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times a transient heat on the whole body; edematous swel lings of the lower extremities,* accompanied with erisipelatous patches of inflammation, sore to the touch, have supervened; urine varies much in quantity and color; bowels still very costive; recourse is had to the pills mentioned in the margin; pulse about 90, weak; her stools vary in color and consistence, and are at times very offensive; she has gained strength and flesh, and the color of the skin is perfectly healthy; she is soon fatigued by exercise, and a hurried motion produces dyspnea; always feels better when the stomach is empty, and the coldest liquids agree best; tea is her favorite beverage. Such is now the altered condition of her stomach, that gr. viij Ipecac. taken one day produced no vomiting, and on the following morning gr. j Antimon. Tart. added did not increase the emetic power of the Ipecac. but operated downwards. Repeated the vomit a week ago, which operated a little, and brought up some fluid of a greenish color, but not acid. These vomits she took of her own accord, in consequence of feeling uneasy at the stomach. She now takes no medicine but opening pills. In May last the menses made their appearance, and returned at the interval of six weeks, but have since totally ceased. Such is the exact state of the patient at this time-a condition comparatively very comfortable to what it was previous to the re-introduction of mercury, and which allows of the exhibition of remedies for a more perfect recovery, however doubtful that may be.

The ink was scarcely dry from writing the communication which I have just closed to you, when your Journal for the present month came to hand, in which I find myself called upon to publish a case, in consequence, it would appear, of a paper on Ischuria, which you did me the favor to insert in your last Number; I must therefore trouble you again.

A poor woman of this town, (still alive, bed-ridden, and suffering greatly from painful disease,) had been afflicted for several years with very distressing complaints; during one period of the progress of which she declared, and this declaration is corroborated by her neighbours, that she vomited her urine. I never personally witnessed this symptom, but

*This symptom had occurred previous to the severity of her illness originally, but disappeared.

+ R. Extracti Elaterii, 3fs. Gambogia, Dij. Extract. Colocynth. Comp. gifs. distribue secundum artem in pilulas xxiv. This quantity in the dose of one or two pills is not very active.

The reader will recollect, that in the first part of the case, gr.j Ipecac. produced full vomiting.

have very frequently visited her both prior and subsequent to its occurrence. Several professional gentlemen of great respectability, with some of whom I am in the habit of very frequent communication, visited this person, and signed a declaration, which was delivered to me by one of the gentlemen, stating such a symptom to be utterly impossible. I was absent at the time of their meeting, which was a casual one, at a considerable distance from Bedford, on professional engagements. This broad and general assertion, both colloquial and in a written document, startled me, believing, as I do, that urinous vomiting has occurred in the human subject. I was thus induced to make a search into our best authors, and the result of this investigation has been a confirmation of my belief. I accordingly transmitted this result of my inquiries, instituted both from curiosity and a just respect for the opinions of my professional brethren, to your Journal, without referring to any case, under the hope, arising, I trust, from a proper professional spirit, of drawing the attention of your ingenious correspondents to the subject of urinous vomiting, that they might supply, if they thought proper, either from their experience, or reading, or both, their ideas on this symptom; keeping in view the well-authenticated facts from the best authorities, both of ancient and modern date,* stated in the paper on Ischuria. With respect to the patient herself, I credited the relation of those symptoms which I did not personally witness, from the extreme severity of affliction and sufferings which I and very many others had frequently witnessed; and I have as yet found no reason whatever to withdraw the credit I gave. But whatever belief may be withheld from the woman's report of her symptoms, it cannot affect the general question of urinous vomiting, which, in a physiological point of view, is principally interesting. The pledge, if it is to be considered such, for publication, was given in private conversation, in a similar way that a hint at publication is publicly thrown out in the preliminary observations to the paper in your last Number: and if it had not been so announced, however loosely, in either way, probably the case would at some period have been submitted to the public; but surely, whether pledged or not, it must be allowed to take place, to speak in the language of Alina Mater, horâ locoque consuetis.

I am, Gentlemen,

Bedford, June 2, 1813.

Your very obedient Servant,
G. D. YEATS, M.D.

* Of the latter, the case published by Dr. Senter, in the Transactions of the College of Physicians of Philadelphia, is particularly deserving of attention.

To

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

FEAR I was not sufficiently explicit in my communication in the 170th Number, page 302, of your valuable Journal, relative to the effects of the Antim. Tartar. in immediately arresting the progress of the purulent inflammation of the conjunctiva, commonly called the Egyptian Ophthalmia, as it appears by a paper from Mr. Fielding, of Hull, in your last Number, that my principle, as well as mode of administering that medicine, have been misunderstood by him. I stated that "constant sickness and vomiting" was kept up for eight or ten hours by repeated doses of Antim. Tartar. :-it would have been more correct if I had said that violent sickness and vomiting were continued during that period. The diminishing the action of the heart and arteries by inducing nausea, is a practice which most professional men have pursued in lessening acute inflammation in various parts; it is not therefore surprising that it should have been tried in a disease where this character is so strongly marked as in the Egyptian Ophthalmia; but I know of no one who has recommended violent vomiting to be excited and continued in the manner I have described, although it is probable that vomiting may accidentally have been produced by small doses of the medicine, when given to produce nausea.*

The mode of exhibiting my remedy, and the principle on which it is supposed to act, differ so much from those described by Mr. Fielding, that they cannot with propriety be considered the same, or even as analogous. To produce nausea, a quarter, or at most the third, of a grain of the Antim, Tartar. is exhibited for a dose once in three or four hours to an adult; whereas in my practice I should direct two grains to be given at the first, and half that quantity to be repeated every half hour until full vomiting is produced, which is to be kept up for the stated time, by repeating the dose at longer intervals.

