part where the author speaks of his own efforts in this important cause. "I come now to the last part of the task I have undertaken; which is, to state the result of my own practice. Deeply impressed with the magnitude and importance of this discovery, and of the benefits that would accrue to society from its adoption, I considered it as a duty incumbent on me to promote it to the utmost of my power. In consequence of this opinion, I laboured to overcome the prejudices which prevailed; and not altogether without success. "Much experience has convinced me, that the prejudice of the public in general is not insurmountable; and that the prejudice of certain individuals would not be insurmountable, nor rise to such a height, were not a little of the leaven of self-interest blended with that prejudice. The annihilation of the small-pox is the annihilation of one of the principal branches of the medical revenue. Having overcome the first difficulty, by prevailing on a few families to submit to the new inoculation, having also ascertained the mildness of the disease, and its efficacy in protecting the patient from the small-pox, I resolved never to inoculate with variolous matter again, unless the vaccine fluid should prove less capable of superseding a previous infection of the small-pox. "Nor should I deem it a perfect discharge of duty, in any professional man, on an occasion like this, did he not exert every faculty of his mind to remove the obstacles that retard the progress of this improvement; did he not explain the advantage of the practice to all ranks of people; did he not exhort and encourage, and enable all ranks of people to avail themselves of that advantage. "Impressed with these sentiments, I have held out every encouragement in my power to all persons; but especially to that order of society, of which a very great majority have hitherto tasted only the bitter fruits of inoculation. To the rich it has proved a blessing; but to the poor in general, at least in this metropolis, it has proved a bane. Favourable as the opinion was, which I first entertained of the new practice, the success which has attended it has exceeded my most sanguine expectations. For a while it had some difficulties to encounter, like every other innovation; but when a few in any neighbourhood were inoculated, and its mild nature was ascertained, the tide of popularity turned in its favour; and instead of 800, which is about the number that I have now inoculated, if time and other avocations had permitted, I might have inoculated at least as many thousands. In the populous villages of Lambeth, Walworth, Newington, Bermondsey, and Rotherhithe, and in the Borough itself, there is no vaccine institution, nor inoculation hospital; nor was this practice scarcely known to any of the labouring poor, who constitate the bulk of society every where, but there is particular. "In these parts in general, the houses and apartments are small and crowded the streets narrow, the accommodations very seants, the air in many places unhealthy; the prope in general, from their situation in life, ar ill-informed, and unable to procure good me dical advice; and from a combination of these causes, the small-pox in that district is very fatal. Anxious to extend the blessings of this happy discovery, to acquire and communi cate all the knowledge I possibly could of the subject, to dispel the mist of prejudice which was excited by certain malignant persous, and to establish the practice on a solid foun dation, I devoted every moment which I could spare, and more than I could well spare, to these important objects. This is the reason why the present treatise has been so long delayed; and, I trust, will plead some apology for those imperfections which it now contains. "In pursuance of this plan, I have assiduously sought for patients, whom I might inoculate with the vaccine virus; and laboured to remove every obstacle that opposed my progress. With the multitude, l'have reason to believe, the expence of inoculation at home, and the trouble of having it performed at a distant place, are the principal objections to the practice: objections which, I sincerely hope, will soon be removed "It is now unnecessary to exhibit a ta bular statement of cases, or to detail those which are regular; I shall therefore confine my observations to those which tend to some practical inference, or serve to confirm, in a striking degree, the principal axioms laid down by the great advocates for this invention." Of the great success which is likely to crown the endeavours of those who have zeal enough to give, not merely their money, but their time, and personal attention to this object, the author speaks in the following very satisfactory terms; and from all that we can collect, be has a good right so to speak. "About the same time I inoculated a child of a wet nurse, who was suckling the child of Mr. Bourne, whose case is before mentioned. Anxious to propagate the prac tice, and to render it popular; anxious also to acquire all the knowledge I possibly could, of the nature and treatment of a disease on which I proposed to write, I embraced every opportunity of recommending this inoculation, and spared no pains in persuading the parents of children, who had not had the small-pox, to comply with my advice. This child was at nurse in York-street, Newington-causeway; and the woman who had the care of her neglecting to bring her to me, I went to that place, and inoculated the infant. Observing a number of poor people in the neighbourhood, I determined to inform them of the advantages of this new practice, to which they were perfect strangers; and, by various arguments, especially by an offer of gratuitous inoentation at their own houses, found it not very difficult to prevail. "Every proselyte which I gained facilitated the conversion of others; and my efforts were powerfully seconded by the encomiums lavished on this practice by those. who experienced its good effects; but above all, by the benign appearance of the disease. Hence, instead of seeking for subjects to be inoculated, in a short time I had numerous applications; and was earnestly solicited to diffuse