Oldalképek
PDF
ePub
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small]

M. Dupin, in his Narrative of a Tour through Scotland in 1817, (see last Number, p. 437,) having alluded to a contrivance at Leith for launching vessels, 'the invention of an ingenious ship-builder,--we are desired to mention, that the principal object of this invention is not to launch vessels, but to bring them out of the water for the purpose of repairs, which is done with expedition, facility, and safety. We hope to lay before our readers a full description of this machinery, with engravings, in an early number.

The Correspondents of the EDINBURGH Magazine AND LITERANS MISCELLANY are respectfully requested to transmit their Communications for the Editors to ARCHIBALD CONSTABLE and COMPANY, Edinburgh, or LONG MAN and Company, London, to whom also orders for the Work should be particularly addressed its

[ocr errors]
[ocr errors][ocr errors][merged small][ocr errors][ocr errors][ocr errors][ocr errors][ocr errors]

THE

EDINBURGH MAGAZINE,

AND

LITERARY MISCELLANY.

DECEMBER 1818.

ORIGINAL COMMUNICATIONS.

FEVER.

[ocr errors]

gow, 1818.

REMARKS ON SOME LATE PUBLICA• transmitted, than none at all,” we TIONS ON THE PRESENT EPIDEMIC are convinced that a perusal of it will

convey to his readers, whether medi1. Edinburgh Clinical Reports, &c. of the results of that benevolence and

cal or not, a satisfactory view of sonne By Dr Duncan Jun. Edın. 1818. 2. Observations on Contagious Fever,

skill, which have for nearly a cen&c. By Dr Yule. Edin. 1818.

tury distinguished the medical prac 3. Observations on Continued Fever,

tice of the Royal Infirmary of Edin&c. By Dr Graham. Glasgow,

burgh.

The causes which led to Dr Dun1818. 4. Statements relative to. Epidemic liamentary inquiry which had recent

can's publication were, first, the parFever, &c. "By Dr Millar. Glas

ly been instituted into the state of fe

ver in the metropolis of England; It has long been a matter of regret and secondly, the example set by the to us, that we have never been put in hospitals of Dublin, Cork, Glasgow, possession of a regularly connected and London, in the admirable de series of facts illustrative of the in- scriptions of the reigning epidemic, ternal history of the various hospitals which have been communicated to of the empire ;-particularly of the the public by the physicians of these noble charity that has so essentially institutions. We shall present to our contributed to the high character readers, in the course of our observa, which our school of physic has so long tions, some of the more interesting and so jastly maintained. The practice facts connected with the “Statistics and precepts of clinical medicine also, of fever, if we may adopt the expresas pursued in British hospitals, have sion, contained in these communicabeen principally recorded in the fleet- tions. The results of the inquiry ing and desultory pages of the stu- in parliament, we shall not at present dent's note-book, or in the medical enlarge upon, pur views being in no records of the establishments them- shape directed towards the neglects, selves, which to the public in general or alleged neglects, of any institution; are nearly as inaccessible as the me, but we shall merely state, that, while moranda of private individuals. In some of the hospitals of England, conone of the publications before us, Dr tent themselves with giving a meagre Duncan, junior, has presented us annual detail of the numbers of sick with a plan, which, in a small compass, that have been admitted or died withappears to us to combine many of the in their walls, others do not publish points requisite to be noticed in the even these unsatisfactory notices, and documents, the want of which we some, from keeping no records, possess lament; and notwithstanding the mo not the means of affording any indest quotation from homest old Kirk- formation whatever on the subject. ton, prefixed to his book, “ I think, Independent of the urgent calls better I had ane imperfect account which the indigent sick naturally have

upon our humanity, and the satisfac- bracing a general account of the ad tion we enjoy, in a consciousness of missions, recoveries, and deaths, with having discharged a paramount duty & particular detail of the nature and to these unfortunate fellow-creatures, extent of the principal diseases, espewe have a more personal and tangible cially if epidemic, their modifications interest in the institution of public by season, situation, sex, profession, hospitals. This interest divides itself and modes of living, the extent and into immediate self-preservation by more obvious operation of their conthe removal of the diseased poor from tagious qualities, and the respecour own doors ;-and the less urgent, tive merits of the different plans of but scarcely less important, pre cure adopted, with the comparative caution of separating them from success which has attended their athe general mass of their fellow-, doption at various periods. Nor is citizens in a similar class of society, this a visionary or Utopian scheme; with whom, either directly or indi- it has been required from, and exrectly, we hold communication almost ecuted by, the physicians who attend every hour of our lives. Besides these the fever establishments recently inadvantages, we look up to public hos- stituted in Dublin; it is followed, as pitals as affording practical schools for we are informed by Dr Duncan, in all the education of those, to whom we the military hospitals throughout the entrust the health and the lives of empire ; and since its introduction inourselves and our families, and we to them, under the auspices of our view them as a central point from distinguished countryman Sir James which may emanate all such improve- M'Grigor, we are assured, from the ments in medicine, as may have pas- best sources of information, that it sed the ordeal of impartial trials on has effected more in three short years numerous individuals, instituted by for the improvement of the army me. humane and scientific men ;---a field dical practice, than lrad been attemptof experiment which no private prac-ed for the preceding quarter of a centice, however extensive, can afford. All tury, the period from which may be these, but very especially the last, we fairly dated, the general introduction conceive the public have a right to look of scientific men into military emfor, as a return for the liberal support ployments in our islands. which they bestow on such establish Among the numerous advantages ments.

