an attempt should be made to divert the inflam- | that the parturient efforts occasionally flag, and, matory action to the organ from which it has re- indeed, are wholly suspended; yet they recur, and ceded, by the immediate application to the latter the labour proceeds rapidly to a favourable termiof hot fomentations, and subsequently by local nation; and if in any such case a remedy, preirritants: blisters have been usually recommended sumed to be parturient, were administered during for this purpose, but as the probabilities of suc- the period of the cessation of pain, the recurrence cess (at all events very slight), it is reasonable to of the pain in this sudden manner could hardly suppose, would diminish in proportion to the fail to be ascribed to the administration of the length of time from which the inflammation had presumed parturient. Let the obstetrical pracleft the particular organ, a sinapism, we conceive, titioner, who has never had recourse to any such on account of its quicker action, would be pre- agent, call to mind how few the cases are in ferable. [It may admit, moreover, of doubt, which delivery has had to be aided, in consequence whether the irritation produced by a blister or of the total cessation of the pains, and how comsinapism, may not also be transferred to the seat mon it is to meet with a partial or temporary cesof the metastasis, and add to the irritation there.] sation; and he will see, that the absolute necessity In advanced life, Dr. Mason Good observes, for the use of a parturient is not a common occurcynanche parotidæa is apt to run into a chronic rence. form, accompanied with symptoms formidable in their nature. This is more especially apt to take place, he adds, in females when menstruation is on the point of ceasing, and the general action of the system labours under some disturbance. The tumour should, if possible, be carried off by leeches and cooling repellents, as he further advises, urging as a reason that if it proceed to suppuration, which it tends to, though very slowly, the ulcer rarely heals, usually degenerating into a foul offensive sore that sinks deeper and spreads wider, resisting all medical treatment, and at length destroying the patient. Vomits, frequently repeated, he continues, have in this case been found highly serviceable, and those of the antimonial preparations rather than ipecacuanha, from their maintaining a longer action, and determining more effectually to the surface, or rather to the excernents generally.

WILLIAM Kerr.

[PARTURIENTS; from parturio, I bring forth.' Substances that promote the parturient energy' are thus designated by the writer. The term has been objected to, (Brit. & For. Med. Rev. Jan. 1844, p. 244,) and is objectionable; but it is not so easy to propose one more appropriate. Abortives, Amblotics, Phthorics, Apophthorics, and Ectrotics, used at times, are certainly not less objectionable. Fifty years ago, no one, in this country, would have ventured to affirm, that the lists of the materia medica comprised any agents possessed of the virtues ascribed to parturients. In Germany, indeed, ergot has long been regarded in this light, as its old German names, mutterkorn, (womb-grain,') and gebürpulver, (parturient powder') sufficiently testify. Within the period specified, ergot has been brought to the notice of the profession here, and elsewhere, and has received so many testimonials in its favour as to cause its admission into every work on materia medica. In no country has it been more employed than in the United States, and in none has it so many supporters. Yet there are many who, from their experience, are not satisfied, that it exerts the power over the gravid uterus, that has been ascribed to it. It must be admitted, as the writer has elsewhere remarked, (General Therapeutics and Materia Medica, i. 422, Philad. 1843,) that no cases could present themselves, in which it is more difficult to trace accurately the relation between cause and effect. Every one who has practised extensively in obstetrics must have observed,

But if hesitation be indulged in allowing the ergot any special powers over the uterus, there can be none in denying such powers to other reputed parturients. They are all indirect agents, and act only upon the ovum through the mother, endangering her life, as well as that of the new being. The drugs and agencies employed with the view of inducing abortion are of the most powerful kind,-emetics, drastic cathartics, acronarcotic poisons, &c., &c. Many of the German writers, indeed, (Schroff, Taschenbuch der Arzneimittellehre, u. s. w. s. 108,) ascribe to borax a specific influence over the uterus by which it is supposed to favour the catamenial secretion, the pains of parturition, and the lochial discharge, when their failure is dependent upon inactivity of the organ. Dr. Copland (Dictionary of Prac tical Medicine, art. ABORTION) recommends it combined with ergot, in cases of abortion, when the embryo only is expelled-the appendages being retained, and the hemorrhage great.

ROBLEY DUNGLISON.]