the benefits of this happy discovery in every direction. Could I have employed my whole time in the prosecution of this pleasing task, by which so much good may be done with so little trouble, and at so little expence, the number which I might have inoculated is incalculable. But many impediments lay in my way. The places were distant from my residence, and from each other; and, in addition to unavoidable avocations, a considerable part of the day was occupied in explaining the nature of the practice to those who requested information, and collecting matter to supply the increasing demand.” Mr. Ring, in his zeal to preserve the immaculate purity of the vaccine virus, speaks of some of the original experiments with more asperity than we ought to expect from a reformer. "The virus generated by similar mal-practice has already been attended with ill consequences; already spread consternation in Great Britain and other parts of the world; and proved fatal in more places than one. It has disseminated a destructive pestilence far and wide under a fictitious name, and attacked unawares those who were totally unprepared for its reception. This ought to have been a warning to all men; and particularly to the parties immediately concerned in its dissemination. Such a practice, equally repugnant to every principle of reason, justice, and humanity, is a monster which ought to be strangled in the birth. It contains, how ever, within itself the seeds of its own dissolution. By lessening public confidence, lessening the number of patients, and lessening the demand for a lucrative commodity, it will at length work its own downfall. If those who ask for the small-pox at one house, receive the cow-pox, and those who ask for the cow-pox at the other receive the small-pox, they will in time lose all pa tience; and exclaim with Mercutio, A pox on both your houses. How accurately is this rage of making jdle, useless, and wanton experiments, de Mr. Ring scorns to compliment the good sense and liberality of the British public at the expence of truth: he speaks his opinion plainly and forcibly with regard to the reception which the new inoculation has met with in this island. "I lately received from Dr. Moore, who left England last year, a pamphlet published by Dr. Anderson, Physician-General at Madras, from which it appears that vaccination is welcomed there with the warmest enthusiasm; and that the governors, and medical officers of the British establishments in India, vie with each other in their zealous exertions to promote the practice. This is very different from the reception it met with in our frigid climate, where it first occasioned a very long and general cold fit; then a very short and partial hot fit. which terminated in a critical sweat of a few guineus. How unlike the profuse and salutary perspiration of certain individuals, on the rumour of an invasion! and the sacrifices they offer at the shrine of patriotism, and on the altar of humanity, when their own dear persons and property are in danger! "Parliament, which gave its mite to one of the greatest benefactors of mankind, in consequence of his humble petition, and acknowledged the importance of the practice in the most unqualified terms, has done nothing to put that practice into execution.— But parliament has nothing to fear from the small-pox." In this disheartening sentiment, we entirely concur with this zealous friend of vaccination; we agree with him that the reception of this discovery has been marked with a singular degree of coldness and indifference; that barren pas tronage has taken the place of active efficient co-operation; and that the examples of a contrary line of conduct, though individually numerous and respectable, include so small a proportion of the leading and influencing part of the community, as to shew that the mere preservation of human life is not regarded as an object of public concern. Abundance of praise has been lavished on the liberality, discernment, and public spirit of parents who have satisfied themselves with procuring for their own offspring the advantages of a practice, which interests the sordid equally with the benevolent feelings. That parental affection must be ardent which will not shrink at the harassing duty of tending a child through a painful and loathsome pestilence; and cool economy will calculate the cost of present sickness, the wear and tear of con stitution, and the damage to future pros pects in life, when the smooth harmony of the female features is ploughed up b the seams of a merciless distemper. A coloured plate is added to the s cond volume, which gives a most faithful and perfect resemblance of the vaccine pustule in its several stages, and is executed in a manner very creditable to the artist. ART. XXIV. Five Common Sense Arguments to evince the Efficacy, and enforce the Duty of Inoculation with the Cow-Pox. By JOSEPH SIMMONS. 8vo. pp. 42. A PERSUASIVE to cow-pox inoculation, principally taken from Mr. Addington's neat comparative view of the two diseases, and from the circumstances attending the establishment of the Royal Jennerian society. ART. XXV. A Fifth Dissertation on Fever, containing the History of, and Remedies to be employed in, irregular con/inued Fevers; together with a general Conclusion of the four preceding and present Dissertations. By the late GEORGE FORDYCE, M. D. F. R.S Fellow of the Royal College of Physicians, Senior Physician to St. Thomas's Hospital, and Reader on the Practice of Physic in London. Edited by CHARLES WELLS, M.D. F. R. S. and Physician to St. Thomas's Hospital. pp. 70. THE present dissertation, which completes the view of fever originally proposed, is very nearly in the state in which it was left by its learned and venerable author, who, a short time before his death, desired that Dr. Wells might be requested to superintend its publication. Its design is to point out the discases which may be complicated with, and the irregularities and accidents which may occur in continued fevers. General inflammation is the first disease which the author treats of, as sometimes forming a part of such combination, and its particular nature he has described at some length in a former dissertation. The union of this complaint with continued fever, he tells us, often takes place in the beginning of the latter disease, in men of strong constitutions, but very seldom shews itself in great towns, where the habits of life are unfavourable to general vigour. Cold climates and seasons are much more favourable to the occurrence of general inflammation than the reverse, and this the author endeavours principally to account for by reasons dependent upon the nature of muscular contraction.