cludes with some observations upon the change of shape which the head experiences in the different stages of the complaint, and on the progress of the ossificacation. Dr. Monro junior has, in another paper, given us a minute account of the appearances exhibited in a subject who died of diabetes. The principal circumstances in which the body differed from its usual state were, that the fat was much altered in its appearance and texture, the lymphatic glands were enlarged, and the kidneys likewise were of a larger size and more vascular than in their na tural state. We have three papers on the influenza which prevailed so generally in the spring of 1803, the first by Dr. Carrick of Bristol, the second by Dr. Scott of the Isle of Man, the third by Dr. Duncan himself. With respect to the question, whether the disease was propagated by contagion, Dr. Carrick declines giving a positive opinion, while Dr. Scott and Dr. Duncan do not hesitate to decide in the affirmative. We are strongly inclined to adopt this opinion; the progressive spread of the complaint we consider as a circumstance which affords a powerful argument for its contagious nature. Dr. Carrick, though he acknowledges that in its commencement the influenza exhibited signs of consider able debility, conceives that in the subsequent stages the patients bore bleeding as well as in other inflammatory complaints. Dr. Scott, on the contrary, though he often derived advantage from bleeding, found it necessary to exercise a greater degree of caution in the use of the Lancet. From the statement of Dr. Duncan, the disease seems to have produced less mortality in Edinburgh than in many other parts of the kingdom; for in England, though few persons died from the direct effects of the complaint, yet it cer tainly hastened the deaths of many who were debilitated by age or previous disease. Among the articles of medical news we have an account of the report made by the committee appointed to inquire into the merits of Dr. Carmichael Smyth's petition, that a reward should be granted him by parliament, for the discovery of the nitrous fumigation. On this point we are sorry to be obliged to differ in opinion from the editors of this volume, who appear to be fully satisfied with the justice of the doctor's claim. We have always regarded it, we confess, as a gross misapplication of the public money. That Dr. Smyth has merit in trying the experiment upon a larger scale, and in bringing it more fully into notice, we readily allow; but we can give him no credit for the invention. The advantage of acid fumigations had been clearly stated by others, and as to the substitution of one process for another, we think it a petty consideration. It is very far from being ascertained that the one which Dr. Smyth has adopted is after all the best, and it is clear from his own expressions, that he was mistaken as to the nature of the operations. But we will place the question upon a broader basis, and venture to assert, that the plan of bestowing pecuniary rewards upon every person who either has, or can make others believe that he has, made any scientific discovery, will prove ruinous to the interests of true philosophy, by debasing the dignified feelings of those engaged in the pursuit of knowledge. ART. XIV-4 System of Arrangement and Discipline, for the Medical Department of Armies. By ROBERT JACKSON, M. D. 8vo. pp. 460. IN a work of Dr. Jackson's, reviewed in our second volume, several circumstances respecting the medical department of the British army were pointed out, which seemed to call for correction; in the present performance the subject is discussed more at large, and while the defects are very forcibly brought into public view, the author proposes a system by which he conceives they may be remedied. He com mences by a dedication to the medical officers of the army, in which, while he dwells upon the peculiar advantages they possess for improving the science of medieine, he endeavours to make thein sen sible of the importance of the regulations which he is anxious to see adopted. In a preface which follows he briefly, but strongly, points out the defective arrangements of the present system. The conse quence of such a state of things must be a want of economy in the expenditure of the public money, and our author is so confident on this head, as to have addressed a letter to the minister, setting forth, "That two-thirds of the means provided for the uses of the army employed on foreign service, especially during the course of the late war, was positively supertinous, as ceeding the just wants of the occasions, the air, and thus produce a state of disease proofs incontrovertible." As no answer was ever returned to this letter, Dr. Jackson conceived himself obliged to communicate his ideas to the public, and accordingly the present work made its appearance. We think the publication requires no apology; if it did, the one mentioned above is no doubt amply suffi cient. The work is divided into five chapters, under the following titles: "Constitution of a medical staff, construction and equipment of hospitals, medical management, economical administration, and recapitulation." To the first four chapters are subjoined copious notes, containing illustrations or proofs of the positions advanced in the body of the work. In Dr. Jack son's former publication he was led to lament the change which had been introduced by the medical board instituted in 1793, by which the regimental surgeons are excluded from the prospect of ever arriving at the most honourable posts, while these are occupied by a description of men (graduates of the English universities, or licentiates of the London college) who, from the nature of their previous education, cannot be supposed to possess the kind of knowledge requisite for their