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disposing of some of their superfluous which is often inseparable from them, stock. From the moment they en- but also on account of positive bad eftered the house, Mary seemed to eye fects which may arise either from them with a kind of melancholy at- spreading unnecessary alarm through tention. She made signs to her fa- the country, or from misconceptions ther to insist upon their remaining all of statements or misapplication of innight, and seemed very urgent that struction by the half informed. they should occupy her bed. They, Popular medical instruction should however, paid no attention to the be confined to what may be called pre“ dumb wean's” whims, but set out on ventive medicine, or a knowledge of the their journey homewards. They had means of preventing disease, and checkno sooner left the house than Marying it at its first approach, and to the burst into tears. She made a hole in correction of vulgar errors. For a Mathe ashes on the hearth similar to a gazine occasional communications of grave, and intimated, by her cries and this kind are well fitted, when there gestures, that the hour of these two is reason to dread the introduction of men was at hand. About a mile a contagion, or during the prevalence from the house of Mary's father, they of an epidemic, or when a hurtful had to cross a river, and, as she had practice is generally adopted. But to foretold, the passage-boat was overset write a monthly or quarterly report by a sheet of floating ice, and they the diseases prevalent in Edinwere both drowned. The actions of burgh, or any other large city, would the dumb girl had such an effect upon be a task indeed, utterly useless, or her father and his friends, that they, worse than useless. The state of fearing some accident was to befall health in Edinburgh varies with the their acquaintances, left the house and season, with the abundance or scantifollowed them with the intention of ness of the means of subsistence, with prevailing upon them to return back; the introduction of a contagion, and but, though they made every possible some other general circumstances. But haste, they only reached the banks of still that diversity is not such as to the river to witness the last struggles furnish matter for a series of popular of the unfortunate sufferers, and to reports for a succession of years. They assist in searching for their lifeless would soon become uniformly uninbodies. Such is the tale we have of- teresting, or at least a mere repetition ten been told by one who was a wit- of what was formerly written, or ness to the whole circumstances, and would be filled with irrelevant and who, as long as Mary was in life, inappropriate discussions. I am awas a firm believer in her superna- ware, that, in opposition to this opi
nion, the admirable reports of Dr Willan upon the diseases of London may
be quoted, which were inserted in the REPORT ON THE PRESENT STATE OF Monthly Magazine with so much suc
cess, that every Magazine now must
have its medical report. But every MR EDITOR,
physician is not a Dr Willan, and, I SHOULD very willingly comply accordingly, the effusions of many of with your request to contribute a pe- his followers or imitators, are 'roriodical report upon the diseases pre- mances, dreams, or any thing but a valent in Edinburgh, if I considered true report of the diseases of the city myself competent to the discharge of which they profess to describe. To such a task, and if I could satisfy my- this censure there are certainly soine self that such a report would be either honourable exceptions, but they are useful or fit for a Magazine, which is written for the profession, not for the intended for general r aders. I am very public. The fact is, Dr Willan wrote far from thinking that the profession for the profession, and his reports, col. should be wrapt up in mystery, or lected into one volume, have become a that all access to some acquaintance valuable addition to the library of the with its principles should be denied physician. But even Dr Wiñan did to the general reader. But much not write a report of the diseases of discretion must be used in introducing London, but only of his own practice medical discussions into a popular work, in the General Dispensary and in prinot only on account of the indelicacy vate, and this is all that any reporter
FEVER IN EDINBURGH.
can write from his own knowledge ; lent at present than in past years ;-the so that a very different view of the greater attention paid to the state of the diseases of the same place and period sick poor, both by the Dispensaries rimay be given, as the reporter is a per- valling each other in doing good, and the son of great experience, and sees no- increased exertions of theactive and huthing unusual in the present times, is mane Society for relieving the destitute in practice in high or low life, or is an sick. The consequence is, that almost active practitioner attached to an Hos- every case of fever is brought to light, pital or Dispensary, or writes from and is made a subject of conversation books more than from patients. and remark in the circles of our ac
After such a preamble, it may seem tive philanthropists. Next, the sickare inconsistent to send you a professional no sooner discovered than, very procommunication; but at present I wish perly, they are furnished with recomto correct some vulgar errors, and to mendations for admission into the disseminate, through the medium of Royal Infirmary, and advised, and your Magazine, some precepts of pre- often reluctantly induced to go to that ventive medicine.