-Blood vessels are tubes, which, however they may change their capacity from the different quantities of blood contained in them, are always cylindrical. This circumstance arises from a constant contraction of their parietes round the blood, which, in proportion to its diminution in quantity, re quires a greater exertion of the powers of the vessel to accommodate it to the change, and to keep up the same form. This the author conceives, requires an exertion of the vital power, which, as the contraction is permanent, and not casual as in muscular contraction, must be a continued source of expenditure to the vital power. When the diminution of blood proceeds to a certain degree, the vital power thus necessary for contracting the vessels may be withdrawn in such quantity as to produce death. In order to apply this reasoning to the production of a disposition to general inflammation, the author states, that as the external vessels are much more distended with blood in warm than cold climates, the internal, in such circumstances, must have a smaller than usual quantity contained in them. Hence they must be more contracted; and as this contraction supposes the abstraction of a greater quantity of vital power, than happens when they are of a larger size, the general strength of the body must be more diminished, and therefore a smaller tendency exist to general inflammation. The same reasoning is applied by the author to different circumstances of the body in cold and warm weather. On this theory we would only remark, that it is by no means proved that a con stant exertion of such a contraction as requires vital power to support it, is ne cessary in proportion to the diminution of the size of vessels. There is a certain extent, beyond which vessels cannot be emptied, and as we know that they possess an elastic force, it is not improbable that this may be sufficient for producing a change of dimensions. When general inflammation occurs in intermittent fevers, the author conceives that there can be no doubt of the propriety of bloodletting, because the system has time to recover, and the vessels are enabled to fill themselves before the next paroxysm; but in continued fevers, the practitioner ought to satisfy himself well on the propriety of the measure, from the existence of some urgent symptoms, such as de. termination to the head, before he have recourse to it. But when it is once resolved upon, he thinks that as much should be taken at once as is necessary to remove the symptoms of general inflammation. The propriety of general bleeding, in the continued fevers of this country, is at all times extremely problematical, if not decidedly improper, on account of reasons stated by the author; and it is much to be doubted, whether the symptoms of general inflammation, indicated particularly by hardness of the pulse and a buffy coat to the blood, even in such cases shew themselves, without any degree of local inflammation. Several irregularities are particularized by the author as occasionally shewing themselves in continued fevers. The first of them is the want of some particular symptom which is usually present, or a disproportion between the violence of some one symptom and the others. This circumstance is frequently regarded as a favourable one, but Dr. Fordyce is of opinion that in general it is not so, and enumerates the cases in which he has had occasion to make this remark. "Sometimes a fever does not attack a patient all at once, and he cannot exactly ascertain the time at which the first attack took place. In this case most commonly the system is not equally affected. In the next place, it sometimes happens, that although the fever came on in such a manner, that the patient can perfectly ascertain the time of the attack, yet at that time he felt no sense of coldness, or, as he generally expresses himself, chilliness. If this should happen, the fever is often irregular; but not so frequently as in the former case. In the third place, when the attack comes on, the depression of strength is sometimes in a much greater degree than the appearances of the contraction of the small vessels, and sometimes the reverse. If the depression of strength be greater than in proportion to the contraction of the small vessels, there is greater danger of delirium, such as has already been described, at the beginning of the second week of fever. vessels be greater in proportion than the deIf the appearances of contraction of the small pression of strength, there is less chance of à crisis, and a greater probability of the disease running out to a great length. In the fourth place, the symptoms not found in particular parts of the body are the patient's being either totally free from head-ach, or very slightly affected with it; the tongue's not being covered with a crust, not only at the begiming, but likewise through the first week of the disease; there being no costiveness, but rather too great evacuations from the intestines. This last symptom sometimes increases to a diarrhoea, which, besides the irregularity it shows in a want of equal affection in the disease, tends also very much to weaken the patient. The appetite not being totally lost is a very deceitful symptom, because it would give an inexperienced practitioner the idea, that food might be easily digested, and so the strength be prevented from being exhausted during the progress of the disease. The skin's being soft and moist, and the sleep not being at the beginning of the fever very much disturbed, are also to be regarded as irregularities. If one, or two, or three of these mild appearances should take be equally mild, the fever is