expectoration two table fpoonfuls and entirely free from purulency. The 15th, the weather about this time fet in extremely fevere, and he had in confequence a fresh attack; the cough, dyspnoea, and expectoration became more troublesome and profufe, which continued for feveral days; but all these bad symptoms have again difappeared, and he now appears to advance with a firm pace towards a perfect cure, (the 26th,) although the cold continues unabated. He has been all along extremely fufceptible of being affected by changes in the atmosphere, and unfortunately this has been too much the cafe during the whole year, efpecially fince the commencement of winter. I an inclined to impute the protraction of his cure to local cir-. cumftances conftantly operating, of which the principal were, long continued eafterly winds, blowing over a deep marthy country, to which the icite of the prifon is much expofed, and the common effects of imprisonment on a mind already debilitated by a confuming difeafe. The power of the medicine was moft confpicuous in diminishing the quantity, changing the quality, and removing the fætor of the expectoration, as well as in leffening the force of the vafcular fyftem. If we attentively confider the history of all the cafes hitherto published by different authors, refpecting the peculiar effects of the digitalis, nothing fatisfactorily decifive can be inferred, if we except the two cafes of Maris and Grimes, fo accurately related by the ingenious Dr. Drake, of Hadleigh; but even in thefe, the ftate of the pulfe was only attended to once a day, and, from the history already narrated, it must be manifeft that the action of the medicine on the circulation, can only be accurately defined by a more frequent daily examination of the pulfe, &c. The cafes enumerated by Dr. Fowler, and inferted, like the former, in Dr. Beddoe's valuable volume of Contributions, are fo vague and defultory, that nothing more than very indefinite general refults can be collected; as the mode of preparing the medicine, dofe, &c. as well as its particular effects on the head, ftomach, and pulfe, are related very defectively. To those re cited by Dr. Bree, though more methodical than the preceding, I muft object for nearly fimilar reafons; it would appear likewife that the fubjects on whom he tried the experiments were, what in medical language is generally termed, loft cafes; in fact, the Doctor fays fo himfelf, in very explicit words. Page 432, his obfervations are," the remaining fix cafes were too far advanced to have been capable of cure from any medicine." In the three cafes which he terms incipient, one of them only perfevered in taking the medicine for any length of time, and it proved permanently fuccefsful: Of the others, Harrison took the the powder nineteen days, and then difcontinued. Underhill commenced with the tincture on the 8th July; but the quantity he took, or the time he perfevered in its ufe, is not mentioned, only that he purfued it till anorexia and weakness made him lofe all patience. It is to be obferved, alfo, that in the greater number, the powder was adminiftered, a form of exhibiting which renders it impoffible to regulate the dofe with that degree of precifion fo neceflary to be attended to, when active remedies are to be employed. From those unfuccessful cafes, then, to draw unfavourable conclufions refpecting the anti-phthifical effects of the digitalis, is most affuredly unjust, and what the premises will by no means warrant. The remarks of Dr. Maclean, of Sudbury, on the common effects of full dofes of the digitalis, were in general found perfectly juft and conformable to the phænomena obferved in Stroed's cafe; but the Doctor was evidently mistaken when he afferted, page 119, that those who expect to fucceed in reducing the pulfe to any confiderable degree, without inducing vertigo, with vomittings, will be difappointed. The preceding cafe proves, that the pulfe, after a certain space of time, was, in the evening, almoft conftantly at or under forty, frequently at 38, 36, 34, and once at 32, when neither the head nor ftomach was affected; even at the extraordinary reduction of 32, the pulfe was free from intermiffions, and the patient, on being afked, if he felt any particular uneafy fenfations, replied, not in the leaft. What is ftill more remarkable, is, that the pulse was always found more regular, and generally fuller, when under 40, than above that and 50. On the neceffity of having a ftandard formula, in order to regulate general practice, I fully agree with Dr. Maclean, and the tincture ufed in the prefent cafe was made from his prefcription; it was found impoffible to conform to that of Dr. Drake-one ounce of grofs powder absorbed four ounces of proof fpirit entirely; and I am perfuaded his laft improvement of one ounce to five will be found likewife inconvenient. A tincture prepared according to Dr. Maclean's method, may be administered with more freedom, and the dose better regulated. The digitalis fhewed no tendency whatever to act as a diuretic, nor were the intestines at all affected by it, the body having continued perfectly regular from the commencement to the end. Upon the whole, then, after maturely confidering the phænomena attending the internal ufe of the digitalis in the prefent cafe, and comparing them with thofe obferved by other gentlemen, we fhall be warranted in drawing the following general conclufions. First, That this medicine, in the form of tincture, if carefully and gradually exhibited, may be ultimately given in large dofes, and continued for months with the most perfect fafety to the patient. Secondly, That after a certain length of time, when the fyftem is charged, and completely under its influence, it poffeffes a power of arrefting the motion of the heart and arteries in a furprifing manner; but that, under fuch influence, they are exquifitely fufceptible of being roufed into action on the flightest bodily exertion. Thirdly, That the pulfe may be brought to a degree of reduction hitherto thought incompatible with the existence of animal