"The peculiar obscurity confessed by many in the pathology of purpura, I cannot perceive. That it is not of the nature of scurvy, nor of the petechia of fever, is clear. Neither can it be placed among the exanthematous eruptions. As an hæmorrhage it must be considered, varying from others in this respect chiefly, that while the generality of them are assignable to obvious causes, this one comes on in the absence of every thing to explain its production. Coupling this circumstance with the extensiveness of its prevalence over the body, I know not to what else it is referable than the constitutional state, vaguely called the hæmorrhagic diathesis or tendency. Great reason have we to suppose that it is independent of any of the ordinary organic lesions, and proceeds from derangement of innervation, producing the change in the capillaries and in the blood itself, favoring sanguineous effusions, and which condition may be natural or acquired, the latter, sometimes, also permanent or very enduring."

We copy his remarks on the treatment of purpura:

"Called to a case of any activity, venesection should be instantly performed. It is the only decisive remedy. Nor is the amount of blood detracted to be small, or any timidity to deter from a repetition of the operation, where the necessity for it exists. I drew as much as sixty ounces in one case, and in another half this amount, in several successive bleedings, with the most decisive advantage. The course is justified by the state of the circulation, by the appearance of the blood, which is thick and sometimes heavily sized, by the albuminous urine, by the acuteness of pain in the cavities, and by the relief afforded from the hæmorrhage itself when not excessive. Many of the European practitioners, as Parry, McIntosh, &c., give to it their support, though not so intrepidly as I have ventured. But it is not to be supposed that under any other circumstances than stated, and in the extremest emergencies, would I carry it to such an extent. Generally, my bleedings are far more moderate, and especially in an advanced stage, where the loss of blood is ill borne.

"Next in value of the remedies is purging deemed, with the saline articles, and there are facts to render it probable that the sulphate of soda is specially adapted to the disease. Great benefit, however, is derived by cold applications to the surface-either sponging or covering it over with cloths wrung out of water of a moderate temperature. Nay, on one occasion, in consultation with Dr. Meigs, we immersed a girl in a

cold bath, and with such effect that henceforward she speedily recovered. It was on the second day of the attack-the purpura pervaded her skin, and though she had been previously depleted, the pulse was still full and strong, and the surface

warm.

"No confidence do I place in the astringents and acids. usually appropriated to hemorrhage, and have little experience of the alkalies and neutral salts recently recommended on the authority of Stephens. But I am disposed to believe that opiates are deserving of attention, more, however, from analogy than any better evidence. Emetics and the spirits of turpentine I would, for the present, place on the same footing.

"In the less active states of this disease, some variation in the treatment is required. Blood-letting, if admissible at all, must be practised cautiously, as well, indeed, as whatever else is calculated to increase debility. Debarred of the former, however, we are nearly destitute of means of any certainty of advantage in an urgent emergency. Those previously enumerated, and commonly employed, have proved nugatory in my hands. My trust would be mainly in the sulphate of soda, the spirits of turpentine, the sulphate of quinine, opiates and wine."

The following extract is hygienic in its character, and will be read with pleasure. The testimony borne in it to temperance by the veteran professor is emphatic and consolatory. He is treating of gout, the connexion of which with particular modes of living is well understood. He says:

"Of the dependence of gout on the habits of living, no stronger proof can probably be supplied than from the annals of this city. When I commenced my professional career, the disease abounded in the higher circles, and then it was the practice to drink punch in the forenoon, to continue it at dinner, or to resort to ardent or malt liquors, followed by a liberal use of diverse wines, closing the evening with substantial suppers and stimulating potations. But, in this respect, within the last thirty years, a signal change has taken place. No punch or distilled spirits, and comparatively little malt liquor, has been consumed, and the custom of supping is nearly extinct. Temperance has superseded debauchery or excess, and gout, thus deprived of its aliment, is fast perishing away. My opportunities have enabled me to ascertain the fact, that so late as the commencement of the present cen

tury, a hundred cases of the disease existed in this community where one is now to be met with, and, with few exceptions, these are the remnants of other days, serving as memorials of a state of society, of which there are scarcely any other traces to be recognized. Literally is it true, as expressed by May, one of the oldest of the English dramatists:

"Contemplating this happy reformation, who can forbear to exclaim with the fair poetess—

"Tis to thy rules, O temperance! that we owe

All pleasures which from health and strength can flow;

Vigor of body, purity of mind,

Unclouded reason, sentiments refin'd,

Unmixt, untainted joys, without remorse,

Th' intemperate sinner's never-failing curse."

To the causes of gout must, as previously intimated, be added sedentary, indolent, or intensely studious habits.