which may be derived from such reIn the reports now before us, Dr. ports, those peealiarly the product of Duncan takes a much wider range einulation, are by no means the least than a bare narration of cases; he en- considerable. To a superficial obters upon the consideration of some server, the palm of superiority might very important points of medical po- appear due to that hospital within lice; and in doing so, he professes to whose walls the fewest deaths occur ; " have quoted no authorities, and but a proper degree of reflection will entered into no controversies, but at once point out to us, that many merely to have attempted to give an more circumstances are to be taken abstract of what he saw and of what into view ; and unless a general statehe did ;" and it every clinical physi- ment of these accompanies the reports cian would but follow this example, of an hospital, it is quite absurd to and in a simple, condensed, and even think of calculating correctly on its popular form, submit to the public utility to the public. The leading the results of his views and his profes- circumstances which strike us as nesional exertions, we are convinced cessary to be attended to, are, that he would, in discharging this 1st, The numbers which receive react of duty, confez a most important lief from the establishment. These benefit on society. Indeed, we con- again are to be considered with a ceive, that one of the most judicious view to determine the mildness or se regulations that could be introduced verity of the cases, their acute or their into the management of all publie chronic nature. Thus more deaths hospitals, would be to provide not will happen among cases of a severe only for a periodical account of the contagious fever, than in less serious expenditure of their pecuniary funds, : complaints ; and it is equally obvious, but also for a summary view of the that the injuries which occur from results of their medical practice, em, the powerful machivery employed in.

large cities, and unhealthy manufac- the subsequent ones should be added turing towns, will be more danger. a faithful statement of every importous than ordinary accidents among ant change which may have occurrobust inhabitants of country vil red in their intervals. A com. lages. Nor should we omit in our prehensive meteorological register calculations, the more important 0. should also accompany the report, not perations of surgery, to which fatal merely containing an account of the effects so frequently succeed. A very number of days which were hot or few such consequences, would at once cold, dry or rainy, with the winds turn the scale of mortality against an which blew at each period, and the hospital which had the highest pre- forms assumed by the clouds ; but an tensions to general excellence ; for, account, as far as had been observed, as Dr Duncan well observes, a high of the influence of these changes of mortality may depend upon a proper the weather on the number and na selection of dangerous cases, as well. ture of the diseases treated. ås upon improper management and In the Royal Infirmary of this city unskilful treatment."

regular journals of the practice have 2d, The shortness of the period always been kept ; but to this species employed for the cure of the patients of diurnal detail Dr Duncan strongly taken into the establishment; still recommends the addition of a tabular keeping in view the nature of the scheme, into which the leading para cases received, and, above all things, ticulars might be entered, so as to pretaking care, that while every practi- sent the results of a multitude of in cable and salutary indulgence be sulated cases in one uniforin view. granted to the actually diseased, nei- The plan which he himself recomther the lazy, the vicious, nor the mends, is one which embraces the chronic incurable, become a burden disease, nåme, age, sex, and profes upon the hospital funds, to the exclu- sion of the patients, and, in cases of sion of real and urgent sufferers. contagion, their residence also; the

3d, The expence of each patient cause, or supposed cause, the coma received into the establishment. This mencement, crisis, duration, and reinvolves a multiplicity of inquiries, sult of the disease, with notes upon and can only be fairly calculated, its mode of treatment. It is not when the prices of bedding, clothing, our intention to follow him through food, furniture, medicines, and me- out the purely medical part of his dical materials, are fully taken into observations; but we shall present view.

to our readers some of the inforLastly, That hospital will evident- mation elicited by his tables on the ly be the best, which receives the important subject of onr epidemic fegreatest number of severe cases, and ver, in which every individual is more dismisses the greatest number of them or less interested. cured, with the least expence to the · The whole number of patients ad. funds of the establishment, and the mitted into the clinical wards of the least liability to become a burden up- Royal Infirmary, with epidemic feon them again by relapsing.

