He found great difficulty in procuring medicines, from different medical men, that would act on his bowels. In this emergency, scanty evacuations of slime were procured by the administration of clysters; but he passed no solid stercoraceous stools; pills of soap and rhubarb, combined with an aromatic, and also the ointment, were now prescribed for him. Pimples appeared within twentyfour hours. These suppurated, and discharged pus with unusual freedom, and disposition to continue to discharge. About the time at which the pustules appeared, a sudden burst of evacuations took place, consisting first of bilious coloured fluid, next of slime of a green hue, and an abundance of shreds of a skinny appearance. In his first stools, at this time, my patient observed a mass, which he conceived to be food and medicines which he had taken previously, and had remained unaltered in the alimentary canal. The pain in his right shoulder and right hypochondrium abated rapidly, and his stools came away more solid, but still enveloped in slime. He is now convalescent, but tender under the margins of the right ribs, and possessing a mitigated degree of unhealthy action about the liver. As his health improved, the eruptions evinced a disposition to dry up, but they have been continued. He had, four years ago, a constitutional sore, which has occasionally healed and re-appeared: its final suppression may have had some connexion with his present complaint. His recovery went on and was perfect in far less time than I could reasonably expect, considering the extreme state of debility to which he was brought by his long and severe sufferings. Within six weeks he resumed his laborious occupation, which was that of a sawyer." 24.

We were lately in attendance on a remarkable case of jaundice from simple obstruction of the ducts, some particulars of which may not be uninteresting. A young medical gentleman in the city had been attending a bad labour-at first protracted, then with retention of the placenta, and afterward, we believe, uterine hæmorrhage. The fatigue or anxiety-or both combined, produced jaundice in about 48 hours after the accouchement. Dr. B. became quite yellow, but continued to go about his professional avocations, complaining of lassitude and all the usual symptoms of jaundice, with very yellow urine and white stools. The jaundice continuing, and the tint deepening for ten or twelve days, with loss of strength and appetite, the patient and friends got alarmed, and we were requested to see the gentleman, with Dr. Farre, and occasionally Dr. Babington. There was at this time no pain in the side or at the pit of the stomach; but the skin was intensely yellow, the stomach irritable, the stools white, the mind desponding, and the physical powers all depressed. The usual remedies were tried, as the warm-bath-mercurials, aperients, local bleeding from the region of the liver, &c. &c. but all without the slightest advantage. In short, the com

plaint went on nearly seven weeks, the patient getting weaker and more emaciated every day, with great gastric irritability. Some of the attendant physicians considered the case as very dangerous, the obstruction being looked upon as of some fixed or organic nature, which would terminate by effusion in some of the cavities. About the middle of the seventh week, however, when great despondency prevailed on all sides, Dr. B. complained of pain, for the first time, at the pit of the stomach, which gradually but rapidly increased, till it ended in the tortures of gall-stones. In about 24 or 30 hours from the commencement of the pain, vomiting, and spasms, a burst of bilious faces came away, with cessation of pain, and, of course, an end of the jaundice. This took place in the night, and the servant threw away the first two or three motions, so that the biliary concretions were not detected, but no doubt could exist as to their having been past by stool.

The above case is highly important in many respects. In the first place it shows how quickly mental anxiety will produce jaundice by obstructing the biliary ducts, probably from spasms of their mouths, whereby the bile stagnates in the passages, and becomes inspissated there. In the second place it teaches that complete obstruction to the natural course of the bile-in other words, simple jaundice, may continue many weeks without being fatal. We have seen but one other case where jaundice from gall-stones continued so long, and ultimately did well. In the case here alluded to, which was also that of a medical man, the obstruction remained thirteen weeks, and then terminated by painful expulsion of gallstones. In general, however, simple jaundice lasting longer than two or three weeks, becomes a dangerous disease, and requiring a very guarded prognosis. In old people it is still more dangerous than in young. In organic diseases of the liver, as where a tubercle presses on and obstructs the ductus communis, jaundice will last many months without proving fatal. We are at this time (April 1822) attending with Mr. Brien, an intelligent surgeon of Spencer Street, a man who has been intensely jaundiced for more than ten months. He has organic disease of the liver, probably tubercles, and is greatly emaciated, but not yet dropsical,

To return to the case of our young medical friend. It appears either that the obstructing cause lay dormant in the duct for so many weeks, like a foetus in utero, until its size or other circumstances induced expulsive efforts in the duct; or else the cause was gradually and slowly advancing to the extremity of the tube, and did not cause pain till it came to its mouth, which is known to be much more sensible than

any other portion of the canal. In either case, we apprehend that we have very little power over the mechanical obstruction. In the case under consideration, every mean was tried in vain-including impregnation of the system with mercury-emetics-clectricity-warm baths-soap and alkalies -purgatives-frictions of mercurial ointment, &c. &c. &c. After we had ceased to administer remedies, the expulsive nisus in the duct came on spontaneously, and the concretion was dislodged. But we may here mention that we have seen some instances of jaundice from mental affections, where the cause was very quickly removed, (at a very early period of the complaint,) by administering five or six grains of calomel and two grains of opium over-night, and next morning giving the patient a brisk emetic. We pursued this plan on the supposition that spasmodic constriction of the biliary duct is the first link in the production of biliary concretions, and consequently jaundice; and that the opium and calomel tended to relax this constriction and increase the vis a tergo, or secretion of bile. The mechanical action of vomiting was employed for very obvious reasons. We have to apologise for this digression; but hope it is not entirely devoid of in

terest.

