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pitals (of wood) were erected for the accommodation of the sick, and a Council of Health was established. The disease diminished rapidly, after the setting in of a hard frost. The effect of cold, in checking the communication of infection, appears to be very considerable, from some facts mentioned in this part of the narrative. Dr. Pogaretsky told the author, that some of the persons who carried out the dead had put on sheep-skins, which had been worn by the impested*, after having exposed them to the open air for forty-eight hours, in the month of December, when the frost was very intense, and that none of them became infected.
The total amount of deaths, in this epidemic, was upwards) of seventy thousand; of which the author supposes that 22,000 took place in September alone. Adding to these the number of clandestine interments, and the deaths in neighbouring villages and towns, he thinks that this plague swept off 100,000 persons. It is a fact worth noticing, that most of the people, who were infected by carrying out and burying the dead, fell ill about the fourth or fifth day of their employment. The contagion was communicated solely by contact of the sick, or of infected goods, and did not seem to depend at all on the state of the atmosphere. The physicians, who visited patients in the town, were secured by avoiding actual contact with them; although there was frequently not more than the distance of one foot between them.
The higher class of people were, as usual, less liable to infection than the poor.
The Foundling Hospital at Moscow, which contained 1000 children and 400 adults, was preserved from the contagion, while it raged in all the surrounding buildings; and though the disease attacked eight persons who had stolen out of the house during the night, yet it was prevented from spreading, by separating them immediately from the rest. This is a fact which deserves great attention; as it proves that the progress of the plague may be impeded as effectually, and by the same means, as that of the common typhus.
In enumerating the symptoms of the plague, the author produces nothing which has not been noticed by former writers. In addition to the common symptoms of fever, he mentions itching or pain in those parts of the body in which buboes and carbuncles are about to appear. The accession of glandular swellings, or of eruptions, seems indeed to be the pathognomonic symptom of the disease; for the mixed appear
*. From this word, which is repeatedly used, we suppose the translator to be a foreigner; it ought to be infected.
ance of the eyes, mentioned by Dr. Russel as characterizing the plague, is not unfrequent in our typhus. The author considers buboes as salutary efforts of the system, and carbuncles and petechiæ as only denoting a general depravation of the habit. It follows, therefore, he says, that the plague is milder in proportion as buboes are more common, and as those erup
tions are more rare.
A particular account of the symptoms of the plague, under all its different forms, taken from the work of Dr. Orraus, is given at p. 46; to which we refer those readers who wish for full information on the subject. The extreme violence of the symptoms, and the almost invariable affection of the lymphatic glands, appear chiefly to distinguish the plague from typhus.
It seems, from the observations of M. Samoilowitz, (who with singular intrepidity examined the state of the pulse in his patients,) that the pulse was irregular from the beginning. When there was much head-ach, and high delirium, the pulse was full, hard, strong, and quick; when these symptoms ceased, it became soft, feeble, intermitting, and not to be felt.
Dr. de M.'s division of the course of the plague, into nervous and putrid stages, appears rather obscure. The propriety of bleeding is slightly and vaguely mentioned, in the former stage. In the latter, emetics, Peruvian bark, and the mineral acids, are recommended. He very properly advises that these medicines should be administered in the most powerful doses. We are sorry to learn, however, that he conceives this method of treatment to be useful only in the milder form of the plague, and that he has not found any plan successful in its violent attacks.
The method proposed for arresting the progress of infection consists in removing infected persons, or families, into a separate building, on the appearance of the symptoms. This, Dr. de Mertens would conduct rather more abruptly than the feel.. ings of our countrymen would permit: but the principle is right. The foibles and prejudices of individuals ought to give way, on such occasions, to the general safety.
The regulations proposed by the Doctor for indemnifying, at the public expence, persons whose infected goods it is necessary to destroy, and for supporting the indigent sick, are dictated by true humanity and just policy. The construction of permanent fever-wards, on the plan which has been adopted in Chester, Liverpool, and Manchester, would probably secure those ports which are at present exposed to the importation of the plague, from any extensive mischief from that disease.
We cannot conclude this article without again expressing our surprise, that the translator should have confounded the
yellow fever with the plague. Not to insist on the difference of the symptoms, we would only remind him that many respectable writers have of late denied that the yellow fever is communicable by infection. Respecting the plague, this was never doubted. The only difficulty consisted in limiting the sphere of its contagion.-Had this opinion related to a subject merely speculative, we should not have returned to it: but, as the dread of infection from America might produce serious evils, if the translator's assertions were admitted, it is proper to object to them before an alarm be excited, which might preclude accuracy of reasoning at a time when discrimination would be most necessary.
ART. XV. A Defence of the Casarean Operation, with Observations on Embryulcia, and the Section of the Symphysis Pubis, addressed to Mr. W. Simmons, of Manchester, Author of Reflections on the Propriety of performing the Casarean Operation. By John Hull, M. D. Secretary of the Literary and Philosophical Society of Manchester. 8vo. pp. 229. and Six Plates. 35. 6d. Boards. Bickerstaff. 1799.
