a residence and many attacks in amarsly district, the first circumstanceswhich attracted my attention were, that menwere more liable to the disease than females,whites than blacks, the dissolute than the

steady, and that agues were most prevalentat new and full moon ;"

.

The daily effects of evaporation being atthat time more prominent, from the tidescovering the marshes.

The Pathology.—Dr. Mackintosh con-

siders that the symptoms which occur in thecold stage are evidences of, and are great inproportion to, a congestion of internal organs,and irregular determination of the blood,the lungs being gorged, and the blood notproperly decarbonised. That the tremoursare attributable to congestion of the spinalmarrow. The sense of cold and pains owingpattly to the state of the nervous system,and partly to the state of the lungs. The

prostration and sinking to obstructed actionof organs; of all which circumstances Dr.Mackintosh considers proof is to be found,in the fact that,

" Abstracting blood in the cold stage willimmediately remove, not only the difficultyof breathing, the pain in the head and loins,disordered functions of the brain, the op-pression at the præcordia, &c., but will also

stop the rigours, restore the strength of thepulse, increase the heat of the whole body,and cause the sensation of cold to vanish."

We come now to the trerctanerct of inter-

mittents, and taking up the argument at thecommencement, shall extract as much of it

as is necessary to the full elucidation of Dr.Mackintosh’s practice. The whole of the

section is written in a style vivacious, prac-tical, and familiar, and, we believe, will beread with a degree of interest that will

render unnecessary any apology for the

length to which the quotation extends.

°’ In the cold stage, which generally lastsfrom half an hour to two or three hours, thefirst thing to be done is to endeavour, byevery means in our power,- to restore theheat of the body, and to relieve uneasy feel-ings, with a view to shorten its duration, andbring about re-action. Hot applications,increasing the quantity of bed-clothes,warm drmks, stimulants, opiates, and asther,have been strongly recommended-with howlittle success, every experienced man cantestify. The best method of applying heatis, to surround the patient with bottles filledwith hot water; and it affords considerable

relief when a sufficient degree of heat is

applied to the epigastric region. It appearsto he more efficacious than the general warm

’ bath, in which I have seen a patient shiver,

and complain loudly of the cold, when thebath was heated above 100°. It is a com-mon plan to give a bumper of gin or brandy,with some pepper, to create re.action, andcut short the cold stage; and there can beno doubt that it has sometimes succeeded ;but I have seen much injury ensue in manycases. This enables us to account for thehorror entertained by the older writers,against cutting short the cold fit, because itwas never attempted by any other meansthan by ardent spirits, large doses of opium,and Eether. Vr. Gregory used to mention,in his lectures, two cases of violent epis-taxis, which reduced the patients to greatweakness, succeeded to doses of brandy andpepper. In the instances which fell undermy own observation, and to which I havealready alluded, violent head symptoms SUC.-ceeded, and, in two or three instances, localinflammations.

Bleeding in the cold stage will in a greatmajority of instances, cut it short; in fact,it will rarely fail in stopping the existingparoxysm, and, on many occasions, it has pre-vented a return of the disease to which thepatients had been long subject, and by whichthey were nearly worn out. It is difficultto determine what quantity of blood it willbe necessary to draw in any given case ;} sometimes it requires twenty-four ounces ;! I have known three ounces suffice, and, inone case, an ounce and a half produced thefull effect. The better the vein is opened,the greater is the chance of destroying thedisease at a small expense of blood ; but, inmany cases, the operation is attended withconsiderable difnculty, from the convulsivetremours Wh1Ch affect the whole body. Iwas once successful by Mepning in a cold

