medical experience, and one in which there are not the same difficulties to contend with, which frequently presént themselves in private practice. The patient and his attendants are equally under military discipline, which enforces, as a duty, whatever mode of treatment may be considered as proper. It is much to be lamented, that the greater number of army medical practitioners do not possess a portion of that ardour for which Dr. Jackson is so much distinguished. The habits of life, it is true, which they are apt to acquire are by no means favourable to observation and enquiry; and, though this may be considered as affording an apology for the want of energy in the improvement of their profession, which is so often observed, yet it is to be regretted that the necessity for it so much exists. The first part of this work is on the constitution of the medical department of the army. Dr. Jackson laments that the army medical officer has in general little to say on the means necessary to be pursued for the preservation of health. This, he informs us, generally rests with commanding officers, who are little disposed to consult the medical department, except on the immediate subject of discase. We have known, however, many examples, in which a spirited but decorous interference has been respectfully attended to, and have no doubt, that in greater number of examples the mind of a commanding officer is open to the suggestions of good sense and philanthropy. The author represents the elements of the British medical department as extremely heterogeneous, and as therefore by no means adapted to produce an arrangement, and union of exertion, throughout the whole service. Much practical experience is required in the heads of departments to appreciate adequately the wants of the service, and the qualifications of those to be employed in it. This experience can only be obtained by actual observation, in the stations which they are to superintend, where they will learn the practical difficulties which often present themselves in the arrangements for the sick, and the means to be adopted for obviating them. The medical board, we are informed, has not one member composing it whose education or habits had at all given him an opportunity of being acquainted with the details of military medical service; and besides this circumstance, it is objected, that the more lucrative engagements of private practice, from which it is not attempted to debar them, necessarily withdraws much of that attention which ought to be exclusively devoted to the regulation of an important branch of the service. The author considers it as a material disadvantage that the education of army surgeons is not uniform, and is of opinion that an examination, as it is usually practised, can by no means be regarded as a proper test of medical ability. He would, therefore, recommend an establishment, such as that of the hospital at the military depôt in the Isle of Wight, to be fixed upon as a medical seminary, where lectures might be given, and every candidate for admission into the army in a medical capacity obliged to study for a certain period. According to the practice in use, when Mr. Hunter was surgeon-general, army physicians were generally promoted to that rank after many years service as surgeons. This plan is considered by the author as a very proper one, and as infinitely better than that which has been adopted since his time, in which surgeons are precluded from the chance of being physicians, and the latter rank confined to such as are graduates of the English universities, or licentiates of the London College. He conceives that the whole number employed in the various medical departments of the army is far greater than necessary, and goes so far as to entertain no doubt that the number thus employed is adequate to the care of the whole army establishment, even if all the individuals composing it were actually sick. The second part contains the detail of management of the hospital of the army depot in the Isle of Wight, in the year 1801. In this chapter the author informs us that the hospital was new, slight, and by no means commodious; and that the troops at the depot were for the most part recruits destined for foreign service, who were very liable to sickness, and frequently brought with them dangerous fevers, generated during their passage from Ireland. In the details which are given us of the management of the hospital, great vigilance seems to have prevailed in every department, and at the same time a careful obser vance of economy in the various heads of expenditure. Forty-eight attendants were found to be sufficient for 400 sick, and this diminution, (from above 100, the number formerly employed) united to the disuse of the purveyor department altogether, produced a saving of 25001. per annum to government. at War. The author's exertions in the public service do not, however, appear to have met with the approbation of his superiors, and the third part of his work is devoted to an examination of the management of the hospital of the army depot, in consequence of some reflections thrown against it in an official letter from the army board to the Secretary In this letter Dr. Jackson is charged with having carried a regard to œconomy too far, and with having employed too debilitating a plan of regimen and medicine, which gave rise to great mortality, frequent relapses, and tedious recoveries, with a debilitated state of the patients. A board of army physicians acquitted him of those charges, and considerable pains are taken by the author to shew, that the hospital of the army depôt, while under his management, stands on advantageous ground, in point of mortality in similar diseases with the same hospital at other periods, or with other hospitals in other places. The cure also appears, by good testimony, to have been equally perfect as in the periods