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as placing the occurrence of the disputed symptom, even for a considerable length of time, beyond the possibility of a doubt, as the Q. E. D. and the redemption of any pledge I may have given on this point. My feeling has been ail along absorbed in the consideration of this subject, and but for the denial of the utter possibility of the symptom, I should not have engaged in the discussion at all. The reasons for publishing the paper in the form in which it appears are before the public. Having thus published according to what have been my feeling and intention as to the immediate redemption of any pledge given, the onus refutandi now rests ■with any gentleman who thinks proper to dispute the point; but an explanatory answer, if it appeared necessary, would be more immediately due from me to Mr. Gibbon, as between us the difference of opinion originally commenced.
That I have said I would publish the case, and that that expression was uttered with an intention on my part so to do, I do not at all dispute; but, however forcibly or loosely such expressions came from me, the times and seasons for such a production are certainly to be chosen by me. Not feeling myself under any public pledge properly so called, more especially after the paper on ischuria, adducing proofs of vomiting of urine, the original and only matter of difference notoriously between Mr. Gibbon and myself, I cannot acknowledge the right to demand that which a willing endeavour would be made to grant, to the wishes of Mr. Pulley or any other gentleman whatsoever.
Nothing that I have personally witnessed, or that has been stated to me by the patient herself, conveys to my mind the conviction of imposition. If, however, facts are knotvn clearly proving that the patient- has practised the arts of imposture, let all these circumstances be communicated, for it must not be forgotten that I was not present at the meeting of the gentlemen who took these circumstances into consideration, as mentioned in my last communication, In any stage of an inquiry, unquestionably I would readily yield my assent that imposition was practised, if circumstances had sufficient weight with me to produce that conviction; but if that opinion is to be maintained solely on the ground that vomiting of urine, even for a considerable time, is utterly impossible, I have stated the facts from which I must continue an infidel on what was the original question, and which was the only point I ever considered myself strictly bound to prove.
Bedford, August 8, 1813. G, D, YEATS.
To the Editors of the Medical and Physical Journal.
THE jealousies and dissensions which exist between medical men cannot be too highly censured, since they are truly disgraceful to a profession which is confessedly of the most liberal, kind. A man of eminence who dares to publish to the world an important discovery, and which bids fair more effectually than any other to restrain the ravages of disease, will perhaps risk the loss of that reputation which his superior acquirements have justly attained for him, by the interference of an officious contemporary, who, in the plenitude of his zeal, vociferates that either he has previously made use of the same remedy for the same disease, or that it may be met with in some ancient or modern publication. ,
I was particularly led to these observations by reading a paper, in your excellent Journal for June, on the utility of Nausea in Ophthalmia and other Diseases of the Eye, by Mr. Fielding of Hull. This gentleman sets out with an encomium on Mr. Adams's method (which is inserted in a former number), but apparently only with the view of introducing his own, and thus, as he seems to think they are in every respect similar, he takes away from Mr. Adams the merit of originality.
It is foreign from my present purpose to make any remarks on the rationality of the practice recommended by either of these gentlemen, but it appears evident to me, that if the same effect be brought about by nausea as by active vomiting, it must be the product of causes diametrically opposite to each other. In order to substantiate this assertion, it is necessary for me to consider the effects of nausea and of vomiting on the constitution, and thus, by contrasting them, point out their dissimilarity.
Nausea, by acting primarily on the stomach, seems, as a consequence of that action, to depress very materially the powers of the whole system. The patient, even if he be of the most athletic make, and consequently previous to the administration of the nauseating matter could have made effectual resistance to the most powerful efforts of restraint, becomes deprived of all muscular energy, occasioning the highest degree of prostration of strength and listlessness, so that he is not only unable but also unwilling to struggle for liberty, if even such were necessary. The same general cause represses, to a certain degree, the action of the heart and arteries, which, being thus rendered incapable of propelling; pelling their contents onward to the extremities, give to the surface of the body (especially the cheeks and lips) a pallid death-like appearance; and I make no doubt that if the patient be at this time laboring under ophthalmia, and the vessels of the conjunctiva injected with red blood, they also Will be emptied of their contents, and will put on their naturally healthy appearance. In short, the effects of nausea are a relaxation of the voluntary muscles, and also of the involuntary so far as the heart and arteries are concerned.
Could the degree of nausea be cauried to an indefinite, extent, I make no doubt but the powers of life would be ultimately extinguished byt it; but here nature seems to have placed an effectual barrier, for by increasing the nauseating matter, instead of increasing the nausea we excite vomiting, and thus effects very opposite to those I have been describing are produced; for now, instead of a relaxation of the muscles, instead of a languid circulation and a death-like listlessness, nature is roused to make a powerful effort to get rid of the offending matter; the muscles, not only of respiration, but also of the extremities, are thrown into strong contractions, and the heart and arteries propel their contents onward to the ultimate branches with increased velocity; so that it frequently happens, during violent vomiting, the delicate vessels of the conjunctiva covering the sclerotic coat are ruptured, and blood consequently extravasated into the cells of the reticular membrane, constituting what is called a blood-shot eye; the pulse, instead of being so quick and feeble as scarcely to be felt or counted, as we find it to be during nausea, now bounds under the finger; and the face, partly owing to the pressure of the contracted muscles on the veins hindering the return of the blood through them, and partly to the increase of circulation, is suffused with a dark crimson hue, and apparently sworn, instead of being flaccid and deathly pale.
