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ing periodical publications of the day. It is the misfortune of one so engaged, to see matters too often through a jaundiced medium : not that we wish to apply this particularly to the present individual."
The remainder of this life is confrred to Dr. Bateman's connexion with the Edin. Med. Journal, and also with the late Dr. Willan. The asperity of some reviews in the former is thus easily accounted for. The connexion with Dr. Willan, having been sub judice, becomes rather a mat. ter for the lawyers than the faculty.
But, though we are ready to admit these confessions as some atonement for the wanton severity of that expired journal--the London Medical Review, and for the more severe critiques in the respectable publication from a sister metropolis, we are far from considering them as apologies for either. If there is a department of science in which truth is more important than in all others, it is medicine
; because in all others she may ultimately prevail
, and maintain justice. The same may happen in medicine; but, in the meanwhile, a mistake in medicine is irretrievable. What may be sport to the wanton or malicious critic, or afford food to the hungry gazetteer, may be death to thousands. Let us, however, dismiss this painful subject, and attend only to the work before us.
Several lives of defunct physicians will be found in our COLLECTANEA. The subjoined Appendix consists of a long Preface concerning the privileges of the College, and their unfair usurpations; an Introduction, containing an apology for offering the lives of living characters; a London Me. dical Directory, containing a medical and almost statistical Topography of London,-like most others, somewhat too circumstantial for the means in the power
any individual to arrive at,--a concise view of the Royal College of Physi. cians, the Royal College of Surgeons, the Society of Apothecaries, the Medical Society of London, the Medico. Chirurgical Society of London, the Linnæan Society,--next the charitable establishments, comprehending the Hospitals, Dispensaries, Truss Societies, Vacciné Establishments, and Veterinary College.
Such are the contents of this volume, which, with all its imperfections on its head, we prognosticate will be a source of much amusement to the present generation, and, in future times, frequently become a book of reference, though, perhaps, not of complete authenticity.
Edinburgh Medical and Surgical Journal, No. LII.
October, 1817. Art. I.-Case of Injury of the Spinal Cord. By John Gor
DON, M.D. Fellow of the Royal College of Surgeons, Edinburgh.
This case is well worth recording, as it contains a more minute description of the effect of fractured vertebræ than is usually met with. We think the practice of applying leeches somewhat tame, where the consequences are so soon and so much to be dreaded. We should have preferred cupping-glasses or bold venæsection, or both. There is, indeed, no reason to suppose either would have been useful; but, if any thing was attempted, it should have been with a boldness and decision equal to the danger. Audacter ferramentum imprimere debet, ut agat aliquid. Art, II.--Cases of Typhus Fever, with Observations on the Na
ture and Treatment of that Disease. By J.C. PRITCHARD, M.D. F.L.S. and F.W.S. Physician to the Infirmary and to St. Peter's Hospital, Bristol.
This paper abounds with just observations, but there is a want of attention to language which surprised us greatly in such a writer. To several very just remarks concerning a deep-rooted prejudice in the public, and even in some of the profession, against blood-letting in continued fever, a note is appended, complaining of the unbecoming language and conduct of two praetitioners in a case of epilepsy, for which the author advised blood-letting. ... On this occasion we are forced to remark, that, if philosophers, and such we consider Dr. Pritchard, indulge them. selves in the use of loose terms, when discussing so important a subject as the treatment of a disease, they must not wonder if men of inferior acquirements seize the only advantage they have over so powerful an antagonist; if they urge that bleeding is improper in typhus, and that epilepsy, being nervous disease, is likely to be exasperated by evacuants of any kind. Had we been honoured with this communication, we should not have scrupled to return it to the author, with a few hints for his better consideration : as it is, we can only offer them for his government in future, or for our own cor, rection if we are found in an error. To the term continued fever we can have no objection; but where was the neces. sity of introducing the word typhus. If this term relates to the infectious property of the disease, every practitioner kuows that infectious and contagious fevers from similar
sources will, in different subjects, require a different treatment. If it relates to the nature of the fever, either that fever was the typhus of authors, or we should have been informed in what it differed: and, if that difference was so great as to require a totally different treatment, it should have had a different name, or some reason should have been given why the name was retained. In the case of epilepsy, too, we ought to have been informed whether the complaint came under the description of chronic or acute; a distinction as old as Aretæus, and the inattention to which among the moderns has brought into disgrace so many remedies for this formidable disease. . We have dwelt thus long on a subject the importance of which has so often been urged by us, because we particularly wish that a physician whom, from his former writings, we so highly respect, should be aware, that, whilst he uses the terms Typhus and Epilepsy in so loose a manner, he is one among the number who, with the best intentions, and, in other respects, the soundest judgment, is perpetuating a practice the ill consequences of which he so justly deprecates.
There is another subject on which we enter with much satisfaction, when we reflect on the respectability of the character whom we are addressing.
