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experience, should not reflect some of its rays upon the less en lightened of their contemporaries.

"I now conclude this paper. It may be said by many, that in some places I have used too much the language of panegyric. It may be so, perhaps it is so. For the general strictures included in these observations I offer no apology:- Licet omnibus, licet etiam mihi, dignitatem 'Medicina' tueri; potestas modo veniendi in pub licum sit, DICENDI PERICULUM NON RECUSO,''

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The Morbid Anatomy of the Brain in Typhus Fever, with a few Observations on its Nature and Mode of Treatment. By THOMAS MILLS, M.D. Licentiate of the King's and Queen's College of Physicians, Dublin, 1817. Pp. 26. THE following preface introduces twelve cases of fever, with the appearances after death.

"While an epidemic typhus, fatal, especially among the higher orders, spreads general alarm in several parts of this country, whatever throws light on the nature of that disorder cannot fail to interest the public mind.

"In a work, written expressly on the subject of Fever, I proposed venesection and evacuants as the best remedies in typhus, and gave numerous cases, from my private as well as public practice, in which these remedies were used with advantage.

"This mode of treatment has since received the sanction of prac titioners of eminence; while others, without adopting it themselves, have been disposed to allow, that it is not attended with any inju Tious consequences.~

"But, besides my own experience and that of others, I think it proper to appeal to a test, no less decisive, as to the merits of any practice the morbid changes which appear in the bodies of the dead. An examination of these changes, as Dr. Baillie, in his Morbid Anatomy, observes, is calculated to correct theories too hastily taken up about diseases.

"I recommended venesection on the ground that the disease, though attended with extreme debility, proceeded from inflammatory actions in the brain. If this be a theory taken up hastily, or from erroneous views of the subject, dissection will detect its errors; but, will, on the other hand, give it additional strength, if it be founded on just observation and in truth.

"The following sheets present twelve cases of dissection, shewing the morbid appearances of the brain in typhus, or brain-fever."

We transcribe only one of the cases, as, with a few exceptions, chiefly in degree, they are all similar.

"Mrs., aged 32,-Townshend-street,-of a melancholic temperament, and subject to a lowness of spirits. Nine days ill of fever, caused by suppression of the menses and exposure to cold and No, 226,

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wet.

wet. Shivering, pain and fulness of the head, languor, loss of ap petite, and a soreness of the flesh and bones, ushered in the attack. The pulse was frequent, irregular, and variable in strength; the skin was hot; there was delirium, throbbing of the temples, coma, deafness, and hurried respiration; there were involuntary dejections: the body was covered with petechia, and there was a loss of speech and the power of deglutition.

"The patient died on the 15th day of the fever.

"On dissection, several distinct osseous tubercles were found along the line of the longitudinal sinus; the dura mater was highly vascular, and adhered closely to the cranium; the veins of the pia mater were turgid, and there was a considerable degree of arterial vascularity throughout this membrane, particularly at the posterior part; the arachnoid membrane was raised from the pia mater by a serous effusion, principally at the anterior portion of the brain.

"On cutting into the substance of the cerebrum, it exhibited numerous red points, but the cortical part was somewhat paler than usual. The plexus choroides were more vascular than natural; about twelve drams of a watery fluid were found in the ventricles and at the base of the brain. The cerebellum was still more vascular than the cerebrum.

"The right lobe of the liver was rather darker and harder than usual, and the left was adherent to the diaphragm; but its sub. stance, when cut into, was of a natural appearance. The pancreas was gristly, hardened, and enlarged; the right ovarium was altered in its structure, and, when cut into, exhibited matter of a cheesy consistence; the left ovarium contained a large hydatid.

"The thoracic viscera were healthy.".

With the exception of the bony tumours, such was the appearance within the cranium of each, excepting that in some the quantity of serum was greater, and in others coagulated lymph was discovered in different parts of the plexus. In some of the subjects, also, there were appearances of inflammation in other viscera. There is no account of the manner of treatment in any, and unfortunately no account of the period after death at which the examinations were made. The last is of no other importance than as a means of conjecture how far the fluid found in the ventricles was the effect of disease, or of transudation after death. Other desiderata in the account are, a proper description of the petechiæ during life, and whether the blood coagulated after death. Only one of the subjects had delirium ferox.

Having related his cases, Dr. Mill's concludes,

"The above are twelve cases of typhus fever;-the debility, the head-ach, the derangement of the mental powers, and the petechia with which the body was covered, sufficiently determine the nature of the complaint. The dissections were conducted by surgical gentlemen of character; and the descriptions of the morbid appear

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ances, taken down on the spot from their report, were confirmed by my own inmediate examination.

"These appearances were almost uniformly the same;-vessels gorged with blood, extending themselves through the substance of the brain, overspreading its lining membranes, the dura and pia mater, and the arachnoid coat; and effusions between these membranes and into the cavities of the brain. These are analogous to the changes observed in phrenitis, in hydrocephalus, in apoplexy, and similar to those which are found in the cavities of the chest or abdomen, after a fatal pleurisy or peritonitis.

"While we pronounce, without hesitation, that, in these cases, the changes are indicative of increased and inflammatory actions in the organs in which they are discovered, can we suppose in typhus fever, where analogous changes take place in the brain, that the same disordered actions do not go forward?-especially, since the appearances on dissection, by shewing the relation between the symptoms and the organic changes produced by disease, are expla natory of the phenomena.

"It is true, great debility occurs; but, when the brain is oppressed and deranged by excess of action, that consequence is to be expected, since the oppression is exerted on an organ which is the very source of muscular energy: and hence, in the apoplectic, where the oppression arrives at its height, the powers of the voluntary muscles cease altogether.

