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would also have unprecedented success; for the facts collected from the records of the past would be completely new to nine-tenths of medical society; and, with our now extended knowledge of pathology, would turn to excellent account. This has long been our conviction, and were it not that a delineation of what is now going on in the world requires the whole of our review, we certainly should put the suggestion into practice. We hope some others, more equal to the task, will take the hint here thrown out. The cases recorded only 30 or 40 years ago by the author, whose work now lies before us, are virtually unknown to the great mass of practitioners, and therefore we shall take some notice of them in this place.
The first was a melancholy case of fanatical abstinence, from which Danté might have drawn his too celebrated Jescription of the wretched and emaciated Ugoline. A young man, studious and dyspeptic, commenced a course of abstinence in the year 1786, ostensibly to relieve certain uneasy sensations in his stomach, but secretly from some mistaken notions of a religious nature.
Having betaken himself to an obscure lodging, he entered on a system of diet, composed of water slightly acidulated with orange juice. After three days' fare of this kind, the craving for food, at first troublesome, subsided entirely, and he then pursued' his meditations without inconvenience. He took no kind of exercise-slept little--and spent most part of the night in writing. The quantity of water used each day was about three-fourths of a pint; and two oranges served him a week. He made water in moderate quantity, clear and without sediment. He had a natural stool on the second day of this course, and none again till the fortieth day, which was the last, though he persisted in bis aqueous regimen for twenty days longer. During the last ten days of this infatuated course his strength wasted rapidly, and when he found himself unable to rise from his bed, he got alarmed, and his delusive visions began to fade away. His friends, at this time, having discovered his retreat, a clergyman and physician (Dr. W.) were sent to him, and obtained his consent to try the means of resuscitation-he being now in the sixty-first day of his fast.
“ He was at that time emaciated to a most astonishing degree; the muscles of the face being entirely shrunk; his cheek-bones and processus zygomatici stood prominent and distinct, affording a most ghastly appearance: his abdomen was concave, the umbilicus seem. ing to be retracted, from the collapsed state of the intestines; the skin and abdominal muscles were shrunk below the brim of the pelvis, and under the ribs, leaving the space vacant betwixt the ossa Vol. lll. No. 9.
ilia, the lower ribs, and spine. His limbs were reduced to the greatest possible degree of tenuity; the ossa ischia, the internal trochanters, and all the processes of the bones being easily distinguishable.
“ His whole appearance suggested the idea of a skeleton, prepared by drying the muscles upon it, in their natural situations.
“ His eyes were not deficient in lustre, and his voice remained clear and sound, notwithstanding his general weakness.” 440.
He was at first directed to drink a pint of barley water and two cups of panada daily–which, in our humble opinion, was too much, at first, for organs so long unaccustomed to nutriment. He had some feverish heat the first night, but slept better than before. On the second day he had some mutton tea ; and on the fourth, a pint of milk for breakfast, and a pint of mutton broth for dinner. He had that day two formed motions, and was sick and vomited. For a few days every thing seemed to go on well; but in a week from the commencement of the new system the scene entirely changed. He began to lose his recollection, and before midnight became frantic and unmanageable. Pyrexia, tremors, delirium, and other symptoms set in, and he died at the end of a fortnight from the time he was first seen by Dr. Willan, quite emaciated, and more wasted than ever.
Many are the instances on record of_long abstinencesome of them longer than this, of which Dr. Willan did not seem aware-but few of them are so well authenticated as to claim implicit credence. * It is curious that M. Ponteau, long ago, proposed a water diet for the eradication of cancer -and assures us that one person was completely cured by tbis plan. In others who could not be prevailed upon to persist long enough, the disease, he says, appeared to be · very much mitigated. M. Ponteau therefore anticipated Dr. Lamb in bis more recent proposals and practice of a similar kind. We are convinced that physicians and surgeons do not make such use of this powerful measure as they ought to do in the eradication or mitigation of formidable diseases-probably from the reluctance with which
• Haller, in his Elementa Physiologiæ, tom. vi. cites a great number of instances; one is that of a young woman, who passed three years without any kind of aliment. In general these cases of long abstinence have happened in females, who have lain in a torpid state, with little or no secretion or excretion to require aliment—in fact, in a state considerably analogous to that of hibernating animals. We would recommend to the curious reader a little work of Hoffman, “De Inedia, magnorum morborum Remedio,” as containing many important hints and observations.-Ed.
patients are brought to such rigid abstinence. In tumours, aneurisms, and many organic diseases of internal parts much might be done by aqueous aliment, were it properly urged by the practitioner, and implicitly adopted by the patient.
The next case related by Dr. Willan is that of a remarkable obstruction of the bowels. A lady, fifty years of age, subject to frequent attacks of pain in the bowels, and generally constipated, was seized on the second of April, 1784, with the usual symptoms of colic, attended with almost constant vomiting. Purgatives of every description were exhibited, together with glysters of all kinds, including the smoak of tobacco, but without any effect. The abdomen was also cupped. After six days obstruction and great pain at intervals, there was still no fever, nor mark of irritation in the pulse. Ice was now applied to the abdomen, which gave great pain, and excited much commotion in the bowels, but produced no evacuation. On the 10th April she passed some flatus downwards, and this encouraged the attending physicians to try quicksilver, which was given to the amount of six ounces in two drachm doses. As it produced a sense of weight and uneasiness, she could not be prevailel upon to take any more of it. On the 17th and 18th there appeared some slight feculency in the motions which gave some ray of hope, but nothing more appeared, and the patient continued in this deplorable condition till the 1st of May, when sbe expired.
