322 Monthly Medical Report. [MARCTfr, 



inflammation, palsy, dropsy, &c. ; but between the ages of fifteen and five-and-twenty, it is 

 very rare to find deatli occasioned by any other cause than fever and consumption. It has 

 been supposed by some, that cousuniption is actually inorc frequent at this than at other 

 periods of life, and even the great Dr. CuUen will be found to advocate sucli a doctrine ; 

 but the fact is not so, as the records of any of our large Life Insurance Offices amjily 

 testify. Consumption is more noticed at that age, because there is then none otlier to 

 compete with it, but it is equally common up to the seventieth year of life : but at that age 

 is overlooked, from the comparatively greater number who then perisli from the natural 

 decay of the frame, from apoplexy, dropsy, and the like. 



Measles, as the reporter ventured to predict in his last communication, has been very 

 prevalent during the month just elapsed. It has, in general, been light and mild, to M'hich 

 the openness of the weather has, no doubt, most materially contributed. The reporter 

 has met with no case in which the disease proved fatal during its height or crisis ; but, 

 it has occurred to him to witness one or two cases in wliich the inflammatory sequclic, 

 or drec/s of the measles (as they are popularly but most expressively called), have beeit 

 sufficiently urgent to carry off children of an originally delicate frame of body. Measles - 

 is still to be met with, and is perhaps the only disorder now prevailing, to which the 

 term epidemic can with any degree of propriety be applied. Small-jjox has almost 

 entirely ceased, in accordance with the maxim of the old school— that these two diseases 

 follow each other, but seldom, if ever, occur together. The reason is obvious :— That 

 condition of atmosphere which if favourable to the dilfusion of small-pox contagion (viz. 

 lieat and moisture), is adverse to the dissemination of measly contagion, and vice versa. 

 The inflammatory dregs of the measles are always, in the eyes of the reporter, more to be 

 dreaded than the violence of the crisis. Against the one the practitioner is better on 

 his guard, but the insidious advance, and the dogged obstinacy of the other mislead him in 

 the first instance, and weary him out in the second. In the management of these cases 

 great caution is as requisite as constant ngilance. Antiphlogistic measures are of course 

 indispensable, but the reporter, from vei-y ample experience, would wish to put all his 

 younger professional brethren on their guard with respect to blisters. Tliere seems to be 

 something in their action wliich is peculiarly unfavourable under such a state of disease. 

 They create great uneasiness, much local irritation, often going on to inflammation and 

 suppuration, and not unfrequcntly in weakened habits of body, to consequences yet even 

 more alarming. The circumstance was well known to the old authors, especially to 

 Baglin, and was by him attributed to the acrimony of the cantharides. 



That great benefit must accrue to Medical science, from the examination of tliose wlio 

 have died from well-marked disease, must be obvious to every thinking mind ; and it is 

 very gratifying to the reporter to perceive, that this feeling is now verj- general among 

 the lower orders in the metropolis. With very few exceptions, they afford every facility 

 to medical men to make the necessary imspection of the bodies of those who have died 

 under their care. In the practice of the reporter, it is not uncommon to find the friends 

 of the deceased actually requesting such an examination, as a matter of favour. The 

 reflection is suggested by the opportunity lately offered to him, in this very manner, 

 of observing the appearances of the body under very unusual circumstances. The patient, 

 was twenty-eight years of age, and had laboured under jaundice for twenty-eight days, 

 when suddenly and unexpectedly the brain became affected, and coma supervened 

 which in two days afterwards proved fatal. Permission being given to open the body, 

 the following circumstances, among others, attracted attention. The bile did not pene- 

 trate all parts of the body with equal facility. The substance of the brain was of the 

 purest white colour, while the coverings of the brain were deeply tinged with the yellow 

 livery of jaundice. No obvious impediment existed to the free passage of tlie bile in its 

 usual channels. There were no gallstones, no inspissation of the bile, no obstruction of 

 the principal ducts. The fiicts are curious and instructive, and may be made indeed 

 conducive to a clearer understanding of the nature of jaundice ; or, at any rate, to . 

 the avoiding of certain errors in the theory of jaundice which physicians have often fallen 

 into. 



It would appear, then, that the worst kinds of jaundice are those_ which are purely 

 functional diseases of the liver, and where no mechanical impediment exists to the 

 passage of the bile. Most of these cases will be found in practice, dependent upon 

 anxiety of mind, the influence of which in the production, in the propagation, in the con- 

 tinuance, and lastly in the cure of diseases, is far, very far, from being fully appreciated 

 eitlier by physicians or by patients. Of the influence of mind, generally, in producing 

 and keeping up indigestion in all its more severe and obstinate forms, the reporter will 

 hereafter take occasion to offer his opinion. At present he confines himself to a notice 

 of the effects of mental anxiety (particularly of that incessant and irremediable anxiety 

 which arises from domestic affliction) in disturbing the functions of the liver, and above 

 all in occasioning jaundice. Tliat such was the origin of the complaint in the present 

 instance, the reporter had strong grounds for believing ; and he thinks there can be 

 little doubt, that to a continuance of the same cause is to be ascribed that deep implica- 



I 



