violence; he has had no sleep, pulse feeble and irregular ; voids his urine involuntarily in very small quantities: continue his medicine with gutt. xxx. tinct. opii and the warm bath as before.

9th. This day I could not visit him, being detained by a case of midwifery; he therefore continued the use of his antispasmodics.

10th. Spasms, if possible, still more violent, agitating the whole body with great severity: pulse very feeble, fluttering, and intermitting: discharge of blood from the rectum almost continual; his feet cold. Continued his antispasmodic medicine, with tinct. opii gutt. xxxvi.

11th. Died this morning about two o'clock.

13th. By permission of his friends, I proceeded to open the body, a medical friend being present, together with Mr. B. before mentioned (Vol. xxi. p. 226). On laying open the abdomen, the viscera had a healthy appearance; there was a considerable accumulation of fat surrounding the bladder and kidneys; the rectum was somewhat thickened, and the blood-vessels ramifying on it charged with blood. I dissected away the bladder, making the incision to include the prostate gland, (Plate a) which was much enlarged. I then laid it on a table, and opened it from the neck to the fundus, which displayed at once the ragged remains of the sac, (b) which contained the hydatids, pendulously attached about two inches from the neck of the bladder, the coats of which (c) were thickened to about an inch and one-eighth; the inner surface was sacculous, (d) and contained about two ounces of a brownish-coloured, thick gelatinous fluid. I next proceeded to take away the kidneys, and opened one of them longitudinally; its pelvis was so much enlarged as to admit a moderate sized hen's egg; the ureter as it departed immediately from the kidney was proportionally wide, and further on its approach towards the bladder was sufficiently capacious to admit my little finger within it. Mr. B. will doubtless feel the importance of this case, pointing out the great necessity of weighing in his mind with much deliberation the obscure symptoms of disease which do sometimes occur, and of investigating cautiously so as to be decidedly confident of the real nature of the complaint. Lamentable indeed must the conclusion of the present case have been, had the operation of lithotomy been performed, and truly degrading to the present enlightened state of medical science! JOHN KENWORTHY. Dobcross, Yorkshire, October 16, 1810.

To the Editors of the Medical and Physical Journal. Scarlatina Anginosa Maligna.

GENTLEMEN,

SCARLATINA Anginosa Maligna having made its appearance in its very worst forms, in a large district round Debenham, in Suffolk; I take the liberty of sending you the particulars attending several fatal cases, with the general plan, and medicines employed.

The first case appeared at Debenham in February last, commencing with a cold shivering fit; enlarged and ulcerated tonsils, surrounded with an erysipelatous purpley inflammation attended with grey coloured spots; in a day or two, the scarlet cruption appeared about the neck, face, and bosom, and afterwards extended to the extremities, and generally accompanied with stiffness and tumefaction of the wrists, fingers, ancles, and toes. Pain of the head and back, and very distressing heat, were the most usual symptoms complained of, together with great prostration of strength, and faintness, want of sleep, and a low tremulous pulse, from 110 to 140 in a minute.

On the 15th of April last, I was called to Mr. Pooley, a stout fat man of about 34, who was well and about his business on Friday, was taken in the evening with a rigor and sore throat, which, on examining was found with greenish spots, inflamed tonsils, with ill-conditioned ulcerations.

His skin was red, spirits and strength fallen, pulse low, and 115. Fumigations with vinegar, gargles with myrrh, cinchona and muriatic acid; sponging the surface with vinegar and water, were immediately and actively applied; an emetic and a calomel purge were immediately given, together with strong decoction of cinchona, serpentaria, aromatics, muriatic acid, and oxygenated muriatic acid. The danger being imminent, the pulse low, and the patient sinking, wine, and Occasionally brandy, were given. He had every advantage from attentive nursing, a large well aired and ventilated room; but sunk under the disease on the 4th day, and in a few hours the strongest marks of putridity, and indeed rottenness, attended the dead body.

Mr. K- a respectable farmer, was well at a friend's house, on Monday, the 30th of August; on that day, he had a cold chill and soreness and stiffness of his throat; on Tuesday was worse; on Wednesday complained of head-ache, pain of his back, great loss of strength, scarlet eruption, pulse

low,

low, tremulous, and 120. Calorgel and an emetic were first given, and then antisceptics, acids, fumigations, &c &c. as in the first case, were boldly tried, but without effect; we having the mortification to see him die on the 4th day, in the 31st year of his age.

Mr. Garnham, 30 years of age, was at work on his farm, on Tuesday the 2d of August, was chilly on Wednesday; his throat being stiff and sore, he rode three miles for an emetic, was worse on Thursday, throat swelled, and much ulcerated, tongue and fauces very foul, distressing head-ache, pulse 140, urine high-coloured, and countenance yellow, which more or less was the case with most of those who had the disease in its worst form.

He died on the 5th day, and the body almost immediately became puirid and rotten.

I forbear reciting more of these melancholy cases, of which' we have had but too many; some, even children, have died in 48 hours from the first attack. All the Surgeons for ten miles round, have had to attend Scarlatina Maligna in a variety of cases, in all ages from infancy to 50 or 60 years, and all have had their share of losing their patients.