Dissection. The bowels were found amazingly distended throughout, particularly the caput coli, and containing pot less than four gallons of fluid feculent matter. The whole tract of intestines was inflamed, and in many places sphacelated. The constriction was found at the lower part of the sigmoid flexure of the colon near the top of the sacrum. For about the length of an inch the intestine was so contracted that nothing could pass it. This portion of bowel was quite hard and callous. Some of the quicksilver was found above the stricture; a part of it also seemed to have been triturated with the mucus of the bowels into a black gelatinous mass. The other abdominal viscera were healthy. Dr. Willan makes some reflections on this case.
It is remarkable, he observes, first, that extensive inflammation, and even mortification, may take place from a gradual distention of the bowels, without producing heat, fever, or any of the common inflammatory symptoms. Secondly, it is interesting to know that a patient lived upwards of thirty days without any evacuation, and without any stercoraceous vomiting. Thirdly, that quicksilver taken into the stomach, in considerable quantity, and retained in the bowels for some time, does not always produce dangerous effects from its bulk or momentum. Fourthly, that constrictions in the large intestines are not attended with the same acute and violent symptoms, such as fever, sharp pain, constant vomit. ing, hiccupping, prostration of strength, &c. which generally soon prove fatal in contractions or spasms of the smaller bowels. This observation, he thinks, may belp to distinguish the seat of the discase, and when we conclude that the obstruction is in the large intestines, he cautions us against persisting in the use of active purgatives and stimulant enemata, which often give unnecessary pain, and tend to aggravate ibe disorder. In such cases, he thinks, the introduction of a candle or bougie up the rectum and into the colon might lead to relief.
We lately attended a female in Bond Street, who had been ill with enteritis several days before we saw her, and who lived sixteen days without any evacuation. The fever, however, was considerable, and the decisive depletion, which we put in use, completely quelled this part of the complaint. But no evacuation could be procured by any of the usual means. She came at last to vomit up the contents of the small intestines daily, after which she was quite easy, cheer. ful, and comfortable, till the next day, when similar evacuations took place from the mouth. We are strongly disposed to think that life might have been eventually preserved, thougb with this dreadful appendage of daily vomiting up the fecal remains of the small intestines, had we not, on the 16th day, been induced to exhibit quicksilver. She died that night. We found about eight inches of the ileum, where it terminates in the colon, in a state of complete gor. dian knot, and glued together by the effects of adhesive inflammation, but all inflammation itself of this and other parts of the bowels was gone. We could not find the quicksilver at all. Mr. Tebbs, of Bond Street, was present at this dissection. There were extensive marks of repeated attacks of inflammation about the uterus and ovaria—but all fever and phlogosis bad disappeared for many days previous to death. We understand therc is a man now in London, who lives, with a complete obstruction in some part of the alimentary canal. He has daily one or more fits of fecal vomiting, after which he pursues his usual avocations in common health, and without ever having a motion by stool.
The last case wbich we shall notice in this volume, is that of a woman, 38 years of age, who having caught a severe
cold, became soon afterwards affected with anasarcous swellings of the legs, which did not subside when the catarrhal symptoms disappeared. When our author first saw the patient she was universally bloated-her legs especially were swelled to an enormous size-and there seemed to be fluctuation in the abdomen. After the natural cessation of a menstrual discharge, there came suddenly on a flow of water per vaginam, which drained through the bed before she could get assistance, and afterwards filled a vessel that beld three quarts, leaving her faint and languid. The evacuation continued in a more gradual manner for two days, when the dropsical effusions bad entirely disappeared. Within ten days the water had again accumulated, and again the same evacuation as before took place, and with the same effect. She now went into the country, took the cinchona, and completely recovered. It is proper to observe that the patient took two grains of the digitalis thrice a day (a pretty large dose by the bye) for a fornight prior to the first evacuation of water, but with only trifling effect on the urinary secretion. “ The sudden termination," says Dr. Willan, “ of the disorder must be referred to the operation of the remedy coinciding with the state of the uterine vessels, and determination of blood to that organ at the time.” in fact, one of those God-sends, where nature does the business for us in a handsome way. From some cases, however, which we have seen, and others that we have heard of, we are inclined to doubt that this watery discharge was uterine. We have seen the urinary discharge so copious and involuntary sometimes that the patient could not be persuaded the fluid came from the bladder. In such cases the renal secretion had not the common characters of urine.
The paper on the use of arsenic in intermittents, and the cases of ischuria renalis in children, we are obliged to pass over, having already dedicated a considerable space to the volume under consideration.
III. Notes on the Medical Topography of the Interior of Ceylon;
and on the Health of the Troops employed in the Kandyan Provinces, during the Years 1815, 1816, 1817, 1818, 1819, and 1820 : with brief Remarks on the prevailing Diseases. By HENRY MARSHALL, Surgeon to the Forces.
Octavo, pp. 228. London, 1821. No nation ever possessed equal disposition and equal power with the English, to investigate what was useful or curious