not a drop of rain for the whole three months. It was a very healthy period; rheumatic pains, and the intermittents were the moft common complaints.

The memoirs which obtained the prize for the following queftion are fubjoined To determine the caufes of the aphthous disease, known by the name of muguet, millet, and blanchet, to which infants, particularly when collected in hofpitals, are fubject, from the first to the third or fourth month of their age. What are the fymptoms, what is its nature, and what are the prefervative or curative methods of management and treatment? The first prize was gained by M. Sanponts, physician at Barcelona; the fecond by M. Auvity, furgeon at Paris; the third by M. Vande Wimperfle, phyfician at Leyden; the fourth by M. Gadfo Coopmans, phyfician at Franeker. The first acceffit was gained by M. Arneman, phyfician at Gottingen; and the fecond by M. Lebrecht-Fred-Beng-Lentin. The differtation of each author is fubjoined, and we fhall notice each in its order.

The first memoir is, undoubtedly, in the opinion of the Society, the best. M. Sanponts, after fome judicious obfervations on the utility of hofpitals for the purpofe of examining the nature of difeafes, and the allowances, which must be made from the various circumftances in their conftruction, proceeds to defcribe the fituation of the city where he practifes (Barcelona), as well as the fymptoms and cure of the difeafe; and in the fecond part compares the difeafe, as it occurs in the hofpital of Vaugirard at Paris, with that which he has defcribed.

The defcription of Barcelona deferves attention, as a fubject of medical topography, but it offers little elucidation of the difcafe before us. It is evidently the thrush of this country in its acuteft form, paffing from the mouth into the ftomach where from the forenefs felt externally, it feems to be particularly violent. It is certainly a febrile difeafe, and therefore called, mofe unaccountably, by our author, foda miliaris infantum: foda is the pyrofis of modern nofologifts, almost always a chronic, and generally a fpafmodic disease.

One

Our author proceeds to the caufes, and, after fome embarraffment, objections ftarted to be overturned, and difficulties raifed to be conquered, he confiders the disease as arifing from impure air, joined to an acid in the ftomach. There is, however; a little inconfiftency, even in his own account. part of the caufe is fuppofed to be owing to the diet of the parents; for the common fort, among whom the difeafe is moft frequent, feed on falted fifh, with rancid oil, and fimilar putref cent fubftances. But this is evidently inconfiftent with a too great acfcency of the milk, and can only operate by rendering the perfpiratory and other exhalations more putrid, or the con

ftitution

ftitution more weak. In reality, the acid in the stomach is peculiar to the infantile conftitution, and the caufe muft be wholly foul air and putrefcent exhalations: the other was only invented to explain the practice.

The period of the disease is uncertain: it continues from the fourth to the fourteenth day. In fummer, and in fcorbutic habits, it proceeds more gently and flowly, fo as to be fometimes almoft chronic. It becomes generally fatal by a termination in gangrene, and the worft confequences are obferved by repreffing the eruption, particularly the puftules, which extend from the extremity of the rectum round the nates, by faturnine applications. The cure is embarraffed by the fame difficulties as the caufes. At laft the whole is almoft confined to magnesia, joined with free air, and the most careful attention to cleanlinefs. Though we have rarely had occafion to fee the difeafe in the worst ftate, we can easily conceive, that gentle refrigerants, demulcents, and medicines which promote an eafy perfpiration without heat, or occafionally a little of the bark, ought to be added. The only application to the anus recommended, is magnesia. To the mouth nothing is applied. In the malignant aphthæ bark is mentioned, but faid to have little effect.