This is the

PELLAGRA, or PELAGRA. name of a disease in which a morbid condition of the skin is a prominent symptom, very prevalent amongst, if not exclusively peculiar to, the peasantry of the northern states of Italy: the word pellagra is obviously a compound from the Latin pellis, the skin, and agria, “ scabies fera," signifying an inveterate eruption.

The earliest account given of pellagra is from the pen of Francis Frapoli, a physician of Milan, and was published in the year 1771; since which period it has been the subject of a great deal of discussion and controversy amongst the Italian practitioners and medical writers. Of our own country men, Dr. Holland (so far as we have been able to ascertain) is the first whose description of the disease was founded on personal observation; and excepting a recent sketch of its prominent features by Dr. James Johnson, his paper is the only one in our literature to which the desirable distinction of originality can be attached: it has not, however, escaped the attention of Parr and Hooper, (Medical Dictionaries,) and has been noticed by Good under the title of Elephantiasis Italica, and by Alibert under that of Ichthyosis Pellagra. Dr. Holland has expressed himself decidedly of opinion that it should be classed among the impetigines, but has remarked its resemblance to an inveterate degree of Psoriasis or

larity.

lepra vulgaris, admitting also that it has some struation is generally continued without irregu affinity to ichthyosis. [See, also, L. V. Lagneau, art. PELLAGRE, in Dict. de Méd. xxiii. 373, Paris 1841; and art. PELLAGRA, in Encyclopädisches Wörterb. der Medicinisch. Wissenschaft. xxvi. 444, Berlin, 1841.]

General observation has determined that there is considerable variability in the symptoms of pellagra, and that they are often complicated with other forms of disease; a fact which, with the circumstances of the protracted period of its entire development as well as of its intermitting appearance and remissions, may in a great measure account for the conflicting opinions concerning its nature and history. The poor are almost exclusively its victims; and of these chiefly the peasantry and such as are occupied in agriculture. In the ordinary form of its occurrence, according to Dr. Holland, it first appears as a local disease of the skin, preceded, however, occasionally by languor, debility, and other indications of a general cachectic state of the body. The local symptoms very generally show themselves, in the first instance, early in the spring, at the period when the midday heat is rapidly increasing, and when the peasants are most actively engaged in their labours in the fields. The patient perceives on the back of his hands, on his feet, and sometimes, but more rarely, on other parts of the body exposed to the sun, certain red spots or blotches, which gradually extend themselves, with a slight elevation of the cuticle, and a shining surface, not unlike that of lepra in its early stage. The colour of this eruption is a somewhat more obscure and dusky red than that of erysipelas: it is attended with no other uneasy sensation than a slight pricking or itching, and some tension in the part. After a short continuance in this state, small tubercles are frequently observed to arise on the inflamed surface; the skin almost always becomes dry and scaly, forming rough patches, which are excoriated and divided by furrows and rhagades. Desquamation gradually takes place, which, though it leaves behind a shining unhealthy surface in the parts affected, yet in the first year of the disease is rarely followed by a repetition of the appearances just described. Towards the close of summer, or occasionally still earlier, the skin has resumed its natural appearance; and but that the further progress of the disease is familiar to every inhabitant of the country, the patient might be led to flatter himself that the evil was gone by, and that there was no particular reason to dread its recurrence.

With this local affection are connected, even in the first period of the disease, certain general symptoms, important inasmuch as they indicate the constitutional nature of the malady; namely, debility of the whole body; vague and irregular pains of the trunk and limbs, but especially following the track of the spine and dorsal muscles; headach with occasional vertigo; irregular appetite, and general depression of spirits. The bowels are for the most part lax, and usually continue so in the further course of the disease. There are no febrile symptoms, and in females the men

See his valuable paper on the subject, published in the eighth volume of the London Medico-Chirurgical Transactions.

The remission which the patient obtains during the autumn and winter of the first year is almost universally followed by a recurrence of his symp toms, in the ensuing spring, under a more severe form, and with much greater disorder of the constitution. The cutaneous disorder returns and spreads itself more extensively, but, as before, affecting chiefly the hands, neck, feet, and other exposed parts of the body. The skin becomes callous and deeply furrowed; and large rhagades show themselves, especially among the articulations of the fingers. The debility is greatly increased, frequently depriving the patient of all power of pursuing his active labours, and rendering him peculiarly susceptible of all changes of temperature. Partial sweats break out without any obvious cause. All the nervous symptoms of the first year are renewed in a more severe degree; there is a general tendency to cramp and spasmodic affections; the mind begins to suffer under the disorder, and the feeling of anxiety and despondence is very strongly marked. The libido inexplebilis, mentioned by some writers as one of the characteristic symptoms of pellagra, did not come under Dr. Holland's notice, and he is disposed to believe that it has been so considered from the credulity common upon this topic, or to a desire of associating the disease more closely with the leprosy as described by ancient writers. The other symptoms already noticed make progress as the heat of summer advances, and with greatest rapidity in those patients who are much exposed to the sun. As in the preceding year, they begin to decline towards the middle or end of autumn, but the remission, as well of the local affection as of the general disorder is much less complete than before, and the patient continues to suffer during the winter from the debility and other effects consequent upon the disease.

