It is highly probable, more immediate relief would have been obtained by blood-letting; but this is a practice, the efficacy of which remains to be fully ascertained, and can only be done by repeated trials; for since, in the absence of facts, abstract reasoning is at least questionable, we must wait until public expe rience either sanctions or condemns a remedy, which, if used with discrimination, promises fair to alleviate the sufferings of mankind. The fatality most commonly attending these cases, induced me to communicate one, where the advantages of the practice detailed was obvious, without waiting perhaps a number of years to accumulate facts enough to decide on the propriety of such practice in general. If practitioners who have had opportunities of treating this complaint, would impart the result of their experience, the question would soon be set at rest. CASE II.-Thomas Waring, ætat. 15, living in a crowded part of the town inhabited principally by poor half-starved families, and from whence fever had not been absent for several months, had been ill twenty-one days before I saw him; which I was requested to do, in consequence of a copious eruption of petechiæ over the whole body. They were first perceived yesterday, upon the breast and face; to-day, they have made their appearance on other parts; and now (April 6th) no part is exempt from them. They are of a dark-purplish colour, and various sizes; none of them, however, larger than a pea. He is quite insensible, occasionally muttering something incoherent tongue coated with a dark-brown fur; the teeth and their interstices are likewise covered with the same matter; breath offensive; thirst excessive; bowels costive ; pulse, I know not how to describe better than by saying, it conveyed to the finger a sensation similar to a continued stream of water passing through an elastic tube. He frequently applies his hands to his head, as if conscious of pain. Has voided bloody urine several times since the attack. During his illness he has taken an occasional purgative only. I took twelve ounces of blood from his arm, when be fainted. On his recovery the pulsation of the artery could be distinctly felt beneath the finger; but it beat with so much rapidity and irregularity, it could not be counted. A powder, containing vj grains of jalap and iij of calomel, was ordered to be taken every hour; and the body directed to be frequently sponged with cold vinegar and water. 7th.-Powders have operated freely, producing many stools of a dark colour, and intolerably offensive. Pulse 120, feeble, but quite distinct; perfectly sensible, and complains of oppression at his chest, and acute wandering pains in his head; thirst very considerable; tongue same as yesterday; no evident alte ration in the eruption; skin not so hot and dry. He expresses himself much refreshed by the cold-bathing, which, with the medicine, was ordered to be continued as before. This 8th.-Has had some comfortable sleep in the night, and perspired rather profusely. Thirst much abated; the tongue begins to assume a yellowish appearance; pulse 120; bowels continue open; stools of a light-red colour, and much less offensive; petechia not so numerous on the thighs and abdomen. morning, feeling an inclination to eat, his mother indulged him with a small piece of toast, and a basin of tea: this produced great uneasiness at stomach, which was only relieved by vomiting. I prohibited his taking any more solid food. Continue medicines and the cold ablution. 9th.-Continues better. Pulse 100; tongue almost free from fur; bowels purged, and the dejections neither unnatural in colour nor smell. He complains of the medicine griping; to prevent which, I combined about 1-6th of a grain of opium with each powder, and desired him to take one every three hours. Thirst almost gone; petechiæ begin rapidly to decrease in number, especially upon the upper and lower extremities. 10th.-Considerably better; has slept the whole of last night. The medicine procured four evacuations from the bowels; griping ceased; pulse below 100; no thirst; skin cool; has eaten some bread and milk, without producing any uneasiness. A few petechia remain on the breast, back, and abdomen; all the others have entirely disappeared. The cold affusion was only used twice yesterday. 11th, 12th, 13th, and 14th.-Continues to improve; petechia entirely disappeared. The medicine was persisted in until today, the quantity having been gradually diminished. Appetite is now very good, and the only symptom to contend against is debility. The cold washing has been discontinued for two days. He now takes freely of animal food, and is allowed a pint of porter daily. From this time his convalescence was rapid; in a few days he was able to take exercise out of doors, and is now perfectly well. The exceeding prevalence of the late epidemic fever has fully proved the utility of blood-letting, and other depletory measures, in its early stage; whilst it has afforded innumerable facts corroborative of Dr. Clutterbuck's theory, and established the propriety of the treatment instituted by him, and other eminent medical characters. It has also tended in no small degree to dispel the mists of prejudice which have so long enveloped the minds of medical men, and thus prevented its being brought into general use. Its advocates have only now to fear it will be brought into disrepute, by incautious and ill-timed application, Although ts efficacy is admitted by most in the beginning of fever, there are few who would subscribe to its employment in the latter stage; nor should I wish to be understood as advocating the use of the lancet in every case; for I am well aware, that a rash and indiscriminate perseverance, would be a more dangerous practice than refraining from it altogether. In cases, however, where we have a train of symptoms to contend against, arising from excessive circulation in some important organ, which, if not speedily removed, would soon terminate fatally, and where few would hesitate to pronounce purgatives were the only medicines from which we could expect success, because their efficacy consists in the depletory effects they produce, removing irritation, and equalizing the distribution of blood; is it not better immediately to effect our purpose by the abstraction of blood, rather than wait the more tardy operation of medicine, which could achieve only the same end, and cause a delay by which we might lose our patient? In this case, I should consider petechial effusion (if I may so term it) as a consequence of increased vascular action in a constitution already debilitated by disease; for, the greater the debility, the less