I stage, which had lasted twenty-six hours.The blood sometimes only trickles down thearm, and, as the system is relieved, the! stream becomes stronger and stronger, till atlast it springs from the orifice, and beforesix ounces are taken, the patient will ex-press the relief from violent pain in thehead and loins. It will then be observedthat he breathes more freelv. The tre-

mours become slighter and slighter, and, bythe time a few more ounces are abstracted,they wil cease altogether, and with themwill vanish the painful sensation of cold.The pulse will be found stronger, and a

gentle n;oisture ,vill be observed on thebody. If the patient is properly managed! with respect to bed-clothes, neither hot norsweating stage will follow. Most of the pa-tients who bave been treated by myself, orby my pupils under my immediate inspec-

tion, have fallen asleep immediately after

312 DR, MACKINTOSH OVT THE

the operation ; but some of them have evengot up and dressed themselves.*

Cullen stated, that all the subsequentphenomena of fever depended upon the coldstage, which, although a mere hypothesis ofhis, is now, for the first time, proved to betrue ; but it must be recollected that feverssometimes exist without any appearance ofa cold stage, or even a sense of chilliness.The bleeding appears to act by-relieving theheart and large internal vessels from theirstate of engorgement, by unloading the

lungs, and by removing the congestion fromthe venous system of the brain and spinalmarrow; which is exactly what nature

effects, but always at considerable risk, bythe state which is termed re-action. Thatthe practice is sdfe, I am warranted in

stating, not only from my own experience,but also upon the authority of Dr. Haviland,the distinguished professor of the p13ctice ofphysic in the University of Cambridge, whohas tried it in several cases ; of Dr. Malden,of Worcester; of Dr. Buller, of Cork; ofDr. Buchan, inspector of army hospitals,and late physician to the Royal Infirmary ofEdinburgh ; of Dr. Alison, in the clinicalwards of the Infirmary ; of Dr. Cambridge,who saved the life of a gentleman on theContinent by this means, after bark andarsenic had failed, and who was so fully im-pressed with the value of the remedy, thatlie afterwards submitted himself to the

operation on two different occasions. Dr.William Stokes, of Dublin, a physician of

great promise, has also tried this practice ona tolerably large scale, and with all the suc-cess which lie had been led to expect frommy papers upon this subject ; and he haspromised to lay the results speedily beforethe profession. Thee gentlemen, and manyothers, have given their testimony not onlyas to the perfect safety of bleeding in thecold stage, but as to its great efficacy instopping the paroxysm in a moment, andalso in many cases as to its curing the dis-ease. And if still stronger evidence were

required, I can refer, with great confidence,to the cases in the work of M. Bailly, inwhich the usual remedies either failed, orcould -not be had recourse to from the pati-ent’s dying, shivering in the cold stage. To

satisfy the. credulous, and those who arebigoted to the sy,tem of Cullen, I wouldstill further refer to the dissections recordedin the above work ; and in order to provideevery practitioner with means of formingLn own opinions, I have published an ad-ditionai paper iu THE LANCET, togetherwith all the interesting cases and dissectionsfrom the work of M. Bailly. i

* See cases at page 12, 72, 106, -t38, &c.,of our last. volume.—ED. L.

Since writing the above, and while this I

A curious and an interesting fact wascommunicated to me by Dr. Foot, (whoserved with the 17th regiment in -India,)when he did me the honour to attend mylectures, aud which he has since publishedin his thesis—that some Persian physiciansapply ice to the surface of the body in thecold stage of intermittents, and it is report.ed with good effect. I have also heard thatit is a practice with some in India, to use thecold affusion. It is proper, also, to mentionthe plan of preventing the paroxysm uponthe first appearance of its approach, by ap.plying tourniquets to the extremities, whichwas first noticed by Dr. Kellie, in the istand 2d volumes of the Annals of Medicine.The tourniquets appear to act by confinini5the blood in the extremities, and preventingso much at least of the congestion in inter.nal organs.

