pox inoculation being little, if at all, practised, the great majority of individuals consisted of those guarded by vaccination, or else wholly unprotected. In June, 1821, the small-pox was introduced by the child of an itinerant player, from whom several individuals caught the disease. The surgeons of Chichester and the neighbouring villages having de clined inoculating with small-pox, the epidemic might possibly have speedily subsided, but for the interference of an ignorant and assuming individual, one Pearce, a farmer, supposed to inherit, both from his father and mother, extraordinary skill in inoculating, and even power over the progress and degree of the eruption. To this person the sagacious overseers of the parish of Bosham applied to inoculate the pauper children with small-pox, by which means these gentlemen had soon the satisfaction of seeing the disease spread over the whole district, containing a population of 30,000 souls. Mr. Pearce, thus sanctioned by the authority of such important personages, became in great request, and a knife-grinder, a fishmonger, and a whitesmith, observing the new trade of their neighbour to be abundantly lucrative, set up as rival practitioners, and by under-selling, and other means, in imitation of their betters, contrived to rob the farmer of about one thousand patients, to whom they communicated the disease. The surgeons of the district, finding small-pox raging among the people, (who, by the wisdom of the overseers of Bosham, could by no means avoid exposure to contagion,) were now driven to the necessity of inoculating for smallpox; and the number to whom the disease was thus artificially communicated by the professional and ex-professional inoculators is supposed to have considerably exceeded three thousand. Of those inoculated by the regular surgeons, about 1 in 200 proved fatal; of the others, no accurate account could be obtained. Of 130 or 140 individuals affected with natural small-pox, twenty died.

During this epidemic, the individuals who had been vaccinated were exposed, directly and designedly, to the influence of small-pox, with the effect of showing, in many instances, very remarkable power of resisting its contagion. In one family, the four elder had been vaccinated, and seven were now inoculated with small-pox: all the former escaped infection, though living, and some of them even sleeping, together. About eighty cases, however, did occur, in which persons previously vaccinated became affected with small-pox; but it proved extremely mild in every instance, except one. Six hundred and eighty persons, who had been previously vaccinated, were inoculated with small-pox; and of these about thirty showed constitutional affection, the eruption consisting, for the most part, of a few pustules. Nineteen well-authenticated examples occurred of secondary small-pox: these appear to have been much less modified than small-pox after cow-pox usually is, the attack having been in some instances extremely severe, and in two it had nearly proved fatal. The opinion of the surgeons of the district is, that the disease was not in any degree modified by the preceding attack; but they can only speak positively in this respect of one-half the number above mentioned, the others not having been seen during the latter stages.

An account of considerable interest has likewise been published of

the small-pox as it prevailed at the other extremity of the island,— Caithnesshire; and which, at the same time, forms a striking instance of the rise and progress of a disease truly contagious in its nature. Dr. JAMES INNES, of Wick, was called to a patient whom he found labouring under small-pox; and, the disease not having been prevalent for ten or fifteen years, he was induced to make particular inquiries into its origin. This was easily discovered: the individual in question had arrived a few days before from Leith, at which place the small-pox was then raging epidemically, and he had lodged in a house where several children had the disease. This patient proved a focus from which the contagion spread with inconceivable rapidity, and gave rise to small-pox, which raged over the country for the space of four months. The account of Dr. Innes relates principally to the phenomena of the disease in those who were guarded by previous vaccination, -between four and five hundred persons so guarded having been affected with varioloid eruptions during this epidemic. About eight-ninths of these had the disease in the form known by the name of horn-pock ; ten only had it severely, constituting coherent small-pox; and, in thirty cases, the eruption appeared to be purely vesicular from its commencement to its termination. Seven cases are mentioned of the recurrence of small-pox: in one, the first eruption was varicelloid, and the second well-marked variola of the coherent kind; two had passed through inoculated small-pox, and in them the second eruption is stated to have been as mild as the first; four had laboured under the natural form of small-pox, in three of them the second eruption was milder than the first; in the fourth, an old woman, who had lost the sight of one eye during the first attack, the secondary was more severe than in any of the others alluded to. However mild the forms of eruption proved in those protected either by previous vaccination or by having had the small-pox, yet when we turn to the less fortunate individuals who remained entirely unprotected, no doubt can for a moment exist with regard to the true nature of the disease. Here it exhibited all the formidable varieties of this loathsome complaint, in many instances proving fatal even when it was not confluent; and almost all who were attacked with it in this most aggravated form fell victims; pectoral symptoms of the worst kind supervening, accompanied with hemorrhage from the lungs, hæmaturia, and bloody stools. The phenomena displayed by this disease radiating from one individual, as from a centre, and spreading over an extensive district, afforded admirable opportunities of answering the question,may all the varied forms of varioloid eruption arise from one and the same coutagion? Dr. Innes answers this, without hesitation, in the affirmative; having had occasion to witness every possible form of the disease in persons living under the same roof," confluent small-pox in one,coherent small-pox in a second,-distinct in a third,-the vesico-pustular in a fourth, and the pure vesicular disease in a fifth." We think our readers will agree with us in regarding the statement of Dr. Innes (whose veracity we hold to be unquestionable, from per. sonal knowledge,) as one of the strongest that has yet been published in favour of the identity of origin of all varioloid eruptions, as held by

Edinburgh Med, and Surg. Journal, July.