situation. The character of the regimental surgeon, upon whom the main responsibility devolves, is thus degraded in the public estimation, and there is no longer that spirit of emulation excited which is necessary to call forth the complete energies of the mind. The author insists with much earnestness, and, we think, with much force of argument, upon the superior advantages which regimental hospitals possess over general hospitals. It is asserted to be a matter of fact, that in the latter the mortality is greater, and also the length of time greater during which the individual cases remain in the wards. It is not difficult to account for this circumstance; in the regimental hospitals the assistance is afforded immediately upon the commencement of the disease, whereas some time, a day or more, is occupied in the removal to the general hospital, and perhaps another day may elapse before the physician pays his accustomed visit. The sick are separated from their friends, and placed under the care of strangers to whom they had no previous attachment; and in spite of all the care that can be taken, there is danger lest the number of persons crowded 1ogether should injure the quality of the more alarming than that which was brought to be cured. The events which took place in the British army on the continent, during its disastrous campaign in 1794 and 1795, strongly corroborate these ideas; for it appears that those regiments which contrived to carry their sick with them in hired waggons, notwithstanding all the obstacles which they had to encounter, suffered less than those where the sick were deposited in hospitals. lished that medical aid is most efficacious Assuming it a point sufficiently estabwhen applied regimentally, the author pro ceeds to form an estimate of the number of medical officers that will be necessary: he conceives that seven will be sufficient for a brigade of 3000 men, and in the same proportion 231 for 100,000 men. "The allowed medical staff, consisting of dently maintained to be equal to the medical 231 surgeons and assistant surgeons, is confihospitals are well arranged, stations permacare of the number of troops stated, where nent, and quarters fixed in a peaceable country." Supposing that one-tenth part of the whole number was sick, each medical man would have no more than 43 patients. If this estimate be at all near the truth, it will appear from our author's statement that the number of medical officers appointed in the different expeditions undertaken in the late war was considerably too large. He particularly instances the expeditions to the Cape of Good Hope and the West Indies in 1795, where the medical men were so numerous, that if every individual in the regiment had been sick at the same time, there would have been a sufficiency of attendance. Such an excess is not merely useless, it proves absolutely injurious to the service. After having laid down such a plan for a medical establishment as may most ef fectually provide for the health of the troops, Dr. Jackson proceeds to propose that the medical officers should be trained up according to a regular system of professional education. For this purpose he proposes that a military hospital be formed, in which the medical business of the army should form the chief object of instruction. After passing a certain length. of time in the hospital, the student may become an assistant surgeon, and may afterwards be left to rise through the different gradations of surgeon of battalion, and surgeon of brigade, unto the highest me dical stations, satisfactory testimonials and examinations being interposed between each step in the course of his preferment. A regular system of promotion we think extremely desirable; and the advantage of some plan by which every person, before he undertakes the care of the health of the military, should have been necessarily obliged to make himself acquainted with the specific duties of his office, is incontrovertible; it is much to be lamented that the system at present adopted is so widely dissimilar. We are not, however, so clear respecting the advantages of the military hospital. We differ much from Dr. Jack son as to the probable benefit that would be experienced, were all medical men to enter upon their profession with a set of uniform principles, derived from the same preceptor: we are of opinion that the science of medicine in general, and consequently each individual department of it, is much more benefited by that variety of doctrines which are imbibed at the different public schools, and inculcated by the various private teachers. Dr. Jackson complains that "The principles of the medical art, as taught in the different schools in Britain, are not yet fixed upon a general and stable basis; consequently, medical opinions fluctuate and change capriciously according to fashions of time or place." This is true, and is to be lamented; but the evil is not to be cured in the way recommended by our author, by authoritatively imposing an universal standard of medical faith. Who is to assure us that the lawgivers themselves are exempt from error? If principles cannot acquire a preference in public opinion, in consequence of their intrinsic merit, we should be promoting the cause of error by employing any arbitrary method of sanctioning them. The chapter concludes with some strictures upon the constitution of the present army medical board, some remarks upon the regimental rank of the medical officers, upon their pay, and upon the best forms of medical discipline, particularly a regular and strict examination of the troops. The second chapter is on the construction of hospitals, a subject which has, more particularly of late years, formed a frequent subject of discussion. The directions that are laid down by our author are very minute: his