We have now presented our readers with an analysis of those cases which Dr. Jenner has laid before the profession. The trials, as he acknowledges, which have been made of exciting vesiculo-pustular eruptions, are as yet limited, "but he trusts the general favourable results of the experiments made, will apologize for his hazarding a few physiological hints for the consideration of those who may think a wider basis to work upon desirable." These hints are chiefly speculative, and founded on his "favourite pedestal analogy."

It appears that about 40 years ago two papers were pub lished on the subject of the external application of tartrite of antimony-the one by Mr. Gaitskill, an able and experienced surgeon at Rotherhithe ;-the other by Dr. Bradley. The latter gentleman relates some interesting observations respecting the use of the remedy in rheumatic affections. In every instance it appeared to Dr. Bradley to be a remedy of great efficacy; but the disagreeable symptoms produced by it caused many to desert its use. In recent cases, he observes, the first or second application often removed the complaint; but where the cases were of long standing, it was necessary to persevere in the frictions for three or four weeks. In several cases the eruption appeared on distant parts of the body.

Dr. Robinson has lately written (in the Medical Reposi-, tory, January 1821) on the good effects of the antimonial

ointment rubbed on the region of the stomach in hoopingcough. By tartrite of antimony, Dr. Jenner remarks, we can not only create vesicles, but at the same time produce diseased action in the skin itself, by deeply deranging its structure beneath the surface-one cause, perhaps, why the sympathetic affection excited by the lytta, and those changes induced by antimony, are very different. Our author observes that, in small pox, a different degree of secondary fever will follow, when the skin is simply affected on the surface, and when it is partially destroyed beneath.

"Whoever has observed the deranged state of health where vesiculated eruptions have been called into action by an effort of Nature, must have seen how often they arrest the progress of the original disorder, and may we not from thence infer what appears to me to be a pretty general law of Nature, that she often gets rid of diseased action affecting vital organs, by exciting eruptions in other parts not vital?" 31.

Among the illustrations of this doctrine brought forward by Dr. Jenner, he mentions a remark made to him by his able and excellent friend, John Fleming, Esq. now a member of the British Senate, and formerly at the head of the medical department at Calcutta-namely, that when attacked with intermittents, and when he took the bark frequently, he seldom could get well until herpetic eruptions appeared on his lips.

That illustrious observer, Dr. Ferriar, in his medical histories and reflections, has occasionally alluded, in the most pointed terms, to the subject now before us." Cutaneous eruptions (he observes) often extinguish dangerous diseases." Madness and melancholy, epilepsy, delirium protracted after fever, dyspepsia, and various pulmonary affections, are all observed to be mitigated on the appearance of cutaneous disorders-especially on the return of those that, after becoming habitual, had been suddenly suppressed.

Huxham has also related some general facts that bear on this subject and it is particularly worthy of notice that he describes the sympathy between the skin and lungs, which elucidates the favourable effect of artificial eruptions in some pulmonary disorders.

Here Dr. Jenner regrets, and with reason, that Dr. Parry's

It is a doctrine of very old standing indeed; but in the humoral pathology, physicians considered what we now look upon as metastases of diseased action, to be translations of matter, and eruptions, abscesses, &c. were believed to be so many drains for carrying the peccant humour out of the constitution,-Rev.

"Elements of Pathology" is not sufficiently studied and appreciated by the profession. We hope we shall prove instrumental, in the present number of our journal, in obviating this unwarrantable apathy of our brethren to such a valuable work. At all events, we have sent forth an abstract of Dr. Parry's volume, that will be read and reflected on, where the original could never hope to travel-perhaps where it has travelled hitherto in vain.

In order to display, in a still stronger point of view, the analogy between the phenomena of artificial and spontaneous eruptions, Dr. Jenner draws an interesting sketch of the rise, progress, and termination of what is called an exanthematous fever-the small-pox, for example.

"Morbid animal matter, generated by this disease, is applied to the body either by what is termed the natural or artificial mode. After a given space of time, in either case, diseased action is manifested by that constitutional derangement which is designated fever. This goes on for a limited period, when eruptions appear on the skin, which soon shew on their apices vesiculated specks. Here the disease, as far as it depended on the primary action of the infectious matter which called it into existence, terminates. But now a new train of symptoms comes on, consequent to the diseased action excited on the skin by the pustules, the influence of which is felt in proportion to their numbers, their malignancy, the disposition of the constitution, and the extent to which they penetrate the skin. The fever, in the first and second instances, has two distinct origins. In the first instance, it arises from the influence of the morbid matter inhaled, or intentionally applied; in the second, from diseased action going forward on the skin, and, in many instances, also on the mucous membranes of the fauces, trachea, and ramifications of the bronchi. The rapidity with which, in some instances, the secondary diseased action follows the primary, often obscures the distinction. Of this the ordinary phenomena of confluent small-pox and scarlatina exhibit familiar instances. In the first of these the skin is often so quickly and universally assailed, that there is, in most instances, no interval of cessation. Nature is in a hurry to call out her guards." 40.

Here our esteemed author introduces some practical remarks on the benefits which may be derived from sedative applications, where the pustules are formed so thick upon the cutis as to augment, in a high degree, the secondary fever. An experiment was made by Mr. Fry, in the case of a young woman, who had a full burthen of distinct smallpox, and whose countenance was loaded with pustules.

"In this state one cheek was sopped with liq. lythargyri somewhat more diluted than I intended, while the other was suffered to take its course for the sake of comparison. The consequence was,