In the fecond part, as we have obferved, the author compares the disease at Barcelona with that which occurred in the hofpital at Vaugirard. In the latter, the malignity is greater; but, in this the froth round the mouth and the hiccup, which occurred among the children at Barcelona, are not mentioned. Our author enters into fome difquifitions on the effects of the perfpiration in mephytizing the air. He mentions fome facts, to fhow that women infect the atmosphere more than men. With fome exceptions, we think this not true, and the principal fact alledged, feems only to fhow that the constitutions of women are foonest affected by putrid air. In fevers we think we have seen all the putrid fymptoms more frequently mild in females. Children it is very evident, from various confiderations, fome of which are specified in the Irish Transactions, in the first Number of our new fourth volume, are sooner affected by close and impure air than adults. The weakest children are fooneft injured, and, in this, we see some connection between the disease and an acidity in the ftomach, for the weakest children are most subject to the latter. The ftrength of the nurse too has fome influence on this point, but we cannot agree with our author, that acefcent food is improper. This opinion he fupports in oppofition to M. Doublet, the author of the description of the difeafe as it occurred at Vaugirard. He is, indeed, correct, when he remarks, that in all difcuffions of this kind, the conftitution and way of life of the nurse must be confidered; and that, in the Vaugirard, they feem to allow a too acid and Nn3

acefcent diet, as almost all the women who come there are already greatly weakened by poverty and want. He adds a fingular fact, that the milk of the European women in Java is acrid and bitter: it difagrees with the children, which are therefore ufually fuckled by black nurfes. This fact is taken from the Memoirs of the Academy of Sciences, 1707.

The difeafe is, in our author's opinion, contagious; but not highly fo, and children not expofed to the occafional caufes, will be affected only from very familiar intercourfe. At the fame time it seems equally clear, that it may appear without contagion, and independent of the effects of a crouded hofpital. It is not, M. Sanponts thinks, a malignant difeafe, though, from complication and other circumftances, it may become fuch : it has no connection with typhilis. Our author next proceeds to the prophylaxis, which he explains with great minutenefs and propriety the avoiding damps, too much heat, too elofe rooms, a diet faultily acefcent, or putrefcent, the depreffing paffions, among which he mentions a conftraint put on the nurfe, to avoid all communication with her husband, are explained at fome length. Among the medical prophylactics are mentioned antacids and faponaceous medicines, with fome precautions left the latter fhould be carried too far. Thefe are combined in Boerhaave's antacid mixture. If all prophylactics fail, we may have, he thinks, recourfe to innoculation, for the difeafe feldom, he obferves, occurs twice in the fame child; but this, he adds, is an ideal and almost an Utopian plan. We may confider, in the fame light, another remedy, used as a prophylactic and a curative one, the application of cupping-glaffes to the nates.

M. Auvity's memoir is more judicious and practical: had we been judges, it would have received the first prize. He begins with mentioning the authors who have treated of aphtha, but has omitted fome able writers on the fubject, particularly Ketelaer. It is a difeafe more common, he says, in hof pitals than in private houfes, and attacks from the third to the eighth day after birth: when the experiment was tried in the foundling hofpital at Paris, to bring up children, without fuckling, all the infants were infected with the complaint before the 10th day. Seven of ten generally died; but, when the method was changed, feven of ten, infected with aphthæ, recovered. In the malignant aphthæ, almost all who were infected died. The difeafe is defcribed in its different forms of distinct, confluent, and malignant, with great accuracy,

The caufes are too great heat, milk depraved by bad habits, and the diseases of the nurfe; milk, from its age, not fufficiently laxative to carry off the meconium; too putrid or confined air but thefe are, in our author's opinion, only exciting caufes, or fuch as increase the violence and the malignity of the

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the disease. Putrid or clofe air, he endeavours to fhow, cannot be confidered as a caufe, for hofpitals, exprefsly built with a view to avoid this inconvenience, have not been found to preferve infants from it; and thofe, fuckled in private houses, have not escaped better: befides, that even in the clofeft hofpitals, the disease does not always appear. It may, on the other fide, be remarked, that the new hospitals have been erected in cities, and the private nurses have been seldom chofen in a country place, without the inconvenience of a crouded family. Yet, as the disease will certainly occur in the most favourable circumftances, we must admit that it fometimes arifes from a specific contagion: it will certainly alfo proceed from occafional causes. We remember it epidemic at a latin fchool, among boys, who had no other communication than fitting together fome hours of the day in a remarkably large airy room, with windows not in the best repair, or playing together in the open air. It was different in degree, but in no perfon malignant ; and those who escaped did not amount to one in thirty. The activity of the contagion, M. Auvity tells us, is not confiderable, and its bounds not extenfive.

