the body, internal as well as external, unfitted for its vital duties; and thus, not improbably, the disease became mortal. Now I saw no reason to suppose that any undue interference with symptoms, or neglect of treatment, had occurred in this case. Still it is sug

Assuredly, in this

gestive of a warning on that subject. morbid state of the mucous membrane, an irritating purgative might have effected a most dangerous aggravation of the danger of the patient, great as it was at any rate.

Of all the remedies that have been brought forward as effective in scarlatina, none advance a better supported claim than cold affusion, as proposed by Dr. Curry. This remedy, for its application, requires that the high temperature of pyrexia should be well established in the skin; and the possibility of its application may be prevented by a line of treatment which anticipates, as it were, or subdues pyrexia. Now it has been remarked, that the subsequent experience of physicians has not confirmed the views of Dr. Curry in the extent laid down by that eminent author as to cold affusion in fever. May not the remark which I have just made in reference to scarlatina be generalized? Is it not conceivable, that the deep-seated tendency of

"The

*"In the first extensive British epidemic of continued fever which took place after its announcement, it was speedily abandoned, in a great measure, by all practitioners; and for twenty years past it has been almost unknown in the treatment." cause of this fluctuation," says Dr. Christison-from whose article, in the Library of Medicine, I extract this passage" is not very clear, but there can be no question that the charge was not made out without sufficient reason." Now I must

the English practitioner always to commence the treatment of fever with aperient measures, may have rendered the experiment of cold affusion thus far unsuccessful in fever generally?

For my own part, I think the neglect which Dr. Curry's discovery has met with infinitely discreditable to the medical science in England. We are now being indoctrinated into its mysteries by a German peasant and his irregular followers, after repudiating them as offered by the great discoverer himself.

I should perhaps be uncandid, if I closed this statement without admitting that the opinion of Dr. Curry was unfavourable to the appropriateness of his system to one form of scarlatina with early collapse, of which he gives a very graphic description.

"There is," says Dr. Curry, "a form of scarlatina to which the name of purpurate ought rather to be given; for the efflorescence is of a purple, not scarlet hue, in which, though the throat be deeply ulcerated, the pain and difficulty of swallowing are comparatively

66

venture on this point to differ with Dr. Christison; and the grounds of this difference are embodied in the following extract, which I have made from the life of the late Sir Samuel Romilly :— "My little girl," Sir Samuel writes to a friend, was last week seized with a dangerous fever. Having read, in Dr. Curry's book, of the happy effects produced in many cases by the application of cold water in fever, I asked Dr. Pitcairne, who attended her, whether it might not be advisable to try it. He said he thought it certainly would-that it might be of great service, and could do no harm; but the prejudice against it in London was so strong, that he never ventured to recommend it." So much for the sufficient reason!

small, for the passage is kept open, and the sensibility destroyed, by the progress of gangrene. In such cases extreme feebleness and rapidity of the pulse, and great fœtor of the breath, appear even at the commencement of the disease. The heat does not rise much above the standard of health. Great debility, oppressive headache, pain in the back, sometimes purging, accompany its rapid progress; the patient sinks into a delirium, and expires on the second, third, or fourth day. This disease is to be treated by large quantities of bark and wine, and the other remedies employed in gangrene. The cold affusion is scarcely applicable to it, and the tepid makes little impression on it. In my experience, indeed, all remedies have been equally unsuccessful." *

It would appear, that in those cases of Dr. Curry to which he considers cold affusion inapplicable, there was no hot or pyrectic stage completed. But of the two cases in my last chapter, the latter certainly had a pyrectic stage, as witnessed by myself; and the former had been treated conformably to such a supposition by a very intelligent practitioner, before I was called in.

Curry Reports.

CHAPTER XIV.

CHRONIC CEREBRAL AND SPINAL CASES SUCCESSFULLY

TREATED.

JULY 13, 1820-Miss R., a young lady aged 24, of moderate height and embonpoint, well formed, of a dark complexion, of an even temper and strong intellect, complained of a general sense of oppression, heaviness, tightness, and throbbing of the head; a wearing sensation, with heat at the bottom of the back, amounting sometimes to excessive pain; scanty and high-coloured urine. The catamenia were regular; appetite good; tongue slightly furred. It appeared that these symptoms had been recently aggravated by the use of (Tunbridge Wells), which had disagreed with her. The catamenia, though regular, were far from profuse; the latter state, whenever it occurred in the subsequent treatment, always made her worse. The same result followed excessive action of the bowels, which, however, required mild aperients. Walking, and even airing in her carriage, were followed by a sense of weariness and feebleness inconsistent with her age and muscular development. At the right side of the lowest lumbar vertebra I found a space, about the size of a shilling, extremely painful on pressure, which left also a very enduring pain.

Oct. 18th.-The bowels have been kept gently open by Compound Extract of Colocynth and Pil. Hydrarg. ;

doses of Potassi Acetat. 3j. e Mist. Camphora, zj.; Infus. Sennæ, 3ss. occasionally given, and leeches applied to the loins, always, however, with a consequent depression of power, which forbad their frequent use. The patient has been recumbent a large portion of each day, and taken airings in an easy carriage. There is less uneasiness of head and ability to apply the mind. The urine is increased in quantity; but the wearing sensation at the loins, though lessened, continues with occasional exacerbations, under which it passes down the thigh and leg. The lower limbs have become more powerless; there is a rolling and uncertain movement in the legs, which cross each other involuntarily in walking; and on the occurrence of one deficient period, the paraplegic state greatly increased. There is, however, neither numbness nor rigidity, nor spasmodic action, and the spine itself is perfectly normal.

It now appeared to me expedient to add to recumbency the benefit of some local drain, in relation to these last symptoms. Leeches, as observed, benefitted, but weakened unduly. The peculiar constitution of the patient's mind rendered issues or seatons inexpe dient. Local examinations and appliances of this kind were likely to complicate the case; for very obstinate constipation and retention of urine had recently ensued on an unavoidable exposure of her person, with reference to the question whether the hip-joint might be in fault. I determined to carry out a course of small blisters, one applied every other day, on or near the painful point on the right side of the lowest lumbar vertebra. When this had continued three weeks, I