The 12th and 13th Cafes show that sometimes by accident, fometimes from more certain caufes, the eruption of the inoculated small pox may be retarded. In the first instance, the delay was owing to worms. Some remarks on inoculation follow, which feem to have been written in the infancy of the operation. They are not, at prefent, very interefting. The ufe of the warm bath, on the repulfion of the small pox, is now well established: the Cafes, in this pamphlet, were fubjoined to the author's Thefis, printed at Leyden, in 1764.

The Appendix contains the hiftory of a lady who was af fected with an obftinate coftivenefs, and fome anomalous fymptoms. The caufe feemed to be an enlargement of the ftomach, and a fcirrhus on the inferior part of it. Dr. Stack fufpected a tænia; but we think every fymptom may be fatisfactorily explained, from the weight and preffure of the

tumour.

We must difmifs this little work with our approbation; and can only wish, that the author's health and avocations may permit him to enlarge it. Twenty years of practice muft furely have furnished a much greater variety.

Medical Communications. Vol. I. 8vo. 6s. in Boards. Johnson. INCE the principal fupports of the Medical Obfervations" are removed, we may probably confider this work as a phoenix arifing from the afhes of its predeceffor. If fo, our regret will be, in fome measure, diminished; for, though the fucceffor follows its parent with unequal fteps, yet it follows at no great distance. We fee, with pleasure, the aspiring attempts of those who laudably aim at being diftinguished; and if they are, in a few inftances, crude or lefs correct than we wished, they exhibit ftriking proofs of diligence and attention, frequently of learning and genius. In this new undertaking, it will be no useless task to trace the outlines by which, in our opinion, their future efforts may be moft fuccessfully directed.

The great object of thefe occafional authors, feems to be the accumulation of cafes, new, extraordinary, and furprising. It is an old obfervation, that hiftories of this kind are more curious than ufeful; and, if they are ever admitted, it should be only where a very accurate hiftory of the preceding complaints can be collected, and where they can be ultimately connected by the fubfequent appearances on diffection. This connection has been feldom attended to in Bonetus and Lieutaud we have occafion to regret the want of it fometimes even in Morgagni. In general, it is preferved in the prefent volume.

volume. It has been frequently wished, and indeed it would be desirable, that phyficians would record their unsuccessful cafes; we may add also, that they would mention their miftakes and the causes of the error; but, though a work of this kind would be ufeful, it can hardly be expected: phyficians muft indeed fometimes err; yet felf-love always extenuates the error; and an anxiety, which we all feel, to conceal our faults, prevents the best practitioners from mentioning them. As hiftories of difeafes are now written, we think that they are by no means ufeful; detached facts appear extraordinary, merely because they are not connected with others; and the most surprising events would, in fome inftances, fail of fixing the attention, if the collateral circumftances were known. Single cafes, however, have frequently an advantage of which the author is scarcely aware. He who brings them to support the credit of a new remedy, or the ufe of a former one, in new circumstances, frequently explains to his reader what in the ardour of improvement he had overlooked. Facts speak different languages to different eyes; and, though we would not wish to accumulate them without neceffity, yet, on some occafions, they are of service, if not to the cause of the author, to that of truth. Thofe facts are particularly advantageous, which elucidate the diftinction of diseases frequently confounded.

The effects of new remedies, and what is of much more confequence, the circumftances which extend, limit, or correct the use of thofe already employed, is an important part of fimilar collections. On this fubject, almost every one can furnish obfervations; it is only neceffary to guard against the warmth, the enthufiafm, of an inventor or improver. He will be beft fecured from the effects of prepoffeffions, who is moft aware of their existence. On this account, as well as many others, the reigning epidemic should be always attended to; and there can probably be no articles more important than a fhort relation of the nature of those which have occurred fince the laft publicaton, and how far they influence the effect of remedies. Few medical men can be ignorant how feldom intermittents, a few years fince, yielded to the bark, long before the continued fevers affumed an appearance fo decidedly bilious. We attributed much to the red bark ; and it was undoubtedly more efficacious than the common; but, before it was generally employed, the fevers had appeared in a very different form, and the common bark was again fuccefsful. We therefore ftrongly recommend a series of obfervations of this kind: if properly, digefted, they would not be very extenfive; but, unfortunately, thofe who are best

able

able to furnish them, have leaft leifure for the task. The na tural history of those remedies, which we receive in the form of preparations, would be alfo highly useful.

We have premised these few reflections, from a conviction of their utility; and fhall now, as usual, attend to the several articles in their order.

Article I. An Account of the Epidemic Catarrh, of the Year 1782; compiled at the Request of the Society. By Edward Gray, M.D. F.R.S.-The very different accounts of the influenza are brought, by Dr. Gray, into one connected narrative; but, on this fubject, we need not be diffufe. The fum of the whole is, that from May to Auguft, 1782, a catarrhal complaint was almoft univerfal in this kingdom, evidently traced from the north east, and, in fome places, called the Ruffian cold. It was diftinguished, from other catarrhs, by its being a very general epidemic, and by the great debiJity which attended it. If patients were irregular in their conduct, or improperly treated, it then, and then only, became inflammatory; but we have seen this change in putrid fevers, and even in the true ulcerated fore throat, from the fame fource. Its caufe we muft at prefent leave to the pathologist. Dr. Gray enquires, at fome length, and, in our opinion, unneceffarily, how far it might be owing to contagion; for, though contagion was the general mode of communication, yet the miafmata were certainly conveyed alfo by the air. One fact, not fingular, proves this mode. A family, convened in a focial meeting, in perfect health, have before their feparation univerfally been infected. If it should be fuppofed that any one brought it in their clothes, we may reply, that he would probably have been as fufceptible of infection an hour before, as at that time: on the contrary, there feems to have been one general cause, so strong as to be irrefiftible. The fact is, that, like all other epidemics, the poifon feems to be contained in the atmosphere; but frequently, though not univerfally, to require fome exciting caufe, before it exerts its peculiar deleterious powers. We cannot very critically examine each account; but, in fome inftances, we perceive inaccuracies and contradictions, though, on the whole, the compilation merits our commendation. It feems to have been generally agreed, that confumptions were lefs frequent after the epidemic catarrh, than after ufual colds. To us, indeed, there feemed little difference: even at this moment we meet with confumptions, which are easily traced to that period. Our author mentions the circumftance which annually occurs at St. Kilda. This fecluded island fees only an annual vifitor, the fteward who collects the rents; but immediately, on his ar