"The effects of stimulating medicines in such a state of the brain must be to urge the blood with still greater violence on vessels already overgorged, and to increase action in the exhalents which are disposed to inundate the cavities with their exuding fluids.

"On the contrary, whatever lessens the strength of the circulation, the very same remedies which are administered in phrenitis, seem to be called for here-sedatives, purgatives, and venæsection, employed and repeated according to the state of the symptoms.

"Such is the conclusion which, I think, the unprejudiced would draw, and it is supported by my experience and by that of practitioners who have adopted the practice in the present prevailing epidemic.

"Among other communications, I have been favoured by Mr. Henry, surgeon, who has the care of the Dispensary at Castlepollard, with an account of the epidemic fever, as it appeared in that town and its neighbourhood.

"The symptoms,' he says, 'were chilliness, pain in the head and back, low and quick pulse, weakness, petechiæ, delirium, stupor or heaviness in the head, foul tongue, thirst, and restlessness. Recoveries generally took place from the 9th to the 13th day.

"Contagion appeared to be the cause, as it attacked successively several in a family. My apprentice and I blooded nine on the same day, in one family of the name of Walsh, two miles from Castlepollard, on the estate of Thomas Webb, esq.

"From the dispensary books it will appear that there were about 200 ill of the fever, all of whom were blooded, and not one died,

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died. Some were blooded three times: one of these was my apa prentice. The quantity of blood taken at each time was from six to eight ounces from adults-less from children.

"I had several patients not on the dispensary books, and I treated them in the same manner, and with the same success: I also employed purgatives and sudorifics.

"The head was invariably relieved by each bleeding. I found that small and repeated bleedings were more effectual than large

ones.

"The blood was seldom buffed, but generally dense. The fever terminated sometimes by perspiration, but often without any sensible evacuation, with a return of sleep and appetite."

Such are the important facts contained in this valuable compilation, on which we cannot help making a few remarks, First, we have still to learn what constitutes typhus. Is it contagion? The author seems rather to insist on debility and the other symptoms. Now, all these symptoms may occur in scarlatina, measles, or small-pox; or in continued fever from any cause. That the brain was oppressed in these, and is in most or all other, fevers, cannot be questioned. But, when we are told that the appearances are similar to those observed after phrenitis, hydrocephalus, apo plexy, and that such changes are similar to those found in the cavities of the chest and abdomen after fatal pleurisy and peritonitis, we must pause before we admit that effects from such causes are similar. In phrenitis, we have often preternatural strength during life. In violent inflammation of the brain, we have epileptic symptoms, attended also with preternatural muscular strength for a time. In apoplexy, we have entire or partial loss of sense and motion. In the first, we find, after death, strong adhesions of the membranes, with effusions of coagulated lymph. In the second, a peculiar firmness of the brain, probably the effect of effused coagulum. In the third we have extravasation of blood in the ventricles between the convolutions, or, more commonly, under the dura mater. In phrenitis, the blood drawn is usually buffy and cupped. We take no notice of the turgid appearance of the vessels of the brain, as nothing can be more uncertain.

Now, it is to be remarked, that, where the blood was drawn in this fever, the appearance, so far from denoting inflammation, was directly the reverse: "dense," which, we conceive, can only mean of a creamy consistence, the constant mark of blood which coagulates imperfectly, as if from the same diminished power which it partakes with the solids. At the same time, it cannot be questioned that there was effusion on the brain. This, we conceive, takes place in all fevers, and to be the cause of that dulness of

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the senses which the best writers have considered as favourable in a certain degree. Deafness is the sense generally marked, because it is in an organ which is principally wanted during disease.

But, if it is the property of every fever to induce this ef fusion on the brain, there cannot be a doubt that such a process should be closely watched. When it extends no further than to produce a general dulness of the senses, such an effect may be desirable; but, wherever a new action is set up, it may be carried further than is consistent with health. Hence, this effusion may extend to extravasation, in which case we have apoplexy, by no means uncommon in the very commencement of some of the worst kind of camp-fevers, It may induce inflammation, in which case we have delirium feror; or, without either, it may be so considerable as to produce a greater interruption to the necessary functions of the brain than is consistent with the maintaining of those actions by which life is supported. Under any of these circumstances, the indication is to determine less blood to the head, which must be accomplished either by lessening the action of the vessels about the brain, by taking away blood from the common mass, by other evacuations, or by exciting higher action in other organs. The first is accomplished by cold applications to the surface of the head, the second by venæsection or cupping, the last two by purgatives; and, if the symptoms are threatening, all three may be necessary.

But, neither the symptoms in their ordinary form, nor the advantage derived from these remedies, convince us that inflammation of the brain attends every fever; or that a limpid effusion to such a degree as merely to obscure the senses is not salutary in fevers. At the same time, we perfectly agree in the practice; and are convinced that the omission of early evacuations, and, still more, the use of stimulating remedies have produced all the mischief of which they are accused, and of which the most zealous Cullenians are gradually convinced.

A View of the Relations of the Nervous System, in Health and in Disease; containing Selections from the Dissertation to which was adjudged the Jacksonian Prize for the Year 1813. With additional Illustrations and Remarks. By DANIEL PRING, Member of the Royal College of Surgeons, London, and Surgeon at Bath. 8vo. pp. 256. Callow.

IRKSOME as disquisitions on the brain and nerves usually are, we could not withhold our attention from a paper which received the prize from such an ordeal, and had been revised

for

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