The prophylactic method is fufficiently evident from the causes, and, in the curative, our author gives occafionally flight antimonial emetics, keeps the bowels free, recommends Boerhaave's antacid mixture, and orders either mildly refrigerant lohocs and gargles, or mucilaginous ones, fharpened (too often, perhaps, as it will give pain) with the vitriolic acid. In the malignant aphthæ, he orders the warmer antifeptic gargles.The whole is concluded with his plan of regulating hofpitals for children. It is clear, correct, and judicious.

The third prize was allotted to M. Wimperffe. He defcribes the disease, and, among other queftions, confiders one which we were surprised had not been before attended to-the connection of aphtha with miliary eruptions. He thinks, with great propriety, that they are very nearly connected, as well as that aphthæ are generally a critical depofition. To the lift of causes our author adds little: among the predifpofing causes he reckons, seemingly without fufficient reafon, jaundice and imperforated anus. In the prognofis and the cure alfo, common facts are detailed with too much pomp and parade. He is particularly careful to guard against the repulfion of aphthæ, and his gargles are more cooling and more mildly deterfive than thofe of his competitors. That part of the cure also which relates to the mitigation of fymptoms, is detailed very advantageously.

The fourth prize, we have faid, was allotted to M. Coop. mans, physician at Franeker, and his effay follows. In the firft part, he is more diffufe than his competitors in his attempt to

Nn4

afcertain

afcertain the meaning in which the ancient authors ufed the term aphtha. It is well known that they were not accurate in their language; applying the name occafionally to spreading fores, perhaps fcorbutic ones, and fometimes to the white pimples in the mouth. This part of his work contains many proofs of extenfive medical erudition. The defcription of the aphthæ, which follows, is alfo very full. In this part he is greatly indebted to Ketelaer, who practifed in Zealand, where the difeafe is epidemic, and whofe work on that fubjuct is a fingularly judicious and practical one. The diagnofis and fymptoms follow, and this author points out more fully than his predeceffors the connection of the disease with debility. Sordes, and perhaps ulcerations in the mouth, he tells us, are produced by an exhalation from the arteries, and from vapours ariling from the breast and stomach. This laft idea, which is not perhaps very applicable to the difeafe in queftion, our author purfues a little too clofely in Hippocrates and Galen, and confounds the inqui namenta linguæ with a critical eruption; the fur collected on the external part with the matter furnished from within. In fevers, he confiders apthæ as owing to a flow imperfect crisis, but the fubject to which he ought to have confined himself was the apthous fever of infants. On this account also the caufes adduced are not very applicable to the difeafe of which he was to treat. The immediate caufe is, in his opinion, the various acrimony accumulated in the child's conftitution during gestation, added to the repreffion of the perspiration from cold air, On this ground he explains the reafon of aphtha being more frequent in the northern regions, why children and old people are more fubject to the disease, as well as thofe collected in a crouded habitation, or in hofpitals. In this point too, he follows Ketelaer, rather than the question before him: the cause of children in hofpitals being chiefly affected are, 1. the general causes of aphthe being more prevalent in fuch places; 2dly. the state of the air in hofpitals; and 3dly, to the unusual diet. Ketelaer has furnished our author with fome very juft prognoftics, and judicious obfervations on the method of cure. The laft part, however, furnishes little novelty, except that our author confiders aphthæ as fometimes returning, in confequence of debility, and is a little more free in the use of bark than his competitors. The place where he practifes, and the nature of the difeafes, with which he is particularly converfant, may have led him alfo to the more frequent employment

of the medicine.

Of the two acceffits, the firft by M. Arneman of Gottingen, is by much the best. Aphtha he confiders as an exanthe matous eruption, connected with, but not wholly depending on

acrimony