useful asylum, which, we are happy A considerably greater degree of a- to be informed, has, up to this time, larm has been spread among the high- received every fever patient who has er classes of society, concerning the come to the waiting room, although, prevalence and danger of a fever in E- from the extraordinary exertions in dinburgh, than I think is necessary or sending in patients, it would not be well-founded; and, on the other hand, wonderful if their accommodation and the lower classes are, as usual, too funds should have proved insufficient. indifferent about the means of pre- From this cause, therefore, it is posventing it. The subject suggests a sible to account for the greater numfew questions, which I shall endeavour ber of fever patients which have been to answer.
received into the Royal Infirmary duIs fever unusually prevalent in E- ring the last twelve months, without dinburgh ? The answer to this ques- any actual increase of the frequency tion is not so easy as might be suppos- of fever in Edinburgh. It is well ed. If we were to refer to the books known to practitioners, that this city of the Royal Infirmary and Dispen- is never altogether free from continued saries, the answer would undoubtedl- fever;t that it is always lurking in the ly be in the affirmative;* but if we refer to the private journal of practitioners not connected with public in This was actually the case when this stitutions, it might be doubtful. There report was drawn up. But on the 25th of are several reasons to explain why fever October the female wards were quite filled, appears to be so much more preva- and it was necessary to refuse the admission
of a girl labouring under fever. Since
that time, however, fever patients have * Number of fever patients dismissed been almost daily admitted and none re. from the Royal Infirmary during each fused. Several wards, besides the usual month of the present year.
fever wards, have been appropriated to
fever cases, and every exertion made to January
It must also be reFebruary 17
marked, that it has frequently been very March 18 1 19 19
difficult or impossible to dismiss the convaApril 38 2 40 20 lescents when they became no longer proMay 34
38 It's per objects for an infirmary, especially the June 26 1 27
Irish and other strangers, from the total July 33
36 12 indigence of many of them, and their inaAugust 39
bility to work, so as to gain the means of September 49 3
173 even a scanty subsistence. In some instan. October 53 1 54 54
ces, also, patients were detained a few days
longer in the hospital, in consequence of 326 21 347 1611
the Society for relieving the destitute sick
being engaged in cleaning and purifying The deaths from fever in 1815 and in 1816 their houses. were twelve in each year, but the number + The same may be said of almost every of fever patients dismissed cured in these large town. In proof of this, we refer to years could not be ascertained.
the-Report of the Fever Hospital in Dube
Cured. Died. Total. One Death in
narrow closes and lodging houses of ver, none of whom died, and about the poor; and that, from time to time, fifty other individuals belonging to it has always increased to a laments that institution, of whom about one able degree of frequency. But for- in twelve died. But, during this premerly a very small proportion of the sent season, not one person in either unhappy sufferers by it thought of of these extensive asylums for the poor going to the hospital, and there was has been attected; nor, so tar as I have no organized society for sending them been able to learn, has fever occurred in. For more than twenty years I in any other of the public institutions have known continued fever always to in which numbers of individuals are exist, and often to a very great degree, collected together for the education of in Portsburgh. I have examined the the young, or for the relief of the district, by the desire of the gentle aged. Therefore, from the mere inmen connected with the House of In- creased number of admissions to the dustry, with a view to get some of the hospital, I would not positively condunghills removed, and found fever clude that there was an increased prein almost every house. Upon one oc- valence of fever. casion, I remember visiting a close Another reason why the public bewhere almost every individual was ill, lieve that fever is more prevalent is, and in one house í found seven chil that it has caused several deaths in dren affected, the father having gone the higher classes of society. This to the hospital, where he died, and mortality is, I believe, extraordinary, the mother only able to be out of bed, and, so far as I can learn, during the with the precursory symptoms upon present year, a larger proportion of her, and not a neighbour able to lend deaths than usual has taken placeamong assistance; and yet, upon these occa- the rich, not only in Edinburgh, but sions, the public in general heard no- all over the kingdom, and every death thing of the prevalence of fever. The in this rank of society is known, and knowledge of the misery it occasioned excites general lamentation and fear. was confined to the attending prac. But occasionally fever has been prevatitioners and a few active philanthro- lent to a considerable degree, especially pists.