The effect of nausea is to lessen arterial action, consequently, during its existence, inflammation in any organ or viscus must be diminished; but I believe its further progress has been very rarely, if ever, immediately arrested by so gentle an operation of the medicine. The intentions I had in view in adopting the practice in question were, first, by

This, however, would be no argument against the originality of my practice, as, had its efficacy been understood by any of those prac titioners, they would not, I conceive, have failed systematically to adopt it, as I have done.

the

the violent excitement of vomiting to produce a new action in the inflamed vessels, whereby the morbid action constituting the disease would probably be removed; secondly, by keeping up continued sickness and vomiting for so many hours, considerably to exhaust the animal and vital powers, whereby the circulation would become so languid as almost to amount to syncope, during the continuance of which it is impossible that inflammatory action can proceed. By having recourse to the remedy as early as possible before the disease could establish itself, it occurred to me, that not only would the morbid action be removed by inducing a different action, but by the long-continued sickness, and consequent exhaustion, all disposition to a recurrence of inflammatory action would be removed.* The event has most fully answered these expectations, as in no one instance in which I have known the remedy employed agreeably to the rules just laid down, has it failed of success.

After this explanation of the principle and effects of my practice, no candid person, I conceive, will blend it with that recommended by Mr. Fielding, whose liberality I feel assured would not have allowed him to claim priority in its adoption, had leisure permitted me to have been as explicit in my former paper on this subject as I have been at present.

The nauseating practice has indeed also been tried by different surgeons in the army, during the period the Egyptian Ophthalmia raged so extensively among the soldiery; and in a report drawn up by three professional gentlemen, appointed by his Royal Highness the Commander in Chief, to inquire into the probable efficacy of my practice, if introduced into. the medical practice of the army, they also intimate the two modes of treatment to be similar, although I explained to them, at the conference I had with them on this subject, the important difference both in their intention and effect.

I have the honor to be, Gentlemen,

Your very obedient humble Servant,

WILLIAM ADAMS,

Oculist Extraordinary to his Royal Highness the Prince
Regent, and Oculist in Ordinary to their Royal High-
nesses the Dukes of Kent and Sussex.
Albemarle-street, June 13, 1813.

* An additional reason for exhibiting the Antim. Tart. as immediately after the accession of Ophthalmia as possible, is, that ulceration of the cornea frequently ensues within twelve hours, (which, by a typographical error in my former paper on this subject was stated twelve days,) when vomiting would be highly injurious.

3

To

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

THE HE Preamble to the "Act for exempting Apothecaries from certain Offices, &c." Anno 6-7 Will, III. runs thus: "Whereas the art of the Apothecary is of great and general use and benefit, by reason of their constant and necessary assistance to his Majesty's subjects, which should oblige them solely to attend the duties of their profession; yet, by reason that they are compelled to serve several parish, ward, and leet offices, in the places where they live, and are frequently summoned to serve on juries and inquests, which take up great part of their time, they cannot perform the trusts reposed in them as they ought, nor attend the sick with such diligence as they ought, &c.'

I would beg to ask your learned correspondent, Censorinus, whether it is a just and legitimate deduction from the manner in which the words "assistance," "attend," "duties," "profession," are used in the above extract, to conclude that the Apothecary's attendance upon the sick was to be somewhat like that of the nurse, or whether they do not imply that he was to prescribe for them? If your correspondent's opinion respecting the Apothecaries be correct, they are, I apprehend, one and all liable to a penalty of 57. per month for practising; but if they are by the above act allowed to exercise their "profession," then have they as much a right to prescribe for patients as the physicians have.

The disputes at present subsisting between physicians and apothecaries, have caused me to turn over some old tracts upon the same subject: from one of these I find that the apothecaries had very little employment as prescribers of medicine till the time of the great plague in 1666, when the physicians taking the alarm, honestly and disinterestedly ran away, but the apothecaries kept their proper posts, and as far as they were able assisted the sufferings of their fellowcreatures; after which they rose into estimation, and from that time to this have either legally or illegally practised.

*

In another pamphlet I found the following paragraph, which I have been induced to extract for the amusement of your readers: "After all it must be owned that there is something very peculiar in the economy of an Apothecary, and his brain is very much influenced by the weather. On a calm fair day he is very ignorant and stupid; but in the night, and when it rains, he is a man of common sense, and

* See Merrett's Short View of Frauds and Abuses, &c. &c. 1669. a competent

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