indirectly condemns their practice, and very modestly proposes his own.

It appears, on the second day of the disease, the child had so much debility, that Academicus says, "his sleep was seemingly comatose," and yet "in such cases as these" Mr. C. informs us, "he has often had recourse to the warm bath, keeping the child in it until it became faint." But it may still be doubted, whether this plan would have succeeded better than that which was pursued.

Notwithstanding Mr. C. seems very certain that obstructed perspiration was the sole cause of the disease, it is not quite clear that worms in the alimentary canal may not have occasioned both the fever and green stools.

Does not also the "moaning for hours," on the night after the attack, naturally suggest, at least, the possibility that there may have been some affection of the brain, which terminated in hydrocephalus internus; especially when we consider, that the coma increased, and repeated convulsions took place, before the dissolution of the child? Indeed, Mr. Cuming himself is of opinion, that "the fatal symptoms of coma and convulsions, which closed the scene of this child's illness, might have been occasioned by hydrocephalus." If that was the fact, the possibility is, that inflammation of the brain very early supervened, if it was not the primary disease.

Mr. C. very properly observes, that the "connection which subsists between the bowels and the skin is very striking; when the pores are obstructed, diarrhoea or fever, for the most part supervenes, and is frequently attended with sickness or vomiting." In this case, however, we are not informed that either sickness or vomiting took place. It may, therefore, reasonably be doubted, whether obstructed perspiration was the cause of the disease, and whether an emetic and sudorifics would have been more beneficial than the medicines exhibited by B. D.

I like the reasoning of B. D. upon this point very much. He tell us he gave no emetic. 1st. "Because there was no sickness nor nausea." edly. Because Nature bad pointed out the path to be pursued." Now, as B. D. was on the spot, and saw the child very early in the disease, he had certainly the best opportunity of noticing the way which Nature took to relieve herself of the injury, however incurred and being the confidential apothecary of this family, I conclude, that he possessed, even in the judgment of Academicus himself, a competent share of professional ability to decide, both as to the nature of the disorder, and the best method of treating i

Nothing

Nothing can exceed the good sense with which Mr. Millett, junr. writes on the subject; in his letter (page 51, vol. 12.) the wisdom of an enlightened practitioner and the candour of a gentleman are both very conspicuous, and cannot fail in pleasing every liberal and impartial reader.

It is much to be lamented, that an unsuccessful case should destroy Academicus's good opinion of a "confidential practitioner;" and it is no less painful to observe how very anxious he seems (p. 516 and 517, vol. xiii:) to criminate the conduct of B. D. and to impeach his judg

ment.

Upon the whole of the circumstances taken together, allow me to make a few observations.

1st. It is very desirable, in all doubtful cases, to have the body examined soon after death. Had this child been opened, something might have been discovered that might have satisfied the mind of Academicus, that even an emetic could not have saved his life.

2dly. It is very unreasonable to judge of a practition er's skill by the fatal termination of a disease. "Medical men are certainly the instruments towards the recovery of people from sickness;" but it should always be remembered, that they are only instruments. Diseases can be removed by him alone, who inflicts them. But as he employs instruments in bringing on any disease, so also he makes use of them in taking them away. Medical men cannot be expected to work miracles, and therefore should not hastily be blamed when their exertions are not attended with the desired success. But as, without means, we are not warranted in expecting a divine interposition; it is our duty to use such as human wisdom and experience justify us in employing. But depending solely upon the means we use, without imploring the divine blessing, is presumption: So that when one hears another say, (page 568, vol. xiii.) "Except in cases of a natural or artificial old age, or, in other words, when the constitution has been exhausted either by intemperance or by time, no person ought to die of Fever;" one naturally believes, that as "dead flies cause the ointment of the apothecary to send forth a stinking savour, so doth a little folly him that is in reputation for wisdom and honour."

3dly. The knowledge of medicine, possessed by persons out of the profession, generally does them more harm than good. A gentleman may certainly read on medical subjects, till he understands much in theory; and yet not

be able to apply his knowledge to one good practical purpose. Just as he may, by reading Blackstone's Commentaries, thoroughly understand the British constitution, and yet make a very bad lawyer or statesman. Practice alone can produce that sagacity in discriminating, and that decision in treating diseases, which are so essential to insure success. Every practitioner remembers, notwithstanding the stock of theoretic knowledge he brought with hinz from the University and Hospitals, what doubts and fears have filled his mind when first called, in private practice, to the sick beds of his valued friends or endeared relatives; and what wavering and indeterminate conduct characterized the treatment of his early patients. How then can gentlemen, who, like Academicus, study medicine as an accomplishment, be competent to decide on the nature of diseases, or the best mode of treating them? Affection will alarm where there is no danger; and the want of sagacity and promptness will often render the disorder fatal. Such persons should always employ a "confidential practitioner," and suffer his own judgment to be subordinate to his friend's. Most medical men are so aware of the propriety of this conduct, that they usually commit themselves and families,, when sick, to the judgment and care of their brethren in the Faculty.

