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theless, he experienced sensible relief, and even temporary cure, from the internal use of the latter, but no benefit from the former."* 188.
Our author prefers the potash to the soda in calculous complaints in general.
Among many judicious remarks on opium we find it stated by our author that “ he has not seen it manifest any of its peculiar properties, whether local or general ; that is, any narcotic, anodyne, anti-spasmodic, or exhilarating effects, except when brought into contact with some portion of the alimentary canal.” Surely Sir Gilbert cannot be serious here. We have seen both solid and liquid opium ease pain when externally applied as often as we have hairs on our head ; and we fancy there are few of our readers who have not seen the same. Has not every one seen the momentous effects of strong solution of opium, hyoscyamus, conium, &c. when applied in fomentation, where the hot water alone would bave no adequate effect? We refer also to Ward on opiate frictions for further illustration. For our author's observations on the use of alkalies and lime water in irritable bladder, indigestion, and cutaneous affections, we must refer to the work itself, or to the volumes of Transactions already quoted.
The 7th dissertation is on infection or contagion; and though an original article in the volume, it would be uns reasonable to expect much originality on a subject which has been completely exhausted-we are sorry to say without fixed conclusions being come to on many important points. As this section is almost entirely ratiocinative and historical, we could give no fair account of it, and must therefore pass it by. On the great majority of doctrinal points we agree with the learned author-and for the rest we leave them to future tribunals for determination.
The 8th dissertation is on muscular motion, delivered as the Croonian lecture thirty-four years ago. It is too well known to require notice in this place. There are many notes, however, appended, and considerable additions made to the original lecture.
The 9th dissertation is on the yellow fever ; but as “the greater part of this dissertation will be found in the first edition of Medical Logic," and as the subject was taken into consideration rather fully in the sixth number of our
• A remarkable instance of the inefficacy of soda, though given in large quantity, is related in Mr. Home's Observations on Mr. Brande's Paper on the Structure of Calculi, inserted in the Philosophical Transactions for 1808."
Quarterly Series for October 1819, we do not deem it necessary to renew the discussion here. We certainly were not a little surprised to see Sir Gilbert offer as a reason for omitting the greater part of the yellow fever discussion in the second edition of bis Medical Logic, a belief that the question was now decided, and that all
parties had come to the creed of contagion! The parties, we apprehend, have rather too much of a
opposition stuff" in their compositions to be thus so suddenly blended and neutralized, even by the Logic of the worthy Baronet. This he now finds, and like a veteran warrior be returns to the charge, acknowledging that he had calculated without his bost in supposing the enemy vanquished.* The following passage may perhaps shew that Sir Gilbert is not very far, after all, from enrolling bimself with the small band of "contingent contagionists,” among whom we have always numbered ourselves.
“ From my own observation in the islands from the year 1780 to 1783, I had not much opportunity of seeing it in its worst forms. The navy as well as the army, and civil population, were more than ordinarily exempt from it in these years, insomuch, that I saw more cases of what is popularly called the Yellow Fever, which were not of an infectious nature, than of those which were so. I saw enough, however, in the hospital at Barbadoes, and in the ships and hospital at Jamaica, to convince me of its contagious nature in certain circumstances ; and from the best consideration I have since been able to give this subject, I remain persuaded that whenever it is so aggravated as to appear in an epidemic and pestilential form it is truly contagious." 285.
We shall not make more than one or two remarks on this subject. Sir Gilbert allows that he had very few opportunities of seeing the disease in its worst forms, and that in the majority of cases which came under bis notice the disease was not contagious. Now in the majority of cases the fever must have arisen from some cause or causes in the earth or air, for contagion he puts out of the question; and if so, we ask Sir Gilbert, and every unprejudiced man, why it should not arise from similar causes on a large as well as on a small scale ? Why, we ask, is the fever necessarily contagious because a thousand happen to be stricken with it in a day, in various and distant parts of a city or district, instead of a hundred or fifty, or ten? The logic by which we come to such a conclusion may be medical logic, but assuredly it is bad logic.
" I was then (in the second edition) under the belief that the opinion of non-contagion had been nearly eradicated, but finding this not to be the case, I have deemed it my indispensible duty, &c.” P. 286.
In the absence of demonstrable proof, we should be more inclined to come to the opposite conclusion, namely, that where there are only a few cases of the fever it might arise from contagion in the form of fomites; but where a whole people are suddenly assailed, that the cause was a general one conveyed through the air, or springing from the soil. That, in the latter case, (epidemic) an additional source of the disease is occasionally formed by filth, crowding, and want of ventilation, in the form of contagion, we readily admit, and firmly believe ; but that the fever should necessarily be contagious because it is epidemic, is a creed to which we cannot subscribe. It is like too many creeds in this world—the offspring of credulity or prejudice. We are sorry to observe that even a Sir Gilbert Blane is not free from something approaching illiberality, when his darling doctrine of contagion is in question. Thus, in alluding to a very excellent article on yellow fever in the ninth volume of the Medico-Chirurgical Transactions, our author makes use of the following language:
“ The shallow and perverted reasoning of this and some other authors, would not have claimed notice, but as what they give to the world may prove mischievous, by some inexperienced or weak practitioner, applying what is advanced by them, to the pestilential epidemic fever, it becomes the peculiar duty of one, who has been forty years in the medical service of the State, to counteract the baneful impression it may make; and as no example more apt could be selected to illustrate the necessity of verbal precision and discrimination in medical reasoning." 290.
