the 17th the eruption had spread all over the patient, and was painful in the palms of the hands. On the 18th the febrile symptoms had considerably abated, and the lymph in the vesicles had become slightly straw-coloured. On the 19th the vesicles on the face began to pucker and fade, this stage being less observable in other parts. On the 20th there was no fever-a small brown scab had begun to appear on some of the vesicles; which, on the 21st, had become general, and fell off from the 8th to the 11th day. Mrs. D, punctured the vesicles on the palms of the hands, which had the effect of entirely evacuating the contained lymph, and of leaving them on a level with the surrounding integuments, without being again filled.

Her infant on the breast, which was two months old, not vaccinated, showed, on the 25th December, numerous little red spots on the face, neck, and breast. His eyes were red, his throat sore, and the febrile symptoms severe. The eruption gradually spread to the extremities, and some eruptions appeared to come out successively on parts of the body, for two or three days. On the 26th the lips, the tongue, and the membranous lining of the mouth and fauces were thickly studded with the eruption, occasioning great difficulty in sucking and swallowing. The pocks were distinct-surrounded by a circular margin of inflammation-and gradually filled and enlarged. The fever became moderate; but the irritation and restlessness were alarming. "On the 5th day it was evident the disease was not varicella." "The most superficial observer would now have pronounced the eruption to be small-pox." The central depression was evident; "and it was discovered that the structure of the pock was cellular, and filled again on being punctured.' child died on the 8th or 9th day of the eruption.

On the day of the child's death, Master Dickenson, a younger brother of the mother, and who had been living with her during the period of her sickness (formerly vaccinated) became ill. On the next and succeeding days an eruption came out, exhibiting transparent vesicles in the centre. This eruption' was similar to Mrs. Drury's, and followed the same course.' On the 7th day the boy was so well that Mr. Bampfield withdrew his attendance.

66

We are at a loss to conceive on what grounds Mr. Bampfield upholds the identity of variola and varicella, as far as these cases are concerned. We do not see a single particle of evidence in the whole affair that tends to this identity. Mrs. Drury had been vaccinatedand she exhibits what have been described as modified small-pox. Her infant had not been vaccinated-he exhibits unequivocal variola, and dies. Master Dickenson, on the other hand, had undergone vaccination, and he goes through the modified form, the same as Mrs. Drury. What has varicella to do with the business? As for the cellular structure in the infant's case, Mr. Bampfield will hardly set up a distinction as a proof of identity. There appears, in our humble apprehension, nothing in these cases but proofs of the modifying power of vaccination. We do not enter into the general question of the idendity of variola and varicella at all-we only comment on the evidence before us in Mr. Bampfield's paper.

*

21. Inflammatory Dropsy. The writings of Blackall, Crampton, Parry, Abercrombie, and many modern authors, have thrown much light on the nature, and improved the treatment of dropsy. We were lately much pleased with some observations of Dr. Graham, in the 71st number of the Edinburgh Journal, as they conincide with our own opinions, and will, we hope, prove useful to the rising generation of the profession. The professor very properly observes, that large and small doses of medicine or detractions of blood are merely relative terms, and should never be understood as denoting absolute quantities-for what would prove a large dose or detraction in one person, might prove trifling in another. The general rule of conduct, therefore, ought to be derived from the sensible effect of our practice. Every dose of medicine, however large, is too small-every quantity of blood drawn, however great, is too little, if it stop short of the usual sensible effect on the constitution, though not perhaps on the disease.

If," says Dr. G. "we produce upon the constitution the effect we have reason to look for, and the disease remains as before, then we have indeed fairly tried the prescription, and have sufficient 'reason to conclude that our treatment is inapplicable. If we direct purgatives, and succeed in opening the bowels freely, without relieving the disease, then we have reason to think that cathartics are not suited to the case. If we employ blood-letting in a patient with a full hard pulse, however large the quantity may be that we take away, we do not try the remedy if we stop before we have produced its usual sensible effects,-before we have brought down the fulness and strength of the pulse; but if we have done this, and the disease continues unabated, then we are justified in changing the treatment." Edinb. Journal, No. 71, p. 226.

