operations faithfully noted. If this had been done always, instead of theorizing in the closet, he thinks the subject of contagion or infection (he properly considers the two words synonymous, as all infectious miasms must necessarily be contagious before they can operate on the human body) would not now have remained so much in obscurity. The following are the facts, in the order of their occurrence, which drew our author's attention to the subject, and seemed to throw some light on an obscure point of pathology. 1. A female, aged 24 years, admitted into one of Dr. Crampton's wards in the Whitworth Hospital, 24th November, 1817, makes, voluntarily, the following statement : "On the Wednesday preceding the day of her admission, a person not yet recovered from fever came into the house where she then was, and sat down close beside her. She became immediately sensible of a heavy disagreeable odour arising from the person of this individual, which disgusted her exceedingly; she was instantly affected with head-ache, and became so weak that with difficulty she could move her limbs or stand. That very evening long continued rigors came on, followed by heat, to which succeeded perspiration; she spent a restless night, slept in an agitated manner, and awoke unrefreshed. She was admitted into the hospital, labouring under the ordinary symptoms of fever, in an intense degree; she complained of severe head-ache, great prostration of strength, and was covered with large and florid peticha: her fever was tedious, and her recovery slow." 457. 2. On the 17th June, 1818, Nurse Smyth, in the Richmond Penitentiary, administered an enema to a typhous patient, during which operation, the patient's bowels were suddenly evacuated. "The smell issuing from the fæces produced immediate and most intense head-ache, and her strength at the same time was so completely exhausted, that she had neither power to move nor to support herself on her limbs. In a few hours afterwards she was seized with a severe rigor; but, being placed close to a large fire, she became warm, yet not without occasional sensations of chillness; feeling as if some cold substance moved slowly along her back. Typhous fever, of a severe character, yet presenting no unusual symptoms, supervened. The patient to whom the enema had been administered died in two days afterwards, having exhibited the worst characters of petechial fever." 457. 3. A nurse applied leeches to a patient in the last stage of typhus, whose body was covered with petechiæ. The smell of the patient's breath greatly incommoded the nurse. Shortly afterwards she had a rigor, and felt as if cold water was trickling along the spine. Fever quickly ensued, after taking an antimonial emetic; but it was mild, and she recovered. 4. A nurse was employed in washing the linen of an old woman labouring under typhus, covered with petechiæ, and exhibiting all the worst symptoms of that fever. The smell of the sheets affected the nurse powerfully and disagreeably. She was instantly seized with head-ache and great debility. Soon afterwards she had rigor, and when Dr. Marsh saw her, she had head-ache, nausea, and prostration of strength. Her skin was hot, pulse frequent and full. Venesection-leeches to the temples-free purgation. Her fever subsided on the fifth day. 5. A young gentleman, from motives of humanity, visited some poor people living in a wretched apartment, in one of the filthy lanes of the city, and where two people were labouring under bad fever. On opening the door, the smell immediately sickened him-he returned home unwell-and spent an agitated night. Next day, Dr. M. met him in the street, and was struck with his altered appearance. He was pale-his skin had a dingy appearance-there was a livid circle below the eyes-and he complained of great languor and debility. In the evening, his eyes were deeply suffused-cheeks flushedskin intensely hot-mouth parched-tongue loaded-pulse 120, full and resisting-breathing hurried-frequent sighing. Temporal arteriotomy to 24 ounces, by which he was much relieved; but had a wretched night, and was delirious. Nevertheless he awoke next morning free from fever, and only complaining of debility. 6. A nurse, while occupied about a patient labouring under petechial fever, (and who died two days afterwards,) was struck with a heavy smell, which affected her disagreeably, and produced head-ache, accompanied by languor of several days duration. She was at length obliged to take to her bed, and, during a protracted fever, never ceased to complain of intense head-ache and præcordial oppression. Her convalescence was tedious, and it was a long time before she got rid of the weight and oppression at the cardiac region. 7. The Rev. Mr. Fletcher visited, before dinner, a small hospital for fever cases among the parochial poor. While speaking to a woman, he found himself standing among straw, in which was some feculent matter voided by a fever-patient, The effluvium struck him forcibly-and he immediately felt pain of head and sickness of stomach, with such excessive debility that he was unable to stand, being obliged to support himself against an adjoining gate-post. He had rigor that same evening, and a fever of unusual severity ensued, during three days of which, the pupils were permanently dilated, and he lay in a state of total insensibility. VOL. VIII. No. 15. 9 8. Dr. Crawford (one of our author's fellow-labourers) gives the following account, in his Thesis, of the manner in which he became affected with the fever. "On entering a ward very early in the morning, where lay a woman labouring under the worst description of fever, as I approached the bed, I perceived a disagreeable fetor, and was instantaneously struck with head-ache and nausea. In two days afterwards I was seized with a fever of the same character.'" 461. 9. In a few hours after visiting a bad case of typhus, Dr. James Clarke met Dr. Cleghorn in the street, and observed that he had got a fugh (a word in Scotland meaning a heavy disagreeable smell) at the hospital that day, of which he could not get rid. He dined, however, heartily at Dr. Ferguson's; but not finding himself well in the evening, he took six grains of calomel. Next day he could eat nothing. He now became affected with fever, and died on the eleventh day. "10. Dr. Waring, on visiting a patient labouring under typhus fever, found the room so close that he instantly broke a pane of glass in the window. On his return home, he told Mrs. Waring that he had got a knock on the head, which all the College of Physicians could not cure. Dr. Cleghorn saw him on the next day, when he repeated to him the same words. He had been engaged in lecturing for Dr. Cleghorn during the preceding days; and had very much overworked himself. The fever, thus produced, was fatal." 462. 