detecting similar misapplication in those extraordinary accumula tions of fever inserted in the reports of fever under the denomination of typhus, which we hear and read of in other towns and cities equally populous as Bristol, and equally exposed to the causes of asthenia abstinentium."

We confess some parts of this are so much like what is usually called typhous fever, that we know not how to make the distinction. We prefer the word Camp Fever, and leave our readers to the description, as they will find it in various writers, particularly in Dr. R. Jackson, whose name we have so frequently introduced, and our remarks on whose works occur in so many of our volumes.

After

The remainder of the paper consists of very long and learned quotations and authorities concerning the periods at which epidemics have visited Bristol and other places. which, follow a table of the diseases relieved at the Clifton Dispensary for three years. The number of patients amounts to, 1699, of whom died 101, or about one in seventeen. Among the fatal cases, phthysis makes twenty-three; of rubeola, five in fifty-five, a large proportion in a disease nerally considered mild; of typhus, sixteen, of whom onequarter died. We were struck with some of the names: scrofula vulgaris, fifty-four, of which two died. What is scrofula, and what are the other distinctions? Elephantiasis, on the other hand, has no specific or trivial name, yet the various senses in which authors use that word are repeatedly noticed.

ge.

Such are the general outlines of this long paper. We know not in what terms to speak of it, and trust the ambiguity of some parts will be a sufficient apology for our requesting Dr. Chisholm to revise it, giving a precise meaning to each of his terms. This we particularly request, as it may furnish us with many useful hints when we venture to accomplish our promised dissertation on Contagions. At present we shall only in general remark, that we wish to confine the word contagion to diseases, which, under all temperatures and in every known state of the atmosphere, spread from a diseased subject to all who are susceptible of the same, and which can originate as far as our knowledge now extends from no other cause; that marshes produce intermittents or remittents, in proportion as their myasma is more concentrated; that filth has an effect on certain pestilential diseases; and that camp, hospital, or gaol, fever may be generated Wherever sick of any description are crowded.

An Appendix, by Mr. Cumberland, gives the geology of Bristol and Clifton, according to their various strata,

. Art.

Art. VII. Extract of a Letter from Mr. George Birnie, Assistant-Surgeon of his Majesty's Ship Antelope, dated St. Christopher's, 4th January 1817, containing Observations on Yellow-Fever, to James Robinson Scott, F.R.S. Surgeon, Royal Navy, &c.

This paper contains so much matter connected with Dr. Chisholm's, that we have been induced to insert it here, though not in order. It is a very useful paper, and shows industry, genius, and many very good qualities. It is not, however, without very considerable attendant faults. These we excuse in the writer on account of certain passages which, in justice to him, we shall transcribe in his own words. They are contained in the introductory and concluding parts of his letter.

"I now set myself down to give you a brief statement of the observations which I have made respecting the fever of the West Indies. We have suffered severely by it; and I have to lament the loss of two of my dearest friends, who fell early victims to its indiscriminating malignancy. My opinions concerning its origin, nature, and cure, differ in some degree from those of all the other medical -men on the station; I am, therefore, induced to lay before you the result of my experience, for the benefit of your friendly inspection, and shall expect your observations thereon with the greatest auxiety."

The writer concludes.

"I have now given you the sketch which I promised, as far as I observed the nature and course of this fever in the Antelope and Childers, and I beg that as soon as possible you will write to me, and let me know in what we agree and disagree on this subject. If you think this letter worth inserting in any of the medical journals, you are at liberty to do so, or as you please with it. When in the Childers, I had a most severe attack of this fever, and was given over by the physicians at Barbadoes Hospital for five days, but I re covered.'

By these passages it is evident, that Mr. Birnie, who is an assistant surgeon, conscious of his own want of experience, has given only what he observed in the Antelope and the Chil ders, waiting with much anxiety for his friend's opinion, and committing the fate of his letter to the same friend. After this, we are obliged to address our animadversions to Mr. Scott, a full-surgeon in the royal navy. For the same reason, we shall be as sparing as possible of remarks, and copious in extracts, considering that, in a production like the present, the facts related are all that the writer is answerable for. The writer continues,

"Like every other non-tangible subject of importance, the fevers of the West Indies have engendered a vast variety of opinions.

