Complaints and pneumonia, especially where the constitution has been impaired by a former dysentery. When the system has been exposed in a susceptible state to the effects of cold, symptoms of an incipient inflammation in the lungs were accompanied with uneasiness in the bowels; and where the disease was not stopped, it terminated sometimes in pneumonia, sometimes in diarrhoea. In Egypt, bowel complaints were observed by the medical gentlemen, both in the French service and ours, to alternate remarkably with ophthalmia. This last disease, though it did not in general yield to the administration of purgatives, often disappeared on the patient being attacked with diarrhoea. And, on the other hand, it frequently attacked a patient when a diarrhoea or a dysentery was cured. Diseases of the bowels are well known to alternate with the different species of lichen, and other cutaneous diseases."

The author does not consider the effects of obstructed perspiration in producing diarrhea to arise from those humours which would have been thrown out by the skin being forced inwards on the bowels, but to the action of cold upon the sensible fibres of the skin, and to the sympathy of those fibres with those of the alimentary canal. In the cure of diarrhoea he principally trusts to opium, conjoined with some one or other of the various astringents in use. When they have assumed a chronic form, camphor and opium are often found to be the best remedies.

In his description of dysentery, the author is not disposed to consider fever as always forming a constituent part of this disease; he is rather of opinion that it is an independent disease, with which the intestinal affection is accidentally combined; and hence observes, that dysentery often appears as a collateral epidemic, during the prevalence of remit tent fevers. Diarrhoea and dysentery, he is of opinion, are much more nearly connected than is generally allowed, and has had frequent occasion to remark, that dysentery either begins, or, in the course of some of its stages, has had a mixture of diarrhoeal symptoms combined with it. The causes of dysentery are the same as those of diarrhoea, and, whatever may have been its origin, it generally is in course capable of being propagated by contagion. This the author also considers as applicable, though

in a smaller degree, to diarrhoea. The cause of dysentery he attributes to irrita tions, which are attended with slight specific sensations in the parts affected, and which at first produce almost imperceptible changes in the alimentary canal, but by being in time accumulated, give rise to a train of diseased motions and painful feelings, which all at once force themselves upon the attention.

As preventives of this disease, the author recommends caution with regard to exercise, particularly in the heat of the day, flannel clothing, attention to diet and the state of the alimentary canal, and the use of aromatics, as cinnamon or ginger, on finding the least pain of the bowels. In the beginning of the complaint, the alimentary canal is to be cleared by purgatives of neutral salts, or castor oil; but during their operation it is strongly recommended to keep the bowels very warm by thick folds of flannel, secured by a flannel roller applied tight, and in a uniform manner, nearly to the arm pits, and to wear this until the complaint disappears. Emetics are necessary when there is much nausea and heaviness about the stomach, but they are to be given in divided doses, so as to operate by vomiting and stool. After the operation is over, opiates are to be exhibited to quiet the bowels, and after twenty-four or thirty-six hours the purgatives must be again had recourse to; and thus by alternately exciting the bowels and allowing them to rest, the greater number of dysenteries gradually yielded. When the flannel bandage was employed, the author remarks, that opiates were very seldom necessary, as the support which it gave to the bowels, to gether with the warmth kept up by it, were generally sufficient of themselves to produce considerable relief. The author speaks with great confidence of the use of this application, which he was first induced to employ from the recommendation of the late Dr. Whyte. He adverts to various other means of cure which have been employed by different authors, and concludes with some observations on the diet proper for dysenteric patients, and the treatment of some complaints consequent upon this serious disease.

THE epidemic which prevailed so universally in the beginning of last year, has given rise to several publications on its nature and treatment. The ample opportunities which have been so universally afforded, of witnessing every part of its phenomena, might reasonably be supposed to have elucidated every circumstance concerning it. We still however find, that there is considerable difference of opinion, not only with regard to some particulars of its treatment, but on its mode of propagation; many conceiving it to be of a contagious nature, and therefore capable of being communicated from an individual to another, while others consider it as arising from an epidemic constitution of the air to which all are equally exposed. The question is one of considerable difficulty, and we are not yet in possession of evidence sufficient to determine it. The mere statement of an opinion, with which authors for the most part content themselves, cannot be admitted as having much weight in an inquiry, which is only to be successfully prosecuted by a minute attention to facts, in the examination of which there are numerous sources of error. Some observations of Dr. Haygarth's, on the nature of the epidemics, of the years 1775 and 1782, which are published for the first time in an appendix to the account of the influenza now before us, seem to afford an example of the only proper way, by which the contagious nature of so universal a disease can be clearly ascertained: Information was carefully sought for and obtained, from various respectable persons, whether in the profession or not, of the particular periods at which the epidemic made its appearance, both in Chester, and the different towns and villages in its neighbourhood, and of the sources from whence it was supposed to have arisen. In the year 1775, the first person afflicted with the influenza in Chester, was the landlady of a principal inn, to whom it was supposed to have been communicated by some travellers from London; in a short time it spread through the whole town. In the year 1782, a gentleman ill of the influenza, went from London to the same place, and communicated the disease to a lady into whose family he came; in about a fortnight the complaint was

general. In villages and scattered houses in the country, the disease always appeared later than in neighbouring towns, and its introduction could fre quently be traced, without difficulty, to a particular individual. The following was the result of the information which Dr. Haygarth received on the rise of the epidemic in several towns in the neigh bourhood of Chester.