11. Dr. Parkinson visited a fever patient, residing in a small apartment, destitute of ventilation, and, while standing close to the bed, the patient suddenly sat up. "Having perceived a most disagreeable smell, he observed at the instant that he had caught the infection." He rushed to the window and forced out a pane of glass. Next day he made no complaint, but appeared dull and out of spirits-he was flushed, and yet he said he felt cold. On the succeeding day he had severe head-ache, and in a few days more he died. On the 4th 12. The following was Dr. Marsh's own case. February, he found himself in good health and spirits. On the 5th he took a scanty and hurried breakfast, and the business of the day was laborious and fatiguing. At six in the evening he arrived at the hospital, and visited the fever ward, and, on turning down the bed-clothes of a fever patient, he perceived a highly disagreeable odour, by which he was oppressed and overwhelmed. He hastened home, not feeling very well, and ate a hearty dinner; but felt himself so chilly in the evening, that he could not keep himself warm by all the coats and cloaks he put on. He put his feet in hot water that night, which brought out some perspiration. On the 6th, he was unable to leave his bed. On the 7th, he went out in a carriage, perspiring, yet chilly, with severe head-ache, aggravated by coughing or moving-great depression of spirits, amounting to absolute despair-mental agony-copious secretion of limpid urine-clammy perspirations of disagreeable odour-distressing sensation in the stomach, with occasional vomiting-disagreeable taste in the mouth-tongue still clean-pulse scarcely accelerated—no heat of skin. "To a short period of delirium succeeded idiotic manner and gesture-insensibility-spasmodic contraction of limbs-subsultus tendinum." For several hours his situation appeared hopeless; and during convalescence, so much was the nervous system debilitated, and so great was the exhaustion, that frequent fits, accurately resembling hysteria, occurred, excited by unpleasant thoughts, or some slight mental emotion. Upon return of consciousness in this fever, every object appeared to Dr. M. to be black, and beautifully exact and regular in its outline. A great number of other similar cases are related-many of them happening to medical men themselves; but we think it is unnecessary to adduce additional proofs that a poison is received from the bodies of febrile patients which often produces fever in the visiter. We shall now proceed to Dr. Marsh's observations on "the manner in which the febrile miasm, and other poisons, act primarily on the living body." He remarks that "An opinion is entertained by many, (he might have said by most,) that poisons, to produce their specific effects, must necessarily be first absorbed and mingled with the circulating fluid; and that, subsequently to this process, their peculiar injurious effects are called into action." 475. Dr. M. thinks there are strong reasons to doubt the correctness of this opinion. The effects of poison are sometimes too quickly produced, he imagines, to be compatible with the process of absorption. That an instantaneous and very violent impression may be made on the sentient extremities of the nerves, so as to give a great shock to the constitution, or even induce death, there can be no doubt. A dose of prussic acid may unquestionably destroy life by its action on the nerves of the stomach, independently of any absorption. A powerful mental impression has often obliterated at once all the vital functions; and absorption would scarcely be contended for here, by the most stanch materialist. Dr. Marsh having adduced examples of the rapid manner in which narcotic poisons act on the nerves, and through them on the brain, proceeds to apply the same explanation to the miasmal or febrific poisons. But certainly we think his reasonings are not quite convincing. "From these facts, (those cases and others which have been detailed) it appears, that the poison of contagion produces its effects with the same rapidity as the narcotic poisons, to which we have alluded. Head-ache, debility, sickness at stomach or vomiting, are amongst the symptoms first perceived; these sensations, with the rapidity of an electric shock, are at the instant produced. This injurious impression upon the sentient extremities of the nerves is, in a few rare instances, so violent as to be very speedily fatal. More frequently the impression is less violent, but sufficiently strong to disturb the health, produce unpleasant sensations, and lay the foundation for disease. By far the greater number of patients, labouring under contagious fever, are not at all aware of the circumstances connected with the origin of their complaint; the impression at the time of their exposure being in general either unheeded or forgotten. Indeed the impression is oftentimes so slight, as to lead one to think that contagion does no more than predispose to fever, and determine the nature of the disease, of which exposure to cold, fatigue, or some such accidental circumstance, is the immediately exciting cause; so that there appears much reason to believe that many are so mildly affected, that, were it not for the super-addition of an exciting cause, they would altogether escape fever; hence it happens that numbers, affected with contagious fever, trace the origin of their complaint exclusively to cold, wet, and other exciting causes of disease; the time and circumstances of exposure to contagion having been entirely forgotten. Cases of this kind, which are by far the most numerous, throw but little light upon the origin of fever. It is only by a careful observation of facts of occasional and rare occurrence, such as those recorded in this paper, in which the effects of contagion are well-marked and striking, that we can hope to obtain certain and satisfactory results. In the instances recorded, in which the patients were sensible at the moment of the impression made upon the system by the febrile effluvia, some of the earliest symptoms complained of were head-ache, vertigo, nausea, vomiting, a sensation of coldness, and in many instances a sudden and complete prostration of strength. These primary symptoms did not always continue: in some instances they became less severe, or did in a good measure subside; yet the patient was not thereupon restored to health, on the contrary, a permanent injury was inflicted, and the foundation was laid in the system for a series of phenomena, which, taken together, constitute fever. The symptom, which is generally considered to mark the commencement of a febrile movement in the system, is that commotion of the nervous functions which has been technically termed a rigor; the interval of time between the injurious impression of the human miasm or other cause of fever, and the rigor or chillness ushering in fever, is that which has been denominated the latent period. In some instances the infliction of the injury and the first symptoms of fever are simultaneous; in these cases, a latent period |