This we are convinced is the proper general rule of conduct— but, of course, there are many exceptions to all general rules in medicine, and the good physician will not act, like an automaton, upon an invariable principle, but adapt his practice to the specialities of the case.

In respect to blood-letting, the ultimate effect of this measure is to diminish the strength of the circulation, though in the first instance it very often raises it. When we determine on bleeding, where there is a hard bounding pulse, we may allow the stream to flow till the circulation is moderated. The case of inflammatory dropsy minutely detailed by the professor, forms a practical commentary of the best kind on the foregoing reflections.

Case. Robert Norris, a robust young Irish labourer, presented himself at the Infirmary, swelled from head to foot with anasarca, and having obscure fluctuation in the abdomen, little appetite, and thirst; bowels open from medicine; urine scanty; pulse 66, small, and soft. Three days before leaving work, had been attacked with

* Professor Graham, Edinb. Journal, No. 71.

severe rigors, sense of weight and heat at the epigastrium; after which the dema commenced. He had only taken some purgative medicines. Dr. G. learned that he had been much overheated in digging, and as often chilled on going home from his work. The symptoms of fever being inconsiderable, Dr. G. tried the warm bath, purgatives, and diuretics, (calomel, squill, and digitalis,) and on the 3d day blood-letting to twenty ounces, without producing any beneficial effect. On the 4th day he was again bled. On the 6th day another bleeding to 32 ounces, when the pulse rose in frequency and became more soft. The crassamentum had a gelatinous coat, and was contracted on the surface. Seventh day, pulse 80, and soft; but still remarkably full. For several days the lancet was not had recourse to, and the cedema went on increasing, attended with some dyspnoea. The young man now presented a very aggravated case of anasarca, with ascites, and perhaps hydrothorax. "He was distended like a sack"-his weight and bulk prevented motion -eyes sunk and small-appetite quite gone-nights restless. It was determined to carry the bleeding farther. Seventy-two ounces were immediately taken-the first 18 ounces flowing moderately free, the remainder in a very full stream-the pulse continually rising in firmness, and not becoming soft till the very last. There was no tendency to syncope. The patient observed that there was no alteration in his feelings till 60 ounces were abstracted-after this he felt much more happy. There was a slight buffy coat on all the blood. In half an hour after the bleeding he could lie in any position. He slept uninterruptedly in the night, and every night after. Next day his respiration was free, and he declared he felt quite well. Another bleeding, however, of 32 ounces, became necessary a few days afterwards, in consequence of a sense of oppression. This blood was buffed and cupped. From this period the disease rapidly subsided. The bowels were kept very loose by calomel, gamboge, and aloes. The urine rose to eleven pints per diem-the pulse generally about 90, full and soft-no debility attributable to the bleeding, nor other unpleasant symptom, except a degree of chilliness. Some time after he was dismissed cured. It was curious, says our author, to observe how fully the kidneys did their duty after the depletion, without the exhibition of diuretics. When the patient first came into the hospital, the urine was a mere nothing-after the second bleeding it rose to eight ounces-and in the 24 hours preceding the third bleeding he passed two pints of water. On the day after the third bleeding it was two pints and a half-and previous to the great bleeding, it was three pints and a half. After that bleeding it soon got to eleven pints per diem.

We think this case is calculated to do much good. We have no doubt that debility is too often kept up or induced by what is termed cautious bleeding-that is, bleeding to a certain quantity, and not to the production of a certain and necessary effect. We hope Dr. Graham will pursue this and other subjects with that zeal and intelligence which we think are plainly discernable in his character. Vol III. No. 9. 2 D

22. Burns and Scalds. It appears from Mr. Stokes that the Late Mr. Shute, of Bristol, was accustomed to recommend the application of spirit of turpentine, or some warmed spirits, at first, "on the principle of a cooling lotion; knowing that, as the pain. and heat of the part subsided, what at first was a cooling lotion, would become, if continued, a stimulating dressing." After the first day, therefore, or earlier, he inculcated a change to a milder application-the linimentum terebinthina, which might be lowered, if necessary, with olive oil, or simple ointment. He also strictly limited the spirit of turpentine to the injured surface-and had no objection to lotions to the surrounding parts. Where the vital powers were much depressed, he gave cordials-in others, opium to allay irritability. He was very particular in keeping limbs in a state of extension and rest. During the suppurating stage, the following cerate (in use at the Middlesex Hospital) Mr. S. considers as unrivalled. "It seems to soothe while it imbibes the discharge."B. Empl. plumb. oj. ol. oliv. ojss. liquefac. simul, et adjice, assidue movens, cretæ pptæ. acidi acetici aa oss. ft. ceratum.

