1821.] 
t 455 ] 
MEDICAL REPORT. 
Report of Diseases and Casualties occurring in public and private Practice 
oj the Physician who has the care of the Western District of the City Dispensary » 
I T has been more than once remarked in 
these monthly reports, that those bilious 
affections which are incident to the au¬ 
tumnal season, have this year proved more 
abundant than usual—and that they have 
spared neither sex, nor age, nor condition. 
It may now be further stated, that their 
continuance as epidemics has been beyond 
the ordinary period of their duration, and 
even at this moment the writer is witness¬ 
ing- complaints which are seldom seen in 
great numbers after the setting in of No¬ 
vember. 
It may be very fairly presumed that the 
dreadful accounts which reach us from the 
south, have some connection with that state 
of the atmosphere which disposes to the 
milder derangements of the British islands 
—and that the cholera of this country and 
the yellow fever of Spain are alike depend¬ 
ent upon the aerial constitution, connected 
with the endemic peculiarities of the respec¬ 
tive places in which the one and the other 
appear. That the last is thus endemic, and 
confined in its locality, every thing con¬ 
nected with its peculiarities appears to 
prove ; and the writer of the present paper 
believes, that it would be almost as easy to 
transport one of the Andalusian hills into 
Salisbury Plain, as to convey this fever in 
its severity from the south to the north of 
Europe. By some, indeed, it is thought, 
that the yellow fever is in no wise conta¬ 
gious, but this opinion is perhaps as erro¬ 
neous as that which supposes that cordons 
of troops, or restrictions of quarantine, are 
either necessary or efficacious in prevent¬ 
ing its spread. Plague, yellow fever, and 
typhus, are all contagious (probably in 
very different degrees,) but for the full de- 
velopement of their contagious properties, 
they demand the assistance of local cir- 
cumslances—and they will no more flourish 
in soils, and situations, and seasons unpro- 
pitious to their propagation, than would 
the orange-tree of the southern groves, in 
the bleak and barren wilds of Lapland. 
As in cholera, so is it with respect to 
yellow fever, that no precise and abstract 
precept can be laid down of treatment. 
The writer is sometimes summoned to cases 
which actually become different disorders 
in the short space of a few hours ;—at one 
moment bilious disturbance and spasmodic 
derangement being* the only things to be 
combated by the resources of medicine ; at 
another, a rush of inflammation shall pour 
in upon a vital organ, and unless met by 
vigorous counteractives, overwhelm the 
vital powers by its vehemence. Half mea¬ 
sures are here of no avail; and it is won¬ 
derful with what efficacy large doses of 
stimulants, in one case, and large detrac¬ 
tions of blood in another, may, nay, must 
be employed to insure the safety of the 
sufferer. That this assertion is made not 
in the spirit of rashness, but from a full 
conviction of its truth, the reader who is 
accustomed to peruse these reports will, it 
is presumed, credit. 
With respect to the demands of the yel¬ 
low fever, it cannot be expected that one 
who has never witnessed the disorder can 
speak with any authority; the following 
extract, taken from a sensible treatise just 
published on the Andalusian epidemic of 
1820, will serve to shew the virulence of the 
complaint, and the necessity for prompt 
and vigorous treatment :— 
<c Those terminated most favourably in 
which blood-letting was used to the great¬ 
est extent ; but it is incumbent on me to 
state, that many cas?s ended fatally even 
when the lancet had every possible advan¬ 
tage. The Spanish physicians were no 
ad vocates for the practice in any case. My 
treatment of the disease was not very suc¬ 
cessful—theirs still less so. I lost one 
patient out of every five and a half; they 
one out of every two and a half; so that, in 
fact, neither of us had much to boast of. I 
have observed (arid it is important I should 
mention it) that in all cases in which the 
employment of mercury was followed by 
salivation , the,patients recovered. This 
was the result, without a single exception, 
throughout the whole period of the epide¬ 
mic ; and so perfectly am T assured of the 
fact, that I would set down the recovery of 
any patient as certain who should be once 
affected to salivation. I insist upon the 
state of ptyalism ; because I have seen 
many instances in which the mouth and 
gums became sore and ulcerated, without 
any salivary discharge, and in which the 
patients did not recover.” 
In the general fevers of this country, we 
judge either that the malady is of unusual 
malignity, or that the treatment is not what 
it should be, if the deaths average more 
than oue—not in five, but in five and 
twenty. D. Uwins. 
Bedford Boiv , Nov. 2 0, 1821. 
MONTHLY 
