Sayfadaki görseller

in 'effect, and recommending with him the tartarized anti. mony.-Such, indeed, is the ultimate co-incidence of Dr. Fordyce with the celebrated professor, that the inextricable mazes of his previous reasoning seem only calculated to make his reader forget the uradorned approaches of the First Lines. The circumgyrations of Dr. F. are sometimes truly amazing:

• The next question which occurs is, whether there is any other | medicine which produces the same effects either more certainly, less

certainly, or equally with the preparations of antimony which have been enumerated ? It is matter of consideration whether this question should be first discussed, or whether it would be better to enter into the argument in what manner the preparations of antimony, hitherto described, should be employed, so as to have the best chance of carrying off the disease.

• There are many reasons that might be urged for taking the one or the other argument into discussion first; but it is not worth while taking up time in discussing this; it is therefore the author's determination, upon the whole view of the subject, to pursue the best method of employing preparations of antimony to produce crisis in fever, though he is not sure that he is right, as he may be obliged, in many instances, to take notice of the effects of other medicines which have a similar action in fevers, and produce a crisis in them.'

This ingenious passage seems to have been borrowed from the dialogue of the Usher and Physician, in the Rehearsal; where the learned speaker divides the question into three parts ; “ First, When they heard ; secondly, how they heard; and, thirdly, whether they heard or not ??"

We greatly doubt whether any practitioners in this kingdom entertain the opinions thus mentioned by Dr. Fordyce:

• It is still the opinion of many practitioners, that when an inflammation carries off a fever, if it be such an inflammation as tends to terminate in suppuration, the matter that occasions the fever in the whole system is accumulated in the inflamed part. When the abscess is formed and breaks, and the pus is evacuated, many practitioners still believe that the matter which first produced the fever is evacuated. Other inflammations, such as arise in the skin for 'example, do not terminate in suppuration, but in a blister rising; that is the scarf-skin separates from the true skin, and contains in it prin. cipally the superfiuous water and the neutral salts of the blood, 'sometimes along with a little serum, and sometimes also coagulable lymph, which coagulates and gives some degree of solidity to the matter contained in the blister. The scarf-skin afterwards breaks, and leaves the skin excoriated till a new scarf-skin is formed ; until that happens, a quantity of the superfluous water of the blood, together with the neutral salts, flow out. In this case it has been supa posed that the Auid, or whatever other matter it might be that occasioned the fuver, continues to be evacuated, and that so the fever is carried af.'

This laboured refutation, however, must have been suppressed, if the Doctor had not brought forwards these medical antiques as modern fashions.

In proceeding with the work, we find such a want of arrangement, that it is impossible to offer a connected criticism on it. The question concerning bleeding, after having been apparently dropt, is intermixed again with every class of remedies, and stares us in the face, like the “ blood-boulter'd Banquo,” when we least expect it.--Altogether, we must confess, that we have been much disappointed in this part of Dr. Fordyce's performance.


ART. XIV. Transactions of a Society for the Improvement of Medical

and Chirurgical kuowledge. Vol. II. 8vo. pp. 378. 7s. 6d. , Boards. Johnson. 1800. *HE utility of collections like the present, when judiciously

formed, is now well impressed on the public; and the nature of this society has been already explained by its former publication. We shall therefore proceed without ceremony to an account of the different articles in the volume now before us,

Observations on the Case of a Woman who died with a Fætus, in the Fallopian Tube. By John Clarke, M.D.-In this case, a great part of the substance of the fætus was discharged from an abscess communicating with the surface: but, the patient sunk under the process. It was a remarkable circumstance in the case, that pains resembling those of labour came on at the end of nine months from conception. The description of the disa section is illustrated by two engravings.