The disease appears in various forms, from the slightest affection, with little or no sore throat or eruption, to the very worst and malignant type, which seems to baffle all attempts at stemming its violence. Mr. Torrence's cases of Scarlatina in your 185th No. appear of a milder kind, and much less formidable than many of those we have encountered, or cold effusion could scarcely have stemmed the course of the disease; and indeed, however valuable Dr. Curry's plan may be in Scarlatina, or other fevers, unless it was infallible, country practitioners dare not put it in use to its fullest extent; for if two or three lives of any consequence were lost after trying it, all the relatives, nurses, and prejudiced persons would exclaim against the Physician and Apothecary as murderers and barbarous practitioners.

The best writers on the putrid malignant sore throat, from Sydenham, Pringle, &c. down to Dr. Hooper, advise the tonic, antiseptic, aromatic, ascessent, and cordial plan, which have been tried most vigorously in a number of cases, not forgetting blisters over the throat. For children, and those that could not use the gargle, or admit of syringing, a linctus was ordered with mel. borac. alum. rup. pip. cayen. and acid, muriat. The state of the bowels was carefully attended to in all, and in some cases, injections of decoct. cinchon, vin. rubr. R. opii and acet. were administered by the bowels.

Although the mortality has been greater than I can recol

lect

lect in the course of the last 40 years, we have the pleasure to record the escape of by very far the greater number of the afflicted with Scarlatina Anginosa. The best writers on this cruel malignant fever, and the most able practitioners of my acquaintance, many of whom I have met, all concur in advising the ionic and antiseptic plan, which has been actively employed, modifying it according to the circumstances of the different patients, and degrees of malignancy attending; but I am truly sorry to say, without the wished for success in too many, or indeed, without any marked benefit at all in several.

This disease has in some instances afflicted whole families, with various degress of malignancy, from a slight sore throat to the highly putrid, causing death. In others, a part only have the disease at all. Many families are now suffering in different spots around this country, that appear to have had no communication with the afflicted. In one family, a child fell ill with Scarlatina, in its mildest form; the father, mother, and another child, fell down on the seventh day from the first the father died, the others recovered. Since writing the above, I was called to a Mr. Rose, whose wife died of Scarlat. Ang. Malig. two days before; her body was so highly putrid, that the house was hardly bearable. Rose's symptoms were truly alarming from putrid ulcers in the throat, scarlet eruption, low quick pulse, and delirium, with two children in the same dangerous state, but those all recovered after the most severe struggle. Your medical friends will do the profession and the public the greatest favour, if they will point out in your next Journal, a more proper and success. ful mode of treating the Scarlatina Anginosa, under the bighly malignant and rapidly destructive form it has assumed in this spot. Indeed my troubling you with this hasty sketch, is chiefly for the purpose of soliciting advice and instruction from the more learned and able, than,

Gentlemen,

Your obedient Servant, &c. WILLIAM GOODWIN, Surgeon.

Earlsoham, Framlingham, Suffolk.

P. S.-Oct. 22, 1810.-This malignant fever still rages around us; many dying in 48 hours after being attacked.

То

To the Editors of the Medical and Physical Journal.

THE following remarks on dislocation of the limbs have occurred, on reading a very interesting paper on the subject, published in the Medical and Physical Journal in April, 1808. After offering some very sensible strictures on the present mode of reducing luxations, in counteracting, by violent extension, the resistance of the muscles, (as he emphatically terms it) by main force of surgery; Mr. Car wardine proposes to apply a regular and long continued extension, to exhaust their action. This he illustrates by the following case.

A strong muscular man dislocated his shoulder. Attempts to reduce it were ineffectually made in the country where the accident happened; and after an interval of fourteen days, he applied to an hospital which Mr. Carwardine was then attending.

One of the senior surgeons proceeded to the reduction of the joint. After repeated and violent attempts, which proved ineffectual, it was proposed to the man to remain in the hospital till the following day, and in the interim, that he should lose blood, take a cathartic, and keep a relaxing poultice on the joint. His business, however, not allowing of a longer continuance in the hospital, he was about to quit it, when Mr. Carwardine persuaded him to go to his lodg ings. Having provided the necessary apparatus, the patient was placed on a stool, the scapula and trunk firmly fixed, and a set of pullies accurately adjusted and secured to the condyles of the humerus, for the purpose of making extension. The cord was now tightened with a force just sufficient to counteract the gravity of the limb, and prevent its falling to his side. Mr. W with one hand held the wrist, to preserve the fore arm bent, and with the other held the cord to keep it from relaxing, but without tightening it. This extension was continued for ten minutes, without producing any manifest effect. As the extension gave very little pain, it was slightly increased. In five minutes more the man grew very restless, would not allow that he then suffered pain, but said, he felt very faint, begged that Mr. C. would desist, and asked for water, which was refused, under the idea, that if he fainted the muscles would be completely relaxed. At this moment he changed countenance, and the Deltoid muscle was perceived to be tremulous. The cord was tightened a little the arm followed it; the cord being