During the course of this hasty sketch, our readers cannot fail of perceiving from the nature of the soil and its productions, from the topography and climate of the country, that it must be productive of the sources of these endemic diseases.

To trace the effects of those causes upon the frame-to inquire by experiment and observation into the series of causes and effects, as they are sensibly developed in the system, as well as into their primary mode of action-were the objects that chiefly led us to encounter a climate, in which no one could be placed a night without danger. These inquiries will be soon laid before our brethren: we have only to regret that no facilities were afforded us for extending them as we could bave wished; but, notwithstanding, we have some reason to be satisfied with the result."-Foreign Journal.

I have introduced the foregoing.

WESTERN HEMISPHERE.

ON YELLOW FEVER.

The disease which I am now to consider has no common claims to the attention of the Medical Philosopher.-The extent and frequency of its epidemical visitations ;-its fatal tendency and rapid career ;and the merciless selection of the more robust and healthy as its legitimate prey, are circumstances in the history of Yellow Fever, which cannot fail to command a deep feeling of interest in the investigation of its origin and nature.

Much light bas, of late years, been thrown on this subject by the contributions of various practitioners in the public service, who have meritoriously employed a portion of their retirement subsequent to the war, in giving to the world the sum of their observation and experience. It is to be regretted, however, that an increased familiarity with the scenes of woe, has not produced a corresponding unison of sentiment in regard to the etiology of the disease from which those events have sprung ;-It may even be said, that no question in medical science has been more keenly agitated than that of the contagious or non-contagious origin of Yellow Fever. The discussion of this point will be brought forward hereafter. Omitting the names of the older writers, I shall here confine myself to a brief enumeration of the principal of those who have subsequently published their opinions in favour of, or in opposition to the doctrine of contagion, with ont, however, aiming at giving a complete list, or of being scrupulously exact as to the priority of their respective publications. In favour of the contagious nature of Yellow Fever, we have the authority of Lind, Blane, William Wright, Chisholm, W. Currie, Thomas, Pugnet, Bally, Gonzales, Pym, and Fellowes. On the other

hand, in the list of authorities who consider it as not contagious, are included the names of Hunter, Jackson, Moseley, Rush, Miller, Bancroft, Lempriere, Devèze, Saverésy, Valentin, Dickson, Mc Arthur, Burnett, Doughty, Veitch, Ferguson, Dickinson, Mortimer, Sheppard, Robertson, &c. It will be seen that, numerically, the advantage is greatly on the side of the latter; and it is but candid to admit that, in opportunities, also, the preponderance is still more in favour of the non-contagionists, many of whom, for a series of years, held official situations in the West Indies which afforded them ample means of observing this fatal disease, in various places, and in all its forms.

I shall first lay before my readers copious reviews of the essay and sequel of Dr. Bancroft on Yellow Fever, which will be found to include a full discussion of the controverted points; to these will succeed two philosophical papers by Drs. Dickson and Ferguson ; and the subject will be concluded by the correct and valuable histories and methods of treatment of this formidable endemic by Dr. Mc Arthur and Mr. Dickinson. The department will thus, I trust, be found to present a comprehensive exposé of the opinions of the most recent writers on Yellow Fever; of whom it is but justice to add, that their acknowledged abilities and ample experience in this disease, are sure pledges of the importance and accuracy of whatever proceeds from their pens.

An Essay on the Disease called YELLOW FEVER, with observations concerning Febrile Contagion, Typhus Fever, Dysentery, and the Plague; partly delivered as the Gulstonian Lectures, before the College of Physicians, in the Years 1806 and 1807. By EDWARD NATHANIEL BANCROFT, M. D. Fellow of the Royal College of Physicians, Physician to the Army, and late Physician to St. George's Hospital. London, 1811, pp. 811.