to

In the third year, every symptom is renewed at an earlier period, and in an aggravated degree. The constitutional malady shows itself under a variety of forms, some of the symptoms having a considerable analogy to those of scorbutus; all of them indicating a general cachexy, and more particularly a lesion of all the voluntary functions. The debility now becomes extreme: the patient is scarcely able to support himself; and the limbs, besides their feebleness, are affected with pains, which still further impede the power of motion. The diarrhoea continues, and tends, of course, augment the patient's weakness. Frequently a dysenteric state comes on in the latter stages. The breath is generally fetid, and the odour of the perspiration often extremely offensive. The appetite and digestion are irregular, yet, on the whole, perhaps less affected than most of the other functions. Dropsical effusions are now apt to supervene,-occasionally ascites, but more commonly anasarca. Vertigo, tinnitus aurium, and double vision are almost universally concomitants of this stage of the disorder, and all the senses become exceedingly impaired. Some spasmodic affections are very general, and these not unfrequently of an epileptic character.

Connected with these latter symptoms is the effect which the pellagra produces upon the minds

tion.]

To enumerate all the symptoms which the Italian writers have attached to pellagra would, in fact, involve a description of several diseases with which it is complicated: it appears, however, that such complications are characteristic of this peculiar malady, and equally so their occurrence under several varieties of form. At different periods, in the same individuals, the morbid condition of the skin has exhibited the appearance of erysipelas, lepra, psoriasis, elephantiasis, and ichthyosis, and of such as are usually termed constitutional disorders, in which it appears to merge: scorbutus, tetanus in its varied forms, chorea, epilepsy, convulsions, dropsies, melancholia, mania, and marasmus, form a condensed list. "It is on this account," Dr. Johnson has observed, "that we see written over the beds in the Milan Hospital the various diseases to which pellagra forms the adjec tive, as atrophia pellagrina, phthisis pellagrina, hydrops pellagrinus, paralysis pellagrina, mania pellagrina, &c." (Change of Air, or the Pursuit of Health, by James Johnson, M. D. p. 75.) Jan

of the sufferers, which effect forms one of the | eased, and presenting evident traces of inflammamost striking circumstances in the history of the disease. The anxiety, watchfulness, and moral depression of the patient are rapidly augmented. The unhappy objects seem under the influence of an invincible despondency: they seek to be alone; scarcely answer the questions put to them, and often shed tears without any obvious cause. Their intellectual faculties and senses become alike impaired, and the progress of the disease, where it does not carry them off from debility and exhaustion of the vital powers, generally leaves them incurable idiots, or produces maniacal affections, which terminate eventually in the same state. "In demonstration of this tendency of the disease, I may mention the fact," says Dr. Holland, that at the time I visited the Lunatic Hospital, at Milan, there were nearly five hundred patients, of both sexes, confined there, of which number more than one-third were pellagrosi, people brought thither by the termination of their disorder either in idiocy or mania. Even this statement gives little adequate idea of the nature of its ravages. The public hospitals of the country are far from sufficient to receive the vast num-sen, one of the most esteemed authors on this ber of persons affected with the pellagra; and the greater proportion perish in their own, habitations, or linger, wretched spectacles of fatuity and decay. Where debility, as generally happens, is the cause of death, it manifests itself in the latter stage with the usual concomitants of colliquative diarrhoea, spasmodic affections, and coma, and produces a degree of emaciation scarcely to be surpassed in any other disease."

