resorted to without benefit. After three months, oxide of silver was prescribed, and from it complete relief was speedily obtained. Dr. Todd saw this patient two or three times.

Case 18.-Jane W. æt. 25, had been affected with occasional pain of a gnawing character in the left hypochondrium for the last three years: it sometimes came on very violently, but without reference to the stomach being full or empty, and has been much worse for the last few weeks. Bowels regular, and general health pretty good, but "the pain wears her out." At the expiry of three weeks complete relief was afforded by administering the oxide of silver in half-grain doses twice daily, and she had become much stronger and more cheerful. She was a patient of Dr. Golding Bird, at the Finsbury Dispensary.

Cases 19, 20, and 21.-Oxide of silver was administered to three women suffering with leucorrhoea, during periods varying from a week to a fortnight, but no essential benefit accrued. The discharge was merely vaginal.

Case 22.-Jane C. æt. 25, unmarried, of a sallow and aged appearance, complained of great general languor and debility, with loss of appetite. She had been affected eleven years, ever since the commencement of menstruation, with uterine irritation, and apparently in connexion therewith by fits of an epileptic character, but she does not usually scream. They generally come on in the night time, and have latterly been much more frequent, occurring once a fortnight, immediately after the menstrual period and between whiles: they were preceded by swelling of the genitals. Under the use of the pills she improved greatly in the first instance, one menstrual period passing without fits. The improvement continued for a fortnight, but the temporary lull was only fallacious, the fits coming on as badly as ever. She was a patient of Dr. Golding Bird, who deemed the case one of epileptic hysteria.

Case 23.-Esther J. æt. 16, evidently of precocious bodily development. She had the appearance of a woman of 25, and had evidently outgrown her strength, so that it was a question whether spinal irritation might not exist. The menses had appeared two years previously, but since been somewhat irregular. Countenance pallid-bowels torpid-occasional sickness-pain in the left hypochondrium-pulse 80. She was ordered aperients and half a grain of oxide of silver twice a day. Instead, however, of getting better, she got worse-the pain and sickness increasing, and the pulse being accelerated. The remedy was therefore discontinued.

Case 24.-Sarah B. æt. 17, complained of severe pain in the left side, her health being otherwise excellent. The menstrual function had been decayed, but was re-established by the use of electricity. She was ordered half-grain doses of oxide of silver, which at first made her feel somewhat sick, but by persisting in its use for near a fortnight the complaint was effectually relieved. She was a patient of Dr. Golding Bird, as were also the next four persons to whose cases I am about to refer.

Case 25.-Mary H. æt. 31, suffered severely with pain in the left side, and was also somewhat hysterical and weakly. A fortnight's administration of the oxide of silver completely removed the pain, and effected much improvement in her general health.

Case 26.-Marianne P. æt. 21, had suffered severely for some months with pain in the left side, which was constant, but becoming much worse at

times. Was troubled with cough and sickness, though otherwise in good health. A fortnight's course of oxide of silver completely relieved the lateral pain.

Case 27.-George V. æt. 45, of bilious temperament and sedentary occupation, was suffering with severe burning pain under the right scapula, occasional sickness, severe cough, loss of appetite, diarrhoea, (the bowels acting eight or ten times a day,) and sense of fulness about the abdomen: there was much cardiac and vascular excitement, and he suffered from general debility. Half a grain of oxide of silver was ordered twice a day. The diarrhoea was soon restrained (the bowels, indeed, becoming somewhat constipated), the stomach was more settled and the scapular pain abated. He continued the pills with the addition of a small quantity of decoction of aloes and compound camphor tincture, so as to allay the cough and regulate the bowels. Under the above treatment the case progressed most favorably, and at the expiry of three weeks, he was perfectly relieved in every respect, excepting his cough, feeling stronger and more comfortable than he had done for a long time.

Case 28.-Sarah S. æt. 33, had suffered with hæmorrhage from the bowels, ever since her confinement nine weeks previously, by which she had become much reduced. She had been under treatment with lead, and for some time without any permanent effect, constantly losing much blood of a venous character, especially when the bowels acted, which they did regularly twice a day. No piles could be detected. The skin was dry-the pulse weak-the face odematous, and the lacteal secretion nearly suppressed. She took the oxide of silver first in half-grain, and subsequently in grain doses, every six hours, and within sixty hours the hæmorrhage was effectually arrested the medicine was continued for about a fortnight at longer intervals, and a rapid re-establishment of her health was effected.

