inflammation. This violent action is, as in all other cases, suc¬ eeeded by torpor, during which the patient is, or appears asleep. The rigidity of the muscles, for a few days after, is the necessary consequence of their violent exertions, and the dulness of the senses is the effect of the effused lymph. As the lymph is absorbed, the functions of the parts are restored; thus the patient returns to his memory and reason in a greater or less time, in proportion to the violence and length of the paroxysm, and the consequent larger effusion of lymph. Sometimes the quantity of lymph effused is so considerable that the whole is not absorbed before the periodical return of the paroxysm: in this case, a fresh effusion takes place, and the quantity of adhesion in the substance, and of fluid in the ventricles of the brain, is thus gradually accumulated, till all memory is lost and the patient becomes idiotic. If suppuration has taken place, the symptoms subside in part; but the patient is rarely perfectly restored. To the world the difference may not appear, but those immediately about him find his faculties impaired, and oftentimes his temper altered. In this condition the continuance of his life seems to depend on the firmness of the capsules formed by the adhesive inflammation to contain the pus: if these are thin, they. suddenly give way, and the patient dies apoplectic, or in an instant without any immediate preceding symptoms. The above history, it will be remarked, is confined entirely to inflammation excited in the substance of the brain, without external injury. If inflammation attacks the membranes of the brain, the effect is at first intense pain, and afterwards phrenzy. If the brain is injured by mechanical violence, the consequence is coma or convulsion, and sometimes inflammation ending in suppuration, which either destroys the patient or injures the functions of that important organ.. The most common cause of spontaneous inflammation, or inflammation excited without external violence, is plethora, determined to a part from which there is not an easy egress from the body. Plethora is a frequent effect of certain changes produced at particular ages. During growth, a larger quantity of nourishment is necessary, which sometimes produces plethora, when the growth is completed or even during its progress.* In certain parts near the surface, particularly the nose and the rectum, provision is made for relief from plethora, by the increased number of blood-vessels, and the facility with which they are ruptured and heal. If, at these times, the plethora is determined to the head without this relief, epilepsy sometimes follows. As the changes in the constitution are completed, the cause and the effect cease together. Hence, at this age, a paroxysm or two, or more, sometimes occur, after which the patient remains free from any return. These and others occurring Epilepsy, from this cause, is very common in young dogs: it is sometimes considered as rabies; at others the animal is killed from a mistaken wish of putting him out of his supposed misery. at On at a more remote climacteric, are the causes which have given celebrity to certain remedies. The first have also given rise to a very general error, namely, that if epilepsy occurs early in life, it frequently ceases with the change which takes place at puberty. the contrary, as the late Dr. Heberden remarks, if it commences much before that period, it increases as the vigour of the body increases. Aretæus had before noticed, that, if it continues beyond the vigour of life, it becomes chronic, and, without shortening life, only ceases with the patient's existence. On this account he confines his remedies entirely to the relief of the acute paroxysm, referring the cure of the disease itself, or the prevention of its return, to his remarks on the chronic disease. With submission to an authority of which I so gladly avail myself in the division of the disease, I shall consider every paroxysm acute which produces any of the consequences above mentioned; but, most of all, temporary loss of memory and its gradual return. These I can only impute to such a change in the condition of the brain as may admit of restoration; that is, to the adhesive inflammation, the progress, termination, and sequel of which has been sufficiently dwelt upon for our present purpose. [The remainder of this paper will be hereafter noticed in our analysis of the rest of the Transactions.] Miscellaneous Observations on Contagious and Infectious Diseases, from Dr. GALLUP, of America. "THERE was a time, undoubtedly, when contagious and infectious diseases were strangers to this earth; they have had an origin, at different times, by a concurrence of causes unknown to us. It is sufficient for our purpose to learn their present character. Although the appearance of these classes of disease is not precisely the same in all seasons, and in all habits, yet they manifestly have a determined character, and are nearly alike at different times. Those that are assigned to the class of contagion, require about the same term of time to run through the system now that they did centuries ago; those of the class of infection are governed by the same laws now as in former times. "It is believed, there is little doubt that most, if not all, the diseases of these classes may be generated, in certain places and seasons, from a recurrence of the causes which first produced them in former times; and that they spread from one person to another, and become epidemic more or less, according to the particular state of the atmosphere, favouring their propagation. But the productions of these kinds are very rare, and their existence not attended with a satisfactory proof which is sufficient to gain the full assent of the mind: the most we know of them is, that they are propagated in a seminal influence; and probably were instituted for the Scourge of man. "With respect to those diseases that we call epidemic, every term of experience serves to convince that they are very mutable in their character. Where a concourse of symptoms designate the disease in popular language, the discerning physician often discovers a difference from those which he has seen on former occasions, called by the same name. This is so manifestly the case, that hardly any two epidemics are said to be exactly alike; at any rate, they have not the specific character of the fevers from contagion. This difference is imputed to some variation in the predisponent principle. It is agreeable to the analogy observed in the animal and vegetable kingdoms to suppose, that even the diseases of the most specific character become extinct, and that others are generated from the operations of physical causes. Species of animals did exist in former times, as we learn from authentic history, that have now become extinct, and those of the most perfect kind. "Certain insects and reptiles are produced, on certain occasions, from a concurrence of circumstances unknown to us, which seem to be of a different character. They are creatures of a day, as it were; some of them real ephemeras, others of longer duration. All of the same species, alike in colour, size, and duration; myriads congregate together, and become extinct together. We