’ The best treatment which can be pursuedin the hot stage, is to remove the bed.clothes as far as the season and the patient’sfeelings will admit; to sponge the extremi.ties with water, to use cold drinks, and, infact, to employ every means which can di.minish the temperature of the body. lfthere are marks of any local inflammation,bleeding is to be had recourse to, either

general or topical, and has always been em-ployed, by judicious practitioners, undersuch circumstances ; but it is a curious fact,that although bleeding in the cold stagewill, on many occasions, prevent a recur-

rence of the disease, it is rare that the samepractice employed in the hot stage will harethat effect. I need not speak of febrifugeand diaphoretic mixtures, which are verygood for the druggist, will assist in fillingthe pockets of the routine practitioner, andsuit the notions of a symptomatical physi-cian. It is more than doubtful whethersuch medicines ever diminished theviolence,or shortened the duration, of the hot stageof an intermittent.When the sweating stage commences, it

must he encouraged- till all the uneasy feel-

ings are relieved, or at least mitigated.Great injury is done bv allowing patients toperspire longer, by which they are not onlyunnecessarily weakened, but the subsequentparoxysms of the disease are, in -general,rendered more violent. The best way ofstopping this stage is, to change the linens,after drying the patient carefully with

sheet was in the press, I had the pleasure ofseeing Assistant-Surgeon .Marshall of the87th Regiment, who stated that the practiceof bleeding in the cold stage was now com-monly had recourse to in his regiment; andhe added, that he had never seen a case inwhich he had to regrNt employing this

means, and it had been successful in a con-siderable number of instances.

313TREATMENT OF INTERMITTENTS.

towels, and to place him on a couch. Asecond paroxysm has been frequently tracedto a chill, occasioned by the coldness of thedamp clothes, towards the termination ofthe sweating’ stage. Should there be nomarks of any local inflammation, the patientshould be offered light nourishing food, andeven wine, if necessary.Treatment during the Intervalal. —The

first thing to be done, is to determine whe-ther or not there exists any local disease,and if so, what is its nature and seat Medi-cal men have hitherto deceived themselves

very much by treating this disease, as wellas many others, merely from its name ; be-cause it is intermittent fever, bark must beprescribed ! Another error into which theyhave fallen, in the treatment of this disease,is, that they imagine the only organic le-sions which take place exist in the liver andspleen, whereas the brain and the lungssuffer, perhaps, more frequently. I havealso seen fatal affections of the heart arise inthe train of consequences from intermittentfever. Bronchitis is also a frequent occur-rence. These facts are stated from my own

experience; and, except the last respectingbronchitis, they are fully proved by thecases and dissections recorded by M. Bailly,as well as by the facts which are to befound ill" the works of Pringle, Cleghorn,Chisholm, and others. If any organic disease exists, bark will be injurious, until it (is either mitigated or entirely removed.Hence, M. Bailly came to the followingpractical conclusion, that he bled, to disposethe system to receive the action of the bark, Iand that he has suddenly, by such means,subdued intermittent fevers, which had pre- viously resisted all other means ; and he Iassures us, at page 36(;, that although hewould not proscribe bark, yet he believes!that bleeding alone, in most cases, aboveall, in our climate, would bring about a more fsubstantial recovery than the bark. Healso makes a very strong statement at pa ;e 37;). ’ In the commencement of an inter-mittent fever, (says he,) one is almostalways sure to destroy it bv a large bleed- iing ;’ and he shows that this disease is not!so fatal to poor, debilitated subjects, as tothose who are better off, and better fed.For example, the mortality at Rome, wheregreat misery prevails, is 1 in 26 of the wholepopulation, whereas, in the marshes in theneighbourhood of the Sienne, the mortalityis in the enormous proportion of 1 to 10 ofthe whole population. He also assures us,at page 383, that we are not to dread de-bility ; for he states, that those patientswho were bled by himself abundantly, andm short intervals, not only were not de-pressed by this debility, but recovered in afew Jays a state of strength and of healthwhich tlrey had not known, for a long time.