Account of a Case in which Death was brought on by a Hemorrhage from the Liver. By G. Blane, M. D. &c.-l'he appear-, ances in this case were remarkable :

• Upon laying open the abdomen, a large quantity of coagulated blood was discovered, covering the whole left side of the intestines. in exploring the source of this, several fissures were observed in the left lobe of the liver, which were about two-thirds of an inch in length, whence the blood had undoubtedly flowed, for they were found to lead to a cavity in the substance of the lobe of about the size of a pigeon's egg, and full of blood. The peritonzum, on the surface of that part of the liver which was near one of the fissures, was raised from the liver like a blister, full of coagulated blood. These appearances were on the lower surface of the lobe, but on the upper surface of the same lobe there was one fissure, round which was a similar collection of blood between the peritoneum and the substance of the liver, and it led to a small bloody cavity near the surface of the liver.!

We cannot, however, assent to the whole of Dr. Blane's reasoning on the subject.

[ocr errors][ocr errors]
[ocr errors]

· An Account of the Craup, as it appeared in the Town and Neighbourhood of Cheskam, in Buckinghamshire, in the Years 1793 and 1794. By Henry Rumsey, Surgeon at Chesham.—Mr. Rumsey did not find the antiphlogistic method of treatment successful in this epidemic: but his failure may have arisen from the late period of the disease (from the second to the third day) in which he was under the necessity.of adopting it. He turned his attention very properly to other remedies, better suited to the advanced state of this rapid disease at which he was usually consulted; and he found repeated emetics, and large doses of calomel, extremely serviceable.—The cases are clearly stated, and the author seems perfectly candid in his reports of the effect of the different modes of treatment.

The Case of a young Wornan who poisoned herself in the First Month of her Pregnancy. By Thomas Ogle, Surgeon, Great Russel-street, Bloomsbury. To which is added an Account of the Appearances after Death, by the late John Hunter. The only remarkable circumstance, in the accurate statement of this dissection, is the invisibility of the feetus at this early period of pregnancy. We shall extract the concluding remarks:

• The presence of a corpus luteum, the enlargement of the uterus, the newly formed vascular membrane, or decidua, lining the cavity, and the history of the case, sufficiently prove conception to have taken place; and the embryo being no where to be detected by an examination so accurate, and conducted by an anatomist so skilful in minute investigation, would induce a belief that the fætus had not been sufficiently advanced to take on a regular form.

• The appearances in the uterus, here described, the late Dr. Hunter in his lectures mentioned to have seen at a very early period after impregnation : so far they are not entirely new. The accuracy of the examination renders this case valuable, as it seems to enable us to decide a point hitherto not at all understood—That certain chånges in the uterus not only take place previous to the reception of the fætus, but that the fætus does not acquire a visible form for some time after these changes have been made.'

Account of a Case of Diabetes, with an Examination of the Appearances after Death. By M.

By M. Baillie, M.D.-The kidneys, in this case, were in a diseased state; and the blood vessels were more numerous than they naturally are, so as to exhibit an appearance like inflammation.

A very small quantity of a whitish fluid, a good deal resembling pus, was squeezed out from one or two infundibula in both kidnies, but there was no appearance of ulceration in either.'

In some very judicious remarks annexed to this paper, Dr. Baillie examines the most prevalent theories respecting the cause of diabetes. He shews, by very satisfactory arguments, the slight foundation on which the disease has been imputed to a defi

ciency in the assimilation of chyle; which was the opinion held by Dr. Cullen and Dr. Dobson. The theory of Dr. Darwin, which varied from the former only in the difficult conjecture which he super-added, -of a retrograde action in the lymphatic system, by which the chyle was carried to the kidnies, instead of passing into the thoracic duct,-is here powerfully controverted. The quick discharge of urine, ' after watery fluids have been drank,' is explained by Dr. Baillie to arise from the sympathy between the stomach and kidnies.

The author of this interesting paper does not substitute any theory of his own : but he seems inclined to attribute the disease to a morbid action in the kidnies themselves.