preceding or following, The time required for cure not more than half of what it was in the period which immediately succeeded his suspension from medical duty, or which preceded his appointment." An appendix, as large as the body of the work, is occupied with an account of the principles which the author has adopted in explaining the action of causes in the production of fevers, and the action of remedies employed in their cure. From this part of his work we shall make a few abstracts, in order to shew his principal peculiarities of opinion and practice; but it may be observed, that his doctrines on this subject do not now appear for the first time before the public. Health, or the proper performance of the various functions of the body, depends upon a certain harmony, or as the author chuses to call it rhythm (gu) of movement in animal bodies. On the phanomena of life, and in many other parts of his reasoning, he adopts, in some measure, the principles of Brown, though with a modified language. Its mani "The expression of life, or animal action, may be considered as a forced condition.The nature of the radical quality in which it consists is not known; but the expression of it is visibly called forth by the application of festation is thus the effect of stimulation. A peculiar and appropriate causes. pause of rest is the cause of action; for it is a fundamental law of nature, that whatever is moved to action by stimulation tends to rest when the action, the effect of the stimulation, is produced. Thus, as action is the consequence of stimulation, and a tendency to rest the consequence of an action completed, alternate action and rest, however other, while the cause and condition of or varied in period, necessarily follow each ganization preserve their relations. A certain rhythm of movement is, consequently, a condition inseparable from a living animal body; as the integrity of the order and force of that rhythm is une index of health. But as movement is an expression of the presence of life, and rhyt amical movement an expression of health, so the mode of health is liable to be pervertel, the motions of the machine to be even finally arrested or annulled. The scale of the deranged modes is extensive; and as the modes are various, though errors, they have their train of errors, and their productive effects variously multiplied and combined." "A change in the rhythm of movement is the first visible, even supposable step of action, arising from the operation of the causes of fever. Such derangement seems to proceed either from the application of powers, which are in their own nature stimulant of the ordinary movements of health, erring by excess or defect of just quantity, or from the application of new and extraneous matter, stimulant in their nature, but subversive of natural movement-both in time and force, productive of new and artificial action in the minutest circle of organization, communicated to combined organs, and manifested in the operations of functions. This new action originates in the application of a new material; the effect corresponds with quantity and quality, and condition of subject to which the application is made. This last requires a minute consideration in forming an estimate of effect, for it seems to be the prin cipal circumstance which modifies the expression of symptoms. Action is supposed, in all cases, to be in proportion to the force of the stimulating power, and the capacity of the excitable organ. This has different conditions or capacities,-different degrees of facility or difficulty in manifesting action.The facility in excess may be termed irritability, the difficulty torpor. The constitu tion varies radically, that is, constitutionally in different subjects; and it varies in the same subject, according to differences of accidental circumstances." Atmospherical air is stated to be the common stimulant to animal bodies, and various alterations of action, in producing disease, are supposed by the author to arise from "inexplicable deviations in the proportions and conditions of the elements of the atmosphere, and from various extraneous matters enveloped or suspended in it." Irritation seems to be the derangement which accompanies fever, and this appears to be the effect of a variety of causes possessing an irritative power, supposed to offend from excess in quantity, or from nature of quality." The -author admits, however, that where contagion is generated in close confined places, though it is calculated" to produce irritated motions," and possesses the quality of irritating as a cause," that the condition of the subject, as affected by the vitiated air," seems not to obey the impulse."--As the natural harmony which exists in health is interrupted in fever, or as fever consists in a rhythm of movement, irregular in time and force, the resto. ration of this rhythm is necessarily the restoration of health. But previously to attempting to restore the harmony of movement, by the application of causes calculated to excite motions analogous to those of health, the author considers it as often necessary to arrest the irregu lar course of the existing motions.Bleeding and emetics are two of the most powerful means in use for this purpose, and when by them the diseased motions have been arrested, the pure air of the atmosphere is often sufficient to solicit the organic structure to resume its natural action. But when this fails, he attempts to give origin to an action, similar to that of health, by alternate warm and cold bathing, which, preceded by bleeding, furnishes, he asserts, 66 a safe and effectual cure for a form of fever, which destroys life occasionally in every country; but which has committed dreadful ravages among Europeans, particularly among European soldiers in tropical clímates. The remedy is comprehended in the means now mentioned; but the effect de pends on