The

The utility and beauty of classification have given way to the rage of discovery; and every one comes forward with his little bit of an hypothesis to set the world to rights, and claim the rewards of genius. Had I not matter of greater moment to communicate, I could give you great amusement by the recital of many an absurd expla nation of the nature and causes of yellow-fever. I shall here attempt to disprove all the great positions of Mr. Pym. His own words, the authorities he quotes, and the result of my own expe rience, have led me to a very different conclusion from that which he has adopted; but, as I am a young man, and a very young prac titioner, as my opportunities for observation have been few, and perhaps my attention slight or ill-directed, it would ill become me to be dogmatical. I shall, however, with a faithful, though feeble, hand, trace what I have seen of these diseases, endeavour to prove their individuality, and that they are generated in the West Indies, without a possibility of supposing their origin or increase to have been at all connected with contagion.

"Mr. Pym is the first, as far as I know, who has attempted to prove that the fevers of the West Indies differ with regard to their nature and origin. He divides them into three kinds, the continued bilious, the remittent bilious, and the Bulam or yellow fever. His diagnostics are, that, in the first, as the disease advances, the skin becomes of a very deep yellow colour; in the second, of a deep yellow; and in the third, of a pale orange colour, with the addition of a peculiar drunken appearance of the eyes. He says, that, in the first, there is never the black vomit; in the second, seldom, if ever; and in the third, always. The mere statement of these definitions demonstrate indubitably that the diseases in question are but grades of the same affection. Here the black vomit is the only characteristic symptom of Bulam fever (for the drunken appearance of the eyes takes place in fevers of every different type;) and he even allows the black vomit to appear sometimes in the remittent, though he denies it ever to take place in the continued bilious. It is a symptom universally looked on as the immediate precursor of death, and cannot be called a diagnostic. This is a brief statement of Mr. Pym's doctrine; and I shall now proceed to lay before you as short and clear a view as I am able of the forms under which I have seen the endemics of this country, by which you will be enabled to judge of the argument and its utility for yourself.

"Immediately after our arrival in this country, about the beginning of March last, when the inhabitants of Bridgetown [Barbadoes] were perfectly healthy, and no cases of fever on shore, at least I am certain that no one belonging to the ship had been near, or indeed had heard of any, sick person on shore, a fever, characterized by all the symptoms which Mr. Pym has attributed to Bulam fever, made its appearance on board the Antelope; and, since that period, 110 cases have occurred in her, of which thirty-one only have died; of those thirty-one, nine either lived entirely in the fore and after-cockpits, or messed, and, consequently, passed the greater part of their tine, there. None who had black vomit recovered; and of the NO. 222. thirty

thirty-one, seven only had black vomit; and of these seven, six were of the nine mentioned above as living almost entirely below, where the atmosphere in this country is thick and heavy, and produces a peculiar hot sensation on descending from above into it. The temperature is always about the same, is often below what it is on deck, and, from the continual burning of candles, the crowding together of several people, the debris of pantries and mess-rooms, not always exceedingly clean, together with the want of circulation of air, may have caused so great a proportional number of those who were obliged to mess or live below to die, and have black vomit. If we compare the mortality amongst them to that of the rest of the ship's company, I conceive the observation will be of infinite importance in a future stage of this investigation. The patients at first universally complained of a pain extending across the forehead, confined to a line above the eye-brows; frequently the eyes could not bear the light, and pain was always produced by slightly pressing on the eye-balls; the pulse was sometimes natural, at others full, quick, or interrupted; the skin always hot, dry, and pungent; irritability of stomach came on on the first, second, or third days; the matter rejected from the stomach was indigested food or drink, bilious matter, and, in several, towards the latter stage, that peculiar secretion called black vomit. We have lost fourteen officers and seventeen men by this disease, and it possessed, in an eminent degree, all the symptoms attributed to Bulam fever, particularly black vomit. Its course was from two to ten days, but generally terminated in from three to four. This is a concise account of the disease, as it appeared in the Antelope, and it was called Bulam fever.