opinions appear, for the most part, judicious, and his sugges-tions practicable. There are indeed some minute particulars in which we do not coincide with him; he advises that the walls should be "highly polished, painted, and even varnished, in such manner that they may be washed with soap and water as often as is necessary, and thereby freed of all adhering matters of contagion." We think frequent white-washing, which may be employed so easily and with so little expence, is at least as useful, if not preferable to any other covering. We heartily concur in the importance which Dr. Jackson attaches to ventilation; but we doubt whether he is correct in his idea that the foul air is more particularly apt to lodge at the bottom of the room, and that it is therefore necessary to have windows reaching down to the floor. Windows of this description are, on some accounts, inconvenient, and we conceive that the lowest stratum of air will be sufficiently charged by the occasional opening of the door; apertures on a level with the floor may, however, be easily formed, if it be thought necessary, either communicating with the outside of the building, or with the internal passages. After all, the most important point in the construction of hospitals is to prevent the sick from being crowded into too small a compass; an evil which no precautions of ventilation or cleanliness can completely counteract. In the notes to this chapter the author gives an account of the different military hospitals that have been established in this country since the year 1793, when the new system of management was adopted. it appears that some are already abandoned, and that none of them altogether fult the purpose for which they were erected. The facts are in themselves valuable, and tend to confirm the opinion maintained above, respecting the inutility of genera military hospitals. The third chapter is on the medica management of the sick in hospitals The first object to which the author directs our attention is, the classification of the patients according to the nature of their diseases. This leads him to make some remarks upon the origin of disease in gertral, and the mode of its production, in which we observe that singular turn di language and idea which we noticed in the pathological part of Dr. Jackson's forme publication. Instead of stating in a few words, that in some diseases morbid exhalations are produced, which have the power of communicating a similar disease to others, a truth which no one would at tempt to controvert, we have a disquisi tion concerning diseased actions and the mode of propagation, which, though cloth ed in new, and not always very intelligible priety of keeping accurate registers of the language, does not appear to us to convey diseases, with an account of the remedies, any new ideas upon the subject. We in- the principal changes that occur, and the deed afterwards meet with some novel final result. We meet with some valuaopinions. The author admits the exist- ble suggestions respecting the situation and ence of a peculiar kind of fever, which is duties of surgeons during the time of ac. endemic, but not contagious; it is not, tion, remarks upon the discipline and conhowever, characterised in so decided a . duct of nurses, of the method of procuring manner as to enable us to ascertain pre- medicines, and estimates of the necessary cisely to what set of morbid phenomena expenditure for these articles, with an ache refers. It is also stated that the fever count of their present cost, from which it which is generated by crowded and ill-ven- would appear that the sum usually devottilated apartments, though for the most ed to this object is prodigiously greater part easily cognizable, sometimes takes than what is necessary. The minuteness an unusual appearance of the details into which the author enters, renders it impossible for us to give an ade quate idea of this part of the work, but we must remark that the minuteness of the details considerably enhances its value. "It sometimes assumes the mask of dysentery or diarrhea; sometimes it appears under the form pneumony; it even manifests itself in scabby eruptions resembling leprosy; and it frequently commits ravages as an ulcerating process, or peculiar form of sore leg. These appearances are obviously different in aspect; yet the cause which produces them is ultinately one, and intimately connected with the contagion which brings forth, at other tunes and under other circumstances, a diseased movement of distinct febrile forin." We need not point out to our intelligent readers how widely these doctrines differ from those usually embraced. We have not been in the habit of considering either diarrhoea or pneumonia as contagious, nor regarding any of the diseases here enumerated as depending upon the usual febrile infection. The author points out at some length the advantages of having patients classed according to the period of their diseases; when they are thus arranged, the physician can prescribe for them with more ease, and it is conceived that their removal into convalescent wards must have a cheering effect upon their spirits, and consequently a favourable influence upon their complaints. From a similar motive he recommends, that those suffering severe pain, or at the point of death, should be kept as much as possible from the view of the other patients. We are next presented with some remarks upon a method to be adopted with patients upon their reception into the hospital; bleeding, with a view of cutting short the diseases, is we think much too indiscriminately recommended, but we agree with the author in thinking that ablutions of all kinds cannot be too attentively practised. He strongly insists upon the pro The fourth chapter, in like manner, consists principally of minute