"In the meantime doubts were started concerning the duration and ex. tent of this prevention; objections which could have no weight but in so far as they militated against the ultimate benefit held out to mankind; namely, the extirpation of the small-pox. We may affirm, that though the cow-pox should be found not to prove a security for life in every instance, and though it shall be found, that in one case in a hundred, nay, one in ten, it should fail in destroying susceptibility, it would nevertheless be of inestimable value to mankind, for it would still prove an instrument for annihilating, more or less gradually, the whole existing stock of variolous infection."-A Serious Address, &c. 4—8.

We cannot conclude this article more appropriately, than with the following resolutions, containing the results of eleven years practice, at the Original Vaccine Pock Institution, which have just reached us :

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1. That it does appear in the practice of this institution, that the small-pox has occurred subsequently to vaccination, in the most distinct manner, in the proportion of about one of 550 in 5000 patients.

"2. That in these cases of failure the small-pox was in none very sëvere, but on the contrary, in most of them milder than usual, in even the inoculated small-pox.

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"3. That there have not occurred any alarming vaccine cases, except ing in a very small proportion, from inflamed and sore arms.

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4. That in many hundreds subjected to the counterproof of re-inocu lation with variolous matter, not one has taken the small-pox.

66 5. That many hundreds have been re-inoculated with vaccine matter. without being able to reproduce the cow-pock.

6. That according to considerable experience of this institution, persons are alike unsusceptible or susceptible of the small-pox and cow-pock after variolation or vaccination.

"7. That re-inoculation with vaccine is preferable to variolous matter; because it is desirable to avoid the risk of infecting others by disseminating small-pox infection; and because the vaccina is rarely attended with dan ger, or with severe symptoms.

"8. That the cow-pock matter and variolous matter are distinctly dif ferent species of matter in the just sense of the term species or kind.

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9. That there is now good evidence, that in the cases of failure the constitution had generally been rendered less suscepsible of violent action from the agency of the small-pox matter.

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10. That it does not appear that any new disorder is liable to be occasioned after vaccination, excepting probably certain eruptive complaints, which, however irritating, have in no instance produced any serious injury; and it appears that certain diseased states which come on after the cowpock, do not supervene so frequently as after the small-pox.

11. That although it does appear from the London Bills of Mortali. ty, that 420 fewer deaths per annum on an average have occurred during the twelve years of vaccination, than during the twelve preceding years, yet the conclusion that the diminished mortality has been occasioned by vaccination, is liable to error; but the probability is in favour of the new practice."-p. 20-22,

PART

PART III.

MEDICAL INTELLIGENCE.

Account of Diseases treated at the PUBLIC DISPENSARY, (near Carey Street, London, from May 31st to August 31st 1811.

The temperature during the three summer months has been variable, but on the whole moderate. In the latter part of June, and in July, there were occasionally a few days of summer heat; but the whole of the month of August has been temperate, not to say cool, with frequent showers: in the early part of this month, indeed, there were a few days unusually chill for the season, the thermometer scarcely rising above the 50th or 52d degree. Several thunder-storms of considerable severity, occurred during the preceding months.

From the early, but unsteady heats, alternating with coolness and humidity, it might be expected that a considerable degree of indisposition would prevail among those who are most liable to be influenced by the state of the weather; and especially that the various modifications of disease, connected with derangements in the biliary and alvine secretions, would be most predominant. Accordingly we have had occasion to prescribe for more than our average number of patients at the dispensary, particularly during the last two months; the total, exclusive of those under the care of the surgeon, amounting to five hundred and thirty-three: and of these a considerable proportion is referrible to gastric disorder, perhaps to the extent of one third; while the proportion of pulmonary complaints is greatly diminished, and was exceedingly small, until the chilliness and humidity of August set in. In addition to the direct effects of gastric derangement, viz. the cases of diarrhoea, cholera, and dysentery, the painful affections of the stomach and bowels, gastrodynia, and enterodynia, and the disturbed function of digestion,

