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For OCTOBER, 1772.
ART. I. Medical Transactions, published by the College of Physicians
in London. Vol. II. 8vo. 5 s. Boards. Baker. 1772.
medical collection, by an enumeration of the great advances which have been made in natural philosophy in general, within the last century, in consequence of the establishment of academies and other learned societies. We shall only observe, on the present occafion, that the art of physic has shared in the advantages derived from these institutions, and has been still further improved by the societies which have been formed with the sole view to promote that branch of knowledge in particular; by whole care the notice of many important facts and ingenious observations has been speedily circulated and diffused, which would never have been committed to paper, without the pros. pect of these commodious channels of
conveyance, or at leaft would probably never have seen the light. In our Review of the present collection, we shall give the titles of all the papers nearly in the order in which they occur.; adding a more particular account of such articles as are either the most interesting, or moft susceptible of abridgment. Article 1. Of the Hectic Fever. By William Heberden, M.D.
F. R. S. In this article the ingenious Author gives a few general obfervations relative to the nature and cure of the diseafe which is the subject of it, describing more particularly the symptoms that peculiarly characterise" it, and distinguish it from other fevers to which it bears some resemblance; particularly the irregular intermittent, from which however it eflentially differs in its nature and method of cure, as well as in the event, which is too frequently fatal, in spite of the most judicious treatment. VoL, XLVII,
Article II. Remarks on the Pulje. By the Same. Thole who may have lamented their want of the taalus eru ditus, to which some writers on the pulse have pretended, or who may have been mortified on finding themselves unable even to comprehend the numerous distinctions of pulses described by Galen, and still further diversified by Solano, Bordeu, and others, will meet with some consolation in the perusal of this article, on finding so intelligent and experienced a physician as the Writer of it neglecting these unnecessary and incommunicable niceties and distinctions, and considering the frequency or quicknefs * of the pulle, not only as the most intelligible, but likewise as the most important of all the signs to be derived from it. These minute distinctions of the several pulses, he obferves, exist chiefly in the imagination of the makers. Time Indeed has set most of them aside; but with regard even to those that are yet retained, he has observed old and eminent practitioners make such different judgments of hard and full, and weak and small pulses, that he was sure they did not call the Same sensations by the same names.
The pulse, we shall observe, is the only index we are pofsessed of, that can point out to us, or can convey to us any intelligence respecting the force of that concealed organ, the heart, and the frequency of its motions. With regard therefore to these two essential particulars, it may very properly be divided into strong and quick, (including their contraries) to which may be added the intermittent, as a modification of the laft. The 'Itrength of the pulse, as the Author remarks, may undoubtedly become a fallacious indication of the strength of the heart's action, as it is greatly affected by extraneous circumstances; such as the size of the artery, its deep or superficial situation, the Jaxity or rigidity of the integuments, &c. and Atill further, as the degree of this quality is a mere matter of estimation, it is not easily or accurately to be communicated by words to others, in the description of cases, or 'the history of diseases. Nevertheless a proper allowance may be made for these circumstances, so as to enable us to receive from the pulse some useful infor
mation on this head. At the same time we must acknowledge, with the Author, that the frequency of the pulse is a more precise
The Author uses these as fynonimous terms; though they have been carefully distinguished by those who have been pleased to amuse themselves, and puzzle others, by splitting of pulses. By a frequent pulse, thefe gentlemen design a pulse in which the vibrations of the artery succeed each other at very Mort intervals : by a quick pulle they mean to express a rapid or smart motion of the artery, or its coats, in the very act of pulsation.
and certain criterion, as it is generally the same in all parts of the body, and, being an object of number, is capable of being ascertained with the greatest precision, and consequently of being perfectly described and communicated to others.
To judge of diseases by the number of pulsations in a given time, it is necessary previously to know the degrets of frequency respectively belonging to different ages, temperaments, and diseales. This matter not having been sufficiently noticed by medical writers, the Author has here thrown together some remarks, with a view to settle this doctrine by the observations which he has made on this subject, in the course of his practice. The pulse of a healthy infant, asleep, on the day of its birih, he has found to beat between 130 and 140 times in a minute: its mean rate for the first month he fixes at 120, and has never found it less than 108. During the whole first year, its limits may be fixed at 108 and 120 : for the second year, at 90 and ico. In the third year, the lowest number of pulsations is fixed at 80, which will nearly serve till the fixth year, In the seventh, the number of pulsations will sometimes, though seldom, descend to
and in the twelfth be often not more than 70; differing but little from the healthy pulse of an adult, the range of which is from a little below 60 to a little above 80.
Of the Author's observations on the state of diseases, as indicated by the pulle, we shall only mention two or three. The first is that the pulle, singly considered, is in many instances an uncertain criterion of health, and, without a due regard to other figns, may frequently mislead us. In an illness, for instance, where from being feverilhly, quick, it becomes suddenly quiet; or, in a child, when it finks 15 or 20 beats below the lowest limit of the natural standard, while signs of considerable illness yet remain, or the bad fymptoms are aggravated; the quietude of the pulse is so far from being à proof of the decrease of the disorder, that on the contrary it certainly indicates that the brain is affected; as its flowness in this case undoubtedly proceeds from the diminished irritability of the patient: fo that instead of giving us hope, it should alarm us with the probability that a pally, apoplexy, or death are not far diftant.