ver, during the six months of Dr DunA valuable addition to the reports can's attendance, were 89, viz., 28 which we so much desire, would be males and 28 females in 'winter, and an ample account of the medical to 19 males and 14 fernales in summer ; pography of the place where the hos- they were of all ages, from 5 to 69; pital is situated, with a full descrip- he has not been able to give much in tion of the accommodation for the formation as to their professions, or, sick, the nature of the building, and whether their occupationis were sea size of its rooms; its means of venti- dentary or active, carried on in con.. lation and cleanliness ; the number fined apartinents, or in the open air, and extent of its offices, its kitchens, whether they were servants in or out wash-houses, baths, &c. &c ; and a of place, or whether married or single ; full account of the diet of the sick, as these points, however, should all be to quantity and quality, with the ave- , ascertained in future tables. Their rage expence per diem for each class. residences, also, should be distinctly This information might form a princi- marked, in order, as Dr Duncan weli. pal part of the first report, for the expresses it, “ to form a record by purposes of after reference ; and to all which we might trace with certainty

the commencement and introduction of the valuable and curious matter of such diseases, their progress, and that might be collected from tables their decline, - their favourite haunts, such as those suggested, and in part if we may use the expression; and drawn up, by Dr Duncan, if a refurnish the magistracy and police with gular and uniform plan were insti. information by which they may be tuted, and acted upon in all the enabled to take measures to prevent hospitals in the empire. Neither our the introduction, or at least to coun- limits nor our plan allow of our going teract the diffusion of contagious dis along with him in his medical obser: cases.'

vations, nor of examining the cases Wewere anxious to examine into the which are contained in an appendix; causes, or alleged causes, of the fever and which illustrate the facts stated in in these 89 cases, and accordingly we the body of the work. find, that 30 were from contagion, (of In this appendix, also, are given whom 5 relapsed, 2 of them twice,) 10. some valuable dissections, interesting from cold and wet, (one of whom re on many accounts, but' particularly lapsed,) 4 from cold and fatigue ; 2 so as having been perfermed' by that from cold alone ; 1 from cold and intem, lamented physician, “ whose warm perance; 1 from wet alone; 1 from wet heart, with all its generous and open and exhaustion ; 2 from heat and fa- vessels, is now compressed into a cind tigue; 1 from fatigue alone; 1 from in- of the valley:" "To me," says the temperance alone; 1 from distress ; 4 author, alluding to these documents, from relapses in their own houses ; "they are particularly interesting, as and 31 from causes unknown; (one of being the last fruits of my professionwhom relapsed twice.) It is highly pro- al intercourse with the late Dr John bable, however, that several of these Gordon, whose zeal and science as a eauses were frequently combined. pathological anatomist, qualified him

The average number of days the so eminently for the situation he filpatients were under treatment in the led in the hospital, and whose private hospital was 25 for the men, and 27 virtues made him most beloved by for the women during the winter those who knew him best.” quarter, and 18 for the men and 21 There is every reason to suppose, for the women during the summer ; that it is to the influx of Irish las from which it appears, that men were bourers to this country we chiefly owe sooner discharged than women, and the present fever, and it is probably that both sexes remained a shorter from us that it has passed, in various time in hospital in summer than in instances, into England. That the winter.

disease originally proceeded from poOf the 89 cases 7 diel. The com- verty, and its concomitants, hunger, parative "mortality of the men in the cold, and rags, aggravated by filth and winter months was 1 in 28 ; of wo- intemperance, all pressing on thie de men during the same period, 1 in 14; sponding inhabitants of overcrowded of men in the summer months, 1 in and insufficient lodgings, there can 6}; of women, 1 in 14. Average be little doubt. Of its progress, some in both periods, 1 death in 11 of the idea máy be formed from the followmen, and 1 in 14 of the women, or 1 ing facts : The Fever Hospital of Dub in 12 5.7 of both sexes ; viz. 1 in 183 lin, which was opened in 1804, and in winter, and 1 in 8. in summer. admitted that year only 422 cases; in

: “ This mortality," as Dr Duncan 1810, when fever became very general observes, " is certainly sufficiently all over Ireland, admitted 1774; and great to show the severity and dan- in the year 1817, 5T45 patients ! The ger of the disease ; but the numbers Hardwicke Fever Hospital of the saine are much too few, and the circumstan- city, increased, between the years ces of the clinical wards too peculiar 1813 and 1817, from 1842 patients to to afford a fair average of the rate of 8916! mortality.” We shall find, however, In an excellent report on the Fe. that the greater mortality among the ver Hospital of Dublin, by Dr Stoker, inales than among the females, is rendered still more obvious, by the re Dr Duncan alludes to one singular sult of similar inquiries at Glasgow. case, where the skin of a native of Bengal

We apprehend, that, from even this had become almost entirely white without sketch, our readers will be convinced the agency of obvious disease.

« ElőzőTovább »