In spring 1816, every one of among the students of medicine. The the children in the West Kirk poor- present Professor of the Practice of house, about 160, was attacked with Physic in the University mentions, in fever, of whom two died, and between his lectures, an epidemic of this kind, 30 or 40 of the aged poor, of whom which was the reason why the clinical more than a third died, yet its exist- lectures were transferred from the ence was scarcely known, except to hospital to the University; and when the managers and officers of the cha- I was student it prevailed epidemicalrity. In the autumn of 1816, every ly among us for two successive years, child in the City Charity Work-house, in one of which upwards of thirty stu200 in number,' was affected with fe- dents and three clinical clerks, of whom
I was one, were seized within a short
time. In one year eleven medical stulin, by which it appears that the patients dents died of fever. Nothing comadmitted were in
parable in extent has occurred among Numbers. Average Deaths, the students this year.
I do not, One in however, mean to deny that fever has 1804 422 1311
been, and still is, rather more prevalent 1805 1028
than usual. I only wish to state my 1806
reasons for thinking that it is generally 1272 12
believed to be much more prevalent 1807 1092
than it really is. 1072
Is the continued fever at present in 1809
1056 13) Edinburgh more malignant or severe 1810 1774
than usual? To this question I am 1478
happy to be able to answer decidedly 1812 2273
No. On the contrary, it may be ra
ther denominated slight. The reports 1813 2620
of its unusual malignity have arisen 1814 2398
partly from the circumstance already 1815 3787
alluded to, that several persons of the.
higher classes of society, and some of sicians, and as positively declared to these under circumstances of extraor- be certainly not contagious by others, dinary interest and regret, have fal- and both parties appeal for the len a sacrifice to it, and partly from a truth of their opinions to their own misconception of the meaning of the personal and abundant experience. denomination Typhus, as applied to it As far as my experience goes, and as by some medical men. In conse far as I am able to judge from the quence of the theoretical opinions of facts I have witnessed and read of, I Dr Cullen and Dr Brown, the idea of am inclined to think a kind of middle malignity, to a greater or less degree, opinion to be the true one in regard was attached by them to the term Ty- to typhus, viz. that it sometimes prophus, and typhoid was used to desig- ceeds from the concurrence of occanate that state of fever in which the sional causes of disease independent of powers of reaction, or of vitality, were contagion, such as fatigue, want, disdeficient, as characterized by the pre- tress of mind, intemperance, cold, foul sence of certain symptoms, and with air, &c. and that it more frequently is them typhus and typhoid were always propagated by contagion or effluvia geassociated with danger. But typhus nerated in and emanating from a person is now used by many physicians, and labouring under the disease ; in short, I think more correctly, as a proper that typhus is sometimes primary,somename to designate a particular kind of times propagated. But while I thus continued fever, (the common conti- believe typhus to be a contagious disnued fever of this country, capable of ease, for the effluvia of even primary being communicated by contagion,) typhus are capable of communicating without any reference to its degree of the disease, I also believe that it is mildness or severity, so that they only contagious under vertain condispeak of a slight or severe typhus; and, tions and circumstances, or that it is according to this understanding of the not what may be called a very contaterm, I would say that Edinburgh is gious disease. I believe that it is never altogether free from typhus; and most easily communicated in a conthat the typhus of this year has been, fined and foul atmosphere, where among the lower classes, milder than many diseased persons are collected, usual, although it is seldom very se and to persons previously debilitated vere in Edinburgh.