"It is well known, that in the common orders of life, the disease hardly exists, and infinitely less among the higher classes who pursue occupations of active industry. Neglect of the exercise of walking has particularly an effect, and among other evidence of it, which we learn, is, that while the people of Edinburgh, who, from the location of their trade at Leith, the seaport town, a mile or more distant, usually ride, are very liable to the disease; those of Glasgow, the practice of whom is different, are nearly exempt from it.*

*

"Not doubting the influence of this custom, to a certain extent, I am still inclined to impute more to a wider difference in the character and habits of the inhabitants, in other respects, of these two cities. Edinburgh is the abode of the opulent, the noble, the learned, and also the refuge of nearly every veteran of Scotland, of the military, naval, or civil service, who returns from the performance of arduous and lengthened duties, in distant and sickly climes, with shattered constitutions, to enjoy at home luxurious ease. The one city

* Scudamore on Gout.

has claims to the highest intellectual society, though voluptuous, and even grossly dissipated, at least it was so in my time, and the other the reverse, or that marked conspicuously by economical prudence and active, stirring, money-making industry. Thus contrasted, can the disparity, as to the relative prevalence of the disease in the two places, be a matter of surprise?"

The following extracts exhibit the author as historian. In the first he is relating the process of inoculation, and in the second the origin of vaccination. Such passages enliven many of his pages, and amid the dry details of practice must have proved eminently refreshing to his pupils. These extracts afford fair specimens of the style of the author which is not without its peculiarities. Having noticed the slow advances of inoculation in England, he goes on to say:

"The progress of this discovery was, throughout the continent of Europe, still more retarded. Except in Hanover, into which it had very partially crept, no where was it to be recognized. Narcotized Germany laid, at the time, prostrate under the stupefaction of despotism, unable to 'shake the poppies from her head,' insensible to improvements. and, perhaps, without the consciousness of possessing those fine intellectual energies she has since displayed. The very attempts to introduce this new practice were met by mounds of popular prejudice, encouraged and fortified by her most eminent medical men, De Haen, Van Swieten, &c.

"Even in France, with the illumination of her literature, science, and philosophy, it had to encounter, for a season, an irresistible opposition. Condemned, ex cathedra, by the faculty of medicine at Paris, it remained slighted for many years. Neither appeals to reason nor common sense, nor the weight of cumulative facts, had any effect. Finally, however, Voltaire, returning from England, whither he had been, took the subject in hand, and, by his representations of the immense advantage of the new practice, which he had there witnessed, and above all, as the only preservative of female beauty against the most hideous deformities, enlisted the ladies of the court in its behalf, and henceforward inoculation became quite the vogue in the higher circles, whence it spread, as other fashions, among the people. To the influence of this extraordinary man, operating on the vanity of women, does it appear

that we are mainly to assign the just appreciation of one of the greatest boons ever conferred on humanity-such being the mysterious modes often adopted by Providence for the revelation or dispensation of infinite goodness! Means, however, were still wanting to execute the plan which had been devised of extending this blessing to the poor, and these were supplied on the coming into power of Turgot, the wise, the liberal, the benificent minister of the French treasury. Enough, perhaps, has been said to show that this, in common with every other improvement, wheresoever it may emanate, was eagerly received, and skilfully pursued by our own, in the proper sense of the term, truly enlightened country, whose mind has never been perverted by vulgar prejudice, or weakened by fearful superstition, or its determinations thwarted by aristocratic influence, or the power of antiquated corporations, or that of Government itself, so perniciously felt in the Old World."

The history of Jenner's immortal discovery is thus pleasantly mixed up with anecdote, and we give it without any fear that it will prove tedious, although the extract is a long

one:

In 1768, while Jenner was a student of medicine, residing in Gloucestershire, he heard of the prevalence of an affection on the udder of cows, of a pustular nature, which occasionally infecting the hands of those who milked them, produced a correspondent affection, proving a preventive of small-pox, as well in the natural way as by inoculation.*

Deeply impressed with the value of the intelligence he had collected, Jenner repaired to London, to prosecute his studies under the auspices of John Hunter. During the period of their connection, frequent conversations were held between them regarding the cow-pox and its reputed properties. grossed, however, with other occupations, the preceptor was

En

Not uninteresting can it be here to mention, that I have been told by Dr. Neil, of this city, that much about the same period, and certainly without any information from abroad, his father, who practised physic on the Eastern Shore of Maryland, was in possession of essentially similar facts. It has also been rendered probable, by M. Hussen, that a certain M. Robant, Protestant minister at Montpelier, in France, had so early as 1781, made some verbal communications to several persons, indicating considerable knowledge of the subject.