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curred were placed in peculiar circumstances; that the other was in a bilious irritable habit, and took place immediately on our arrival; that, of the thirty-one who died, nine were obliged to be almost entirely below I say, from having observed all the essential and cognizable symptoms to be the same in both these diseases (though I cannot point out exactly what combination of circumstances, or modification of causes, produced so great a number of cases in our cock-pits, in which death was preceded by black vomit, and why a still more nasty state of the lower deck of the Childers so few), I am of opinion that they are essentially the same, and fear that medical observers, in the too eager pursuit of discovery, have been inclined to look over the thousand phenomena which establish their identity, and to find out and magnify the irregularities which occur in this, as in every other disease. For my own part, I grieve to see so much patient inquiry, and intelligent observation, frittered away in the futile attempt to convert classes into species, or in the insignificant invention of a new name for an old disease. As they all agree that the practice in both must be the same, that this difference, if ever so well established, would lead to no practical result, why so eagerly maintain an hypothesis, with only one useless dubious argument or fact to sustain it, and which is opposed by every character of identity and principle of classification?"

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"The Tigris and Scamander frigates have also been visited by this dreadful scourge, but have not lost more than five or six persons each, which exemption they owe to their high state of discipline, their cleanliness and attention to ventilation; while the Brazen, under circumstances somewhat similar to those of the Childers, has lost twenty-four out of eighty men. I do not mean to say that she was dirty, or in bad discipline; but her lower deck, where the people live, is narrow, crowded, and has neither ports nor scuttles, with two decks above it. The different degrees of mortality exhibited in the different ships of this little squadron, according to their different degrees of description, ventilation, and cleanliness, I think sufficiently proves that all the various appearances of these diseases arise from the same origin, and are effects of the same cause, modified, as we have seen, by various circumstances.

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"Dr. Ferguson, Inspector of Hospitals, whose experience of the climate and fevers of the West Indies has been very extensive, and entitle him to the greatest deference, has, with much kindness and condescension, communicated to me some facts respecting the attack of this malady, as affected by local circumstances. He says, that on the tops of the mountains, and in all elevated situations in the West Indies, the only fever known to exist is the ague or intermittent of Europe. As you descend, you find the remittent in a mild form; -still lower it appears in an aggravated type; until at last, on a level with the sea, in the crowded ill-ventilated towns, which, for commercial reasons, are almost all situated to leeward, over the beds of -dried-up rivers, or swamps, it appears with all its dreadful and destructive malignancy, rapid in its course, and accompanied with black vomit. It has also been observed, that, in very dry seasons,

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the ague appears lower; and that, in very wet ones, the remittent occurs in higher ones.' This gradation will account for these en demics prevailing in different situations according to the season; and I conceive it to be perfectly conclusive in proving their identity. Speaking of what he calls Bulam fever, Mr. Pym says, it is a disease, sui generis, of foreign origin, contagious, and attacking a person once only during life.' That it is the same as the bilious remittents, I think I have made sufficiently evident. With respect to its being of foreign origin, I ask, Do the same causes exist no-where for its production but in Bulam? When it has disappeared for many years, or for months, as it did in the Antelope, where did it hide itself; and, being so fatal, how was it concealed and retained in existence? I consider the doctrine of contagion to be altogether unfounded, and eminently mischievous; and that none of these fevers, allowing a difference, is contagious, I think I may assert on the most solid proofs the subject admits of. On board the Antelope, no precaution was taken to prevent contagion, yet, out of 320 men, having the freest intercourse, not more than 14 or 15 at a time were attacked. The surgeon, two assistants, and surgery-man, were always among the sick, and the three last slept continually in the midst of them, and none of them had the slightest attack of fever, for many months afterwards, and only the two assistant surgeons, after being sent, one into the Childers, and the other into the Brazen. The officers frequently came to see the sick; their messmates were allowed to visit, wash, and dress them; yet no appearance of the fever having been ever communicated by contagion occurred. On his being attacked, I lent a pillow to one of my messmates, who died eight days afterwards, having had black vomit, yet I slept on it for four months without any other precaution than that of changing its cuse, and without the least attack of fever during all that period. On board the Childers, where they had the fever, which my medical superiors called remittent, out of ninety meu, only three escaped being attacked, and every person impelled by duty to remain for any length of time on board was seized with the same disease. The surgeon of the Brazen sloop had been left behind, and on the brig's arrival (for she had been sent from Trinidad, that her men might be conveyed to the hospital at Barbadoes,) he nobly volunteered his services, and fell a victim to his humanity. Another surgeon and three assistants sent on duty into her, had very severe attacks; and three clerks, made pursers into her, died in less than as many weeks. This appeared like contagion, but was not, for none of the physicians, surgeons, assistant-surgeons, altendants, or nurses, who were continually with the men and officers after their being sent to the hospitals, were ever in the slightest degree affected with any thing like this disease. That the immediate and exciting cause existed on board the brig, is evident from this relation, and from the fact, that her men were taken ill every day, until she was unloaded and cleaned out, and that the black Creoles employed in this service were also seized with the disease in a day or two after being on board, but that since this purgation she has