"1. That the first patient who had the disease in Frodsham, was seized with it as he

was returning from Manchester.-2. That at Malpas, the first patient was the landlady of the inn and her family, a week sooner than any other patient in the town.-3. That the first person who had the distemper in Middlewich brought it from Liverpool.-4. That the first person affected with the influenza at Mold, had been at Chester a few days before, in a family ill of that distemper.-5. That a gentleman arrived at Oswestry, ill of the influenza before the inhabitants were attacked. -6. That at Tarporley, the first person seized was a postilion who had driven a chaise thither from Warrington, where the distemper had previously appeared.-7. That at Wrexham, the first patient came from Chester, and the second from Shrewsbury. But my correspondents at Holywell and Ruthin did not recollect by whom it was brought in

to these towns."

Reasoning from the analogy of the former epidemics, and comparing their progress with what has happened in 1803, Dr. Haygarth has no doubt of the late influenza having been contagious, but in order to ascertain the fact by the most correct evidence, he advises practitioners to institute enquiries similar to those which he made, in order to discover the very individuals by whom the disease was transported from one place to another. This kind of evidence is certainly necessary to set the question at rest; and it is to be lamented, that the enquiries of Dr. Haygarth have not been equally directed to the investigation of the nature of the late influenza, as to that of the former one; or that other medical men of experience and observation, have not prosecuted the subject on a similar plan.

The principal circumstances which characterize the account given in this pamphlet, of the influenza as it appeared in Bath, and its neighbourhood, are the disposition which frequently shewed it

self to peripneumony, and the consequent necessity there was, in such cases, for general blood-letting. The complaint came on with symptoms of general fever, which were soon followed by headach, cough, and difficult respiration; pain and throbbing of the temples, vertigo, and hot and dry skin. The

pulse was variable, in some very quick, even to 150 in a minute; in others not exceeding 80 or 90. In one of the worst cases which Dr. Falconer saw, it did not exceed 70, and in upwards of 100 cases which appeared in the general hospital, it did not rise above 100. Six only of the cases which occurred in the hospital had peripneumonic symptoms, but they were much more frequent in private practice. Only four persons died in the author's practice, and all of them peripneumonic; he had not an opportunity of inspecting the appearances on dissection, but received the particulars of a case, in every respect similar to them, from Dr. Broderip, in which there was much inflammation in the substance of the lungs, with large adhesions, and consider able extravasations of coagulable lymph.

When the peripneumonic symptoms were at all urgent, bleeding was abso lutely necessary; but they were frequently checked in their progress, by the early employment of an emetic. Neither leeches nor blisters were adequate to the relief of the pectoral complaints. Ammoniacum and squills seemed to do harm, volatile alkali appeared to be serviceable, but most advantage was derived from opiates, given so as to abate the cough.

The author considers the complaint as decidedly contagious, and remarks, that it was always followed by a great and characteristic debility, which remained for some time after the com plaint had gone off. After giving the results of his own experience in this complaint, the author annexes an account, translated from the Moniteur, of the same disease as it appeared in Paris. He subjoins an abstract from the bills of mortality of Bath, in order to shew that the number was very materially increased, during the existence of the epidemic, but as far as his own practice extended, the disease was by no means a fatal one.

THE late epidemic is here represented as having differed from a common cold, in the degree and kind of fever with which it was accompanied, and in the fever, not the catarrhal symptoms, constituting the essence of the disease. From these circumstances, the author is of opinion, that it should be termed epidemic catarrhal fever, or synochus catarrhalis, and not simply epidemic catarrh. The following are mentioned as its most frequent symptoms.

"After some alternations of chilliness and heat, the patient is seized with a heaviness or pain of the head, with sneezing, wateriness of the eyes, hoarseness and cough. These symptoms come on in the order here stated. In the course of a few hours the headach increases, the skin becomes hot, with pains in the back and limbs, or transitory stitches across the chest. The tongue is white; the pulse quick or frequent, and for the most part soft. There is more or less of sickness at the stomach, and sometimes vomiting. The bowels are generally costive; and consi lerable uneasiness, or even a distressing pain, is felt in some part of the abdomen in many instances. But the second or third night,

the cough and fever become greatly aggravated. The former, viz. the cough, is strong and incessant, sometimes dry, but often accompanied (even at its first coming on) with latter, viz. the fever, is attended with increas an expectoration of thin, sharp mucus: the ed heat, and with extreme restlessness and anxiety. There is also some confusion of the head. At this time the pulse is often from 110 to 120. In the morning there is a considerable remission of the febrile symptoms ; but the cough (with more or less dyspnoea) still continues urgent, and the patient complains of excessive languor and dejection of spirits.

"After the third or fifth day, where early perspirations have come on, or sufficient evacuations have been procured by the stomach and bowels, the fever declines: "and although the cough continues, the expectoration is more free, the sputum being of a thicker consistence, and milder quality. The urine, which before was high-coloured and clear, now becomes turbid, or throws down a sediment. In other instances the cough continues very troublesome for many days, or even some weeks, after the abatement or cessation of the fever, and goes off very tediously without any remarkable degree of expecto ration.