more intense to the sensations, than even the thermometer indi. cated. On many days, however, the temperature was as low as 15° of Fahrenheit, and it was said to have descended, on some nights, to 11° or even lower. The effects of the severity of the cold were aggravated, among the lower classes, by the difficulty of procuring fuel, in consequence of the extreme scarcity of coals, which were sold at more than double their usual prices.

Since Dr Heberden demonstrated the comparative insalubrity of a frosty winter, by a reference to the bills of mortality in the winter of 1794, and the succeeding open season of 1795, medical men have been fully aware of the popular error of considering frost wholesome. It would be almost sufficient, therefore, to inspect the preceding catalogue of diseases, in order to infer the severity of the season. For in the first place, the quarterly number of patients has exceeded 700, in an institution which presents an average of little more than 500 per quarter; and secondly, nearly 400 of that number have been affected with pulmonary complaints, which are the most unequivocal products of the operation of cold on the human constitution. These complaints, however, have not been remarkable for their numbers only, but likewise for their violence and fatality. About 200 assumed the form of acute catarrh, and a large proportion of these are entered in the books of the Dispensary under the title of febris catarrhalis, implying the severity of the constitutional disorder which accompanied them; and nearly 50 put on the character of the most active pneumonia. Persons of all ages have suffered from these attacks; but young children and persons who had passed the middle age have been most severely and fatally affected, especially those of the latter who had been subject to annual returns of chronic catarrh during previous winters. The increased mortality, occasioned by severe winters, has generally, indeed, fallen heaviest upon the aged and young children, whose vital powers are possessed of less energy than during the intermediate periods of life; and it is by affecting the lungs more particularly, in both these classes, that intense cold exerts its deleterious influence on the delicate frames of such persons. A cursory inspection of the daily reports of the newspapers, during the last two months, is sufficient to ascertain the unusual number of people of advanced age, who have been cut off by the inclemency of the season.

Very few of the pulmonic affections assumed the type, which has been denominated pleurisy. Severe pain was seldom among the symptoms of the disease; which was characterized by extreme oppression and difficulty of breathing, with a sense

of

of tightness and fulness of the chest, in those which have been put down under the head of peripneumony. This oppression was accompanied, in general, with a rattling noise in the bronchial passages, and with a secretion of a thick and viscid mucus in considerable quantities: the patients breathed more easily when propped up in bed, or in the erect sitting posture; and a sort of wandering delirium, in which they talked incoherently, when left to themselves, was a very common symptom; in a few cases the delirium assumed a character of wildness and violence. The pulse was generally frequent, from 120 to 130, and without either fulness or hardness in any remarkable degree; but, even when small and feeble, there was a perceptible jerk or quickness in its beats, which indicated the inflammatory action of the vessels. For the cure of these peripneumonic attacks the lancet proved the only effectual remedy. In many cases, indeed, the disease proved fatal notwithstanding the employment of bloodletting, especially in people advanced in life, and in those whose lungs were injured by repeated annual attacks of chronic catarrh : and in some, the opportunity for an efficient use of the remedy had passed by before it was applied. We had, however, great satisfaction, in several cases, in witnessing the immediate relief which blood-letting afforded to the most distressing and alarming symptoms: patients, who were restless and sleepless, and extremely distressed with dyspnoea, almost to a sense of suffocation, who were rambling and delirious, and under a state of the greatest anxiety, were seen immediately to become calm and collected, their countenances brightened, their rattling and heaving respiration became free and noiseless, and in a few minutes they fell into a quiet and sound sleep, which continued several hours. The symptoms were, indeed, apt to return, sometimes for several successive periods; but the repetition of the evacuation to the fourth, fifth, or sixth time, was found to be followed by the same temporary, and ultimately by permanent relief. The blood, in these cases, was highly buffed, and the coagulum cupped; and this was sometimes greater in the later bleedings than at first. From the fatality of the disease, where, from neglect in the beginning, or from apprehension of danger from free blood-letting in London constitutions, this evacuation was neglected or insufficiently used, and from the marked and unequivocal benefits derived from the full employment of it, where the age and constitution permitted, we have been led to doubt the correctness of the opinion, which interdicts the most copious abstraction of blood, in the inhabitants of the metropolis, which in the country is universally allowed.

Contagious fever has generally been considered as one of the

products

products of a severe winter, in consequence of the close and unventilated state of the habitations of the poor, which the temperature induces them to resort to for the sake of warmth. No such effect, however, has occurred during the present season; the few cases of fever in the preceding list, were of a mild type, and were not propagated by contagion.

A child, two years and a half old, was brought to the Dispensary at half past four in the afternoon, two days ago, who had just swallowed, by mistake, a small quantity (about a tea-spoonful it was supposed,) of the strong sulphuric acid, from a vial, used for cleansing some copper vessels. The mother immediately excited vomiting by putting her finger into the child's throat; the matter brought up resembled coffee-grounds. The child seemed to suffer little pain, except when vomiting, which occasioned crying, and she died easily and almost unperceived at nine the same evening. On the following day, the body was examined in the presence of my friends Dr R. Bright and Dr W. Henderson, who are at present attending the Dispensary, and I am indebted to them for the following report:

"The peritoneal cavity was largely distended with flatus; and on opening the integuments, the omentum was seen converted into a black pulpy mass, but still possessing sufficient tenacity to retain the food, which had escaped from the stomach, having been taken a short time before the acid was swallowed. The food consisted of considerable masses of undigested meat, very little acted upon by the acid; there was also a small quantity of the same dark-coloured fluid in the omentum as had been vomited. There was an erosion or aperture in the stomach, about three inches in diameter, situated in the cardiac portion of the large curvature, which was bordered by thickened edges of a dark brown cinder-like appearance: through this the food had escaped. An appearance of inflammation extended towards the cardiac extremity of the stomach; but the oesophagus, with the exception of a little purple blush on some parts, shewed nothing which could indicate violent action. The inflammation did not seem to extend towards the pylorus, and the intestines were free from any inflammatory affection: externally, the latter were strongly marked with tranverse corrugated rings, but were not otherwise acted upon in the slightest degree by the acid; indeed the whole of its action seemed to be confined to the stomach and omentum."

