in appearance; generally it was white or yellow, loaded and dry, becoming brown or black; urine scanty, high coloured, and attended with dysury in passing; thirst continued and insatiable. The disease generally ran its course within the fourth day. The treatment was briefly as follows. "In the mild species one moderate bleeding, with cathartics and diaphoretics, in most cases, left the patient convalescent in a few days. "In the violent species it was necessary to bleed largely and repeatedly, viz. to the amount of sixty, seventy, or eighty ounces in the first twelve hours; and it was gratifying to observe the benefit resulting. For instance, a man complained of excruciating pain in the head, which he moved incessantly; his eyes were wild, inflamed, and impatient of light; the head, according to his own expression, splitting to pieces; the circulation so hurried and tumultuous, that the body was agitated by every pulsation, and the throbbing of the heart visible through the clothes; the skin scorchingly hot and dry; and the entire aspect indicative of great distress. Yet that man, by copious abduction of blood, free catharsis, and a full dose of calomel and opium, was free from complaint on the second day of the disease, and in a few days more capable of returning to his duty. Such was the general plan of treatment in this form of the disease, and such, in a great majority of instances, the result. "It was far otherwise in the highest grade of inflammatory fever, or that which I have denominated intense. There the vascular action was so overwhelming, and the progress to disorganization so rapid, and often so irresistible, that all endeavours to arrest the disease were unavailing. Symptoms could be mitigated, but the character of the disease was seldom changed, or its force broken : within the first twelve hours the patient was delirious, often furiously; at other times it was the delirium of engorgement and oppression. In both cases, the action of the carotids was tremendous; the face red, and frenzied in expression; the eye sometimes clear, quick, and piercing, sometimes dull and darkly inflamed, always indicative of great cerebral derangement. The skin had an intensity of heat scarcely conceivable, particularly on the breast, neck, and head. The tongue was parched, hot, and apparently diminished in size; of various colours, generally brownish. The stomach was retentive, and the bowels costive, but not very obstinately so. This state of inordinate action sometimes continued till near the close of the disease, the patient, in such cases, expiring in a fit of violent convulsion. In other cases the high excitement ceased suddenly, and, as it were by a momentary act, and was succeeded by coldness of surface, a state of circulation and respiration scarcely perceptible, calmness of countenance, and perfect quiescence of the body, which soon issued in death without a struggle. The disease was of short duration; and no remission could be observed during its course. "In such cases evacuation was pushed to the farthest extremity that prudence could sanction. Blood was removed at once till some obvious impression was made on the vascular system or morbid condition, but the latter was seldom effected, and this was repeated as often as the symptoms seemed to require the operation, till some favourable change took place, or such collapse or disorganization came on, as absolutely prohibited its further employment. At the same time such assistance was solicited as purging, blistering, scarifying, sponging, &c. could afford. Yet in many cases all was of no avail. The patient has been reduced by blood-letting, till faintness, vomiting, and cutaneous relaxation came on, and in an hour every symptom had risen to its former intensity. The bloodletting was repeated till the same state was induced, and in another hour every thing was to be done again; and thus many times in succession, till destruction of some organ, generally the brain, ensued. There was a fire, so to speak, kindled in the frame, which nothing could quench. I have heard of men, who boasted that they could cure every case of this disease; that was indeed vain boasting, and calls for no remark; but I have read in books of something very similar in pretension. I have no right to measure any man's success by my own; but I may be allowed to doubt, whether in such cases, and in circumstances like mine, such happy results are likely to happen to others." 