"Though, for the sake of brevity," continues Dr. Holland, "I have described this train of symptoms as going on from the third year, I may remark that the pellagra is generally of longer duration, and that other intermissions usually occur in its progress, giving the patient a certain relief in the degree of his sufferings, though little hope as to the issue of the disease. In some instances, the cutaneous affection forms the principal indication of the complaint for several successive years, being renewed every spring, and disappearing again every autumn. In other cases, where it has been found possible to remove the patient to a new situation and mode of life, the disease is still further arrested in its progress. It rarely happens, however, that these means can be practically adopted, and the constitutional malady is generally so far established in the third or fourth year, that little hope remains of benefiting the patient either by medicine or change in the mode of life."

[At times, according to a recent writer, (L. V. Lagneau, op. cit, xxiii. 373,) the insanity assumes the religious form, with tendency to suicide, degenerating occasionally into homicidal monomania, which is directed by preference to children. Numerous examinations of the dead, made in the Hospital Saint Ambrosia, at Milan, by MM. Panceri,-father and son,-assisted by M. Brière de Boismont, (Ibid. or De la Pellagre et de la Folie Pellagreuse, Paris, 1834,) established most incontestably that these mental aberrations were owing to chronic meningitis, often extending into, the vertebral canal. M. Brière de Boismont likewise found the digestive organs of all manifestly dis

subject, states that the cutaneous affection sometimes disappears, but without any mitigation in the other symptoms, and that a person accustomed to see this disease would at once recognise it by the peculiar odour of the perspiration the patients are often bedewed with, compared by him to the smell of mouldy bread. In the advanced stage, the victim of pellagra (the mal de misère, as it has been emphatically called by Vaccari,) experiences, in an extreme degree, the effects of irritation in all the mucous surfaces, whilst at the same time the sensibility of the nervous system seems to be infinitely increased. The whole mouth becomes painful, tense, and phlogosed; the palaté cleft; the gums swelled, fungous, and bloody; the tongue dry and blackish, and covered with a muddy coating: the teeth blacken and fall out; aphthous ulcerations are not uncommon, and the saliva, which is extremely salt, is frequently secreted in such a quantity, particularly in the morning, as to constitute complete ptyalism: the voice is sometimes so changed as not to be recognisable, and, as may readily be imagined, the thirst is excessive; the latter, however, is the only constant and invariable one of this group of symptoms. As the disease proceeds, diarrhoea becomes uncontrollable, and prior to the fatal issue the emacia tion is excessive; but sometimes the patient is said to have the appearance of a mummy. Nervous sensations of a very distressing and peculiar kind also accompany the latter stage; they have been described as a sense of burning heat of the head and spine, radiating to the other parts of the body, and extending particularly to the palms of the hands and to the soles of the feet; occasion. ally as if an electric spark or flash of fire issued from the brain, and darted through the eyes, ears, and nostrils; all kinds of imagined noises distract the unhappy sufferer; saws, grindstones, mills, hammers, bells, the chirping of birds, and buzz of insects, at one time or another, appear to assail his ears; and thus deprived of sleep or rest, in the summit of despair, it not unfrequently happens that suicide is resorted to; an act which (as if

in Lombardy sixty or seventy years before the time when he wrote. Frapolli contends also for its antiquity, but it may be questioned whether his opinion does not rest on the mere analogy of a name, it having been formed from the circumstance of a minute in the journal of the Milan Hospital, dated the 6th of March, 1578, which provides for the reception of patients attacked with the disease known at that time under the name of pellarella.

the means were indicated by some physical asso- | believe that the pellagra must have been known ciation) is often accomplished by drowning, so often as to have induced Strambi to distinguish this particular hallucination by the title of hydromania. (Dict. des Sciences Méd. art. Pellagra.) The consideration of pellagra has been encumbered with a variety of discordant and trivial distinctions. Frapolli, for instance, has divided it into the incipient, the confirmed, and the incurable; Gherrardini into slight, severe, and desperate; Soler into the dry and moist, from some supposed difference in the disorder, according as it appears in dry and elevated situations, or on the flat and moist surface of the plains; and Titius into the latent and manifest, in conformity with the presence or absence of the eruption, the latter being a peculiarity in the manifestation of the disease, but attested by Italian authorities of respectability, amongst whom are Cevri and Zanetti.

It appears that the knowledge of the nature of pellagra has been as yet but little extended by pathological investigation. "In some patients," says Dr. Holland," the liver, in others the spleen, has been found enlarged and indurated; marks of disease are also occasionally seen in the intestines and mesenteric glands, but these appearances are by no means constant, and may more reasonably be considered as effects than causes of the disease."