Case 29.-Mrs. F. had been affected for ten days with profuse menorrhagia, the blood being partly discharged in clots, and, according to her account, in very great quantity. The bowels were open-the pulse was weak and quick. Dilute sulphuric acid, opium, and acetate of lead, in turn, failed to restrain the flux. The last remedy appeared to take some effect, but was compelled to be laid on one side, from disagreeing violently with the stomach. A strong infusion of secale cornutum was then administered, but caused violent vomiting without having any apparent effect on the hæmorrhage. Half-grain doses of the oxide of silver were then combined with the infusion of the ergot, when the vomiting no longer took place, and the menorrhagia was arrested within eight and forty hours.

Case 30.-G. D. æt. 27, had suffered with epilepsy from his boyhood, for which he had submitted to much medical treatment. In August last he had been taking nitrate of silver for nearly two months, under Dr. Burne's directions, without benefit. For two months I then administered the oxide at the rate of from a grain and a half to five grains per diem. It was then laid aside for a fortnight, in consequence of a deranged state of bowels. He then resumed it for a period of six weeks, when he desisted in consequence of apparent salivation, which was supposed at the time to depend on alveolar abscess, situated at the root of one of the molar teeth. He resumed the medicine after a short time at the rate of four grains per diem, but in the course of ten days was again salivated, evidently from its use, and while in this state he was seen by Dr. James Johnson. The further use of the remedy was therefore precluded, but an instance was constituted of the constitution being powerfully under the medicinal

influence of the oxide of silver from a lengthened administration without cutaneous discoloration resulting. The fits became on the average much less frequent and severe at the time, and he enjoyed a much better state of general health, being stronger and less nervous than previously. The man has, I regret to say, since relapsed, and his fits are as bad as ever. In another epileptic case oxide of silver was administered under the direction of Dr. James Johnson, for the space of two months, without any inconvenience resulting, but, not appearing to exert a beneficial influence over the disease, it was laid aside.

In relation to the above cases the following brief considerations may be advanced. The oxide of silver is entirely devoid of causticity, its local application occasioning no pain, a valuable fact in reference to its internal administration. The remedy appears beneficial in various nervous affections, when they have become idiopathic, that is to say, when the cause, whether originally seated in the stomach, uterus, spinal cord, or other viscus, is removed, and the impression alone remains behind. There are no cases in which the oxide of silver is so rapidly beneficial as in cases of idiopathic gastric irritation, whether evinced in pyrosis, gastrodynia, or want of relation between the stimulus of food and the action of the stomach; but if organic change have taken place in the organ, the same benefit is not to be anticipated. In obstinate diarrhoea and hæmorrhages I am greatly in hopes that the silver will be found analogous in its action to lead-as efficacious, but milder and more manageable in its effect; this however requires much further trial. It would be unfair that the merits of the oxide of silver should be at all suffered to rest on its efficacy in epilepsy, of which we are well assured that the great majority of cases depend on organic change, which the medicine cannot influence. In reference to its utility in epileptic cases, all that can be said is, that if, as I consider, the oxide of silver will not produce a discolouring effect on the skin, the utmost advantage that can be expected from the dangerous administration of the nitrate may be safely and fearlessly attained by the substitution of the oxide.

I shall conclude by adducing the evidence on the subject which has been kindly afforded me in written communications.

Dr. Clendinning informs me that

"The oxide of silver has, so far as tried at the Marylebone Infirmary, appeared to exert an influence in epileptic and gastralgic affections similar to that long attributed to the nitrate of silver. The particulars of two or three cases in which the medicine appeared to act decidedly beneficially, have been communicated to Dr. C. by the resident officers, and other cases have been mentioned to him by the same gentlemen in which more or less relief seemed to attend the use of the remedy."

Dr. Ryan writes thus

"I have tried the oxide of silver in very bad cases of epilepsy, I think with some benefit." "From these I am disposed to think that it may prove a valuable remedy, but my experience is at present too limited to justify a positive conclusion. It had a very decided effect in intense gastralgia."

Dr. Golding Bird makes the following observations.—

"From the experience I have had in the administration of the oxide of silver, I have formed a high opinion of its value as a therapeutic agent; not from its possessing any marvellous specific power, but from its tonic, and to a certain extent, sedative properties-rendering it as far as I have seen an useful remedy in several forms of neuralgia, and especially in certain cases of dyspepsia attended with irritable stomach and pain in that viscus after taking food, when the secretions of the liver and intestines have been corrected as much as possible by the careful administration of alteratives. The oxide of silver appears to me to possess the good qualities of the nitrate without its inconveniences, and to exert a more directly sedative action than that salt; in which property indeed it approaches the acetate of lead, at least if the effects of its administration in menorrhagia can be admitted as sufficient grounds to justify this conclusion."

THE

Medico-Chirurgical Review,

No. LXVI.

[No. 26 of a Decennial Series.]

JULY 1, TO OCTOBER 1, 1840.

