}.. 170 J 
{M arch 1, 
MEDICAL REPORT. 
Rerort of DISEASES and CASUALTIES occurring in public and private Practice 
of the Physician who has the care of the Western District of the City Dispensary. 
EVER, within the last few weeks, has 
. been more frequent in the metropolis 
than during many of the preceding months; 
and in some cases the extreme collapse 
* which attended even te onset of the com 
plaint, precluded the employment of mea- 
sures that, without reference to circum- 
stances, would be judged appropriate. It 
were well, indecd, that pathologists and 
practitioners should divest their minds of 
the specific sui generis feeling on the na- 
ture of febrile essence, aud not give in to 
that false phraseology which implies the 
conception of an abstract, ab origine dif- 
ference in the malign something that has 
been the source of the malady. Is the pa- 
tient’s disorder a nervous fever? ora bi- 
lious fever? or a brain fever? or a typhus 
fever ? are questions, in the writer’s mind, 
denoting an erroneous thinking respecting 
the principles of diseased manifestation, 
for the same external cause will produce 
each and every variety of effect, according 
tothe constitutional or accidental condition 
of the recipient—and that which might be 
pamed a bilious fever on one day, might at 
least with equal propriety, be designated 
as a brain fever on the next. 
The reporter is not an anti-contagionist : 
he believes in the communicability of fever 
by an engendered poison ; but he likewise 
believes in the spontaneous origin of the 
sickness, and in its reference for the com- 
plexion it assumes, to other principles than 
the operation of a septic-venom. What vo- 
lunies of useless controversy, respecting 
the contagious or non-coutagious nature 
of the yellow fever aud plague, might have 
been spared, had observers and authors re- 
eognized the absurdity of metonymically 
naming a complaint from the local or other 
variatio.is of its external aspect ! 
The rationale avd remedial demands of 
fever are equally various—and to contend 
that it is inflammation of the brain, or any 
one thing beside, is to contend for a falla- 
cious assumption. It is alland every thing 
that implies deranged sensibility and ac- 
tion, and restorative indications must be 
deduced, not fiom nomenclature or noso- 
Jogy, but from a due consideration of age, 
sex, place, time, and circumstance. 
Rheumatic disorders, as well as febrile 
derangements, continue to prevail; and 
some instances have recently occurred, of 
@ sudden translation of the joint affection 
to internal and vital organs. Since his last 
report, the writer has lost two patients by 
this precipitate conversion, as it were, of 
xieumatism into apoplexy in the one, and 
cropsy of the chest in the other instance ; 
and although rheumatic irritation: are, for 
the most part, unaccompanied by danger, 
the occasional tendency now referred to, 
ought ever to be retained in recollection. 
Rheumatism is not seldom the disorder of 
the robust—and it is often induced by that 
carelessness that characterizes physical 
strength, sothat in this particular, the fee- 
ble have in some sort the advantage. In 
one of the cases just referred to, the com- 
plaint cc mmeuced from a chiil received by 
going upon the river during perspiration— 
an etiect which au individual of a less yi- 
gorous stamina would instinctively guard 
against. The reporter takes- ocsasion to 
say, that he has lately seen, in several in- 
stauces, the best effects from wearing wasli- 
leather over flanuel, as a preservative 
agaiust the consequences of those expo- 
sures to which all are more or less liable. 
A waistcoat of this material will, in many 
cases, supersede the necessity of, and prove 
a more effective barrier against cold, than 
a great-coat—and not seldom, even after 
the establishment of arheumatism which re 
fuses to give way before the most powerful 
medicine, clothing the parts effected wiih 
leather, will almost immediately loosen its 
hold. 
Vaccination still retains its full credit 
with the writer of these papers; and he 
was happy to find the two highest authori- 
ties in the kingdom report this year as fa- 
vourably of the practice as they did on the 
preceding. True itis, that failures, asto 
the thoroughly protecting efficacy of the 
vaccine virus, repeatedly present them- 
selves ; but such a small-pox as we see in 
a thousand to one cases after vaccination, 
is no more, nay, not so much to be dreaded 
as is a common catarrhal affection from 
cold; and it should be remembered, that 
eveu small pox itself is not an absolute se- 
curity against re-infection. Dr. Sims has 
just mentioned to the writer that he has 
lately seen a case of death from second 
small-pox ; the writer himself some time 
since saw the same thing—a result he has 
never witnessed from small-pox subse- 
quent to the vaccine impregnation. 
In the administration of those medicinals 
which ure powerfully sedative under cer- 
tain circumstances, the practitioner should 
be cautious how he increases their dose to 
an immoderate degree, in consequence of 
the apparent inertness of the drug up to 
a certain point, for it is not seldom that 
a!most no effect seems to result from larger 
and larger quantifies, till, at length, aud 
without warning, the whole that has been 
given seems to operate as if at one time. 
A friend of the writer has just related to 
him a ease of collapse almost to death from 
the Prussic acid carried gradually up to 
the extent of teu minims; and nearly a si- 
milar 
