tioned as a sort of medium between the ligature and the excision, comprehending, in cases where it is practicable, most of the advantages of each without the dangers of either. This rude operation of Hippocrates, (which he says may be done without telling the patient any thing of the matter,) or at least the essential principle of it, namely, of producing some kind of contusion at the time of removing the excrescence, is worthy of consideration. It is a well known fact, that the instinct of animals, directs them to bite off the umbilical chord, when they produce their young. The laceration which the parts suffer in this natural operation prevents all hemorrhage from the chord. The life of the young is thus preserved, until the circulation is accommodated to that alteration which is necessary after birth, when the fœtus becomes a perfect and respiring animal.”

Among other remedies to which Mr. Copeland has called our attention, is the frequent injection of cold water up the rectum, with the addition of a few grains of sulphate of zinc, as employed by Schmucker. He likewise relies much upon the application of bougies in this complaint, as practised by Monteggio, an eminent Italian surgeon.

Though the works of Hippocrates are open to every surgeon, yet the merit of bringing into notice a fact from this father of the art, has been left to Mr. Copeland; a fact that will probably supersede the employment of excision or ligature.

We think, and it is but barely a presumption, if our author had pointed out that the common forceps, sharply dentated, would be the properest instrument to embrace the stem of the hemorrhoid, so that by the lacerating action of it, any hemorrhage would be prevented, that the direction would have been useful. And as to ligature, none being made, no consequence from it could follow. The forceps should be applied to bring forward the hemorrhoid, and on its division, all which is left within the gripe of the forceps will be sufficiently lacerated to stop all herrmohage.

The fifth section treats of Fistula in Ano. The author very justly observes in a note, page 58:

"It is remarkable, that a disease of so frequent occurrence shoud have excited so little of the attention of the English sur

gical writers. Fewer cases of the disease have been published, and fewer remarks on the infortunia and the anomalous circumstances attending it during the progress of the cure, than almost any other disease. Except the classical treatise of Mr. Pott, who has by no means exhausted the subject, there has hardly any thing appeared on this subject for the last century." The point of this section goes chiefly to two circumstances, which render the operation of Fistula in Ano more complex and uncertain in its event. From the hemorrhage which sometimes follows; and from the cause of the disease sometimes being too remote to be removed by the operation. The hemorrhage has been known to be fatal. The stricture in the rectum with a morbid state of the inner membrane of the gut, is far from being less frequently fatal; and where this is the case, the fistula becomes only a symptom, or consequence of the original disease.

Our author says, "the degree of inconvenience, therefore, which the fistula produces, and the other circumstances of the more important disease, are to be taken into consideration before the operation be resolved on, in cases of this description. And here also Mr. Copeland appeals to authorities which support his well intentioned improvement.

The latent sinuses, which are to be found in the complex cases of fistula in ano, have not been amply treated on. A dependence on the excellent direction of Mr. Pott has given a confidence to the operative surgeon which makes him blind to any farther inquiry; but it must be remembered that the operation can do no more than relieve the cause within its scope; and that the operation is not the less valuable from not doing more than what Mr. Pott even intended it should do.

The remaining section consists of well narrated Cases, illustrative of the author's observations on the several diseases of which he treats. In conclusion, we may venture to recom- . mend this work to the profession, as containing the most correct and clear account of a class of diseases often obscure, and too frequently neglected..

ORIGINAL PAPERS.

On the use of the Vaccine Crust or Scab.

I HAVE observed, with much concern, the difficulties attendant on vaccination for want of a continued supply of the vaccine virus, and therefore offer the following remarks on the most easy and effectual mode of communicating the infection at all seasons of the year.

On the use of the crust or scab in Vaccination.