increase of action will be necessary to produce this effect; and this exhausted state of constitution might be urged against adopting a measure which would tend still further to weaken our patient. To this I would reply, the loss of a small quantity of blood, sufficient to produce the desired effect, would not bring on prostration of strength adequate to what would ensue from a continuance of the disease. Appearances in Waring's case were so unfavourable, I was apprehensive lest, in waiting the operation of purgatives, the complaint would increase, and my patient shortly be in a state over which human means could have no control: it is in similar instances, and as a remedy which ought never to be lost sight of, I would recommend blood-letting. The good effects of this practice were immediately evident, and certainly such as to warrant a repetition. In the more advanced stages of fever, when the lancet was not admissible, I have seen much benefit derived from topical bleeding with leeches. It is not the least remarkable of the phenomena of fever, to what a considerable extent active depletory measures may be carried, even in poor half-famished families, (among whom the complaint has principally prevailed in this town,) and yet produce so little subsequent debility. If the patient has applied early in the disease, its progress has generally been arrested by brisk purging with calomel and jalap, or a solution of neutral salts in an infusion of senna, and ipecacuanha wine, the action of the bowels being kept up without intermission for three or four days; at the end of which time all complaint has ceased, and the person has generally been able to return to his usual occupation, expressing himself stronger than before his illness. If the complaint has existed for some time before application is made for relief, the period of convalescence has commonly been long and protracted. Wigan; July 9th, 1819. FOR THE LONDON MEDICAL AND PHYSICAL JOUrnal. Two Cases of Genital Mal-formation. Related by GEORGE HUME WETHERHEAD, M.D. COMPLYING with your request, to put on paper a description of the cases of genital mal-formation, the particulars of which I casually mentioned to you, I commence with observing, that it formed part of my duty, when belonging to the flag-ship of Sir Richard Bickerton, at Spithead, to examine all seamen who were either drafted from the other ships of the fleet or impressed from the shore, to see that they were not disabled by rupture or otherwise. It was in the course of this duty that the two cases alluded to occurred. The first was that of a seaman, sent on-board from H. M. S. Halifax. He was a slender-made young man, apparently about 18 or 19, but several years older by his own account; with small features, mild and feeble voice, fair complexion, and blue eyes: his neck was long and slender, his chest narrow and flat, and the mammæ were not at all protuberant; the upper and lower extremities were slim, and his fingers tapering. As he stood upright, his sexual developments seemed those of a woman: the mons veneris was very prominent, and distinct lahia protruded from beneath; but, on closer inspection, a scrotum containing two small testes appeared, which the proximity of his thighs had concealed: this, too, was favoured by its situation being more retired than usual, seeing it was not borne forwards by a penis; in place of which, on separating the labia, a small clitoris, about half an inch in length, came into view, the glans of which had what seemed a meatus urinarius; but, on enquiry, I found that his urine did not pass by this orifice, but through three small apertures in a membrane occupying the site of the hymen, on each side of which the limbs of the scrotum (if I may so call them) commenced. I introduced a probe into the meatus of the clitoris, which proved a false passage, terminating under the skin behind the frænum. The apertures through which the urine flowed, were so placed as to resemble the position of the three angles of a triangle, and these so trifurcated the stream of urine, as obliged him to crouch down, as women do, when he passed it. He affirmed that he had no sexual desires, and that the clitoris was incapable of erection. I got Dr. Denmark to see this example of deficient organization. The second case was that of a tall robust young man, who had been just impressed, the peculiarity of whose conformation consisted in the absence of all vestiges of scrotum or testes. The penis was proportioned to his apparent manhood; but the skin descending thence was quite smooth and tense, and not a ruga of scrotum was to be perceived. The young man said that he was born so. No testis was to be felt in either groin; and he declared, what, from his athletic appearance, I was much inclined to doubt, that he had never experienced any amorous inclinations. 18, Upper Montague-street, Montague-square ; 29th July, 1819. FOR THE LONDON MEDICAL AND PHYSICAL JOURNAL. Observations on Animal Heat; in Reply to the Queries of EMILIUS, in this Journal for March last. By JOHN DOWN, Esq. IT was discovered by Dr. Crawford, and published in 1781 in his Experiments and Enquiries into the Cause of Animal Heat, that, if an animal was immersed in a medium hotter than the temperature of its body, the blood would return to the right side of the heart, nearly in the same state or colour as it was sent from the left side. Since this time, I believe, no rational theory has been advanced to account for this phenomenon. My enquiries were instituted for the same purpose, although my experiments at this time are incomplete; therefore, in venturing my opinion upon the above queries, I shall not warrant their correctness: but, as this seems a chasm in physiology, and so closely connected with EMILIUS's enquiries, that I cannot give a rational reply to them without entering upon the subject of animal heat, I shall state the outlines and deductions drawn from them; and, should they be incorrect, I trust that some of your numerous readers will state their objections, and bring the matter in question fairly before the public. I cannot trespass upon the pages of your Journal to give my experiments in detail, but shall content myself with my general observations upon them. The florid red colour of the blood is acquired in its passage through the lungs, where it changes from venous to arterial. This, I think, is agreed upon by all physiologists; therefore this will be taken for an established fact. It has also been proved, that the two most important parts of our atmosphere are oxygen and azote, and one part of this is absorbed by the blood in its passage through the lungs, namely, NO. 247. 2 C |