“After having attentively noticed (says Dr. P.) the symptoms and progress
of contagious fever, in a great number of cases which have fallen under my observation, I am very much disposed to believe, that there is no such distemper as what Dr. Armstrong, with some other authors, denomínates Simple Typhus. I have scarcely ever witnessed a case of this fever, in which there was not some internal organ that appeared to labour more severely than the rest of the system, and exhibited symptoms which I was disposed to attribute to some local congestion, or inflammatory action; and in the great number of instances these symptoms have been nearly unequivocal. I believe the doctrine respecting fever, maintained by Dr. Clutterbuck and some others, gives too confined a view of the nature of this disease. The facts adduced by Dr. Beddoes seem to authorise the inference, that, in a great number of cases, proofs of inflammation clearly discoverable in the stomach, lungs, or other viscera of the Thorax or abdomen, than in the brain. Yet I cannot but coincide, on the whole, more nearly with Dr. Clutterbuck's opinion than with Dr. Beddoes's, so far, at least, as to regard the general affection of the constitution in typhus as depending on local disease. This opinion I know to be contrary to the most prevalent doctrine in medical schools and anong medical authors; yet, as many false Dotions have long continued to be current from the effect of their previous ascendency, I do not consider this as a proof that my own observations are at variance with the results of general experience. There is one writer, however, who has taken the same side of this
question, which I am disposed to hold; and it will be seen that the facts I have to adduce tend, as far as their evidence goes, to confirm the opinion which he has maintained respecting the nature and treatment of continued fever. I scarcely need add, that the author to whom I allude is Dr. Mills of Dublin, to whom the professiou and the public are much indebted.
" I shall hasten to insert, in as brief and condensed a manner as possible, some notes referring to a few of the cases of typbus, wbich I have lately treated in St. Peter's Hospital; but I wish, in the first place, to state one or two considerations, which are favourable to the notion that this fever is a symptomatic rather than an idiopathic disease.
“ I am persuaded, that, if any pbysician, who would divest bimself of the influence of previous opinion, should attentively examine a number of patients labouring under typhus, he would, in almost every case, be naturally led by the symptoms to infer that there must be some particular organ severely affected, in which was the primary seat of the disease. The idea of some deeply-seated inAammation giving rise to a train of constitutional symptoms, is much more consistent with probability and the general analogy of facts in pathology, than that of a general derangement of the whole constitution occurring independently and primarily. So repugnant, indeed, to probability has the latter opinion appeared on a closer view, that most of those adventurers in medical theory who have framed hypothesis to account for the phenomena of fever, have thought it proper to refer the primary affection to some particular structure,-some of them fancying the nervous, others the vascular, system, to sustain the first shock.
“The opinion which will probably be allowed to be most consistent with tbe general tenor of pathological observations, will be supported, in a large inajority of cases, by an appeal to facts; for it is conceded by all, that the instances are very numerous in which typhus is found, on dissection, to have been connected with local disease. It was long ago observed by Riverius, that acute and malignant fevers very rarely happen without the inflammation of some viscus; and this assertion is repeated even by Beddoes, who allows that it has been confirmed in every single epidemic where search has been made, and often without search.' Why do we persist in declaring the morbid appearauces which manifest themselves, and which seem to be adequate to account for the previous phenomena, to be only accidentally connected with the disease? We have only to extend the same determination to other maladies, and we . immediately deprive ourselves of the whole of the resources derived for the improvement of our art from morbid anatomy.
“Such has been the general evidence which anatomical investi. gation has afforded, and if this 'evidence has not been uniform, we must take into consideration the very imperfect manner in which these examinations have often been conducted. With respect to those cases which terminate in recovery, and do not give us an opportunity of anatomical investigation, we may observe, that they are
under his o
chiefly such as have been treated from the beginning by those ineans which are calculated to subdue visceral inflauimation; and that the more regularly these measures have been pursued in the early stage of the disorder, the greater is the chance of recovery. In my own practice, I have constantly observed, that the most successful measures were those that were founded on the supposed presence of some local inflammation.
“ It is true, that cases of typhus fever occur in which no symptoms appear, that may be considered as giving unequivocal proof of the existence of topical affection. But here it is surely more philosophical to reason from the known to the unknown, and, comparing these doubtful cases with others concerning which there is no doubt, to infer, as a probable fact, the existence of those morbid causes which, in the majority of cases, we ascertain. Examples are not wanting to show, that deeply seated inflammations of the viscera may exist for a considerable tiine, and even occasion the death of the patient, without ever giving rise to syınptons that enable the medical attendant to detect the real nature of the malady. A case was lately mentioned to me by Dr. Craufuird, of Clifton, which fell
observatiou thirty years ago, the circumstances of which strikingly illustrate this remark. A man was seized with the usual symptoms of typbus, and all the appearances which characterize that disease took place in their regular course, nor was the least suspicion entertained of the existence of any other complaint, or of any thing uncommon in the nature of the case. The patient lived upwards of three weeks, and, after death, when his body was examined, a sac full of pus was found adhering to the coats of the duodenum, near the pylorus."
All this leads to several questions, and to some of wbich the author does not seem perfectly aware. We need hardly say, that it leads us to consider the word typhus as a cover for our ignorance of the nature or cause of many fevers; a term, therefore, which a philosopher should never use unless he precisely states his meaning. But it involves a question older than Celsus, and extremely well discussed before his time, namely, that all fever is only the effect of some local disease. That all violent fever is usually attended by some local affection, cannot be questioned; and that the part affected depends much on the constitutional peculiarity of the patient, the season of the year, or the climate. The effects of the two former were extremely well understood by Sydenham, and traced in the different years, and at different seasons, with an accuracy which must immortalize his memory. In our own times, it has been further illustrated by the assistance of morbid anatomy, and by our better aca quaintance with tropical fevers, and probably would have been universally attended to, but for the unhappy attempt at a nosological arrangement of fevers in common with other diseases. It is not, however, our intention to admit that all NO. 225.