REMARKS ON THE PETECHIAL, OR SPOTTED fever.

COMMUNICATED IN A LETTER FROM A GENTLEMAN IN THE DISTRICT OF MAINE, TO THE EDITORS.

HAV AVING formerly written to you on the subject of the spotted fever, so called; I take the liberty again to trouble you; as we have just had two cases of it, which have proved fatal; and a third is at issue. The last will of course be soon decided; but

more may follow.

In the first, no advice was called for till it was too late; though Dr. obviated some terrible symptoms from purges, given by the family, and brought the patient into an apparently promising state. But the patient died comatose. The most remarkable symptoms here were convulsive catchings in the limbs, with a hurried state of mind, and blood from the nose.

In the second case, the patient lived a week, and preserved strength enough to the last to rise from her bed. Here the prominent symptoms were, shifting pains and swellings, pain in the side and chest, with affections on one side.

In the third, the affections have been in the head, and on one side, with a varying pulse, soreness of throat, chills, and spasms in the muscles.-These have all been young females.

In these cases I have mentioned only the marked or peculiar symptoms. But every case has had more, or fewer of the symptoms, enumerated in the Society's treatise on this subject.

I write to know whether you have any thing new on these subjects; for I am sorry to tell you, that we have not found all that has been prescribed in the above treatise, sufficiently efficacious.

Before I proceed, I must acknowledge the deep debt, which the public is under to the committee concerned in that work; which is drawn up with great fidelity and ability, and refers to some very important observations by others.-I still am of opinion, that the greater number of readers would have been pleased, had the theoretical part been placed at the end, by way of ap

pendix; but it is in itself a most important addition, and I am glad to see it any where.

After repeated study of the symptoms and treatment, compared with the theory there detailed, the following observations

occur to me.

1. If the disease be often erysipelatous in the head, there seems not sufficient care to obviate this most alarming part of the complaint. 2. If the circulation is deranged, and the red particles withdrawn from one portion of the serum to be accumulated elsewhere; the measures taken to obviate this may be successful; but they are hardly according to rules in every point of view. 3. The rheumatic affections seem not the object any direct remedy; and yet the relief of a symptom so extensive in the seats of it, cannot but have much influence upon the disease.

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1. You know that I often refer to Kirkland. I find him a very obscure writer; but full of practical hints mixed with theories deserving of notice, and the author of much successful practice. He treats at large of erysipelas in general, and in particular; and I would specifically notice his treatment of it in the head. He makes local applications; not so much of blisters, because creating inflammation, before they produce a discharge; but puts on a neutralized ointment, as he calls it; or, where there is great inflammation, a neutralized emollient cataplasm. He, with many, thinks that oil does not stop up the pores; and uses it accordingly. After reading him and others, I am much inclined to believe that the elder (sambucus) has more virtues than those find, who judge of it by general principles, and not by its specific operations. Turner and Heister speak of it for erysipelas; and Kirkland has seen spirits of wine (which he holds to be a powerful sedative) with ointment of elder, in a few hours cure an erysipelas in the face, from a blast of air. Kirkland uses Glauber's salt at times with vinegar of lead, in a poultice. The communication between the blood-vessels within and without the cranium makes Kirkland trust much to these local applications; but where the case admits, he bleeds and gives saline purges; thinking that the latter, in addition to their anti-flogistic powers, render the "whole state of the vessels” more per

vious than any thing else. He also, where bleeding and antiphlogistic measures are proper, uses cold to the head; also cream (or milk) with vinegar of lead; and lastly, the ceratum ex aquâ frigidâ of Galen. The latter is made of wax, melted with the best oil, which when cooled, is to be beaten up with as much cold water, as it will imbibe, when gradually applied.-I think elder may be taken inwardly, if purging, or rather an open body be wanted; mixing it with soluble tartar, or Rochelle salts. These two neutral salts reach the bile, which Glauber salts do not; though Kirkland uses the Glauber salts; and it may also be mixed with such other articles, as shall be judged proper.— Outwardly, Kirkland says, that a small quantity of neutral salts will suffice; and that inflammation and a stoppage of discharge will be the consequence of putting more of it to the acetite of lead, than is proper.