On immersing small portions of animal flesh in strong sulphuric acid, it produced the same black colour, and pulpy consistence which were observed in the stomach and omentum of this child; but other portions, immersed in caustic potass, a solution

of

of nitrate of silver, and nitric acid, did not receive either the dark hue or the same change of texture.

Bloomsbury Square, Feb. 28, 1814.

Extract of a Letter from Dr BATEMAN.

T. B.

I have received a long and interesting letter from Mr Magrath, relative to the practice of cold washing in measles, which he has been in the habit of employing for a considerable time past, in the hospital for prisoners of war at Plymouth, as I stated in my letter printed in your Journal for October last, on the authority of my friend Dr Lockyer. I regret that my friend Mr Magrath considers this epistolary communication as too hastily written to appear before the public; but, as I trust he will, on revising it, see no reason to withhold it, I shall not anticipate its contents at present, farther than by stating, that he fully confirms the whole of the facts mentioned in my letter. He affirms, that the practice has been uniformly highly beneficial; that he has never seen any of the untoward circumstances which are usually apprehended, such as retrocession of the eruption, increase of the catarrhal and pulmonary symptoms, &c.; and that, on the contrary, the inflammatory affections of the chest, which are apt to supervene, on the decline of the efflorescence, and which prove the most dangerous part of the disease, appear to be prevented by the suppression of the early excitement, to the continuance of which, these supervening inflammations are to be in a great measure attributed. These facts accord so accurately with well established experience, in regard to scarlet fever and small-pox, that we can have no reasonable hesitation in admitting the solidity of the doctrine as applied to a disease of the same family.

I have this day been favoured with the official report of a severe case of measles, in an American sailor, treated on the refrigerant plan, by Mr Magrath; and as it shews that even present pneumonic symptoms are alleviated by the cold-washing, and the subsequent recovery is rapid, I shall transcribe the document of Mr Magrath, and add the testimony of Dr Lockyer as to the decided benefits of the practice, which I also had the satisfaction to receive this morning.

RICHARD GARRISON, a seaman and prisoner of war, was admitted into the hospital of the Mill prison, on the 26th of December 1813." It appears by a written case, which accompanies this patient, that he has been ill five days, and that the eruption is of two days duration. His eyes are much swelled and inflamed, his throat sore, and deglutition difficult; and he is so hoarse, that he cannot be understood in his attempts to speak. He makes signs that he has severe pain in his chest, which he endeavours

to

to alleviate by pressing his hand to the part when he coughs, and which is indeed incessant. He has considerable dyspnoea, and expectorates a thick, viscid, greenish mucus, which is sometimes streaked with blood. His face, chest, and trunk, resemble a boiled lobster; but the eruption appears in scattered patches on the lower extremities. His pulse 110; heat of surface considerable, and such a degree of lassitude, that he could not support himself on his legs, but was obliged to be carried into the ward from the bathing-house, where he was washed with cold water.

"27th. His cough and pain of chest much abated; his feelings comfortable; and he has slept the greater part of the night. The efflorescence of the skin evanescent, after twenty-five washings yesterday, and six in the night.

28th.-No complaint but slight hoarseness, and a trifling cough. Was washed fifteen times through the day and night.

29th.-Convalescent. Has been but five times washed through the day, and not disturbed in the night.

"30th. Allowed to sit up; and the eruption entirely gone, excepting a mealy desquamation or roughness of the skin." On the 3d January he was discharged cured.

The beneficial operation of the cold washings, even upon the catarrhal and pulmonary symptoms, which were unusually severe in this case, was very obvious. In the course of the night, after several washings, he recovered his voice and articulation, and when Dr Lockyer visited him in the morning, at Mr Magrath's request, about 16 hours after his admission, he found him with only a slight hoarseness and moderate cough, without any oppression of anxiety about the chest, and "with evident joy and satisfaction in his countenance, which he also expressed in the strongest language at the wonderful relief he had experienced, in so short a period, from the cold washings." The pulse was reduced to 85; the lassitude gone; and his appetite returning. The eruption was already faded on the face and chest, but Dr Lockyer convinced himself that the eruption was rubeola, by examining it on the extremities, where it was still fully marked and well defined. "I visited him every day," Dr Lockyer adds, "and perceived with pleasure the rapid cessation of cough and hoarseness, and the regular disappearance, and final desquamation of the eruption. He never had, for I watched him ever since this period, any of the dread sequelæ, in horror of which cold air and water have been so long feared and avoided; in proportion as the morbid heat, the pabulum of the disease, was diminished, every catarrhal symptom ceased or greatly abated: here were none of the dreaded effects of repulsion; the eruption proceeded