THE

MONTHLY REVIEW,

For OCTOBER, 1772.

ART. I. Medical Tranfactions, published by the College of Physicians in London. Vol. II. Svo. 5 s. Boards. Baker. 1772.

WE

E need not preface our account of the contents of this medical collection, by an enumeration of the great advances which have been made in natural philofophy in general, within the laft century, in confequence of the establishment of academies and other learned focieties. We fhall only obferve, on the present occafion, that the art of phyfic has shared in the advantages derived from thefe inftitutions, and has been ftill further improved by the focieties which have been formed with the fole view to promote that branch of knowledge in particular; by whose care the notice of many important facts and ingenious obfervations has been fpeedily circulated and diffufed, which would never have been committed to paper, without the profpect of these commodious channels of conveyance, or at leaft would probably never have feen the light. In our Review of the prefent collection, we fhall give the titles of all the papers nearly in the order in which they occur; adding a more particular account of fuch articles as are either the moft -interetting, or most fufceptible of abridgment. Article I. 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 difeafe which is the fubject of it, defcribing more particularly the symptoms that peculiarly characterise it, and distinguish it from other fevers to which it bears fome refemblance; particularly the irregular intermittent, from which however it effentially differs in its nature and method of cure, as well as in the event, which is too frequently fatal, in fpite of the most judicious treatment. ... VOL. XLVII.

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Article II. Remarks on the Pulfe. By the Same. Thole who may have lamented their want of the tallus eruditus, to which fome writers on the pulfe have pretended, or who may have been mortified on finding themfelves unable even to comprehend the numerous diftinctions of pulfes defcribed by Galen, and ftill further diverfified by Solano, Bordeu, and others, will meet with fome confolation in the perufal of this article, on finding fo intelligent and experienced a physician as the Writer of it neglecting these unneceffary and incommunicable niceties and diftinctions, and confidering the frequency or quicknefs of the pulse, not only as the most intelligible, but likewife as the most important of all the figns to be derived from it. These minute diftinctions of the feveral pulfes, he obferves, exift chiefly in the imagination of the makers. Time indeed has fet most of them afide; but with regard even to those that are yet retained, he has obferved old and eminent practitioners make fuch different judgments of hard and full, and weak and small pulfes, that he was fure they did not call the Tame fenfations by the fame names.

The pulfe, we fhall obferve, is the only index we are poffelfed of, that can point out to us, or can convey to us any intelligence refpecting the force of that concealed organ, the heart, and the frequency of its motions. With regard therefore to these two effential particulars, it may very properly be divided into ftrong and quick, (including their contraries) to which may be added the intermittent, as a modification of the laft. The ftrength of the pulfe, as the Author remarks, may undoubtedly become a fallacious indication of the ftrength of the heart's action, as it is greatly affected by extraneous circumstances; fuch as the fize of the artery, its deep or fuperficial fituation, the laxity or rigidity of the integuments, &c. and ftill further, as the degree of this quality is a mere matter of eftimation, it is not eafily or accurately to be communicated by words to others, in the defcription of cafes, or the hiftory of difeafes. Nevertheless a proper allowance may be made for thefe circumstances, fo as to enable us to receive from the pulfe fome ufeful infor"mation on this head. At the fame time we must acknowledge, with the Author, that the frequency of the pulse is a more precise

• The Author uses thefe as fynonimous terms; though they have been carefully diftinguished by thofe who have been pleased to amufe themfelves, and puzzle others, by fplitting of pulfes. By a frequent pulfe, thefe gentlemen defign a pulfe in which the vibrations of the artery fucceed each other at very fhort intervals: by a quick pulle they mean to exprefs a rapid or fmart motion of the artery, or its coats, in the very act of pulfation.

and

and certain criterion, as it is generally the fame in all parts of the body, and, being an object of number, is capable of being afcertained with the greatest precifion, and confequently of being perfectly defcribed and communicated to others.

To judge of difeafes by the number of pulfations in a given time, it is neceffary previoufly to know the degrees of frequency refpectively belonging to different ages, temperaments, and difeafes. This matter not having been fufficiently noticed by medical writers, the Author has here thrown together fome remarks, with a view to fettle this doctrine by the obfervations which he has made on this fubject, in the courfe of his practice. The pulfe of a healthy infant, afleep, on the day of its birth, 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 lefs than 108. During the whole first year, its limits may be fixed at 108 and 120 for the fecond year, at 90 and ico: In the third year, the lowest number of pulfations is fixed at 80, which will nearly ferve till the fixth year. In the feventh, the number of pulfations will fometimes, though feldom, defcend to 72; and in the twelfth be often not more than 70; differing but little from the healthy pulfe of an adult, the range of which is from a little below 60 to a little above 80.