the management. A scanty bleedfor the application of the means; and, uning rarely prepares the condition prescribed less the condition be duly prepared, the effect is looked for in vain." Very ample observations are made on the mode of employing blood-letting, the cold bath, and some other remedies of smaller importance, but for those we must refer to the work itself, only ob serving, that though we pay great deference both to the experience and the abilities of the author, we have occasionally some difficulty in admitting the correctness of his reasoning, and have much hesitation in assenting to the very liberal use which he makes of the lancet. ART. L. Fats and Observations concerning the Prevention and Cure of Scarlet Fever; with some Remarks on the Origin of acute Contagions in general. By W. BLACKBURNE, M. D. 8vo. pp. 166. FEW of the inquiries of modern times have led to more interesting, or more beneficial results, than those which relate to contagion. The nature of this agent, which is so much and so deserv. edly the object of alarm, has hitherto eluded the most zealous, and the most careful research; but though we are not enabled to discover what it is, or even to demonstrate by chemical analysis its existence, much less the parts of which it is composed, yet the industry of some modern philosophers has been able to discover many of the laws by which it is regulated. We have read, with much satisfaction, the observations contained in the treatise now before us, and regard them, as not only confirming some of the valuable remarks which have been made by other writers on the subject of contagion, but as enlarging considerably our knowledge of the opera tion of this agent, particularly as it relates to scarlet fever. This disease has long been a particular object of at tention with the author, but within these two or three years he has had more frequent opportunities of observing collestively its nature and progress, than at any previous period. It has hitherto been generally the custom, where scarlet fever has shewed itself in a public seminary, to break it up; and if, on the other hand, one child of a family was attacked by this disease, it has been usual to send off the others to school, in order that they might be removed from the influence of the contagion; both those measures, the author has clearly proved to be extremely injurious. When a school is broken up, the individuals composing it have a chance of carrying the infection to their respective homes, and of thus widely disseminating a subtile and insidious poison. When a family is separated, an equal risk occurs of its being transported far beyond its first limits, and of its thus extending the scene of its ravages. To prevent those direful effects, the author strongly recom. mends, that whenever the disease shews itself in a school, those affected with it should be kept perfectly separated from the others, in apartments appropriated to their reception, and not allowed to mix with their companions till a considerable period after their convalescence. In a private family the same plan should be adopted. Intercourse with the other branches of it should be strictly prohibited, until the disease has not only gone off, but till the danger of its being propagated from the convalescent subject has ceased. How soon there is no risk of such propagation has not yet been accurately determined; but the author is convinced that the danger exists long after it has been supposed to cease, and has known instances of infection taking place after the 10th day. The dispersion of individuals, who are not apparently affected with the disease, is always done at some risk to those with whom they may afterwards associate, if suffi further period, not yet precisely defined, after their perfect recovery; and that it may be suppressed in its commencement by an emetic, or the affusion of cold water, but that the person who thus escapes its full formation is liable to be reinfected. The success which attended the complete separation of the affected or suspected cases, in the public school, convinces the author that measures of prevention are always practicable, and Should at all times be carried into effect. At this school there were sixty-four scholars, of whom only twenty took the complaint, and none of the family, the assistants, or servants. On the other hand, out of forty ladies at a boarding-school at Chester, as mentioned by Dr. Haygarth, where similar precautions were not taken, only four escaped the complaint, twelve had it very severely, and two most dangerously. With regard to the identity of the origin of scarlatina and malignant sore, throat, a point which has been very much the subject of discussion, the author ascertained satisfactorily, from the histories of both the sets of cases above-mentioned, that the primary sources of contagion were the same in each, and that cient time does not intervene between able to resist it. The occurrence of scarlatina in a large family, and in a numerous school, afforded the author very favourable opportunities of ascertaining several important circumstances relating to this disease. In the former case, he ascertained, that convalescents from scarlet fever are capable of communicating it for ten days, or a 46 Every form of angina contagiosa, or scarlatina, was exhibited in them, some with angina alone, others with angina and eruption combined, others with eruption only." thor's opinion, produced disadvantages The contrary doctrine has, in the au in two ways. "1st. Common cases of scarlatina, having been supposed to belong to a mild and safe class of diseases, have been treated with too little attention in ordinary practice. It is true, that a very great majority of patients lowed, on the other hand, that general anarecover from scarlet fever, yet it must be alsarca, tumid glands, hectic fever, cough, and sometimes dysenteric symptoms, are the too frequent consequences of the imperfect cure of scarlatina. 