by fatigue, want, &c. ; that it acts only Is the fever at present in Edinburgh at a very limited distance from the contagious in its nature? This is a diseased person, and that it requires exquestion of the greatest importance to posure to its influence to be continued the community, because an erroneous for a certain length of time. Further, opinion on this point is attended with many persons, especially those who great and public evils. It may either have already passed through the discause unnecessary alarm, or prevent ease, seem to be proof against, and capathe necessary precautions for arresting ble of resisting it under every circumits progress from being taken. To stance. If these opinions be correct, those not of the profession, or unac there are sufficient grounds for taking quainted with its controversies, it may due precaution to prevent the propaappear strange that there should be gation of disease, while, on the other any dispute whether any disease be hand, there are no grounds for genecontagious or not; yet it so happens ral alarm. The fever is sufficiently conthat this most important fact is still tagious to suggest the impropriety of unascertained with regard to the great- unnecessary exposure to the effluvia est number of the most important proceeding from the bodies of the sick, diseases;
and the doubt docs not arise but not so highly contagious as to defrom want of observation, but from ter us from giving them every attenth: difficulty, perhaps the impossi- tion and assistance which may be use bility, of analyzing the various cir- ful to them, or to authorize any harsh cumstances and conditions of the pro or hurtful regulations for cutting off pagation and generation of disease. all communication with the diseased. Thus, we find plague, yellow-fever, I shall conclude these observations, puerperal-fever, ague, dysentery, chin- already perhaps too long, with recough, influenza, consumption, as questing you to insert the following well as our typhus, maintained to be Instructions, drawn up under the indubitably contagious by some phy direction of the medical gentlemen
of the Fever Hospital in Dublin, in but still not warm.* During the whole order to prevent Infection,
sickness the floor and clothes should Signs of Fever.- For one or two be frequently sprinkled with vinegar. days the person affected cannot bear “N. B. Bleeding should hardly exertion, loathes food, sometimes vo
ever be employed, (unless prescribed mits whatever is taken into the sto- by a regular medical attendant.) mach ; a general sense of uneasiness,
“ To guard against Infection. Imrather than pain, is felt; a wish to mediately after the recovery, removal, lie down, yet a restlessness when in or death of the patient, let all the bed, or sometimes sleepiness.
doors and windows be thrown open, “To these succeed shivering, with and remain so for several hours. a sense of coldness, while to a by
“ Let the house or room be immestander the skin feels hot; thirst, diately cleansed ; all dirty clothes, pain of head and back, and very gene utensils, &c. should be immersed in rally a feel of weight about the sto- cold water. The bed-clothes, and all mach.
clothes used by the sick person, and " Treatment. At any time within every one about him, should also be the first three days, give a vomit of steeped in cold water, then wrung out hippo, (Ipecacuan,) mixed in a tea- and washed in warm water, with soap; cup full of warm water, and work and every box, chest, drawer, &c. in it off with thin oatmeal gruel. If the house or room, should be emptied the belly be costive, give a
and cleansed. mon house clyster, and repeat it
“ If you lie on straw beds, let the every day, if necessary.
Let the straw be immediately burned, and drink be two milk whey, * or thin fresh straw provided, and the ticken gruel, to each quart of which add a steeped in cold water, and dried well tea-spoonful of cream of tartar. No before it is used again; and let your other medicine or food should be given beds, of whatever kind, be exposed to till signs of weakness, or a cool skin, open air as much as possible for a with appetite, come on.
In the for: week. mer case give a little wine or weak
“ Whitewash all your rooms, and punch ; in the latter, frumenty and the entrance to them, with lime, milk, which should be very cautiously slacked in them, and while it conand gradually changed to more nou
tinues bubbling and hot. rishing diet during recovery, as re
Scrape your floor with a shovel, lapses are often the consequence of and wash clean both it and your fura over-eating at this period.
niture, “If fixed pain be felt in the breast Keep yourself in open air as much or any other part, a blister should be as possible for a week. applied over it. The face and hands * Wash your face, and hands, and should be washed and kept clean with feet, and comb your hair every mornwarm water and soap, and the bed- ing at least. clothes kept clean ; the apartment
“ N. B.—The benefit of this advice should (at every stage of the fever) you will soon feel, and, persevering be kept cool, and with as few persons in your attention to it, will, under besides the attendants as possible. God, preserve you from all the variety Should a great disposition to sweat of wretchedness occasioned by infecappear within the first five or six tious fevers. Attend to it then with slays, the room should be kept cool, spirit and punctuality, for be assured,
that cleanliness will check disease, improve your health and strength, and
increase your comfort.” An excellent drink commonly given
A. D. J. to fever patients in Dublin, composed of equal parts of sweet and butter milk. The
• This is evidently a misprint. It should former is made to boil, and then poured evidently be, “ the room should not be upon the latter, when the curd of both is kept too cool, but still not warm,” or, coagulated and easily separated from the " the room should be kept cool, but still &ght and grateful whey.