An Account of Two Cases, shewing the Existence of the Smallpox

and the Measles in the same Person at the same Time. And an Account of a Case of Ague in a Child in Utero. By P. Russel, M. D. &c.-In these curious instances, the eruptions of the two diseases made their appearance together, and ran their course in a few days. The case of the ague in the unborn fætus was well-rnarked.

Cases and Observations on Strangulated Hernia. By Everard Home, Esq.—Three cases are here particularly detailed. We shall insert the conclusions drawn from them at the close of

the paper :

« From these cases we learn, that the symptoms correspond with the state of the intestine. When the stricture is only sufficient to compress the intestine, and to prevent the contents from passing through the strangulated part, there is vomiting, hickup, thirst, and general uneasiness, which symptoms come on some hours after the protrusion of the gut, and are very slow in their increase.

• When the stricture is in so great a degree as to produce inflanimation on the compressed part of the gut, the symptoins come on immediately; the vomiting does not cease upon the stomach discharging its contents, but the retchings continue: there is a considerable tenderness over the whole belly; the pulse is quick and very small, and the spirits of the patient are much depressed. These symptoms are inore or less violent, and their progress is more or less rapid, in proportion to the degree of the inflammation. If it only produces adhesions, the pulse is less contracted, there is less tenderness over the abdomen, and less depression of spirits.

· When the stricture is so tight as to obstruct the circulation of the blood in the part, all these symptoms are met with in the greatest degree of violence; an unusual coldness is felt over the surface of the body, and mortification takes place in the strangulated portion of the intestine.

• As in all the cases which I have stated there was an opportunity both of tracing the symptoms, and examining the state of the intestine, the conclusions which have been drawn are the more to be depended on; and should they be confirmed by future observations,


they will assist us considerably in judging of the expediency of performing the operation at an earlier period in some cases than in others. I am induced to believe, that they are strongly in favour of immediate operation in cases which are in general thought to admit of delay.

"" Tlie femoral rupture, on account of the strength of Poupart's liganient, will be more liable to have the parts compressed in a greater degree, and consequently to be more violently affected by inflammation.

• In such cases the operation should be sooner performed; whereas, on the contrary, surgeons have been more inclined to delay it, from the difficulty and danger arising from the parts which are liable to be hurt in performing the operation.

• Constitutions are very differently affected by the same local mischief; some patients recover after mortification has taken place in the portion of strangulated intestine, while others sink under a much less violent degree of inflammation; it is therefore in general right, even in the most hopeless cases, to perform the operation. There is, however, one symplom that comes on in the last stage of this disease, which appears to be the immediate fore-runner of death, and after it has taken place, I apprehend the operation will always prove ineffectual. This is a general coldness, attended with moisture over the surface of the body; it is, to the feel, even colder than the skin of the same person when dead; but the real degree of cold (I believe) has never been measured by a thermometer.

• In every case I have met with, in which this symptom had taken place, the patient died; in some the operation was performed, in others it was not ; but in all of them the patients continued to sink gradually, and in less than twenty-four hours expired.'

A fatal Case of Hernia of some of the Abdominal Viscera stran. gulated in the Cavity of the Thorax.—By John Clarke, M.D. In this singular case, a part of the colon was forced into the thorax, through an aperture in the diaphragm. We shall add Dr. Clarke's observations :

Similar perforations of the diaphragm, with an intrusion of more or less of the abdominal viscera into the cavity of the thorax, have been sometimes found in children; but the patients have been soon destroyed after birth, by difficulty of respiration, from the lungs not being capable under sach circumstances of being expanded. In these instances, the abdominal viscera have been sometimes found in the right, and sometimes in the lefi side of the chest.

My enquiries have not furnished me with any other instances of strangulation, or even of perforation through the diaphragm.

. Several things in the history of this case, compared with the appearances after death, induce me to believe that the viscera had been for a long time in this unusual sit tation. The diminished size of the lung of the left side, his occasional costiveness for many years, the pain which he always felt from any pressure on his belly, and the pain in his shoulder, all favour this opinion. The liver too was


« ÖncekiDevam »