Dr. Thomson,* Dr. Macleod,† and others. Small-pox, we are told, "had not prevailed epidemically during the last ten or fifteen years." A person labouring under that disease arrives from Leith; its appearance was so little familiar, that inquiry was instituted to ascertain where he could have come by it; clearly showing that the disease was not known,-or, considering the smallness of Wick, we may rather say, known not to exist in the town. "From this young man's case may be dated the origin of the epidemic in this part of the country; and it is inconceivable with what rapidity it spread, attacking a great proportion of the unprotected, and not a few even of the vaccinated." As it spreads, every form of eruption presents itself, from the most malignant to the mildest, and that among individuals living under the same roof. In thirty cases it proves " purely vesicular, from its commencement to its termination;" that is to say, it is genuine varicella, even according to the new and restricted definition given of that eruption by some of the Edinburgh pathologists. We are free to confess, for our own parts, that we cannot conceive evidence more satisfactory on a point of this nature.

Evidence, of an irrefragable nature, of the general occurrence of small-pox after cow-pox, is to be found in the foreign Journals, particularly in those from America; essays on this subject having been published by Dr. JAMESON, of Baltimore, Dr. MITCHELL, of Phila delphia, and Dr. DAVIS, of Columbia. We cannot, therefore, but express our astonishment and regret that any should continue to deny the truth of these and similar accounts; astonishment at resisting such a body of evidence,-regret, because we are convinced it is not the way to remove the prejudices against vaccination. We must open our eyes, and look the evil in the face; otherwise, how can we learn to counteract it?

The history of small-pox has been ably investigated by Dr.THOMSON, of whose work we would speak more fully, but that it is our intention to review it at length in an ensuing Number.

THERAPEUTICS.

The numerous and apparently satisfactory cases of Phthisis Pulmonalis, stated, in the work of Sir A. CRIGHTON, to have been cured by the inhalation of Tar-vapour, induced Dr. FORBES, deputy inspector of military hospitals, to give this remedy a trial:§ "for, (as he justly remarks,) however sceptical we may be with regard to the power of any remedies in producing any thing beyond a partial alleviation, or temporary retardation, of this cruel disease, yet it was possible that a remedy had at length been found capable of alleviating the sufferings of the patient, and, by arresting the progress of the symptoms, affording some chance of permanent cure. These trials were made at the General Military Hospital, Fort Pitt, under the direction of Dr. Forbes; and,

Account of Varioloid Epidemic in Scotland, by Dr. THOMSON. 1820.

+ On the common Origin of all Varioloid Eruptions, by Dr. MACLEOD.-London Med. and Phys. Journal, July and August, 1820.

See Dr. JENNER'S letter to Dr. GREGORY.-London Med. and Phys. Journal, September.

London Med. and Phys. Journal, October.

from the result, he states his belief that the cases recorded by Sir A. Crighton as having been cured by the inhalation of tar-vapour were not genuine phthisis, but more nearly allied to chronic catarrhal affections, between which and tubercular consumption the diagnosis is frequently attended with much difficulty. The statement of Dr. Forbes is given in the plainest and most satisfactory manner, and the experiment seems to have been conducted with the utmost care and attention to every circumstance likely to influence its results; yet in not one case, out of nineteen in which the vapour was tried, did it give "evident proofs of its power either to arrest or to ameliorate the symptoms of the disease." "In general, it rendered the breathing more difficult, and cough almost incessant; the expectoration was diminished, the pulse commonly accelerated, and anxiety and restlessness produced." The manner in which the remedy seemed to produce its deleterious effect was by diminishing the quantity of the expectoration; and, in proportion as this happened, the cough became more frequent, and the breathing more oppressed. In some, it appeared to cause no other inconvenience than thirst and head-ach; but, even where it did not excite greater disturbance, in no case was it regarded as of the smallest benefit.