Of the Author's obfervations on the ftate of difeafes, as indicated by the pulfe, we fhall only mention two or three. The firft is that the pulfe, fingly confidered, is in many inftances an uncertain criterion of health, and, without a due regard to other figns, may frequently mislead us. In an illnefs, for inftance, where from being feverishly quick, it becomes fuddenly quiet; or, in a child, when it finks 15 or 20 beats below the loweft limit of the natural ftandard, while figns of confiderable illnefs yet remain, or the bad fymptoms are aggravated; the quietude of the pulfe is fo far from being à proof of the decreafe of the diforder, that on the contrary it certainly indicates that the brain is affected; as its flownefs in this cafe undoubtedly proceeds from the diminished irritability of the patient fo that inftead of giving us hope, it fhould alarm us with the probability that a pally, apoplexy, or death are not far diftant.

The intermitting pulfe has been confidered as a dangerous fign; but, befides that it is peculiar to many perfons in a state of the most perfect health, the Author obferves that fuch trivial - caufes will occafion it, that it is not worth regarding in any illness, unless joined with other bad figns of more moment. He controverts likewife the common opinion that great pain will quicken the pulfe; and is more fure that mere pain will not always do it, than he is that it ever will.' After obferving

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that the feverest nephritic paroxyfm is often unattended with any quicknels of the pulfe, he adds, that he has seen a man of patience and courage rolling upon the floor, and crying out, through the exceffive torture produced by a gall-ftone paffing through the gall ducts, and which he has fcarce 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 pulle was all the time as perfectly quiet and natural, as it could have been in the sweetest fleep of perfect health. Article III. An Account of an extraordinary Ptyalifm, and of its Cure, &c. By Mr. John Power, Surgeon at Polefworth, in Warwickshire.

The young lady whofe cafe is related in this article had her ftrength exceedingly impaired by the continuance of a profufe falivation, which, for above two years, refifted a course of the moft powerful medicines, and which ceafed foon after the extraction of a piece of fetid wool, which was discovered in one of her ears, and was fuppofed to have occafioned this extraordinary fecretion, by keeping up a continued irritation of the parotid glands.

Article IV. The Cafe of a Locked Jaw, &c. By Dr. William Carter, at Canterbury.

This diforder appeared fix weeks after the patient had received a wound on the ankle, which was nearly healed. After large quantities of opium had been administered without any fenfible advantage, the convulfions foon ceafed, and the patient was cured, after the application of a bliftering plaifter between the fhoulders; the exhibition of a draftic purge, four times repeated, at the diftance of three or four days between each dofe; and of the Ol. juccini, the fetid gum, and the Oleum Amygda linum,' on the intermediate days: the whole length of the spine and jaw having been at the fame time anointed with the Oleum Lateritium.-Thefe, at leaft, were the means that preceded the

cure.

Article V. A Cafe of the Hydrophobia. By the late Nicholas Munckley, M. D. F. R. S. &c. - Article XII. Canine Madness fuccessfully treated. Communicated to the College by William Wrightfon, Surgeon in Sedgefield, Durham.

Article XV. A Cafe of the Hydrophobia. By Mr. Falkener, Surgeon at Southwell, in Nottingham fhire.

The cafe related in the firft of the fe articles terminated fatally. The hiftory of the difeafe is well drawn up; but nothing is faid concerning the medicines that were adminiftered. The subject of the fecond article was feized with the moft violent fymptoms of canine madnefs within three or four days after having received the wound. On the fifth day, the Author was

called

called to him, at which time the hydrophobia appeared. On the feventh day, that and all the other alarming fpafmodic fymptoms were fubdued, except a fmall difficulty of fwallowing; and this evidently in confequence of a liberal exhibition of opium. Some bolufes indeed of mufk and cinnabar had been likewife given: but the violence of the fymptoms was confiderably abated before any of these boluses were adminiftered. The Author very properly expreffes his wifhes that, as foon as the firft fymptoms of this alarming diforder appear, affiftance might be immediately called in; obferving that, in the prefent cafe, only 12 or 14 hours had elapfed from the first attack of the convullions, and the hydrophobia was yet in its infancy; but that poffibly, if as much more time had been loft, the disease, as it was hourly increafing, would have acquired fuch strength, that a general inflammation would have come on, and all attempts to relieve the patient would have been to no purpose.'

In the cafe related in the third article, the convulfions and delirium were violent, and were attended with the hydrophobia. After a copious bleeding, the Author trufted intirely to a mercurial course, and was not difappointed. A turpeth bolus was repeatedly adminiftered, and the hand that was bit, and the whole fpine, were rubbed with mercurial ointment, till a falivation was brought on; during the first days of which the patient recovered her fenfes perfectly, and afterwards her ftrength, and has remained well ever fince.

Article VI. Some Account of a Disorder of the Breaft. By William Heberden, M. D. F. R. S.

A very fingular, lingering, teazing, and dangerous difeafe is defcribed 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 difeafes. The feat of it, and a fenfe of ftrangling 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 confulted an able physician of long experience, who told him that he had known feveral ill of it, and that all of them had died fuddenly. The many particulars which he has here collected, relating to the first fymptoms and progrefs of this non-defcript, cannot be here given. Nevertheless, to extend the notice of it, and to put individuals on their guard against this infidious difeafe, we fhall tranfcribe the Author's first paragraph, containing his account of its first unalarming approaches.

Thofe who are afficted with it are feized, while they are walking, and more particularly when they walk foon after eating, with a painful and most difagreeable fenfation in the

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breaft,