ftill difficult to give a name to the disease, as no particular determination could yet be pointed out. Five times the blood had offered the appearance of a lotura carnium. On the third night, however, the patient began to cough and to spit much mucus tinged with blood. He complained alfo of a pain beneath the right breast, which extended down in the hypochondre of the fame fide, and connected with the fhoulder. A tumor was now difcovered on the liver and felt below the true ribs; for this reafon, depleting and antiphlogistic remedies were continued, with blifters and cuppings on the affected parts, and two grains of calomel every hour or two; but the ftomach was fo irritable that it frequently rejected this, and other medicines, which had very little effect or none at all:it was therefore, by the help of fix fucceffive bleedings more, that the patient apparently grew better and could at the end of three weeks fit up and walk a little.-We must now observe, that during the abatement of the inflammatory symptoms, refpiration was fometimes tremulous, a flight yellow fuffufion had spread over the body; night fweats were profufe; and the patient could not lie down any length of time, without be ing roufed up by horrid feelings of an impending fuffocation, and great was befides the bodily anxiety, which proved his convalescence to be delufive; indeed, a fresh pulmonary inAammation took place, with cough, violent delirium and fever. The exacerbations were great, in the evening efpecially, and required three fucceffive bleedings within the period of four days. On the fifth, the cafe was really much to be despaired of; the debility being extreme, the cough unabated, the pulfe corded, and the night fweats rendered very diftreffing by the heat of the feafon. The night following, he was feized with fuch fpafms of the bronchiæ, that he would have attempted to bleed himself, had he not been promptly relieved by that operation. The emergency of the cafe pointed out to the attending phyfician, that as an internal abfcefs could not be doubted of, he muft ftimulate and even convulfe the prima via to promote its rupture and difcharge. A light antimonial

mixture evidently contributed to that defirable effect; for after several doses were taken, large evacuations of pus were brought on, by, and with cough. They continued as it were, by spells, and took place, once at least, in twelve hours. They were also easily promoted by taking nourishment, or tonics, and by the jolting of a carriage; the nauseous taste of the matter frequently excited vomiting, which all together, with the cough, rendered the convulfive exertions of the abdominal mufcles very diftreffing. Thefe evacuations lafted nearly eight days, and after the two laft, which were more copious and mixed with white flakes, the patient, who was already altered for the better, remained convalefcent. A flight forenefs was felt in the right hypochondre, which gradually dif appeared. By the help of a found and restrained diet, and of exercise by riding, he has attained a perfect state of health.

It

We may diftinctly perceive three periods in this cafe; that of an inflammatory fever preceding the formation of an abfcefs in the liver, and attended with a fymptomatic pulmonary inflammation; that of a ceffation of all inflammatory fymptoms, offering evidently, those of an internal impofthume; and that of a fresh inflammation in the diaphragm and lungs, immediately followed by the discharge of the matter. could not therefore be a matter of doubt whether the abscess was in the liver, fince the patient began to feel pain, to cough, and to fpit blood, on the third day only of the disease. The latter fymptoms indeed should have kept pace with the invasion of the fever, had the pulmonary inflammation been the primarydifeafe. The tumor or hardness discovered and felt under the true ribs, and the yellowness of the skin, were also, direct proofs of the affection of the liver, the fubfequent effects of which were evinced by the existence of the cough, only, during the first inflammation of that vifcus, and at the period of the discharge of the fuppurated fluids, through the diaphragm and lungs. The poffible inflammatory adhesion of thofe parts is a well-established point of pathological doctrine, and of course they may fimultaneously be corroded by the

pus, and open an eafy iffue through the air-veficles and bronchiæ. Lieutaud mentions the inftance of a monftrous tumor on the abdomen, which proved to be an abfcefs of the liver, when it was discharged through the lungs, and almost emptied before the exhaufted patient expired. Indeed, a fortunate concourfe of many circumftances only can determine fuch a favour. able termination of the pleuritic-hepatitis, as Cullen obferves, but it may be encouraging to remark that inftances of the fame are not. uncommon. We may mention that of your honoured grand-father, Dr. John Redman, who to this day, in his eighty-third year, has continued to enjoy a healthy life.*

No cafe of difeafe, I fhould believe, requires a more fagacious and experienced judgment in practice. Contrary to what we have been taught by many celebrated writers, to withhold the lancet, after fuppurative inflammation, in the prefent inftance we fee, that it has been, fifteen times, resorted to, and with fuccefs.-I cannot fay the fame of mercury, although it is almost a specific in hepatitis; for our patient, who was repeatedly put under its operation, received no benefit from it, perhaps owing to the rapid formation of the abscess, or to accidental infufficiency of that medicine. Tonic and ftimulating remedies were of great help, and in no cafe of continual exhaustion have I witnessed more advantage derived from nourishment, sparingly, but frequently exhibited.