life, for any confiderable time, without danger to, or even any material derangement of, the animal economy. And Laftly, That the criterion by which we are to be guided in regulating the increase, diminution, or total omiffion of the medicine, depends on the phænomena arifing from its action on the fenforium and ftomach, and not on the quantum of reduction in the pulfe. Mr. BROWN, on the Neceffity of establishing an Hofpital for the Treatment of Ulcerated Legs. To the Editors of the Medical and Phyfical Journal. GENTLEMEN, AMONG NG the various charities which do honour to this city, there ftill remains one wanting, which I am certain deferves as much the attention of the humane as any yet establifhed; I mean, an hofpital, infirmary, or difpenfary, for the fole reception of ulcerated legs. It is a very melancholy fact, that among the lower claffes of the community, nearly in the proportion of one out of five, labour, and have many years, under this fevere affliction, which to them is a conftant fource of expence, and muft ultimately terminate their existence, by fubjecting them to other diforders more fatal and rapid in their progrefs. It will, perhaps, be urged as an argument against putting fuch a benevolent scheme into execution, that our hofpitals, as, St. Thomas's, Guy's, St. Bartholomew's, the Lon don, don, and all others, indeed, are open for the reception of fuch objects, and therefore there is no abfolute neceffity for establishing one folely for this end. But when we paufe for a moment, and reflect, that many labouring under this loathfome disease, do apply at thefe hofpitals, and are denied admiflion, and that many others are turned out incurable, who, under the fkilful care of fome furgeon, (who, perhaps, devotes more of his attention, and fupplies the patient with thofe neceflaries which an hofpital cannot, or does not furnish,) receives a fpeedy and effectual cure, furely no one but who is infenfible to the agonies - of the mind, and painful diforders of the body, will refufe his mite. From great and (with diffidence I affirm it,) very fuccefsful practice in this branch of furgery, I can affert, that among the many cafes of ulcerated legs, which I have had under my care, fince I have been in practice in this metropolis, I have never found any difficulty in effecting cures, even in the very worst cafes, by attention to the particular circumstances of the ftate of the ulcers, by cleanlinefs, and occafional reft. It would require but little expence to put this charity on a footing with the most refpectable in London. About L. 2000 would erect a building fufficiently large for the purpofe, and a fubfequent fund of about 500 annually would support it. The remedies required for healing bad legs, are very few and cheap, and ten thoufand perfons, yearly, might receive benefit from this charity. It only requires fome fpirited perfons to ftep forward, and intereft themfelves warmly in behalf of fome hundred thoufands, forely afflicted with the diforder, who would offer up their prayers for their benefactors; and from the ftate of poverty they are now in, would be enabled to enjoy fome of the few comforts of life. If any perfons are willing to affist the writer of this, in attaining an object fo defirable, and who is ready to fubfcribe fifty pounds towards the fund, they will be fhewn a plan, drawn up for the purpose, and requiring only the fum before fpecified to fet it on foot. I have the honour to be, Hatton Garden, No. 25, Nov. 5, 1799. CHARLES BROWN. To To the Editors of the Medical and Phyfical Journal. GENTLEMEN, THE following Cafe of Lusus Nature, may, probably, be worthy a place in your valuable Journal, and not unacceptable to its numerous Readers. In October laft, I was engaged to attend the wife of a refpectable tradefinan, who expected to be confined about the end of November, or beginning of December. I heard nothing of her till two in the afternoon of the 12th inftant, when I was informed fhe was unwell, and expected foon to need my affiftance. At half past three I was defired to visit her; I went directly; and on hearing her voice, was convinced that the pain fhe was then fuffering was an expelling one. I found the head and fhoulders born; they were involved in the membranes, which I ruptured at the neck, and flipt over the head; the child at this time apparently lifelefs. I determined to wait the natural expulfion of the breech, &c. rather than haften the delivery. In about five minutes, I received a mafs of a very uncommon nature; the placenta I diftinctly felt; I withdrew the whole with the child, and wrapt it in a flannel which lay at hand. My attention was then directed to the mother, fearful of hemorrhage from fo fudden a feparation of the placenta. I proceeded to afcertain the ftate of the uterus, and difcovered that its fundus was to be felt by deep preffure only, on a line with the pubes. I was now fatisfied with refpect to the fafety of my patient, and proceeded to infpect the child; its appearance was fo extraordinary that I was defirous of taking a more minute examination than I poffibly could in the chamber. I was permitted to take it away in the evening; and on examination, in the prefence of Dr. Ainflie, Mr. Earl, and Mr.. Heavifide, the appearances were as follow: The head, perfect and natural; the thorax, very fmall, with a depreffion of the cofta on the right fide; the arms perfect, but a ftricture in the elbow joints, which prevented their full extenfion, (this ftricture attracted my notice immediately on rupturing the membranes ;) the fpine thorter than ufual, curved to the left fide, fo that the facrum, &c. were in a horizontal pofition; the lower limbs, diftorted and contracted; the left foot, perfect; the right, fhapeless, with two toes only; but the moft remarkable appearance was, the total want of abdominal mufcles and integuments; the liver, ftomach, and inteftines, (the larger ones diftended with meconium) expofed; no omentum; the peritoneum, emanating from the thorax and curvature of the fpine, hung over them as an apron, having no attachNUMBER XII. Τ ment |