SEC. I. Dr. Bancroft having, in the year 1806, been appointed to deliver the Gulstonian Lectures before the College of Physicians, made choice of the Yellow Fever as the subject for that occasion ; and certainly no subject can be more interesting than fever, the nature and causes of which are still involved in so much obscurity, and in the medical treatment of which disease we are still so far from being universally successful, that every attempt to add to our knowledge, and improve our treatment of so dreadful a scourge to mankind, deserves to be received with thankfulness and examined with candour. The Essay on Yellow Fever is divided into four parts; the first of which contains observations on the Symptoms and Mode of Treatment. Previous, however, to giving a detail of the history and progress of the disease, the author enters into a discussion respecting the propriety of its present name. This is derived from one particular symptom, the colour of the skin; pretty general, indeed, but not universal, nor even essential to the existence of the disease, nor proportioned to the magnitude of its violence and danger. Were the

name of the disease to be derived from a single symptom only, the author thinks Causus would be a more appropriate title; not only as a burning heat of the skin occurs more generally than yellowness of it, but because also the degree of heat existing, affords some indication for the successful treatment of the disease. A great objection that may be urged against both these names is, that these symptoms occur in various degrees in most other fevers, and are not characteristic of the nature and properties of any one. The fever in question has been called by Sauvages Typhus icterodes, but it is not generally connected with any morbid state of the liver or the bile; by Cullen, Typhus cum flavedine cutis; by the French, Maladie de Siam, and Fievre Matelotte; by the Spaniards, Chapetonada, and Vomito prieto; the latter of which names the author thinks equally objectionable with Yellow Fever, since neither the black vomit nor yellowness is universally present, nor peculiar to this disease. Sporadic fevers, occurring in very warm climates from any accidental cause, are, the author observes, liable to be accompanied with the same severe and fatal symptoms which occur in the epidemic yellow fever, and have accordingly been confounded with this latter. They are to be distinguished, first, by the causes of the former being generally some excess, over-fatigue, taking cold, or affections of the mind, operating therefore on a few individuals only; while the causes of the latter are of a more general nature, and operate on a considerable number of persons at the same time: Secondly, by their progress; the first being always of a continued type, the latter almost always manifesting a disposition to remit. It is of the epidemic disease the author principally treats, although his observations are equally applicable to both diseases.

There is reason, however, to apprehend, as frequently happens in nosological arrangements, that the above distinction of type is rather artificial than founded in nature. In the plethoric stranger, and in arid situations, the Fever is usually ardent and continued; while in those who have resided some time in the climate, whose systems are reduced from a state of high health and European vigour, and in uncleared woody places, it frequently assumes the remittent form : in other words, the type will much depend on the habit of the patient, season, locality, and the nature and intensity of the peculiarly exciting cause.

Symptoms. As the attack and progress of these are well described by the author, I shall give them in his own words.

"The progress and violence of the yellow fever differ greatly, according to the force of its cause, the vigour and excitability of the patient, and season of the year. When it prevails epidemically in hot climates, and attacks young and robust men, lately arrived from temperate regions, the disorder commonly appears in its most aggravated form. In this, the patient first complains of lassitude, restlessness, slight sensations of cold and nausea, which symptoms are soon succeeded by strong arterial action, intense heat, flushing of the face, redness of the eyes, great pain and throbbing in the head and in the eye-balls, uneasiness and pain in the stomach, oppression of the præcordia, a

white fur on the tongue, and a dry parched skin, with a quick, full, tense, and generally strong pulse, though it is sometimes oppressed and irregular. These symptoms are speedily accompanied by frequent efforts to vomit, especially after swallowing food or drink, with discharges, first of such matters as the stomach happens to contain, and afterwards of considerable quantities of bile, appearing first yellow and then green, sometimes tinged with blood, but in the progress of the disorder with matters of darker colours; an increase of pain, heat, and soreness at the præcordia, also occurs, with constant wakefulness, and frequently with delirium, more or less violent. This paroxysm, or exacerbation, which has been called the inflammatory, or the febrile stage, generally lasts thirty six hours, but is sometimes protracted for seventy-two hours, and even longer, probably in consequence of either general or local inflammation, (particularly in the brain or stomach,) or of irregularity in the circulation, which are known to prolong the paroxysms in fevers of type.