Dr. Johnson, in his notice of some cases of mania pellagrina, collected from the great hospital at Milan by M. Brière de Boismont, who visited Italy in 1830, has included the following remarks on the pathology of the disease by that writer "there is a collection of yellowish serum between the membranes and in the cavities of the brain; congestion of the vessels of the pia mater, plexus choroides, and of the cerebral substance; suppuration and hardening of the brain itself; inflammation of the spinal chord and of its membranes, accumulation of serum in the pleural cavities; inflammation and abscesses of the lungs; ulcers of the trachea; dropsy of the pericardium and of the abdomen; chronic peritonitis; ulceration of the stomach and intestines; hypertrophied tubercles, and scirrhus of the liver, &c." (MedicoChirurgical Review, Jan. 1833.)

The pellagra, as an endemic disease, prevails chiefly in the provinces of Lombardy, lying be tween the Alps and the Po. This country may be briefly described as a vast surface of alluvial plain, little elevated above the sea; but rising on its northern side into chains of hills, which intermediately connect it with the Swiss and Tyrolese Alps. From the long, narrow, and profound lakes among those hills the numerous rivers issue, which, flowing southwards to the Po, and giving their waters into a number of artificial channels for the purpose of irrigation, maintain that extraordinary fertility of soil for which the plains of Lombardy have long been celebrated. The principal objects of cultivation on these plains, besides the vineyards extensively spread over their surface, are maize, rice, and millet. In some districts, and particularly between the rivers Adda and Tercino, the pastures are extensive, and yield a considerable produce of milk, from which the Parmesan cheeses are made. The hilly country, just noticed, on the northern side of Lombardy, is less productive, and cultivated on a more limited scale. The valleys, however, intervening among these hills are of great fertility, yield a considerable quantity of grain, and much wine from the numerous vineyards to which they give shelter.

The district which appears to have suffered most from the ravages of the pellagra, is that which formerly constituted the duchy of Milan, and particularly the Alta Milanese, or that portion of country lying up towards the hills between the Lago Maggiore and the Lago di Como. It was in this part of Lombardy that the disease first became an object of medical attention; and some time elapsed before it was described as appearing in the Venetian provinces, and near the shores of the Adriatic sea. (Medico-Chirurg. Transactions, vol. viii. p. 320.)

The period at which pellagra first made its appearance, is a point that has been much disputed by the Italian and German physicians, without any satisfactory conclusion. According to Mos- The propagation of pellagra has by some been cati, a Milanese of great repute in science, and referred to contagion; facts and authority, how some other writers, it has not been known in ever, preponderate greatly against this opinion. Lombardy more than between sixty and seventy Its hereditary tendency is proved by its frequent years. Allioni, who has attempted to estimate appearance at the earliest period of life, as attested the various opinions on the subject, dates its rise by Dr. Sacco, of Milan, who, in the capacity of in the year 1715, though the attention of the Director of the Vaccine Establishment, has had Milanese physicians was not drawn to it until the best opportunities of observation. It has, 1740. Strambi, who was appointed by Joseph moreover, been generally remarked that the disII. the director of an hospital established at Lag- ease is continued in succession through families. nano, near Milan, for the reception of pellagrosi, Conflicting accounts are given of the sex in which had the best opportunities of gaining information it most prevails, but there is ample reason to conon the subject. In his treatises on the pellagra, clude that the discrepancy has arisen from the ocpublished in three successive years, from 1784 to cupations of the men and women in different dis1787, he mentions the fact of his having seen tricts being reversed, and not from any physical many pellagrosi in the hospital, who gave him peculiarities in the conformation of either. distinct assurances of their fathers and grand- In reference to the remote causes, the most im fathers having had the disorder, and from some portant facts in evidence undoubtedly are, the particular instances he thinks himself entitled to limited period during which the disease appears