Before I conclude this paper, fir, permit me to inform the reader that I was myself the patient alluded to, and to offer my fincere and unfeigned thanks to the three eminent phyficians who conducted my treatment, Dr. Rufh, Dr. Phyfick, and Dr. Caldwell. Their fedulous kindness, guided by a skilful judgment, adopted a mode of practice apparently violent; but it was evinced the wifsest, in a case which offered no chance from nature or conftitution. Of the attending phyfician, Dr. Rush, who had the most troublesome task, during seven weeks of confinement, I fhould not forget to mention VOL. I. Y

• The attack here adverted to, took place 50 years ago.-L.

the humane and affectionate care; nor to remark, that with his great talents, he eminently poffeffes all the qualities which conftitute the phyfician. I wish for thofe gentlemen, all poffible profeffional fuccefs and private happiness.

I have the honour of fubfcribing myself, with great esteem, Dear Sir,

Your moft obedient Servant,

DOCT. JOHN R. Coxe.

FELIX PASCALIS.

An Effay on Superfotation. By DR. WILLIAM DEWEES.

THERE

THE poffibility of fuperfotation is not a new idea: the prefent effay is an attempt to revive it, and to establish its probability, as well by reafoning as by facts. Many cafes have occurred fince the history of medicine to countenance a belief in it, and it did for a long time prevail; but, like many other opinions that could not admit of abfolute demonstration, it has long fince been laid afide, or in other words, held as a phyfical impoffibility.

It has been urged that fuperfœtation could not take place, first, from the indifpenfible neceffity of the male femen paffing through the mouth of the uterus to produce conception; and fecondly, as foon as this event has taken place, the os uteri clofes, and becomes impervious to the femen ejected in subsequent acts of coition.

If thefe opinions are founded on facts, the impoffibility of fuperfœtation is established beyond the power of controversy; but these are the points to be investigated.

Let us therefore inquire into the probability of this theory, and fee how well it will accord with facts and reason.

Before we proceed, however, any further, let us for a moment confider the anatomy and fituation of the unimpregnated uterus: we shall find it a small flattened body floating as it were in the middle of the pelvis; compofed of muscular fi

bres, nerves, blood-veffels, lymphatics, &c. divided in general by anatomists into body, fundus, and neck; having two small perforations near its fundus, which are the passages to and from the fallopian tubes; with a cavity capable of admitting a bean if its fides were distracted; but thefe fides are, for the most part, if not always, when not mechanically stretched by fome power or other, in a state of collapfe or contact, or at least as much fo, as a pretty thick mucus with which it is conftantly fupplied, will admit of; having a neck pendant in the pelvis, which is pervious and capable of admitting a probe, and this, like the body, is alfo lined with a thick ropy mucus; the termination of this neck is the os tincæ, which has no fixed place in the pelvis or vagina; it is fometimes found inclining to the right, at others to the left; now looking upwards and anteriorly, prefently dipping downwards and pofteriorly; but most frequently it is found (especially in women who have borne children) lying or refting on the internal face of the perineum; poffeffing no power that we are acquainted with, to fix its fituation at any time, confequently is fubject to all the changes of place that the pressure of the abdominal muscles may give it, when exerted in making of water and going to ftool; to all those that may arise from the weight of the intestines and vifcera; from the full or empty bladder; from the diftended or flaccid rectum, &c.

After having thus far confidered the uterus, let us next attend to what must be effected by the male, that impregnation may take place agreeably to the theory just mentioned. It is, that the male organs of generation must have sufficient vigour to push a thick tenacious fluid through the narrow aperture of the neck of the uterus, and make a lodgement of it within its cavity can it for an instant be fuppofed they poffefs this power? we think they do not for the following reafons.

ift. Because they have not, in our opinion, fufficient strength for this purpose, if it even be admitted that the extremity of the male urethra and the os tince of the female were in a state of perfect appofition.