"In August last a disease broke out on board the Childers brig, while anchored in the Gulf of Paria off Port Spain, Trinidad, where the squadron had gone to pass the hurricane months. As her surgeon and assistant were both attacked, I was sent to assist Mr. Brown of the Scamander in taking care of the sick. At that time, twentyeight out of ninety men were labouring under a disease which made its appearance by the same circumscribed pain of the forehead, affection of the eyes, variable pulse, hot, dry, pungent skin, and succeeding irritability of stomach, which ushered in the disease on board the Antelope.

"In the first ten days about thirty persons died: three women and two infants fell victims to it; and this was called bilious remittent. But the only difference which to me appeared to exist between the disease on board the Antelope and that on board the Childers was, that, in the former, black vomit appeared in seven cases out of 110, while on board the Childers I observed it in one case only. It was, indeed, said to have existed in the cases of two of the women, but, as I was seized with the disease myself before they died, I cannot assert that they had it on my own authority, and that the disease on board the Childers was attended with a much greater mortality. But, premising that the same causes do not always produce precisely the same effects on the human body,

this difference of termination may, perhaps, receive some elucidations from considering the following circumstances.

"The disease appeared in the Antelope immediately on her arrival in the West Indies. The Childers had been nearly six months in the country when the disease broke out in her. The Antelope was in good order, clean, and well aired, with the exception of the cock-pits, as already mentioned: the Childers was the opposite of all these. On board the Antelope twenty-five died who had no black vomit; on board the Childers one died who had black vomit. Can it be supposed, that the twenty-five who died in the Antelope, without having black vomit, were different from those who exhibited similar symptoms and died about the same time, but who had black vomit? I think not. When the peculiarly circumscribed pain of the forehead, and the great and almost unconquerable irritability of stomach, were the distinguishing and leading symptoms in every case; because a certain appearance takes place in a limited number, shall we call them by different names? Let us pursue the comparison still farther, and we shall find that the mortality and Jiability to attack was equal among those who were obliged to live or mess below in the Antelope, and those who lived on the lower deck of the Childers. The lower deck of the Antelope, where the people mess, is always well aired, except in a heavy sea, which does not often occur in the West Indies, and is always kept in an exceedingly clean state, which accounts for the disease not running through the ship's company, and for its comparative manageableness; but, in the cock-pits, every person was attacked, except two seasoned hands: about one half died, while, in the other parts of the ship, not more than a fourteenth, viz. nine of the thirty-one who died on board her had either lived entirely or messed in the cock-pits, and, of the seven cases of black vomit which occurred on board, six were of those nine. The lower deck of the Childers, where the people mess, was dirty in the extreme. On lifting the hatches of the fore or after holds, a horrid suffocating stench issued from them: it was confined, lumbered with lockers, and the heat increased by the fire-place being on it. It was in a nasty filthy condition, and I do not recollect that it was attempted to ventilate it by wind-sails. This state of the vessel, the want of accommodation and attendance, and the sudden fall of the medical officers, accounts for the mor. tality on board of her, and the disease attacking all her crew:-only three escaped an attack, and about half died. Here we observe a remarkable coincidence between the extent and mortality of the disease in our cock-pits and in the Childers. We see the influence of the climate modified by the different situation of the two ships, and by the different situation of the parts of the same ship.

"From having observed that this influence is the leading character of these diseases; that, in every individual case of them, the first symptom was the circumscribed pain of the forehead, pain of the eyes, particularly on pressure; that all cases were alike characterised by irritability of stomach and rejection of great quantities of bilious matter; that six of the cases in which black vomit oc