Had this distinguished author been aware ofthe safety and -success of my plan of bleed-ing in the cold stage, he would not havemade the complaint, that in the worst in..

termittents, that is to sav, those which diedin the cold stage, he had ’ not time to em-ploy bleeding.’ Speaking of bleeding inthis disease, he says, at page 383 :- Car

j’en excepte toujours les fievres intermit-tentes pernicieuses, dans lesquelles on n’au-rait pas le tpmps d’employerla saignee, si onne se rendait pas maitre du mouvement ner.veux par ce precieux anti-periodique.’

It is in such instances as these that thegreat advantage of bleeding in the cold stageis most apparent. In some of M. Bailly’scases, stimulants and bark, in con siderable

quantity, were given without benefic. Bybleeding in the cold stage, we stand uponvantage-ground. We assist the powers ofthe constitution, struggling to create re-

action ; we remove the congestion prompt.ly, before any mischief is produced ; and weplace the patient in a situation in whichthere is no occasion for these efforts to becalled into action, and which, as has beenalready stated, are never excited withoutconsiderable risk. Experience has alsotaught me, that bleeding in the,cold stage isfar more efficacious than bleeding during thehot, or in the intervals. Several cases mightbe quoted, in which bleeding was liad re-!course to in the hot stage, to moderate threat-ening symptoms, but without preventing areturn of the disease at the regular period ;and in these same instances, bleeding in asubsequent cold fit, has had the effect, notonly of stopping the existing paroxysm,but of preventing its return.Bark has been long in use ; and although

I never denied that it had virtues in thisdisease, yet, when given in substance, inthe large doses which are admitted to be

necessary, I have so frequently seen it domischief, that the question has often sug-gested itself to me, whether or not it wasnot more injurious than beneficial? It seems

. to be injurious, in many cases, by overload-ing the stomach and bowels with indigec,*tible ligneous fibre, and I have seen it causeserious intestinal irritation, as displayed bygriping pains in the bowels, diarrhoEa, andpainful tenesmus. On examining the stoolsin these cases, they seemed chiefly to con-sist of bark, with a considerable quantity ofmucus, occasionally tinged with a litt:eblood. The preparation from bark, whichis known by the name of the sulphate of

quinine, is the greatest improvement in mo-dern pharmacy, and the knowledge of itsbeneficial, one might almost say specific,effects in simple illtermittents, affords sui-ficient proof of the virtues of the substancefrom which it is extracted; yet this remedy,all-powerful as it is, is useless in the cola

314 DR. MACKINTOSH ON INTERMITTENT FEVER.

stage, and must also fail in cases complicat-ed with organic disease. Dr. Fordyce, whohad great experience in the treatment ofthis disease, states, that ’ in many cases ofperffctty regular tertians, the most skilfulpractioners have been baffled in the use ofPeruvian bark, and every other medicinerecommended as useful in this disease.’ Myvonthful readers mav rest assured, that thesame observations are equally applicable tothe sulphate of quinine ; yet they will meetvery probably with many practitioners, whowill assure them that they have never seena case in which bark, exhibited in substance,or in any other fom, has failed in theirhands. When they hear such statements,they may rest assured that such practitionershad had the good fortune never to meet witha severe case, or that there is some subter-

fuge. Some medical men, it is but cliari-table to suppose, are in the habit of deceiv-ing themselves ; for 1 have heard of manywho allege they cure every case of fever,and every case of inflammation, by brandy,port wine, and beef steaks; and that the pa.tients are to be regarded as in no danger, ifthey can only be got to swallow plenty ofthese articles. They also state that they icarry lancets in their pockets, but that they inever use them on any occasion. The sen- sible part of the profession regards any manas a quack, or an impostor, who asserts such Iuniversal success in the treatment of fevers iand inflammations, and particularly by such Imeans. It will be found that such indivi- Iduals have recourse to subterfuges of the ifollowing kind. They undoubtedly lose pa-tients; but as they do not choose to admitthey died of fevers or inflammations, theyassert that such a one died in a faint, or