under

under the heads of dyspepsia, bilious vomiting, &c. we must refer to the same source many of the cases of headache, vertigo, and continued fever, and perhaps the majority of instances of asthenia, not to mention those of jaundice, hepatalgia, hypochondriasis, &c. The cases of vertigo were obviously sympathetic, being unaccompanied by lethargic disposition, by flushing of the face, throbbing of the vessels, or other symptoms of local fulness, occurring often at intervals, and being obviously connected with constipation, loss of appetite, loaded tongue, flatulence, or other dyspeptic symptoms, and generally yielding in a few days to absorbents, aromatics, and laxatives. With the exception of a few instances of rheumatism of the scalp and muscles of the head, the cases of headache were perhaps all of gastric origin. The pain was most frequently seated in the forehead, over the orbits, or in the crown of the head, and sometimes in the occiput, of an obtuse kind, and unaccompanied by tenderness of the integuments, except occasionally at the crown, in cases of some standing. It was commonly accompanied by some of the dyspeptic symptoms, above alluded to, and yielded to the same plan of treatment. In one woman, in whom the sympathetic irritation had terminated, as may be frequently observed, in a degree of local congestion and increased vascular action, the vertigo was considerable, and was accompanied by an illusion of the sight; whence she fancied that she frequently saw people standing by her, who vanished, however, when she steadily directed her eyes towards them. She was perfectly aware that this was a mere illusion, and it gradually disappeared with the other symptoms.

Several of the cases of fever, though such as usually termed continued, manifestly assumed somewhat of the remittent character, exhibiting a very material alleviation of the symptoms in the morning, and an exacerbation in the evening, which occasioned much restlessness in the night. In some of these, however, the head suffered no observable disturbance of function, except an inability of attention and mental exertion, while the acceleration of the pulse, the heat of the skin, the depression of the muscular powers, the total loss of appetite, continued from day to day, and confined the patient at first to a couch, and afterwards to his bed. In two instances, the fever shewed a tendency to intermit about the end of the third week, a slight rigor preceding the exacerbation, for two or three periods, on the alternate days. There was no one indication, either in regard to the seat of the disease, or to any active remedy which might be resorted to with a prospect of abbreviating the febrile action, unless the alvine discharges were examined, which were always found in a very morbid condition; and it was interesting to observe the progressive

progressive amelioration or increase of the symptoms, in an exact proportion with the changes of the egesta. In the House of Recovery, as well as in some other patients, I have lately had occasion to see several examples of this modification of fever, which Manningham has very well described in his treatise on the febricula. The principal method of cure, in such cases, consists in regulating the alvine discharge, not by active purgatives, after the manner of Dr Hamilton, but by a continual gentle operation, especially by means of the mercurial laxatives, aided by combination with others, and their irritation being counteracted by anodynes. The synochus biliosus, in which the bilious secretion is perhaps more augmented in quantity, than materially altered in quality, differs altogether from the fever just alluded to. head is, in that case, affected with great pain, probably through sympathy with the great irritation in the first passages; and, as in the case of cholera, when these passages have been effectually cleared, the general fever speedily subsides. The present season seems to have produced fewer instances than usual of this variety of fever,

The

The congeries of symptoms, included in the term Asthenia, which has been formerly described, partakes in some measure of the nature of the febricula, is always connected with a condition. which the nosologist would refer to dyspepsia, and especially with certain characteristic sensations of sinking, fluttering, imbecility, &c. in the epigastrium and left hypochondrium. In one case, which we lately saw, there was a most acute pain in this region, which was even increased on pressure; but it was accompanied with extreme languor, almost amounting to syncope, cold sweats, extreme sickness, &c. which excited alarm for the patient's life. But all these symptoms were speedily alleviated by medicines, (which, from their small bulk were retained on the stomach,) containing the extract of poppy, with aromatic powder, and small doses of calomel, and aided by an anodyne and saline enema, which brought away a considerable quantity of clayey and offensive fæces. Etmüller wrote an essay to prove that these symptoms originate in that part of the arch of the colon which lies in the left hypochondrium, where, he says, the excrements often stagnate and much wind is pent up: and this circumstance appears, in addition to the disordered state of the stomach, to afford a probable explanation of some of the local symptoms attending the complaint. This asthenia, which is a disease of women, seems to be more allied to the hypochondriasis of men, than hysteria. The diffusible stimuli are requisite in the treatment of this disease, which does not bear purging; but a gentle stimulus upon the bowels, in the first instance, guarded against any considerable