11. The congestive genus is a still more formidable and fatal disease--and that which embraced the greater number of Dr. Wilson's cases. "A sense of stupor, weight, and oppression, rather than pain in the head; a feeling of helpless debility, affecting the spine, most distressing about the sacrum; a paralytic failure of the lower extremities, with pains in the knees and calves of the legs; a pulse having all degrees of celerity and expansion, but always weak, sinking under the finger without resistance, a state of the skin various and difficult to define, but always deficient in tone, sometimes dry and tense, sometimes greasy, and sometimes drenched in sweat; generally without increase of heat, except at the præcordia, where it was confined and smouldering; a most distressing expression of countenance, deadly pale or livid in colour; a drunken idiotic eye, with dilated pupil and sleepy motion; deafness; desire to be left alone; sighing deep and interrupted; early tendency to coma; tension of the hypochondria; and early irritability of stomach; were the principal symptoms by which this division of the disease was characterised. "In the lowest grade of this genus, viz. the slight, these symptoms were not all perceptible, and those that were, had a mild and manageable character. Moderate purging, followed by the use of calomel in five grain doses, two, three, or four times daily, with or without opium and antimony, according to the state of the stomach and skin, soon roused the slumbering energies of the brain, adjusted the balance between the nervous and vascular systems, and restored health. "In the second or aggravated species, more forcible measures and greater perseverance were necessary. I generally bled, as soon as possible, to the extent of ten or twelve ounces at first, for even that quantity induced faintness and vomiting; then administered a purgative medicine; and repeated the blood-letting, or not, according to circumstances. Beyond this I seldom thought it safe to abstract blood; but trusted the remainder of the cure chiefly to calomel. And here I think mercury a remedy of great, of paramount utility. When the patient says that he has no pain; is ill, but cannot tell what is the matter with him; when he turns away with a countenance of helpless despondency from the person addressing him, letting the head drop as in hydrocephalus; when the pupil begins to dilate and hearing to fail; when he shrinks on applying the hand to the epigastrium, and vomits every thing which he swallows, and even in larger quantities; then, in my opinion, nothing can supply the place of calomel. But it must be given largely, and perseveringly. From ten to twenty grains, twice or thrice daily, sometimes with opium, sometimes with antimony, or both, and sometimes alone, I have given in such cases, and, aided by blisters, &c. I have reason to be satisfied with the result. Ptyalism will, in most cases, soon be established; but after all that has been written on the subject, I think I have witnessed the perfect benefit of its operation, without that manifestation. I tried turpentine, but it did not answer my expectations. "In the highest grade of congestive fever, or that which I designate apoplectic, I had to deal with a much more formidable and fatal disease. In the preceding species, there were generally some slight premonitory symptoms; but in this the attack was like the effect of electricity. In an instant its subject was seized with giddiness, dull pain of head, and confusion of ideas; a sense of coldness, weakness, and indescribable uneasiness along the spine; spasmodic pains in the legs, and paralytic incapacity of the lower extremities. He lay as if stunned, and labouring under concussion of the brain, with dilatation of the pupils, and a gloomy, despairing countenance. The pulse was rapid or slow, full or small, but always weak. The skin was cold, generally greasy, or covered with cold liquid sweat, sometimes dry and lifeless. The stomach was sometimes irritable from the beginning, and there was a strange compound sensation of desire for drink and loathing when tasted. From this state the patient, in some instances, never rallied, but sunk down rapidly to dissolution; he became perfectly comatose: the blood seemed to stagnate in the brain and large internal trunks, and, with filmed glassy eye, faltering pulse, and involuntary discharges, he soon expired. In other instances there was reaction, but faint, partial, and irregular: then existence was protracted, and hopes entertained which were seldom realized, profuse hæmorrhage coming on and exhausting life. In such cases, medicine, I fear, will never effect much; and, placed as we were, I consider the usual methods of treatment altogether useless. In some instances, where vascular action succeeded the first fearful impression, I tried blood-letting, and am persuaded that it did mischief; whether or not it might be useful if hot baths and powerful frictions were premised, I cannot say ; but I have the strongest conviction, that, without some such preparatory process, it will only precipitate the fatal event. I endeavoured, by friction occasionally, blisters, and calomel, to rouse the sensorial and vital powers from their appalling lethargy; but I must admit, that, with thirty-five cases of fever on my hands at a time, and without assist. ance, these means were not followed up to my satisfaction. That no other method of treatment would have had happier results, I cannot pretend to say; but I should not expect much from any method Still I would not leave the patient to his fate, in hopeless inactive despondency. With