to have existed in the country, its being confined | phenomena has led Albera, Frapolli, and other almost exclusively to the lower classes, and its Italian writers, to refer the origin of the disease to rare appearance in the towns or cities of Lom- the frequent exposure of various parts of the bardy. The climate is obviously not the cause body to the action of the sun's heat, which, it concerned; since this, as far as it is known, has seems probable, is an exciting cause of the cutabeen unchanged for a much longer period than neous and some other of the symptoms; but that that which includes the history of pellagra; or it is not the fons et origo mali is proved by the had it been changed, it would have affected alike circumstance of the peasantry of other parts of both the higher and lower classes of the popula- Italy and of tropical countries being subjected to tion. The same objection may be made to the more intense exposure of the same kind without opinion that any circumstances of mere locality corresponding results. That such insolation, are concerned in producing the disease. It may moreover, is not the only exciting cause, has been possibly be true that the plains of Lombardy are proved by the fact adduced by Strambi, that the more frequently and irregularly flooded than for- cutaneous eruption may be prevented by avoiding merly, and that the general surface is more marshy exposure to the sun, whilst the other symptoms and unwholesome; but this does little to explain proceed in their usual course. There is also reason the causes of a disorder which is chiefly prevalent to expect that the incipient stage of the disease in the higher lands, where such changes have not would, if induced by this cause, be common when equally taken place. the sun's heat was most intense, a circumstance contrary to common observation; and it may be presumed, as suggested by Dr. Holland, that the increased labours of the peasantry in the early part of the spring, being speedily followed by the development of the symptoms, must have some influence on their production at this particular period. Perhaps, also, adds the same observer, the periodical returns of the pellagra, during its early stages, depend in part on the natural periodical changes of the body itself, independently of the external causes just alluded to.

The point, then, to which we are almost necessarily conducted, is the mode of life and subsistence among the peasantry: this, it appears, is as wretched as the soil is productive; an evil which has been progressively increasing for more than the last half century, and is probably the result of devastation from repeated wars, political changes, and the consequent heavy taxes and imposts, combined with a decaying commerce and bad arrangement between the landlords and cultivators of the soil.

The ordinary diet of these people consists chiefly It must be acknowledged that the chain of of maize prepared in different ways, of rice, millet, connection between the causes of pellagra and its beans, and some other articles of vegetable food. specific symptoms has not hitherto been distinctly Their bread, which is principally made from maize, traced; but we know from universal experience is for the most part of bad quality, ill fermented, that identity of disease has a common origin in a and not unfrequently deficient in salt. Animal prevailing insufficiency of food, or in the use of food rarely forms a part of their diet; and though such as is depraved or innutritious in its quality : living on a soil which produces wine, their poverty we know, moreover, that the combined evils, alalmost precludes the use of it, even when sickness ready detailed, in the moral and physical condition and debility render it most needful. The same of the people who become subjects of pellagra, condition of poverty is evident in their clothing, have at all times been observed in connection in their habitations, and in the want of all the with the prevalence of analogous disorders, which minor necessaries and comforts of life. By several have been variously described under the compreof the Italian physicians, the common use of hensive name of leprosy. It is further evident maize has been considered a specific cause of this that the end of the several processes subservient peculiar disorder. Dr. Holland controverts this to alimentation demands a sufficient and suitable opinion by the results of his personal observation supply of aliment; and in defect of either, the with regard to the peasantry in the northern parts immediate wants of the system, as well as the of Greece, who, though subsisting chiefly on the imperfect actions of the various organs, become same kind of grain, are wholly free from the dis-evident by the train of phenomena constituting ease, as is also observed in the south-western parts the symptoms of disease. Added to and aggraof Europe, where the same diet is as generally in vating these in pellagra, we have the direct action use among the lower classes; and, with the ex- of an irritant (the sun's heat), which, besides the ception of a disease occurring in the Asturias, local effect, and its direct consequences upon the (the elephantiasis Asturiensis of Mason Good), nervous system, must, by impeding the important Dr. Holland further states that he does not know function of the cutaneous secernents, reflect their of its existence in Spain or Portugal, where the uneliminated material through the medium of the maize is very extensively used. Rice has also circulation over the whole body, and thereby help been supposed to be specifically productive of the to generate its universal disorder. When we disease, but it must be acknowledged that facts by further consider the diversity of modifying inno means warrant the supposition. One circum- fluences, the mutability of their nature, and their stance which seems to deserve a prominent place relative operation, we cannot be surprised at the in the consideration of this part of the subject is, diversified appearances, nor at the endless discusthe first appearance of the symptoms in the spring|sions on the identity of diseases of this nature, of the year, their partial disappearance in the autumn, their renewal in the ensuing spring, and the continuance of this alteration for successive years, whenever the disease is protracted thus long without reaching its latter stages. This chain of VOL. III.-61 20

arising no doubt from the unwarrantable habit of endeavouring always to limit to the arbitrary signification of a name circumstances confessedly Protean in their nature, and which have a very distant analogy to the distinct and circumscribed