STATISTICAL REPORTS OF THE HEALTH OF THE NAVY, FOr the YEARS 1830, 1831, 1832, 1833, 1834, 1835, and 1836, IN THE SOUTH AMERICAN, WEST INDIAN, NORTH AMERICAN, MEDITERRANEAN AND PENINSULA COMMANDS. Ordered by the House of Commons to be Printed.

1840.

THE Returns from the Army, published by Major Tulloch, are now followed by similar Returns from the Navy. We were confident that the able physician at the head of the Medical Department of the latter Service would take care to render the Reports transmitted to the Admiralty as available as possible to the interests of medicine and the public, and we have not been disappointed. There is no man who would do more in the exercise of his official authority for the promotion of science than Sir William Burnett.

The returns before us are drawn up by Dr. Wilson, who informs us of the circumstances under which it was commenced and has been carried on. It appears the inquiry was begun towards the close of the year 1836, by order of the Lords Commissioners of the Admiralty, and had been in progress some months, when, on the sudden death of the officer first appointed to the duty, Dr. Wilson was called on unexpectedly to perform it. When he had fairly entered on it, and considered the ends in view, with the best method of obtaining them, it appeared to him that the plan adopted by his predecessor was in some points defective and ill-devised, and that to pursue it, without addition, or correction, would, in a great measure, defeat the object of the undertaking; because it must lead to unsatisfactory, or worse, to erroneous conclusions. It was defective, inasmuch as it was not proposed to trace disease from ships rigidly to, and through hospitals, thereby omitting much of the mortality and invaliding; and the method of computing the mean force of squadrons was erroneous, raising it, and in some instances by a large amount, above the number employed. The effect of omission in the one case, and addition in the other, would have been to give an exaggerated view of the health of the navy, and to represent it as being more exalted than it appears to be by the following Reports, and than it really is. In these circumstances, it was necessary to begin the work anew, and all the previous labour, however unwillingly the sacrifice was made, was lost. This statement is given, not with a view of disparaging No. LXVI.

X

another, who is gone, but to account, in some measure, for the time which has elapsed between the ordering, and presenting the Reports.

This much seems due to Dr. Wilson. He explains, in an INTRODUCTION, the mode in which the Reports are collected, and, consequently, the degree of credit that attaches to them.

It appears that, medical officers, whether surgeons, or assistant-surgeons, while in charge of the health of ships' companies, are required, by Admiralty instructions, to transmit to the Physician-general of the Navy the following documents, relating directly to such diseases and injuries, and their results, as may occur in the ships to which they respectively belong, viz. a Daily Sick Book, Monthly or Three Monthly Nosological Returns, and a Journal of Medical and Surgical Practice.

The first exhibits, in separate columns, the date of entry on the surgeon's list, the patient's name, age, quality, nature of disease or hurt, date of discharge from the list, and the issue of complaint whether in cure, removal to hospital, invaliding, or death; it is transmitted annually.

The second gives a comprehensive view of the first. In it names of patients are omitted, but all cases of disease, and injury, are contained and arranged in a tabular nosological form. This return is transmitted at the end of every month from ships on the home stations, and at the end of every three months from ships on foreign stations, except in cases of prevalent, or of unusually fatal disease, when more frequent communication is ordered. It exhibits in classes and orders, the number of cases added to the list, the number discharged to duty, the number sent to hospital, the number dead, the number invalided, the number on the list at the time it is sent, the number confined to bed, the number convalescent, the number of objects for survey, and the number remaining from the previous return. The Cullenian method of arrangement is that adopted in the navy. In each Nosological Return it is required that remarks be appended to the figures on health and sickness, and whenever it can be done, on the appreciable causes.

The third return contains a detailed account of the symptoms of disease, and injury, and of the treatment instituted for their cure. It is, in fact, a journal of the medical transactions of the ship, showing the nature, progress, and management of all important complaints, till the subjects of them shall be cured, removed to hospital, invalided, or die. Attached to it is a tabular abstract of all the cases therein treated, with their terminations; it is concluded by general remarks on the matter it contains, and is transmitted annually. And it is especially desired, when very prevalent or fatal forms of disease happen in ships, that they should be traced to their sources, accounted for, if possible. It is also directed that states of weather, degrees of temperature, the general interior economy of the ships, and whatever else may appear to conduce to health, or to induce disease, be specified. The tables have been deduced from these documents, together with returns from hospitals, and sick quarters.

and

At present there are only five naval hospitals, viz. at Portsmouth, Plymouth, Malta, Jamaica, and Bermuda, and two marine hospitals, those of Chatham and Woolwich, for the reception of seamen; but sick seamen and marines are received into all military and colonial hospitals, in such places as do not contain naval hospitals. Besides those institutions, sick quarters are established at fifty stations for the accommodation of sick and hurt sea