details. It commences by giving an account of the number of servants of all descriptions which are necessary in a hospital establishment, and also points out the uselessness of some that are at present admitted into them. We have afterwards a number of observations upon diet, and a plan proposed, by which the duties of the purveyor may be much facilitated. Instead of the plan of checking the hospital accounts, which is at present adopted for the purpose of ensuring their accuracy, but which is proved to be very inadequate to the end, it is proposed that the necessary arti cles should be furnished by a stoppage from the soldiers' pay during their sickness, and that the accounts should at all times be open for general inspection. The subjects discussed in this volume are in themselves of the highest importance, and the manner in which they are treated is such as to convey an irresistible idea of the ability and patriotism of the author. It is a work which concerns not only the physician but the statesman, and while it illustrates medical science, conveys the most important lessons on political economy. The ardour of Dr. Jackson's mind may have occasionally led him to exaggerate facts or over-rate calculations; but we have no doubt that his representations are true in the main, and we totally acquit him of the intention to mislead, From the quotations which we have given our readers will observe that the style is of a somewhat similar cast; it is, however, forcible and impressive, and for the most part perspicuous. ART. XV.-Proceedings of the Board of Health at Manchester. 8vo. pp. 262. THE attention of the medical world has of late been particularly directed to the subject of febrile contagion; the laws of its propagation have been assiduously investigated, and the means of its preven tion anxiously inquired into. The town of Manchester, partly depending upon local causes, and partly owing to the peculiar nature of its manufactures, has been always remarkably subject to the attacks of a contagious fever; and this disease had spread to so wide an extent, both in the town and neighbourhood, that in the beginning of the year 1796 the subject attracted general notice, and a committee was formed of some of the most respectable inhabitants, to inquire into the best means of arresting its progress, under the title of the board of health. They attempted to accomplish the object of their association, by enforcing the necessity of ventilation and cleanliness in the dwellings of the poor, and in the buildings where persons were assembled together in great numbers, for the purpose of carrying on the different manufactures; but above all they strongly recommended, as paramount to every other consideration, the necessity of having some place into which those infected with fever might be received, so as to ensure to the patient the requisite accommodations, while his removal prevented the communication of the disease to the other members of the family. Some valuable letters, recommending this plan, were addressed to the board from several men of the first eminence in the profession, among others from Dr. Percival, Dr. Ferriar and the other physicians of Manchester, Dr. Perceval of Dublin, Dr. Haygarth, Dr. Carmichael Smyth, and Dr. Currie of Liverpool. They all tended to one important conclusion; that although nothing could exceed the virulence of typhous contagion, while permitted to accumulate in close and crowded dwellings, yet that it was disarmed of almost all its fatality, when the patients were removed to clean and well-aired apartments. This opinion is now almost universally acquiesced in, and we believe that the communications contained in this volume, and the measures adopted by the Manchester board for giving them publicity, were among the principal means of its general diffusion. In pursuance of this system the board began by opening wards for the reception of fever patients, and after some time enlarged their plan so far, as to propose that a building of considerable extent should be erected for this purpose, under the title of the house of recovery. The proposal appears to have been seconded with much zeal by a large and respectable portion of the inhabitants of Manchester, but unfortunately there were not wanting others who as earnestly opposed its establishment. We shall not scrutinize very accurately the motives by which the opponents were guided; the ostensible one was an apprehension lest the bringing together a number of persons labouring under fever, should operate as a means of increasing the violence of the contagion, and diffusing it through the neighbourhood. This was the ostensible motive; but it must be confessed, that in the progress of the contest, measures were adopted by the opponents, which seemed to indicate that they were influenced by other feelings than those of humanity. We cannot pass without notice a threat which was thrown out by a titled land-owner, that if the house of recovery were erected upon the plan proposed, he would so dispose of his property, as almost entirely to destroy the utility of the present infirmary. The opposition was, however, at length silenced, and the volume concludes with a set of regulations which were drawn up in August 1804, for the government of the house, previous to its being opened for the reception of patients. The work before us must not be considered as an object of literary criticism, and the nature of its contents does not admit of our giving a regular analysis of them. We shall, however, venture to assert, that any one who is desirous of being informed how he may effectually benefit the poorer classes of society, and particularly how he may remove from them a considerable portion of the evil which they suffer from bodily disease, will find himself amply repaid by its perusal. |