from debility ; cr from cachexia; or from a Ileuco-phlegmatic &tate ; or from the nerves ; i,or from softening of the brain, or some otherorgan, the effects, according to them, of anything but inflammation ! it may be de- ipended upon by those who are young in theprofession, that no means hitherto deviseùcan be expected to be universally success- ,ful ; and the cases have been already pointed ,out, iu which that most potent of all reme- :dies ni intermittents, the sulphate of qui-nine, may be expected to be beneficial, aswell as those in which the same happy re-sa’t is not to be looked for. It cannot betoo strongly impressed upon the mind, thatexperience has taught me to beware of anypreparation of bark, while the putient has,fever, or compiains of oppression at thepraecordia.

Sydenham’s recommendation of pres- ’:

cribing bark in the intervals, has been sup-’ported by subsequent experience. Bark isgiven in substance, in decoction, infusion,and in extract; but no one who has seenthe superior effects of the sulphate of qui- í

nine, will, I am persuaded, ever use bark inany of the other forms, if he can obtain it.With respect to the doses of quinine, An-dral states that Lerminier has prescribed itin a very great number of cases, in twodoses of three and four grains each, with aninterval of half an hour, four or five hoursbefore the paroxysm..And he assures us,that given in this manner, it has almost al-ways cut the fever short. In some cases,the fever has been equally prevented, by theexhibition of the quinine twelve or fifteenhours before the paroxysm. Once the qui.nine was given by accident in the middle ofthe cold stage, and that paroxysm was nei.ther weaker nor more intense than the pre.ceding one. The greater part of those indi.viduals who took the two doses of threegrains each, had slighter paroxysms thanbefore ; but the fever was not suddenly cutshort, as it was in those who took the twodoses of four grains each. He also states,that in two cases the sulphate of quinine.did not subdue the fever till the dose wasincreased to twelve grains ; and Lerminiergave three individuals twenty grains eachduring the day, stopping the fever withoutproducing any accident. But with severalother patients, to all appearance in the samecircumstances with the preceding, a fewgrains of the sulphate of quinine createdtroublesome nervous symptoms, such as,violent palpitation of the heart; oppression ;the globus hystericus ; general uneasiness ;flying pains in different parts of the chestand abdomen. The manner in which 1 have

prescribed the quinine, is to give threedozen of five grains each, with half an hourof interval immediately before the expectedparoxysms ; or three grains every half hour,beginning about three hours before the pa-roxysm. I have taken three and five grains,,without feeling any thing unusual, and Iafterwards ventured upon ten, but a violentheadach followed, and continued nearlvthree days ; I have given ten grains, how-ever, to others, on two or three occasions,without producing any such effect.

Arsenic has been long in use in intermit-tent fever, and there can be no doubt that ithas often proved very serviceable. Fowler’ssolution is the preparation now in generaluse, under the name of liquor arsenicalis ;the dose is from two to twentv drops,twice or thrice a day. Other tones andbitters have also been recommended ; thebest of these is the infusion of quassia.Opiates have also been exhibited, immedi-ately before an expected paroxysm, some.times with benefit, as far as they occasion-ally cut short an attack, but they generallyproduce violent heaaach. Laxative medi.cines, to keep the bowels easy,-form an es’sential part of the treatment ; and in severeinstances, the stools should always be ex.

315MONSTROSITY.—DELIRIUM TREMENS.

amined. I have met with caees which re-sisted every remedy, till it was ascertainedthat the patients had given erroneous ac-counts respecting the number and appear-ance of the stools; and upon the bowels

being put in roper order, the disease hasgiven way without any further trouhle.From the idea that intermittent is a disease

of debility, many practitioners give nourish.ing and stimulating diet, with wine, in all

cases; but after the pathological accountwhich I have given, and the appearancesfound on dissection, a word more need notbe said to show the impropriety of suchconduct. In some instances it is beneficial,where there is no local disease, in others itmust prove prejudicial.-* The patient shouldbe clad according to the season of the year,and the temperature of the climate. Heshould avoid exposure ill bad weather, andparticularly in our climate during the preva-lence of easterly winds, and keep to thehouse after sunset, till he is sufilciently reocovered."