had no new case of fever, and but one of relapse. I noticed above, that one-third of those who died on board the Antelope, either messed below, or lived there entirely, where they were, in some de gree, under similar circumstances with the crew of the Childers; and I have no doubt, had those strangers who were attacked in the Childers been sent into our hold, steward-room, or cock-pits, to breathe a close vitiated atmosphere, loaded with every miasm which such a state is calculated to produce, that they would have experienced some similar attack; or, had our ship's company been crowded down there, so many would not have escaped an attack, nor so many who were attacked have recovered. I think sufficient evidence is here given to prove that these fevers are not at all contagious. The fever in the Childers was endemie, not contagious; and it is by confounding the different ideas conveyed by these words, that many wander in a labyrinth of their own construction. This disease is in all cases endemic; it is the result of the influence of climate, modified by all the circumstances which I have already mentioned, and perhaps many others; and it is the different nature of these modifying circumstances that determine its nature and appearances. There is no such thing as idiopathic fever. Every effect must have a cause; and no cause can act in the general system, but must affect it through an organ or set of organs. Disease, as well as motion, must originate from a single point; and the power that affects that single point generates the disease, and the elimate is that power. With respect to the statement that the disease attacks person once only during life, if the evidence I have adduced to prove the identity of these diseases, and that they are not contagious be conclusive, this position falls of course; and it is well known that the remittents of this country attack the same person frequently, though each succeeding attack is generally milder, in proportion as the constitution becomes creolised."

After so copious and uninterrupted an extract, we may bé allowed, without the danger of any imputation on our candour, to call the reader's attention to certain passages. 1st. That the Bulam and yellow fever are the same. 2d. That, on board the Antelope, the fever originated in the ship, and the mortality was greater in proportion as the men lived below in atmosphere confined, though often cooler than on deck. sdly. The mortality in the lower deck of the Childers was very similar to that of the cock-pit in the Antelope. 4thly. Bridgetown was healthy when the Antelope arrived-we ought to have been informed of the health of the squadron in the Gulph of Paria, where the Childers anchored in August. But, 5thly, The lower deck of the Childers was dirty and ill-ventilated, and the mortality great in proportion.