WHEN Mr. Simmons's "Reflections" were noticed in our Review for February last, it did not appear that they were levelled against any particular instance of the Cæsarean operation::-but we now find that the author of this Defence had lately performed it unsuccessfully in Manchester, and that he thinks himself highly aggrieved by Mr. Simmons's publication. What previous differences might have fomented the animosity displayed in the present letter, it is impossible for us to conjecture: but we regret to see a controversy, on a question of great importance to the community, debased by so much personal asperity. Whether so painful and dangerous an operation as the Cæsarean Section ought or ought not to be performed, in certain circumstances, is a problem about the solution of which two medical men may fairly and candidly differ; and their readers would willingly compare the arguments produced by each, in support of his opinion. We took up the volume before us with the expectation of seeing new light thrown on the subject, from the cases promised by the Author, and from the different sources of information to which he seems to have resorted :-but he occupies so large a portion of his book with attempts to prove that his antagonist is ignorant of Greek and Latin, and shews so much anxiety to give an odious turn to every passage that is capable of misconstruction, that we were tempted to close his performance in disgust, before we arrived at the argumentative part.
REV, MAY, 1799.
We shall not hazard an opinion, whether the operation be in all cases inadmissible: but we must own that Dr. Hull has not furnished any additional strength to its supporters. His own experience is unfavourable to the cause which he espouses, for he informs us that he has twice performed it without saving his patients; and the synoptical table, which he has drawn up, exhibiting a brief view of the cases of this operation on record, presents only melancholy proofs of its fatal consequences. Qut of seventeen patients who underwent the section in these kingdoms, only two appear to have recovered; and one of these cases Dr. Hull acknowleges to have been a case of gastrotomy; the child having escaped into the cavity of the abdomen, through a laceration of the uterus, previously to the operation.
The inference which Dr. Hull draws from the want of success in these cases, compared with the frequent success of the operation on the Continent, is, that surgeons in this country have delayed the performance of it too long; and that, if it were earlier practised, it would prove less fatal to the mother. On this subject, he will perhaps form more accurate distinctions, in the larger work which he promises: but we cannot suppose that he would perform it, as he informs us (p. 99) that Professor Sandifort of Leyden has done, in a case in which the delivery might have been effected by the crotchet, without much difficulty; though an adversary might draw such an inference from his expressions. Since the publication of Dr. Osborne's Cases, we had understood that the minds of practitioners in this country had received a very different impression; and that they now hoped to deliver by the crotchet, and to save the mother, in cases which were formerly supposed to require the Caesarean Operation, and in which the parent's life must probably have been sacrificed.
We think that this author would have obtained a more favourable audience from the public, if his defence had been offered with more diffidence. The severity of his personal reflections is still more reprehensible. It is an implied disrespect for the public; who, in every contest of this nature, are interested only in the strength of the arguments, and must be totally unconcerned respecting the private character of the disputants; excepting in those cases in which the evidence of facts depends on their veracity.
The plates accompanying this volume exhibit views and sections of the pelvis, in some deformed patients mentioned in the letter. They are but indifferently executed.
A pamphlet in reply, by Mr. Simmons, is just published.
ART. XVI. Substance of the Speech of the Right Honourable Henry Addington, Speaker of the House of Commons, on the 12th of February 1799, in the Committee of the whole House, to whom his Majesty's most gracious Message of the 22d January, relative to Ireland, was referred. 2d Edition. 8vo. 1s. Wright.
ΤΗ HE information which this speech manifests and conveys, the fairness of its arguments, and the considerate attention which it displays towards the, interests of both countries, entitle it to a superior degree of public notice. Of the many orations in favour of the measure, we do not recollect to have seen any more temperate, or, within an equal compass, more comprehensive.-The Right Honourable Speaker, remarking on the state of Ireland, observes that even at a period of apparent. tranquillity, it was impossible not to discover those seeds of animosity, which have unhappily been matured by circumstances into insurrection and rebellion.' In considering the different plans which have been proposed for restoring tranquillity to Ireland, and for perpetuating her connection with Great Britain, Catholic emancipation; the re-enacting of the Popery laws, in the whole or in part; and an incorporation of the legis latures of the two countries, are selected as those measures which have been most strongly recommended.
Agreeing, we believe, in the opinion that Catholic emancipation is coupled with parliamentary reform, Mr. Addington adopts the objection of Mr. Foster, (the Speaker of the Irish House,)" that it has the tendency to give the influence to numbers, and to take it from property; and to overwhelm the rights of the protestants of Ireland." The re-enactment of the penal laws against the Catholics he likewise condemns, as being ill adapted to heal the divisions of Ireland; nor could it have the effect of conveying to the Protestants a greater degree of confidence and security, by allaying the irritation of the Catholics.' Both the foregoing plans being rejected, the measure of a Legislative Union comes next under consideration.
Here we wish to observe that Catholic emancipation would in itself be a partial reform of parliament. Whether, beyond that, it is necessarily connected with parliamentary reform, we cannot pretend to determine. The restrictions on the Roman Catholics of Ireland are justifiable only on the principles of self-defence, as being necessary to the safety of the Protestants. It is on all hands acknowleged that the influence of the Catholics, supposing them to be restored to their political rights, would be much less, and of course less dangerous, in an united legislature, than in the present separate legislature of Ireland. If, then, consistently with safety, CaG 2