23. Influence of Chagrin on the Hepatic System. The agency of moral emotions on our physical structure has been observed in all ages and countries. We are no advocates for the identity of mind and matter; but every thing shews us the strong though inexplicable bond of connexion between body and soul-whence spring all the sympathies of mutual pleasure and pain-all the reciprocities of rest and action. We see every passion of the mind act primarily, and with greater or less influence according to their force, on the functions of the body. We see the quickened circulation follow the anger-the start follow the surprize-the swoon succeed the sorrow. In these instances, and a thousand others, it is manifest that the priority of action belongs to the mind. But the converse is not the less apparent in numerous instances. We see mental emotions rendered more vivid by the application of vinous stimulus to the nervous coat of the stomach-depression of spirits follow dyspepsia-irritability of temper result from quickened circulation in the brain-prostration of mental energy from antimony in the stomach, &c. &c. These are all familiar to the least attentive observer; but the peculiar and striking effects of mental emotions on the liver and its functions, have not been so generally described, or indeed remarked, as their frequency would authorize. Of the in- stance related by M. Husson, in the work before us, we shall present a brief outline in this place, as it is calculated to excite our sympathy, and also our indignation on more accounts than one. "Frances Guidet, a female servant, 32 years of age, of strong

* Mr. Stokes. Med. Repos. p. 101

↑ M. Husson. Annuaire Medico-Chirurgical.

constitution, but much sensibility, had enjoyed good health formerly; but having paid the most assiduous and zealous attention to a sick mother and son, in the family where she resided, this faithful domestic, exhausted by watching and fatigue, experienced in her turn a slight indisposition, when those she nursed had recovered. Instead of giving the poor young woman an asylum under the roof of those who were so much indebted to her, she was turned out of the house, and forced to seek shelter in an hospital! This act of ingratitude made such a deep impression on the susceptible mind of the poor creature, that she fell into a state of profound chagrin. When interrogated at the Hotel Dieu, she could only answer by sighs and tears. The most attentive examination could only detect debility of body and dejection of mind. She said she should die of chagrin-a prognostic but too fully confirmed! The day after she entered the hospital her skin and eyes presented a slight yellow tint the countenance being indicative of much internal suffering. The yellow tint became deeper the region of the liver swelledthe prostration of strength became more considerable. The right hypochondrium now became painful, the pulse small, the respiration quick, the stomach affected with bilious vomiting, the bowels with diarrhoea of ill-conditioned matters. No remedies appeared to do good. The liver projected below the ribs-and felt hard-the patient could only lie on her right side, and experienced great pain and misery. Leeches were twice applied to the anus without effect -to which were added diluents and antispasmodics. A bowel complaint reduced her to a skeleton, and finally terminated her existence on the 25th day after her entrance in the hospital. The inspection of the body was objected to by the friends."

This case offers a good illustration of the influence of mental despondency and chagrin on the hepatic system in particular. We have seen a very great number of similar cases, and they were generally much more unmanageable and fatal than hepatic affections from other or physical causes. It was therefore well observed long ago by the celebrated Ballonius:-"Nos vos (inquam) in ipsis operibus artis experientia dedicimus eos omnes quos meror ægritudoque animi in morbum conjecerit, aut letaliter aut gravissime periculosissimeque ægrotare. Tanta est vis ægritudinis ipsius pathematumque animi."-Consil. medecin. lib. iii. It is needless to remark that, in the present instance, no means were taken to check the disease that were at all calculated to effect that object.

24. Poisoning by Arsenic.* A diabolical wretch attempted to poison four people in one house, and succeeded in one case out of the four. The fatal case did not terminate till the sixth day, and consequently no poison was to be substantially detected in the dead

* Mr. Murray, Ed. Journal, No. 71.