"A remission then occurs, in which many of the symptoms subside, so often as to induce a belief that the fever is at an end, and recovery about to take place. Frequently, however. the foundations of irreparable injury to the brain or stomach have already been laid in the former paroxysm; and in such cases the remission is short and imperfect. During these remissions, the pulse often returns apparently to the condition of health, the skin feels cool and moist, and the intellect, if previously disturbed, sometimes becomes clear; sometimes, however, the patient remains in a quiet and stupid state, a symptom generally denoting great danger.-Another sign of danger, as denoting a very morbid condition of the stomach, is the renewal of the efforts to vomit, when pressure is made on that organ, or food is swallowed. After a certain interval, this remitting stage is succeeded by another, which may be called a second paroxysm, and which, probably, would appear as a renewed exacerbation, if the violent effects of the first had not almost exhausted the patient's excitability, and in conjunction with the extreme depression of strength which usually attends inflammation of the brain or stomach, rendered him nearly unsusceptible of those morbid actions which are necessary for that purpose. In this latter stage, then, instead of great febrile heat, and strong arterial action, the wamth of the body, and the frequency and strength of the pulse, are often less than when the patient was in health; but frequently the pain and heat in the stomach become excruciating, with incessant strainings to vomit, which in most of the fatal cases, are followed by hiccough, and repeated discharges of matters resembling turbid coffee, more or less diluted, or the grounds of coffee, and also by evacuations of similar dark matters from the bowels. Here it is to be observed, that when these symptoms occur, (indicating a violent affection of the stomach and bowels,) the patient is, in general, sufficiently in possession of his intellects to know those about him, and to give distinct answers to questions made to him, although his excessive weakness often renders him incapable of mental exertion, and his inability even to raise his head, may induce the appearance of coma. In those cases, how

ever, in which the brain has suffered greater injury than the stomach, the retching and black vomit, just described, do not so commonly occur, but, instead of them, low muttering, or coma, with convulsions of the muscles of the face, and other parts of the body, supervene. About this time, also the tongue and teeth are covered with a dark brown fur; yellowness of the skin and petechiæ make their appearance; the urine, when passed, has a putrid smell and dark colour; the fæces likewise become most offensively putrid; hæmorrhages sometimes take place from the nostrils, gums, and various other internal surfaces; there is in some patients, a suppression of urine; in others an involuntary discharge of it, and of the fæces: the pulse becomes feeble and intermits; the breathing is laborious; portions of the skin assume a livid colour; the extremities grow cold; and life is gradually extinguished."

The above description of the disease accords with the distinction which the author has attempted to establish; but as he is here delineating the most severe and fatal form of yellow fever, the propri. ety of characterizing the subsidence of great heat and vascular action at the close of the first stage as "a remission," is very questionable. It is, in fact, the transition from inordinate action to exhaustion-to that almost hopeless state which, (the foundation of almost irreparable mischief having been already laid in the most important viscera,) is speedily to terminate in disorganization and death, and has nothing in it of the salutary tendency of a remission. As Dr. Gillespie observes, it is proper to caution young practitioners against a mistake very common with regard to the yellow, or ardent fever; that is, of taking the fatal stage which follows the cessation of ardent heat and great excitement, and which accompanies a sphacelus of the viscera, for a salutary crisis of the disease."-Diseases of Seamen. "Cette diminution des symptômes en impose quelquefois au malade, et meme aux médecins in expérimentés."—Dict. des Sciences Medicules-tome xv. p. 336.

This declension of fever at the close of the first stage excited early attention, and is often so marked as to have been frequently mistaken for a proof of returning health. It is noticed by Dr. Hume, who had the charge of the naval hospital at Jamaica between the years 1739 and 1749, and was afterwards a Commissioner of the Sick and Hurt Board, in the following terms: "The pulse is at first full, quick, and strong, but in forty-eight hours after seizure, or thereabouts, it sometimes becomes calm and regular, scarce to be distinguished from the pulse of a person in health."-See Dr. Hume's Account of the Yellow Fever, published by Dr. Donald Munro.

The preceding, (says Dr. Bancroft,) is a description of the disease in its most violent form, and it sometimes proceeds with such rapidity as to destroy the patient on the third or fourth day, or even sooner. It seldom happens that in the most severe cases the head a d the stomach are both equally affected; one of those organs however generally suffers such derangement as to destroy the patient. Those who die early in the disease appear to perish from an affection of the head, with less vomiting, whereas those who have the stomach more violently affected, are usually found to have their mental faculties