have abundant reason to suppose, that these are the production of certain elementary principles: the particular combinations of matter, however, are wholly unknown to us. An analogy is here presented worthy of our attention. It was "We are fully apprised of the danger of classing diseases in the ordinary method of nosological arrangement, according to the different types or states of the system that have been assigned to particular diseases. This has been a source of infinite error. considered more appropriate to make only some general classifications of fever, founded on their remote causes. If one reasonable argument can be urged in favour of this mode, it will be full as much as can be said in favour of the common nosological arrangements. One important benefit, in a classification by remote causes, will be to draw a discriminating line between those diseases that may have a foreign origin, and those that may have a domestic or elementary origin. The former may be transported from place to place, and may be communicated under all circumstances; whilst the latter are susceptible only in certain places, or under certain circumstances. From the want of this discrimination, great discordance of opinion has prevailed amongst physicians; and much perplexity has arisen in different countries in public and private concerns. From an apprehension that certain diseases of an epidemic character are contagious, the sick have been abandoned to their fate by friends and physicians; the common acts of hospitality, and the necessaries of life, and a common burial, have been denied them! "Tedious and oppressive quarantines have been established, to the great injury of commerce, and annoyance of individuals. It will not be denied but that quarantines, of short duration, may be necessary, for the purpose of cleaning ships, wearing apparel, &c. of every impurity and fermenting principle whereby miasmata may.. be be produced; the same as in streets or houses: but forty days detention for the purification of the bodies of men is useless in epidemic fevers; and the restriction had its origin in a profound ignorance of the laws and principles that govern epidemic diseases. "The folly of adhering to nosological arrangement is conspicuous in this, that almost always, when an epidemic is present, the type of disease is different in different cases, and in the same case at different stages: for example, when an epidemic angina prevails, some cases appear more distinctly in the character of what is called synocha, and others more distinctly in that of typhus; and also the states of the system are often so blended between the two extremes, that it is believed the most acute nosologist is put at much strife with himself to determine which genus to place it in. It is divided sometimes, and the mean difference is called synochus. Dr. Cullen, with all his nosological ingenuity, would find no place for putrid fever, notwithstanding it was so common, and often appeared in intermittent fever, &c. His other works stand, perhaps, unrivalled. It may be added, that nosology would be at least innocent, if it did not lead the student to prescribe for names, and neglect the degree of morbid excitement and real character of the disease. "The disease should be treated according to what it is, and not according to any generic character it may have forced upon it. The spotted fever seems yet unaccustomed to the yoke of nosological restraint, notwithstanding the attempts to subdue it. Perhaps there is no disease in history that is so variable in its phenomena, and requires such versatility of treatment. It is a conspicuous example of the variety of febrile action, and is well calculated to test the skill of the physician. CRITICAL ANALYSIS IN THE DIFFERENT BRANCHES OF PHYSIC, SURGERY, AND MEDICAL PHILOSOPHY. Practical Observations in Surgery and Morbid Anatomy; illustrated by Cases, with Dissections and Engravings. By JOHN HOWSHIP, Member of the Royal College of Sur-" geons in London, and of the Medico-Chirurgical Society. 8vo.-Longman and Co. 1816. pp. 483. In a short introduction the plan of this work is explained, which consists of a series of cases, interesting, well related, and all of them concluded with practical remarks. To do justice to the writer, we shall select a portion from each division, in the order in which we find them. The following, among other interesting brain cases, may serve to show the importance importance of attending to the slightest symptoms of disease, particularly in those organs, without the regular operation of which, life is neither desirable nor can be long preserved. Slight Injury to the Head, producing Symptoms, and ending fatally near Forty Years afterward. "In 1792, I was desired to examine the head of Mrs. E-―n, who had died the day before, and whom I had attended with Dr. Turton and Dr. Harvey, about eight months previous to her death, having made her various setons, issues, &c. by their direction. Her case and the appearances were the following. "She was about fifty; the widow of the late Bishop of D When about fifteen, being at play, she received a slight tap, rather than a blow, on the right side of the head. It gave her at the mo ment rather severe pain; but she disregarded it, and no immediate consequences of any kind followed more than a common headache, commencing always in the part stricken. "For above thirty years after, she was subject to these attacks, and then began to grow heavy, and sometimes stupid and sleepy, without any known additional cause, though she was naturally one of the liveliest, and most witty women existing. "This disposition continued gradually increasing till, for the last year and a half, it was very difficult to keep her awake; but, when she was awake, as I have often known, though it was but for half an hour, she had all her natural brilliancy of conversation about her; then all at once would drop asleep again, not to be roused. In this way, she went on till a perpetual comatose state took place, and she died convulsed. ❝ Latterly her vision had become very much, although very gra dually, impaired. "Examination.-On examining the head, as soon as I had removed the scalp over the right parietal bone, I saw a portion of the bone, about the size of a crown-piece, seemingly of a very dark colour, directly under the part where the blow had been ori ginally received, and to which spot she invariably pointed as the seat of her pain. On removing the right parietal bone, I found that part of it which appeared discoloured was transparent, and almost wholly absorbed. It had that colour given it from the portion of the right hemisphere of the brain directly under it being perfectly black, and the colour appearing through the bone, for the dura mater at this part was altogether removed by absorption. Had she lived much longer, I am clear the bone also would have been altogether absorbed, and the brain itself protruded. "The portion of brain under the seat of the injury was indu rated, and scirrhous, and this change had taken place through the whole of the middle lobe cerebri. The colour was a dark livid hue. "Every other part of the cerebrum and cerebellum were perfectly sound, nor was there any disease whatever in the contents NO. 221. of |