2. As to the circulation, I know that some measures are taken to regulate it: but has any one used fox-glove and opium, which have been given for rheumatic fever?-Chalybeates have much power in regulating the distribution of the red particles of the blood; as well as in increasing their quantity. There are various constitutions, where chalybeates throw the blood into the smaller extremities: but they may add too many red particles in the interior of the body for safety, in the present complaint.

3. For rheumatic affections, I have mentioned digitalis and opium. I have to speak of guiacum for the same purpose, especially as it is diaphoretic, and often aperient. When too aperient, opium may be added.-I could say new things about rheumatism, but this is not the time for it.

CASES OF APOPLEXY WITH DISSECTIONS.

BY JOHN C. WARREN. M. D.

(Concluded from page 41.)

Ir gives me great satisfaction to be able to support, in some measure, the opinions founded on the cases, in the former part of this paper, by such authority, as that of the author of the fol lowing letter.

LETTER FROM JOSHUA FISHER, M. D. VICE-PRESIDENT OF THE MASSACHUSETTS MEDICAL SOCIETY.

DEAR SIR,

BEVERLY, March 6, 1812.

In the first number of the New England Journal, I have read with pleasure your account of the appearances, observed on the dissection of two persons who had died of apoplexy: they seem to confirm the hypothesis of the sympathy, between the stomach and the brain, in some cases at least, of that disease. The same idea was impressed on my mind by the following case, which occurred to me when a young practitioner.

In the autumn of 1774, I was sent for, about sun-set, to visit a poor man who was attacked with a fit of apoplexy; not being at home another physician was applied to: on my return home, being informed that the physician who had visited him had attempted in vain to bleed him; had pronounced his case desperate, and had left him; I did'not think it necessary to see him. After the lapse of more than three days, hearing that the man was still alive, I called on him; found him perfectly insensible; incapable of voluntary motion; his breathing slow and sterlorous. I was informed that such had been his situation since the attack, and that in the mean time nothing had passed into his stomach; that on the day on which he was seized, he had procured a beef-steak for his dinner, of which, as I knew that to him it must have been a luxury, he had probably eaten voraciously; and that it was probable also, that after dinner, he had indulged himself in drinking ardent spirits to excess. Under these circumstances the source of his disease was sought for in the stomach. As he lay on his back, with his mouth open, I conveyed into his throat a small quantity of water, which

appeared to pass gradually into the stomach: I then dissolved ten or twelve grains of Tart. Emet. (Tart. Antimon.) in some water, and introduced it as fast, as it would pass down his throat. In less than an hour he began to puke. What he threw up consisted, principally, of large pieces of beef, the fat and lean parts of which were obviously distinguishable: nor did the meat appear to have undergone any considerable change, by having lain nearly three days and an half in the man's stomach, excepting that the pieces were enlarged. After a strong effort to puke, the patient appeared to be strangled; a finger was introduced into his throat, and a long piece of steak was extracted, so large that it could not pass without assistance.

The whole quantity of meat, thrown up, was nearly equal to that of a common meal for a man. I did not suppose that the emetic had thoroughly evacuated the stomach; but such was the effect of it, that, immediately after it had done operating the man spoke, and with some assistance could move himself With the aid of cathartics, &c. in a short time he recovered completely.

With sentiments of esteem,
Yours,

JOS. FISHER.

We infer from the preceding facts and observations that there are good reasons to be found in anatomy, physiology, and pathology for believing, that the stomach is capable of “materially affecting the head." A disturbance in the functions of the stomach may therefore, by means of sympathy, cause an excitement in the vessels of the brain, and an accumulation of blood; hence may proceed an effusion of serum, or the rupture of a vessel and effusion of blood. Whether such a sympathy can operate to weaken the cerebral vessels, or whether its effect be to cause a diseased excitement, we do not pretend to determine.

As an objection to this doctrine, the author we have been examining, adduces the condition of the brain, in organic diseases of the stomach. Patients, who labour under a scirrosity of this organ, are observed to suffer the most distressing and violent symptoms, during a considerable time, without disturbance of any of the functions of the brain. The external senses lose nothing of their acuteness; the power of motion is slowly diminished, and the intellect is undisturbed to the last moment. This objection has considerable weight at first view; but when examined, its importance vanishes. The character of symptoms in chronic diseases differs totally from that of acute or sudden de