Let us now remark, that the crew of the Antelope, though always clean, was seized as soon as she arrived in the West Indies. The Childers, though dirty, remained free for six

months

months after its arrival. The periods of the Tigris, Scamander, and Brazen, are not marked; but it is observed in all that the degree of disease was in proportion to their want of ventilation and cleanliness. Mr. Birnie and his fellowassistant, who escaped on board the Antelope, were seized, one on board the Childers, the other on board the Brazen, both in a similar condition. On board the Childers, even the Creole blacks taken from shore were seized; but the crew sent to the hospital at Barbadoes did not infect any one, and the ship, when well cleaned and ventilated, was found equally inocuous. From all this, Mr. Birnie concludes, that the disease was endemic, but not contagious; that is, we presume, that it originated with the people. But, says Dr. Ferguson, the type of the disease depends on local circumstances, and is different on mountains, in vallies, or swamps, or the beds of old rivers. This, therefore, refers, to places, and is rather exigios than endemic. επιχώριος

From the above, we may fairly conclude, as we ventured to hint in the preceding article, that confinement and waut of ventilation will generate a ship fever in the West Indies as well as in England, though its form may depend on climate and other causes. Hence, in the West Indies, the influence of vitiated atmosphere, whether from confinement or swamps, may produce fever with a yellow skin. In other words, that a ship fever may originate between the tropics, and be conveyed, in a similar form, from Bulam to the West Indies; or, if it originate in Europe, it may be conveyed to the tropics and assume a new form. That such an atmosphere may, like that of gaols or poor-houses, prove even more deleterious to strangers than to those among whom it originated, but that such strangers cannot propagate the disease, excepting in a confined atmosphere. Hence, that the contagion, if any exists, is different from that of small-pox; that it is also different from the miasma of marshes, but that, in the latter, the effects, particularly the yellowness of the skin, may be similar. That hence a yellow fever may be excited between the tropics either by the vitiated atmosphere of a ship or by the miasma of a swamp, and that the mode in which each spreads will depend on the exciting cause, though the symptoms of the fever may often be the same. That, therefore, a fever between the tropics, excited by any cause excepting the exanthemata, may come under the de nomination of yellow fever, as far as relates to symptoms and mode of treatment. We are, however, by no means partial to the term yellow-fever, but we think it less likely to mislead the learner than typhus icterodes, because the ship fever in the West Indies, in its character and its mode of treat

ment,

ment, has a nearer resemblance to the fever from miasma in the same country than: to the gaol or poor-house fever of England; and because, in all acute cases, we conceive the symptoms, and not the cause, of a disease, are to direct us in the immediate application of remedies.

Art. II.-Some Observations relative to the new Method of Extracting the Cataract, as proposed by Dr. Löbenstein Löbel, &c. By EDWARD CHAPMAN, Surgeon, Bath.

We shall take an early opportunity of repeating the author's experiments, before we offer our opinion on this article.

Art. III. Contributions to Diagnosis. By MARSHALL HALL, M.D. &c.

These relate to Hydrothorax.

Art. IV.-Case of Morbus Cæruleus arising from Ulceration of the Lungs, and accompanied with the Medullary Sarcoma of Mr. Abernethy. By WILLIAM HOWISON, M.D. Member of the Royal Medical Society.

This case, though by no means uncommon, is extremely interesting. We have several times expressed our wish that, in the treatment of internal tumours, our brethren would show greater courage; and, after the bold attempts lately made in obliterating large arteries seated within the peritoneal cavity, we may expect that in diseases as necessarily fatal as aneurism, similar attempts will be made." Our meaning will be better understood by giving the leading particulars of the case.

The following are the external indications of the tumour during life.

"Situated on the outer edge of the sternal origin of the left sterno-mastoid muscle, there is a large, hard, incompressible, somewhat irregular, and moveable tumour, extending hence along the upper margin of the clavicle, backwards nearly to the trapezius muscle, upwards to the angle of the lower jaw, and reaching anteriorly to the trachea; its basis seems to be very extensive, and deep-seated; its investing integuments are of their natural appearance; and its presence is reported to give no impediment to the performance of respiration or of deglutition. Pulsations, synchronous with the pulse at the wrist, but obscure, are to be felt in the swelling; and the belly of the sterno-mastoid muscle seems to be involved in it."

The patient suffered much for a few days with pain and dyspnoea, and died in the hospital.

"Sectio cadaveris.-The integuments covering the thorax being divided, the fat was found to be of a firni consistence, and to ex

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