Lastly, It is our duty, when we are bereaved of our dearest relatives, to bear our loss with becoming submission to the Divine Will. The propensity there generally is in survivors to blame the medical attendants, when their friends or relations die, is both ungrateful and sinful. The largest sum of money (generally small enough) is a poor compensation to a man of a liberal education and refined feelings; when his assiduity, time, council, patience, and kindness, are returned with the most stinging and mortifying reflections; merely, because the event, which he could not controul, has been contrary to his warmest wishes. Surely, gratitude is due to a professional man, whatever be his success, unless he can be fairly charged with wilful neglect, or indisputable and gross mistakes.

This propensity to condemn the conduct of medical men is sinful, inasmuch, as it discovers a murmuring and discontented spirit; and is, in effect, if not in words, charging God foolishly."

66

Academicus, probably, is a clergyman; if not, he is doubtless a gentleman of education and refinement. Whilst, therefore, I most tenderly sympathize with him, on the loss of a beloved child, I cannot but hope, that his

good

good sense will induce him, upon mature reflection, to repose again in Mr. B. D. the confidence his family formerly placed in him. He will also, it is hoped, not perplex his mind, with imaginary cases and modes of cure, by reading medical books on the diseases of children; but will charitably conclude that the physician and Mr. B. D. did all that his child's case required, or that human means could effect. I am, &c.

Kidderminster, June 17, 1805.

GEORGE CUSTANCE.

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

FROM a thorough conviction of the utility and import

ance of the vaccinating system, I have been one of its earliest and most strenuous advocates. I have myself inoculated upwards of five thousand, and have supplied the virus to other practitioners to a great extent.

Yet, as truth is my only object, I take the earliest opportunity of informing you, that two of my patients, who went through the disease in the most satisfactory manner, one nearly five years ago, and the other about a year and a half since, have recently undergone a decided natural small-pox.

How far two instances out of five thousand, are to be considered as an argument against the cow-pock, it is not my intention to discuss here; I simply state the fact for the consideration of my professional brethren.

No. 75, Grosvenor Street, June 21, 1805.

I am, &c.

J. GRIFFITHS.

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

DR.

R. MOSELEY has lately published a pamphlet, in which he asserts, that a child of Mr. Curling, in George Street, Portland Chapel, vaccinated by me, has since had the small-pox. The fact is, that the child had a disorder attended with a slight eruption, which Mrs. Curling sup

A 3

posed

posed to be the small-pox; but having carried the child to Mr. Leighton, of Welbeck Street, and Mr. Draper, of Bul strode Street, they both declared it to be the chicken-pox, On this account the case was never communicated to me; nor should I have known it now, but from Dr. Moseley's publication.

Dr. Moseley seems not to be very difficult of conviction on such occasions; for having called on Mrs. Curling, and asked her whether her child had the small-pox after the cow-pock, she answered, that he had, according_to her opinion, but that she was not certain; to which Dr. Moseley immediately answered, there was not a doubt of it, for many others had the same.

The case alluded to in the third paragraph of Dr. Moseley's pamphlet, p. 129, I have authority from the family to say, is a misrepresentation of the fact; and the doctor must have received wrong information.

From these, and other circumstances, I am inclined to believe, that the cases published in Dr. Moseley's pamph let are in general ill-founded; and that he has been too ready to believe what agreed with his pre-conceived hy, pothesis; but I shall, hereafter, express my sentiments on this subject more fully, in another form.

False alarms are daily spread, concerning vaccination; but there are others which deserve attention. The following is the first instance in which I have ever seen a failure in my own practice; and a clear case of the small-pox after the cow-pock. A child of Mr. Fairbrother, in Exeter Street, Brompton, vaccinated by me about two years ago, has at this time the remains of a pustulous eruption, which appeared to be variolous, and was in some degree confluent; but it turned on the sixth day, and is rapidly disappearing. Many of those eruptions which first appeared, had vanished by the sixth day; and the complaint has proved more favourable than could be expected.

When this child was vaccinated, which was about two years ago, he laboured under the tinea capitis, which, sometimes, occasions an irregularity in the vesicle; but nothing of that kind was observable in the present instance, I am therefore inclined to suppose, that the morbid action already existing in the habit, partly, or entirely, prevented the vaccine vesicle from producing its full effect on the constitution.

Instances of local cow-pock are already recorded; one of them occurred at the Vaccine Pock Institution, another in the practice of Mr. Forbes; this is the first that has fallen under my observation. Such cases are uncommon;

and