likely to run out place, and all the other symptoms should not for a great length of time, and has a much less chance of being terminated by a crisis. "This is not only the case, but every attempt to carry off the fever by any remedy is frustrated. Every medicine, such as prepatends to produce symptoms similar to those rations of antimony, ipecacuanha, &c. which which take place in the crisis of fever, has its whole force exhausted upon those parts, in which the appearances of fever are slight, and does not at all affect those parts which are most afflicted by the disease. For example, if there should be considerable pain in the forehead, and the skin should be soft and moist, preparations of antimony being exhibited, the patient will fall into a profuse sweat, without the least relief of the pain in the forehead. "It is further to be observed, that not only if there should be a want of febrile symptoms in any one particular part of the body, but if even those appearances should arise, which take place in a crisis, in some particular part of the body, and not in the whole at the same time, the mischief is much greater, and the patient in such a case rarely recovers. If, for example, there be a lateritious sediment in the urine from the beginning of the disease, or if it take place before the middle of the second week, and neither the head-ach nor delirium is any way dimnished; if the skin should remain hot, coi◄ tracted, and dry, the tongue covered with a mucous crust, and the pulse continue of equal frequency; it hardly ever happens that the patient recovers from the disease. In like manner, the skin having been dry and contracted at the beginning, if a profuse sweat afterward takes place, and continue for some time without any diminution of the other symptoms of the disease; that is, if there should be no lateritious sediment in the urine; if the costiveness and the head-ach should continue; instead of being favourable appearances of the disease, we are to expect that it will prove fatal. Independently of the mischief arising from inequality of the disease, any evacuation will weaken the patient, and render him incapable of supporting the further progress of it, if there be not at the same time an alleviation of the other ances of the disease." appear When such irregularities as have now been described exist, the author knows of no means by which we are able to increase the appearances of fever in those cases where they are wanting. Another irregularity mentioned in this work is, when the fever instead of going on to its acme, and then gradually declining, has alternate exacerbations and remissions of two or three days duration, which in time wear out the patient. In those cases we should employ such means as tend to produce an artificial crisis; but if those are ineffectual before the tenth day, they should not be persisted in, but the disease left to wear itself out; the practitioner taking care to keep up the strength of the patient, to bear him through the complaint. Cir. chona has sometimes had a good effect when given in large doses during the re missions. Hysteric symptoms, and an imperfect crisis, are mentioned by the author a forming irregularities which are occa sionally observed in continued fevers. The first are very alarming to the patient and his friends; but are no other. wise prejudicial, than as they often pre vent the disease from subsiding in its or dinary course. An imperfect crisis, such as occurs when the delirium does not subside, or the pulse remains very fre quent, the sleep continues unrefreshing, and the appetite is bad, though there is in other respects a concurrence of critical symptoms, generally indicates an un favourable termination. Where hysteric symptoms make their appearance, the patient should be supported by nourish ing food, and should have occasional doses of laudanum, with some antispasmodic, as Russian castor. To the present dissertation is annexed a general summary of the opinions which the author has advanced in his essays on fever, and a reply to some objections which have been made against them. ART. XXVI. Essays on the Diseases of Children, with Cases and Dissections. Essay Y. On the Bowel Complaints more immediately connected with the Biliary Secretion, and perticularly of Atrophia Ablactatorum, or Weaning Brash. By JOHN CHEYNE, M.D. Fellow of the Royal College of Surgeons of Edinburgh. pp. 80. IN our last volume we gave an account of the first of the author's essays on the diseases of children, that on the subject of cynanche trachealis or croup. The second essay, which we are now to notice, is prefaced by a few observations on the importance of the hepatic system in the animal œconomy, and by a statement of the change which takes place in the circulation connected with the liver, after birth. During the fetal state nature seems to have prepared for the functions which were afterwards to be exercised, by the large size and maturity to which the liver was brought. Whether, however, the secretion of bile, immediately after birth, is established in the way in which it is intended by nature that it should continue, may admit of doubt; for though the author considers the evacuation of the meconium as the natural consequence of the stimulus applied to the intestines, yet nature seems to have aimed at more effectually se curing this in another way, by the purgative effects of the milk first secreted by the mother. The first of the complaints connected with the biliary secretion, which the author takes into consideration, is the jaun dice, which occasionally attacks children a few days after birth. This disease has been supposed to arise from the ducts being obstructed by meconium, mucus, or viscid matter; or from pressure on the common duct by milk coagulated in the stomach or duodenum. Such causes, the author is of opinion, may give rise to these slighter species of the complaint, which disappear in a few days, but are insufficient to produce the jaundice, which sometimes terminates fatally. This species is attended with languor, flatulence, and bilious urine,' and continues many days, or even weeks, sometimes going away gradually, but generally |