2dly. It being generally presumed, that the same contagion does not in one instance produce eruption, and in another ulcerated throat only, among the members of the same family where scarlet fever is present, the state of the throat is too often not adverted to in proper time." The general treatment of scarlatina, Dr. Blackburne conceives, should its source, and its debilitating propensity.be grounded upon the knowledge of But at the same time that this is acknowledg ed to be the true complexion of it in an enlarged and general seuse, yet where such various degrees of morbid affection take place, general rules cannot be laid down with propriety, or carried into effect with success in every instance. The practitioner is therefore bound to exercise his own discrimination in individual cases, and proportion his mode of prescription to the degree and the form in which the disease individually appears. The too early exhibition of tonics and cordials is equally pernicious with profuse and excessive evacuations. For this reason I object to the indiscriminate use of strong antimonial emetics, which commonly induce too great a degree of debility, where the tendency to it is inherent in the disease itself, and the inflammatory symptoms extremely transient, even in the robust and adult subject. There are two indications to be answered by emetics in this disease, corresponding with the different stages in which they are administered. In the first stage, the great good effect of an emetie is to restore obstructed perspiration, which is of the greatest consequence in mitigating and shortening the febrile period in this particular disease. In more advanced periods, where this has not been done, an emetic, if not too long deferred, will excite perspiration, and will also act mechanically in cleansing the throat, discharging the sloughs, aud inducing a more active and healthy secretion in the glands and neighbouring secreting sur faces. In neither of these instances are violent emetics required. Mercurial or drastic purges are liable to the same objection. The plan, which I adopted with general success in Mr. E.'s school, will be found equally safe and efficient in a great majority of mild incipient cases. My general intention was to diminish the violence of fever by gentle evacuations, by relaxing the skin, inducing moisture, and after this, by an early assumption of moderate tonics and nutritives, to prevent the access of great weakness during the actual presence of the disease, and by protracting the use of more powerful tonics and a full diet over the convalescent state, to guard against the approach of the ordinary consequences of scarlatina, viz. anasarca, &c. This mode of practice, like every other, must be appropriated to the peculiar habit and circumstances of the patient-those of robust and plethoric constitutions require a shorter continuance of, and less powerful, tonics, than those of a contrary frame; but no constitution ought to be allowed to strug gle unassisted through the disease itself, or through the convalescent state. If the milder instances of scarlatina demand the physician's vigilant eye, to prevent future ills, where no immediate danger threatens, the severer instances of this pestilence, where affection of the throat constitutes most urgent degrees of hazard, require his utmost solicitude andskill. The insidious progress of ulceration in the organs of deglutition has been permitted too often to rob an afflicted family of a valuable parent, or the tender parent of a much-beloved child, even where the full manifestation of scarlet efflorescence has given, though too late, undoubted proof of the existence of the nature of the malady." "It will be a good rule, therefore, to proportionate early and seasonable medical exertions to the seat of ulceration in angina contagiosa, remembering, that the most hazardous situations, and which require the most prompt and uninterrupted assistance, are those immediately concerned in the act of deglutition, and are so near to the larynx and trachea, as to afford a ready path of communication to those organs, which are essen. tial to life." In such cases the author has found it necessary to recommend "The exhibition of wine or negus*, with bark and the mineral acids, to be taken alternately with strong soup, every hour or two, in proportion to the advancement of the ul cer, the debility of the patient, &c. for eight and forty hours in succession, or three days and nights without intermission, if occasion requires. Life has been saved by these extraordinary efforts, which otherwise must have been lost." The author disapproves of the method recommended by Dr. Withering, of treating this complaint by the frequent administration of strong antimonial emetics, which have too great a tendency to weaken the patient. Towards the conclusion of the first part of this treatise, the author inquires into the modes by which infection is generally introduced into the human Body, which must be either by simple contact, inoculation, or inhalation. The first is considered by him, from a multiplicity of facts, as insufficient for the purpose. The second is voluntary, and on that account, not applicable to the question. The third is therefore the only way in which contagion can be propagated; and consequently to guard against its communication, by the respi-ratory organs, is the most simple, intelligible, and practical means of prevention which can be adopted. The second part of this work is on the subject of contagion in general. Since, it has been discovered that the progress "Negus, of the following composition, forms a very pleasant and grateful beverage, for the patient. Wine, eight parts; water, four parts; lemon juice, one part; sugar, 4 sufficient quantity, or none, according to the taste of the sick." |