790 
various deprées of morbid affection take place, 
general rules cannot be laid down with pro- 
priety, or carried into efect with success in 
every instance. ‘T'he practitioner is there- 
fore bound to exercise his own discrimina- 
tion in individual cases, and preportion his 
mode of prescription to the degree and the 
form in which the disease individually ap- 
pears. The too early exhibition of tonics 
and vordials is equally pernicious with pro- 
fuse and excessive evacuations. For this 
reason J object to the indiscriminate use of 
strong antimouial emetics, which commonly 
induce too great a degree of debility, where 
the tendency to itis inberent) in tue disease 
itself, and the inflammatory symptoms .ex- 
tremely transicat, even in the robust and 
adult subject. There are two indications to 
be answered by emeiics in this disease, cor- 
responding with the dificrent stages in which 
hey are adminisidred. In the first stagé, the 
great good eflect of an emetic is to restore 
obstructed perspiration, which is of the 
greatest consequence in, mitigating and short- 
ening the febrile period in this particular 
disease. In more advanced periods, where 
this has not been done, an emetic, if not too 
long deferred, will excite -perspiration, and 
‘will alse act mechanically in cleansing the 
throat, discharging the sloughs, aud induc- 
ing a more active and healthy secretion in 
the glands and neighbouring secreting sur- 
faces. In neither of these instances are yio- 
lent emetics required. Mercurial or drastic 
purges are liable to the same objection. The 
alan, which [ adopted with general success 
an Mr. E,’s school, will be found equally safe 
and efficient in a great majority of mild inci- 
pient cases. My general intention was to 
Qminish the violence of fever by gentle eva- 
euations, by relaxing tlie skin, inducing 
moisture, and after this, by an early assump- 
tion of moderate tonics and nutiilives, to 
prevent the access of great weakness during 
the actual presence of the discase, and by 
ptotracting the use of more. powerful tonics 
and a full diet over the convalescent state, 
to guard against the approach of the ordinary 
consequences of scarlatina, viz. anasarca, &e. 
This mode of practice, like every other, 
must be appropriated to the peculiar habit 
and circumstances of the patient—those of 
robust and plethoric ‘constitutions require a 
shorter continuance ‘of, aud less powerful 
tonics, than those of a contrary frame; but 
no constitution ought to be allowed to strug- 
gle unassisted through the disease itself, or 
through theconvalesceist state. If the milder 
instances of scarlatina demand the physiciay’s 
vigilant eye, to prevent future ills, where no 
immediate danger threatens, the severer in- 
stances of this pestilence, where affection of 
the throat constitutes most urgent degrees 
MEDICINE, SURGERY, ANATOMY, &c. 
of hazard, require his utmost solicitude and 
skill. ‘The insidious progress of ulceration 
in the organs of declutition’ has been permit-. 
ted too often to rob an afflicted family of a 
valuable parent, or the tender parent “4 
much-beloved child, even where the 
manifestation of scarlet efflorescence has 
given, though too late, undoubted proof of 
the existence of the nature ef the malady.” 
«© Tt will be a good rule, therefore, to 
proportionate carly and seasonable medical 
exertions. to the seat of ulceration in angina 
contagiosa, remembering, that the most ha- 
zardous situations, and which require the 
inost prompt and uninterrupted assistance, 
are those immediately concerned in the act 
of deglutition, arid are so near to the larynx 
and trachea, as to afford aready path of com- 
munication to those organs, which are essen- 
tial to life.” : 
In such cases the author has found it 
necessary to recommend 
«© The exhibition of wine or negus*, with 
bark and the mineral acids, to be taken alter 
nately with strong soup, every hour or two, 
in proportion to the advancement of the ul+ 
cer, the debility of, the patient, &c. for eight 
and forty hours in succession, or three days 
and nigitts without intermission, if occasion 
requires, Life has becn saved by these extra- 
ordinary efforts, which otherwise must haye 
been lost.” 
The author disapproves of the method 
recommended by Dr. Withering, of 
treating this complaint by the frequent 
administration of strong antimonial eme- 
tics, which have too great a tendency to 
weaken the patient. =” ' 
Towards the conclusion of the first 
part of this treatise, the author inquires 
into the modes by which infection is 
generally introduced into the human 
bedy, which must be either by saple 
contact, inoculation, or inhalation. The 
first is considered by him, from a multi. 
plicity of facts, as insufficient for the 
purpose. The second is voluntary, and 
on that account not applicable to the 
question. The third is therefore the 
only way in which contagion can be 
propagated ; and consequently to guard 
against its communication, by the respi- 
ratory organs, is the most simple, intel- 
ligible, and practical means of preven- 
tion which can be adopted. _ 
The second part of this work is on the 
subject of contagion in general. Since 
it has been discovered that the progress 
* « Negus, of the following composition, forms a very pleasant and grateful beverage 
for the patient. Wine, eight parts ; water, four parts; lemon juice, one part; sugar, 4 
sufficient quantity, or none, according to the taste of the sick.” : adi Ta 
b 