The intermitting pulse has been considered as a dangerous fign; but, besides that it is peculiar to many persons in a state of the most perfect health, the Author obferves that such trivial causes will occasion it, that it is not worth regarding in any illness, unless joined with other bad signs of more moment. He controverts likewise the common opinion that great pain will quicken the pulse; and is more sure that mere pain will not always do it, than he is that it ever will.' After observing T 2
that the severest nephritic paroxysm is often unattended with any quicknels of the pulse, he adds, that he has seen a man of patience and courage rolling upon the floor, and crying out, through the excessive torture produced by a gall-stone paffing through the gall ducts, and which he has scarce been able to Jull into a tolerable state with nine grains of opium given within 24 hours, to which medicine he had never been accustomed; and yet his pulse was all the time as perfectly quiet and natural, as it could have been in the sweetest sleep of perfect health. Article III. An Account of an extraordinary Ptyalism, and of its
Cure, &c. By Mr. John Power, Surgeon at Polesworth, in Warwickshire.
The young lady whose case is related in this article had her ftrength exceedingly impaired by the continuance of a profuse falivation, which, for above two years, resisted a course of the most powerful medicines, and which ceased soon after the extraction of a piece of fetid wool, which was discovered in one , of her ears, and was supposed to have occasioned this extraordinary fecsetion, by keeping up a continued irritation of the parotid glands. Article IV. The Case of a Locked Jaw, &c. By Dr. William
Carter, at Canterbury. This disorder appeared fix weeks after the patient had received a wound on the ankle, which was nearly bcaled. After Jarge quantities of opium had been administered without any sensible advantage, the convulsions foon ceased, and the patient was cured, after the application of a blistering plaister between the shoulders; the exhibition of a draftic purge, four uimes repeated, at the distance of three or four days between each dose; and of the Ol. jiccini, the fetid gum, and the Olcum Amygdalinum,' on the intermediate days: the whole length of the spine and jaw having been at the same time anointed with the Oleum Laieiitium. These, at least, were the means that preceded the Article V. A Case of the Hydrophobia. By the late Nicholas
Munckley, M.D. F.R.S.'&c. Article XII. Canine Alaitness successfully treated. Communicated
to the College by William Wrightson, Surgeon in Sedgefield,
Durban, Article XV. A Coje of the Hydrophobia. By Mr. Falkener, Sur
geon at Southwell, in Notsinghamshire. The cale rclated in the first of these articles terminated fatally. The history of the disease is well drawn up; but nothing is faid concerning the medicines that were administered. The lubject of the second article was seized with the moft violent fyınptoms of canine madness within tnree or four days after having received ihe wound. On the fifth day, the Author was
called to him, at which time the hydrophobia appeared. On the feventh day, that and all the other alarming fpalmodic symptoms were subdued, except a small difficulty of swallowing; and this evidently in consequence of a liberal oxhibition of opium. Some boluses indeed of mulk and cinnabar had been likewile given: but the violence of the symptoms was considerably abated before any of these boluses were administered. The Author very properly expresses his withes that, as soon as the first symptoms of this alarming disorder appear, aslistance might be immediately called in; observing that, in the present case, only 12 or 14 hours had elapsed from the first attack of the convullions, and the hydrophobia was yet in its infancy; but that possibly, if as much more time had been lost, the disease, as it was hourly increaling, would have acquired such strength, that a general infammation would have come on, and all attempts to relieve the patient would have been to no purpose.'
In the case related in the third article, the convulsions and delirium were violent, and were attended with the hydropho. bia. After a copious bleeding, the Author trusted intirely to a mercurial course, and was not disappointed. A turpeth bolus was repeatedly administered, and the hand that was bit, and the whole spine, were rubbed with mercurial ointment, till a salivation was brought on; during the first days of which the patient recovered her senses perfectly, and afterwards her ftrength, and has remained well ever since. Article VI. Some Account of a Disorder of the Breafl. By Wil
liam Heberden, M.D. F.R.S. A very singular, lingering, teazing, and dangerous disease is described in this article, and which, though the Author observes that it is not extremely rare, has, we believe, escaped the notice of many of the faculty, nor has probably till now found a place or a name in the family of diseases. The feat of it, and a sense of strangling and anxiety with which it is attended, have induced the Author to give it the appellation of Angina pectoris. When he first took notice of it, and could find no fatisfaction from books, he consulted an able physician of long experience, who told him that he had known several ill of it, and ihat all of them had died suddenly. The many particulars which he has here collected, relating to the first lymptoms and progress of this non-defcript, cannot be here given. Nevertheleis, to extend the notice of it, and to put individuals on their guard against this infidious disease, we shall transcribe the Aushur's first paragraph, containing his account of its first unalarming approaches.
" Those who are afficted with it are seized, while they are walking, and more particularly when they walk soon after cating, with a painful and most disagreeable sensation in the