This extract is sufficient to show, that thework deserves the highest station in me.dicallibraries.

LONDON MEDICAL SOCIETY.

May 25th, 1839.

Mr. CALLAWAY, President, in the Chair.

(The last Evening of the Session.)KfTAL MONSTROSITY—DELIRIUM TREMENS

-OTITIS-CLOSE OF THE SESSION.

THE Minutes of the last Meeting wereread.

M;!. FENNER exhibited a specimen of

monstrosity. The patient from whom it hadbeen taken, was a woman at the full periodof utero-gestiitioti, to whom he was called.At’ter delivering her ot a perfect living child,Le thought there was stil, something in theuterus, but from the size of the abdomen,did not expect there could he another child.

* It is quite unnecessary to notice thepractical recoramendations of Dr. M’Cul-loch, who has not practised since the lastcentury, but who, in the year 1827, hastaken upon himself to write a practicalwork. It is surprising that a geologistthonid be allowed to occupy a patho!oO’icalfield of inquiry, without being blown out ojit into his own proper sphere ! ! I entertair.great respect for Dr. M’Culloch, as ache.mist and geologist, but certainly hold himvery cheap as a pathologist.

On introducing his hand, however, he dis.covered an extremity, and, with slight as-sistance, brought away the monster whichwas now before the society. There was butone extremity, which terminated in a sort ofclub-loot, and was attached to somethinaiesembling an abdomen. At the oppositeend was a growth, which seemed designedfor the head, but it had neither ears,

eyes, perfect nose, nor mouth, though it ex-hibited a sort of profile, with the appearance; of a nose. It was attached by the navelstring to the placenta of the other child.

Before the navel string was cut, there wasa very indistinct pulsation in it, but all vi.tality seemed to leave the moment it wasdivided. As far as had been traced, there

was nothing representing heart, lungs, or

stomach. lIe intended to dissect it at afuture period, and shcuid take an opportu-nity of detailing the appearances.The REGISTRAR read a paper, detailing

the circumstances of a butcher, 43 years ofage, who had been attacked with deliriumtremens, which had proved fatal, with anaccount of the post-mortem examination byDr. Hodgkin. The patient had been atw,

tended by Mr. Callaway and Mr. Iliff. Hehad been a hard drinker, as well as a labo-rious man. For a long time past, he hadbeen unable to get out of his bed, and put onhis cloti:es, until he had drank a pint ofporter and a glass of gin ; immediately ongetting up, he had been in the habit ofadding to that, half a pint of ale, and hewould not let many hours of the day pass with-

out doing homage at the shrine of Bacchus.

On Saturday h& was taken ill ; lie had ex-treme difficulty in lifting his hand to his

mouth, when he attempted to take fluids;he had also huskiness and inflammation ofthe throat. Between the time of his being’ taken ill and the following night, he wascupped, had leeches and blisters appliedand opium and aperients administered, whichseemed to have given him relief. Eariy onMonday morning, however, he was seizedwith a violent paroxysm which carried him

o!T. Dissection exhibited a turgidity of all thevessels of the brain ; some ossific patches ofthe dura mater, and a considerable quantityof puriform matter expressible from the

lungs. -

Dr. RYAN wished to know on what prin-ciple this case had been treated.

Mr. ILIFF said, that at the beginning ofthe complaint, a few ounces of blood weretaken away by cupping ; as there was evi-

dently a pharyngeal affection, ieeciies were

applied about the throat ; opium was given,and the bowels were opened, which for atime afforded considerable relief. The dif-

ficulty he had in swallowing, and the con.vulsions lie laboured under, when fluid was


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