Although the inhalation of tar-vapour would appear to be thus inefficient in the tubercular phthisis, Dr. Forbes was led to a more favourable opinion of its power in chronic catarrh; understanding by that term a disease succeeding previous inflammatory action of the bronchiæ, but which does not itself consist in organic lesion or actual inflammation, having for its cause a morbid relaxation of the mucous membrane of the air-passages, which gives rise to an increased secretion. Tarvapour appears to possess stimulant properties, "and perhaps astringent ones," and, consequently, to be a remedy peculiarly adapted to restore the energy of the parts. Proceeding upon this principle, Dr. F. administered the vapour in this class of complaints; and, of thirty-two who were submitted to its action, eight were cured, six improved; in eighteen it produced no effect, and in none any bad effect.

The results of Dr. Forbes's experiments seem to agree with those of HUFELAND and NEUMANN, who tried it in the Charity Hospital at Berlin,* in fifty-four cases of what is called "consumption;" but, from the circumstance of four having been cured, we are inclined to be sceptical as to these last having been genuine phthisis pulmonalis. The point of coincidence, however, is, that, according to the German phy sicians, the vapour was most beneficial in "blenorrhoea" of the lungs, or "phthisis pituitosa ulcerosa atonica," which probably depends on a state of the mucus membrane lining the air-passages analogous to that in "chronic catarrh," as described by Dr. Forbes. In Hufeland's experiments, two wards were appropriated to it, which were kept filled with the vapour by a large pot of tar placed in the middle. Fifty-four cases were submitted to the inhalation; of these, four were cured, and six much relieved; sixteen received neither good nor harm by its use; twelve got worse, and sixteen died.

The treatment of Inflammation of the Respiratory Organs by means of the Tartarized Antimony, has for a considerable time been the

* Bericht über die zur Prüfung der Werkung der Keerraucherungen bei der Lungensucht, &c.-Journal der Practischen Heilkunde. Erstes Stück, 1820.

fashion in some parts of the continent, particularly Italy; and, although it has not yet, nor indeed seems likely at any time, to gain ground in this country, we still conceive it to be our duty to lay before our readers the evidence that appears in its support. At Naples, the plan is to administer small doses of tartar emetic in solution, following it up with digitalis and nitre. At Milan, however, RASORI is in the habit of exhibiting the medicine in much larger doses, giving, in some cases, above seventy grains in the course of twenty-four hours."

In addition to the Italian physicians, M. PESCHIER,† of Geneva, has recently stept forward as an advocate for the treatment of inflammation of the chest with antimony, to the exclusion of blood-letting; and his statements are more decidedly in its favour than those of any other writer. He has used it for five years in the Canton de Vaud, during which time he states pleurisy and peripneumony to have been twice epidemic; and that, while his less fortunate professional brethren lost a considerable proportion of their patients, he cured all his without any exception. His plan, when he is consulted in such cases,-whether chronic or recent, slight or severe, with fever or without,-is to administer from six to twelve or fifteen grains in six ounces of water, which is to be given in the course of twenty-four hours, at divided doses; some laxative tisanne being taken every hour. The dose of tartar emetic was generally increased three grains a-day, till the patient took twelve or fifteen; while, at the same time, any indication which nature seemed to hold out was attended to. Thus, if there was a disposition to sweating, two drachms of nitric, muriatic, or acetic æther, were added; if there was much pain, one or two drachms of tincture of opium; if dysuria and dry skin, a like quantity of nitre. The effects were, that the patients generally vomited after the second and third spoonsful; then the medicine acted on the bowels, or perhaps produced no sensible effect, but speedily removed the disease. It was, besides, observed that a large dose of tartar emetic produced less vomiting than a small one; and that, when a grain or a grain and a half only were given in the twenty-four hours, it caused distressing fits of retching, without beneficial result. Although vomiting and purging generally followed its exhibition, yet the antimony is stated to have acted equally well in removing the disease where no sensible effect was produced; the cure being generally completed within eight days, and rarely requiring fifteen. It was never deemed necessary to bleed, either generally or locally; but blisters were sometimes applied over the seat of pain.

Dr. ARNAUD, of Moulins, has likewise published a paper, in which he details numerous cases of pleurisy and peripneumony cured by anti. mony, without bleeding; and M. LAENNEC communicated to the Academie Royale de Médecine, at Paris, some cases of hydrocephalus and inflammations of the chest similarly treated. M. L. thinks the sequelæ of the inflammation more quickly removed by the tartarized antimony than by blood-letting. The mortality is calculated at one only in forty at Naples, where this system is in repute; while at Rome, where the new doctrine is less generally received, it is said to amount to fortyfive in the hundred.

Voyage Medicale en Italie, fait en l'année 1820. Par LOUIS VALENTIN. + See London Medical Repository, November.

Voyage Medicale en Italie, &c.