When the wonderful discovery of vaccination was first made known by doctor Jenner, so desirous were physicians of proceeding with safety in this untrodden path, that they generally adopted the doctor's directions in using the limpid fluid taken from the vesicle, on the eighth day before the areola was formed. The danger of using the purulent matter secreted round the vesicle in the after stage of the process, appeared to be a sufficient reason for this cautious mode of procedure. But the difficulty of procuring vaccine virus in thus following doctor Jenner's prudent advice, operated as a 'real discouragement to the practice of vaccination. When the season for performing it arrived, the inquiries for the virus were anxiously made, and it was often necessary to procure it from a distance before the business could commence. We are now happily relieved from these embarrassments, for, in the year 1802, James Bryce of Edinburgh, surgeon to the vaccine institution of that place, published an account of his experience in using the scab in which the vesicle terminated-and this is justly considered as one of the greatest improvements on doctor Jenner's valuable discovery, as it furnishes us with a most certain mean of communicating the vaccine virus, and one which affords it at all times of the year.

The most perfect vesicles which go on to the state of crust or scab, without any deviation from the proper character; and which, when they fall off are somewhat transparent, smooth, of a mahogany color, and rather brittle than tenacious in their texture, are to be chosen to propagate the infection. Great care

is requisite to ascertain that it is really the vaccine crust or scab formed from the vesicle, which first falls off, as another scab of a different nature will often quickly form on the part. The scab should be wrapt up in a clean linen rag or white paper, and kept in a cool dry place. When used, the margin, which is of a lighter color, should be removed with a knife; and a portion of the remaining dark, hard, internal part is to be shaved off, reduced to powder on a piece of glass, and moistened with a small quantity of cold water, mixing it well together and then introducing it in the arm on the point of a lancet, leaving also a small portion of the scab on the scratched part. No more of the scab must be moistened at one time, than what is used, and no greater portion should be shaved off from the scab than what is wanted for the present occasion, as it appears to retain its strength better by continuing in the undetached state. It is believed that the livid vesicle, and especially the unopened one, is the most powerful.

By attending to the above directions I have lately vaccinated, from different scabs, twenty persons in succession, without a failure, on the first attempt. The frequent applications I have received, for vaccine virus, from many parts of the United States, occasion the present attempt to diffuse the knowledge of this easy and effectual mode of preserving it for use at all seasons of the year. The oldest scab I have ever used with success was one which I had possessed for eleven months. It is my present practice to vaccinate in every month of the year, and to use the scab only for this purpose.

It does not appear, by the European medical publications, that the vaccine scab is there much employed, but it is reasonable to hope that so certain and easy a mode of communicating the infection will soon come into general use.

Philadelphia, 3d mo. 9th, 1811.

SAMUEL P. GRIFFITTS.

Account of a Fever which prevailed among the Indians on the Island of Nantucket, in 1763-4.

BY JOSEPH PARRISH, M. D.

HAVING passed several days on the island of Nantucket in the summer of 1805, it afforded me an opportunity of making many inquiries respecting the epidemic fever which swept away almost two thirds of the Indians.

For the information on which the present narrative is founded, I am particularly indebted to Richard Mitchell an ancient and very respectable friend; who was one of the selectmen at the time of the calamity, also to the relatives of Zaccheus Macey (deceased), who obligingly permitted me to examine his manuscripts on the subject.

The disease was a very malignant typhus or ship fever, and appears to have been introduced in the following manner.

A snow arrived off the bar of Nantucket, having a number of passengers from Ireland. The first intelligence of any sick being in the vessel, was brought by several persons who came from an adjacent island, and reported that they saw two dead bodies floating on the sea. The selectmen were alarmed lest they should have the smallpox on board, and deputized several of the inhabitants who had passed through that disease to go and ascertain the fact; they returned with information that it was yellow fever.

The selectmen issued orders to the captain, to throw no more of the dead overboard, but to bury them on the shore, and sent off spades and shovels for that purpose; and further directed that no person from the vessel should enter the town.

Soon after this, information was lodged that several persons had left the vessel, and together with their baggage were at the house of Mary Quinn an Irish woman who resided in the town. As it was late in the evening when this intelligence was received. they were not ordered off until morning. When a messenger was despatched to Mary Quinn for that purpose.

The messenger found an Indian woman at the house engaged in washing the clothes of the passengers. She resided in one of their villages, in the family of the priest. In nine or at furthest eleven days, this woman was seized with a malig