Having thus endeavored to contrast the different effects of nausea and of vomiting, 1 shall briefly conclude by asking, where is that similarity of action between them which can justly give rise to the following conclusion—because one of them is a useful remedy for a particular disease, the other, acting on the same principle, must also necessarily be so? The only difference is, that the latter is more decisive in its effects, because it is more powerful in its operations. I remain, Gentlemen, Clifton, Bristol, Your obedient Servant,
August Sik, 1813. C. W. S.
To the Editors of the Medical and Physical Journal.
THE very polite manner in which you inserted a compliment paid to my writings by a correspondent signing himself Ephebus, induces me to notice another paper contained in the same number. Mr. Aber, with a proper sense of justice, claims for Mr. Borrett a priority in suggesting a practice which has lately been much noticed: 1 mean the similarity between inflammation of the stomach and rabies canina. Without wishing to lessen the merit of that gentleman, give me leave to add, that a year before the date of his paper, in the last edition of Morbid Poisons, page 380, speaking of hydrophobia I have concluded thus: "In this surely it would be justifiable to push the auxilium anceps of Celsus much further than has hitherto been attempted, and not only the constant fatality of the disease, but the symptoms of a case of inflammation of the stomach, as described by Dr. Innes,* would sanction such an attempt.
After having turned to the paper to which Mr. Aber has directed your readers, (Med. and Phys. Journal, vol. xxi. p. 268) you must indulge me with a very few remarks. Without insisting on the turgescence of the vessels in the pia mater, the uncertainty of which I am ready to admit, it cannot be questioned that the appearances about the brain were those of inflammation. The affusion over the lobes, the firmness of the brain itself, and the fluid in the different cavities, are enough to ascertain this point. But the candour of Mr. Borrett will excuse me if 1 conceive the marks of inflammation about the stomach not so well ascertained. "The upper part of the oesophagus (says that gentleman, page 271) appeared free from inflammation, and covered with its fine cuticle till within four inches of the cardia, ■where there were evident marks of inflammation. The cutjcular covering of the oesophagus was seen at this part as it were terminated by a loose frittered edge, and from this point to where the oesophagus expands into the cardiac orifice of the stomach, the cuticle was wholly gone. The oesophagus at the cardia, and for two inches upward, shewed strong marks of having undergone great inflammation. The cuticle was completely destroyed. The mucous membrane
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* See Edinburgh Medical Essays abridged, vol. ii. p. 361. This patient, under the symptoms of hydrophobia, recovered after losing a hundred and sixteen ounces of blood.
NO, 175. . D d had
had passed through the first stage of inflammation, had lost its redness and assumed an ash color, with dark-colored patches. The cardia had the same dark-colored spotted appearance, and the inflammation extended to nearly the breadth of the palm of the hand on the upper orifice and larger end of the stomach, which had a studded appearance of red points; these points becoming fainter as the inflammation extended in the direction of the larger curvature. In appearance the redness was not unlike a well-injected maternal part of the placenta. The rest of the stomach appeared free from inflammation."
I shall not pretend to urge that such a stomach had not been inflamed, but an attentive comparison of Mr. Borrett's accurate description with Mr. Hunter's account of the digestion of the stomach after death, may induce him to think with me that most of the appearances were rather to be ascribed to that cause than to inflammation. I shall only notice Mr. Borrett's happy allusion to a " well-injected maternal part of the placenta," and it may not be uninteresting to compare the appearances of the two as given by Mr. Hunter. "When we cut into the placenta," says that accurate pathologist, "its whole substance seems little less than a net-work, or spongy mass, through which the blood-vessels of the foetus ramify; and indeed seems to be principally formed of the ramification of those vessels: it exhibits hardly any appearance of connecting membrane."*
In his paper on the digestion of the stomach ;ifter death, he describes two forms in which that phenomenon occurs; one in which the whole substance is eroded, and the contents of the §tomach found loose in one of the cavities: this is uncommon. The other is so frequent that "there are few dead bodies in which the stomach, at its great end, is not in some degree digested; and one who is acquainted with dissections can easily trace the gradations." (Here Mr. Hunter, probably, would have explained himself, one who is in the habit of always examining those parts with a view to this particular appearance.) These gradations depend very much on the season of the year, and the mode of dying. If in the summer, the patient being in previous high health, and killed by violence soon after a meal, the substance of the stomach is sometimes completely eroded; but this is rare. If at any other period of the year, (and the progress to death has been rapid in all its stages)—" to be sensible of this effect
• Animal Economy, p. 167, 2d edition.