proper appliances and means,' I would endeavour to arrest the disease by the following means; baths of high temperature, with strong frictions, electricity, and galvanism, sti muli diffusible and permanent, enemata of turpentine, eau de Cologne, &c." 14. The foregoing graphic sketches of the two genera and six species of the disease are well deserving of record, though our author acknowledges that these different forms were not always so well defined in character at the bed-side, as he has endeavoured to render them in description. The species sometimes ran into each other, and mingled like light and shade-and not the species only, but even the genera, were sometimes so blended as to render it difficult to determine which was the more predominant. Some years of subsequent experience have only tended to confirm Dr. Wilson in the truth and fidelity of his original description, (transmitted at that time to the Navy Medical Board,) though he now believes that it would have been more nosologically scientific to have made but one genus of fever, leaving the inflammatory and congestive forms to constitute species of the same. The mode of nosological arrangement, however, is of such little consequence, that we shall not dwell upon it here. Dr. W. has introduced a running commentary on the foregoing descriptions, suggested by more extended experience, but not materially altering the principles of treatment already laid down. This first memoir terminates with a selection of cases in illustration; but for these we must refer to the work itself. II. CAUSE OF YELLOW FEVER. We all know the controversies to which this subject has given rise; and we are not inclined to renew these altercations. Dr. Wilson comments very acutely on the several causes assigned by different writers-as insolation, or atmospheric heat-marsh miasmata-contagion-contingent contagionatmospheric constitution, &c. With none of these is our author satisfied, and least of all with contagion. He does not very peremptorily deny the possibility of contingent contagion, though he evidently doubts the soundness of the doctrine. He slurs over the convincing facts presented by the fever in the Bann and at Ascension-because he was not an eye-witness of them, which, we think is rather an awkward way of getting rid of difficult subjects. The following pretty severe philippic on Sir Gilbert Blane has been called forth by the dogmatic and somewhat contemptuous manner in which that venerable physician impoliticly treated those who differed with him on the subject of contagion. Perhaps he may extend to me the contemptuous pity, with which he treats a certain American journalist, who dares not to be convinced, after having considered the arguments adduced by Sir Gilbert Blane, in proof of the contagious nature of West Indian fever. This does not appear the most likely method of obtaining proselytes to a faith, which Sir Gilbert thinks of such importance to humanity. Should not a reasonable being be reasoned with clearly, forcibly, but patiently? Is the mere word of authority, the oracular declaration of any man, however talented, and however exalted, to convince another man, who has the power, and uses the privilege, of thinking for himself? But Sir Gilbert Blane tells us that the controversy is to be decided by facts, not by reasoning. Are the facts then so clear, that he who runs may read? Has no reasonable doubt ever arisen in the minds of rational inquirers respecting the import of facts, which, according to Sir Gilbert Blane, ought to remove all doubts and answer all questions for ever? Were all the men who disbelieved, are all the men who yet doubt or disbelieve, either idiots or knaves? for to this conclusion would the declamation of Sir Gilbert Blane lead. To answer such questions would be at once idle and insulting. Men of equal penetration, with better opportunity of judging, and not less anxious to learn the truth, have been led to different conclusions from those drawn by Sir Gilbert Blane; nay, some of them have been driven by irresistible evidence, and in opposition to early and long cherished modes of thinking, to draw different conclusions. Was Rush, was Jackson, was Hunter, destitute of common sense or common honesty? Are all the men of the present time, who differ from Sir Gilbert Blane, incapable of observing facts, or unwilling to interpret their meaning faithfully? Facts are not always obvious at first sight; they are often encumbered by factitious circumstances, or disguised by false appearances; and ordinary observers do not always find it an extremely easy matter to remove such incumbrances and to strip such disguises: we do not know how Sir Gilbert Blane accomplishes these things so perfectly we are not told how he has learned, so easily and so unerringly, to interpret the hand-writing on the wall. It is strange that the men who have had the best opportunities of observing these facts, who have lived long, laboured arduously, and I will add conscientiously, amid the perils and perplexities of West Indian fever, : |