Of these forty years spent in the service of the State, we apprehend that little less than thirty-six were passed in London. Our author was about thrce years in the West Indies, at a period of unusual salubrity, and where he bad, on his own shewing, very little experience of yellow fever. We do not suppose that Sir Gilbert will quote the time during which he was a inedical commissioner at Somerset Place, as particularly fraught with opportunity of observing yellow fever, and therefore we cannot but regard this forty years experience as a knock-down argument very much beneath the dignity of science, and very unfortunately chosen, when the extremely limited sphere of observation of our author is made known. In fine, we cannot help making the remark that, in our humble opinion, Sir Gilbert's knowledge of yellow fever is very scanty, and his opinions very prejudiced.
If our author complains of this language, let him compare it with his own in the extract just quoted. We appeal to himself which of the two is the more severe. to be obliged to express ourselves with any thing like warmth upon this occasion ; but we loo have a duty to perform, as Vol. III. No. 12.
We are sorry
well as Sir Gilbert, and the public will probably give us credit for being equally as anxious as he is to establish truth, and “ counteract baleful impressions."
Sir Gilbert cannot accuse us of being exclusive non-contagionists. We have, ever since we were capable of forming a judgment on the subject, considered the exclusive contagionists and non-contagionists as equally in error. Diseases and their causes are not so simple and uniform as either party represent theni. Fevers will arise from general causes, and they will be propagated afterwards by local ones:-in other words, fevers, endemic or epidemic in their origin, will become contagious in their course--and thus keep up the ball of contention among the ultras of both parties. It is these last, by the way, who chiefly come before the public in brawling controversies. We are convinced that the great body of practitioners, who write little on the subject, are of the moderate way of thinking, and view the question in pretty much the same light as we do.
As our author admits that his practical knowledge of yellow fever is very limited, he makes but two therapeutical remarks, and these we shall give in his own words.
“ The first he will mention is, that he has some reason to believe that a course of mercury, previous to entering the Carribean station, has the effect of removing, or at least of lessening the susceptibility to the yellow fever. The chief fact upon which he founds this, is what occurred in one of the ships of war which arrived in the West Indies towards the end of the American war, in which a great proportion of the crew had been under a course of mercury on the passage; and it was remarked, that after these men arrived and were exposed to the same cause of sickness as the others, they were the only persons who escaped the fever of the climate.
It would appear, that the mercury had reduced their constitution to the standard of the coloured and Creole inhabitants, and of the seasoned Europeans. The Author has no experience of his own on this subject, and leaves it to others to pay such regard to it as their own judgment
• The other remark he has to make, respects certain violent methods of practice which have been followed, even at a very late period, in the tropical fevers. He alludes particularly to the severe depletory remedies of bleeding and purging, especially the former, which have been employed without that discriminating judgment which is indispensable in all sound practice. His attention has been very strongly drawn to this subject, by lately reading the detail of a most afflicting case of a young naval commander, on the West India station. He was seized a few weeks after arrival with a continued fever, the symptoms of which were by no means violent or alarming, nor was he of an athletic frame. The practice followed was that of bleeding every day, from one to two pounds for the
first four days of his illness, and two pounds two days before his death, which happened on the sixth day. The whole quantity of blood abstracted amounted to a gallon. He was also repeatedly and severely purged with salts and calomel. This is the revival of a practice, which had been tried and abandoned on account of its want of success, at the beginning of the great epidemic in 1793. The author does not mean here to explode depletory remedies in all cases; on the contrary, he is well assured, from his own experience, and that of others, that a single bleeding in the first day, or at farthest, the second day of attack, may be highly useful in the case of strong plethoric subjects newly arrived from Europe. It is to be lamented, that the most cautious and judicious employment of remedies have not made any sensible difference in the general rate of mortality in this most malignant disorder; but it is truly humiliating to reflect, that it should be increased by rash and undistinguishing practitioners. Will the junior members of the Medical Service of the Navy forgive a veteran in that department, who has zealously devoted to it a large portion of a long life, for warning and imploring them not to give lightly into such outrageous and indiscriminate practices, as they regard the sufferings and value the lives of their fellow men who are entrusted to their care: not to mention what is above all price in the estimation of every good man--peace of mind, and a clear conscience." 333.
To a certain extent we agree with Sir Gilbert in condemning the indiscriminate, and still more the reiterated and protracted bleedings which have been resorted to in yellow fever, as if it was a mere topical inflammation, for which the lancet must continue to be used as long as the symptoms remain. We are advocates for liberal depletiou at the very onset of the discase, where the reaction is violent; but we deprecate a perseverance in sanguincous evacuations beyond the first or second day.
The 10th dissertation is on vaccination, published in the Medico-Chirurgical Transactions for the year 1819. It bas also been re-printed, with some additions, in the year 1820, by the desire and at the expense of the venerable discoverer of this invaluable preventive of variola. It would be needless for us to farther notice a paper so widely circulated and so favourably known among the profession.
The 11th dissertation contains the narration of a hurricane in the West Indies. This is not noticed as a re-publication by Sir Gilbert ; but we suspect that it has before appeared in print; as it is in the form of a letter from Sir Gilbert to Dr. William Hunter, dated December 220, 1780. Probably it was only published in some of the ephemerals of the day, and is now rescued from oblivion by its parent. * These
This is very natural. As age advances, we look back with mellowed