rival, all the inhabitants are affected with the epidemic cold. The fact is curious, and certainly true, though not new; it is mentioned by Martin, in his account of the Western Islands, and feems to fhew, that the particular caufe of the epidemic, is more generally diffused than we fufpect. In fmaller degrees, we probably elude its force, in confequence of its being habitual.

II. Remarks on the Influenza of the Year 1782. By James. Carmichael Smyth, M. D. F. R. S.-This account came too late to be incorporated into the general one. It is apparently accurate, and written with ease and propriety: indeed all Dr. Smyth's communications fhow him to be ah intelligent practitioner, and a careful observer.

III. An Account of a gouty Body, diffected by Henry Watson, F. R. S.-This paper might require a large .commentary: even the foul itself, if it indeed refides in the pineal gland, became gouty, or, at least, had an uneafy feat, fince this celebrated protuberance was changed into a chalky matter: this appearance feems to fupport the opinion of thofe who confider the gland as of the lymphatic kind. The brain was hard and dry; and this change will affift the arguments of Dr. Cullen and others, who think that mental diseases are connected with an organical affection of the encephalon; for the patient had funk into a fecond childishness fome time before his death. In fhort, not only the joints were stiffened by the earthy depofition, but it even appeared between the fkin and the periosteum of the tibia. The glandular parts were particularly affected. We fhall infert our author's opinion on the nature of the chalk, which will at least afford fome comfort to the gloomy athritics and, though we wish that this opinion had been fupported by a chemical analyfis, yet we can add, from practical obfervation, that we have not feen the gout combined with calculous complaints, except when, in confequence of the patient having been confined, for fome weeks, on his back, the bladder has been prevented from entirely discharging its contents.

It has been, I believe, a pretty common opinion, that those who have gouty concretions in their joints, are very li able to the ftone in the bladder and kidnies; as if the one difeafe were generally productive of the other.

Is not this pronouncing rather too much? for of zil the patients cut in our hofpitals, men, women and children, how few do we meet with that have any the flightest indications of gout about them?

Both the gout and the ftone are morbid fecretions, and may poffibly exift together, in one and the fame subject; but differ effentially in their material principles, and have very different tendencies.

• The

1

• The calculous matter is formed in the urinary paffagesthe gouty depofits itself generally on bones, cartilages, membranes, and lymphatic glands.

The gouty feems to be a kind of earth different from that which generally forms a ftone in the urinary bladder; for it never appears lamellated, or to have any kind of nucleus, but is white, foft, and uniform throughout; it may be diffolved, and being ground down by the motion of a joint, readily mixes with the fynovia, forming a fmooth creamy fluid.

The gouty earth is then a kind of greafy bole, which may eafily be made to mix with oil and water, which, in general, the calculous cannot be made to do; fo that in every respect, in colour, form and confiftence, it feems to differ effentially from that which lays the foundation, and causes the increafe of the ftone in the bladder.'

IV. A Cafe of Proptofis. By Edward Ford, Surgeon.The moft material fact, in this article, arifes from the diffection. The cause of the difeafe in the left eye, was an enlargement of the left thalamus of the optic nerve; and, in its progress, it preffed on the right nerve, fo as to deprive the patient of the fight of that eye, which had been hitherto unimpaired. It has been imagined, that the nerves of the eye arife from the fide of the brain oppofite to that on which they are finally diftributed; and, even those who doubt of this total change of distribution, as Monro and others, yet allow that the fibres decuffate in their progrefs. But, in this cafe, a confiderable disease of one nerve had not the smallest effect on the other.

V. A fingular Cafe of Hydatids. By Samuel Foart Simmons, M. D. F. R. S.-The fac containing the hydatids, or rather the habitation of the tænia hydatigena feems to have been the gall bladder, which was diftended fo as almost to fill the whole abdomen. It then perforated the diaphragm, and, contracting a little in its paffage through that muscle, again expanded and filled nearly the left fide of the thorax in the fubftance of the liver was also a large fac containing ten pints of hydatids. This cafe is indeed furprifing, but it furprises rather from the vaft bulk, which originally arofe from the Small cyft ufually containing the bile, than from the nature of the contents. Similar facs are more commonly from the ovarium but the deftructive animal, which caufes fo great devaftation, may appear in any glandular part. We once faw it arife from the spleen.

VI. Obfervations on that Species of Hæmorrhage which is occafioned by an Attachment of the Placenta to the Cervix Uteri. By Andrew Douglas, M. D.-Every one, who has practifed Midwifery, knows the diftrefs which this mode of

at