lately been denominated bronchitis: but though the similarity in many cases is very great, yet it cannot be considered as complete, for those cases which have symptoms nearly allied to pneumonic inflammation, must be regarded as exceptions; nor, indeed, if established, would it clear up all the obscure points in the history of this disease. The existence, however, of extensive inflammation in most severe cases, is a fact established not only by the evidence of symptoms, but by the still stronger testimony of anatomical examination. The information contained in Dr. W.'s work on this subject, is highly important, as it places this fact in the strongest point of view, and affords most decisive evidence of the importance of the early employment of curative means, and of the urgent necessity of carrying them frequently to the greatest extent which the powers of the system will bear. The following may be taken as a fair specimen of the reports on this subject, which we are induced to transcribe for the satisfaction of our professional readers. The subject was a daughter of the Author's, four years and a half old.

The lungs were found of a purple colour, irregularly interspersed with whitish spots slightly elevated, which were found to be owing to a mixture of air and mucus under the pleura. There were no adhe sions between the pleuræ, but the lungs had not collapsed nearly so much as usual. On the convex surface of the right lung, a very small quantity of tough purulent looking matter was observed, which seemed to have escaped by one or two small openings in the pleura, whether the consequence of rupture or erosion could not be determined. Similar matter was found interspersed through the substance of the lungs, but there was no where any cyst containing it. The Jungs felt knotty, and uncommonly firm in some parts, but on cutting into them no tubercles, such as are met with in phthisis, could be detected. In some places, though their bulk was increased, they were firm, and sunk in water; in others they sunk from being collapsed, though not indurated. The pleura cortalis seemed rather more vascular than common. The trachea was slightly inflamed on its internal surface, and covered with a quantity of frothy mucus, intermixed with a small portion of purulent-like matter, which increased in quantity downwards, till it nearly plugged up the smaller ramifications.'— P. 131.

In this case the disease appears to have passed through its whole course, until the lungs were no longer capable of performing their office, and the immediate cause of death was, probably, the entire deprivation of the influence of the respiratory function on the blood in its circulation through the lungs. The evidence which it affords, however, of the presence of the most extensive and destructive inflammatory process in these vital organs, is complete and satisfactory; and it is morally certain that nothing but the most active and judicious application of appropriate treatment, at a very early period of the disease, could arrest the

course of this disorganizing process. It is important to remark, that this was a case in which, from the period at which it assumed a threatening aspect, the pulse was so quick as to make it extremely difficult to ascertain its frequency; we must, however, refer our readers for the history of the case to the work itself. That portion of it which embraces the histories and dissections, will be studied with interest and advantage by all who seek to obtain practical deductions from a careful comparison of symptoms with morbid appearances; and it is, in our opinion, a most valuable part of the work.

It strikes us as somewhat remarkable, however, that Dr. Watt, with these cases and dissections before him, could allow himself to be so far led astray from the legitimate objects of sober inquiry, as to indulge himself in offering hypothetical speculations on such a subject as this. His more formal statement of his views of the disease we shall notice presently; but we are induced to advert to his theoretical observations, not because we admire their ingenuity or acknowledge their force, but because we should be glad to see every thing of the kind banished from works on medical science.

Is it not possible, then, (Dr. W. asks,) that there may be some eruptive disease of this membrane of the air cells and bronchie, so minute, indeed, as to escape ordinary observation, but so considerable as to excite that inflammation which is, apparently, the principal part of the disease?'

This notion he remarks,

-clearly explains why the inflammation which always accompanies this disease of the bronchria and air cells, may be mitigated or nearly subdued, but that it cannot be thoroughly removed till the eruption, on which it depends, has run its course.'

Speculations of this kind carry no conviction to the understanding, and if they were permitted to influence our practice, their tendency would be to lead us into error. In the example now under consideration, the theory seems to us to be singularly unfortunate, for the exanthemata are remarkable for the steadiness and regularity of their course, and are in this respect more conformable to general laws than almost any other class of diseases, while the Chincough is, perhaps, more remarkable for the uncertainty of its progress and duration, than any other acute disease. We must, however, do Dr. W. the justice to remark, that this is not an error into which he is prone to fall; and, in general, his observations are those of a reflecting mind which is sincere and unbiassed in its pursuit of truth. The following are the general conclusions which Dr. W. regards as established by the histories and dissections with which his own opportunities have supplied him, as well as those which are scantily supplied

by other authors, or have been collected from the different medical journals.

It seems pretty clearly proved, that Chincough is in all cases an inflammatory disease, and that its chief seat is in the mucous membrane of the larynx, trachæa, bronchiæ, and air cells.

When it is mild, it may run its course and cease spontaneously, without disturbing very materially the other functions of the body, or even the functions of that very membrane where it is seated.

In some cases, the inflammation, in its acute stage, is so severe and extensive in the mucous membrane, as to obstruct, if not wholly to prevent, the objects of respiration. Such patients generally die convulsed.

In other instances the inflammation proceeds to a more advanced stage, producing such a profuse and altered secretion of mucus, as to plug up the air cells and bronchiæ, and thus prove fatal by preventing

the access of air.

Sometimes the inflammation, leaving the mucous membrane, extends to the deeper seated parts, and proves fatal in the form of ordinary pneumonia.

In other instances the pneumonic inflammation runs on to suppuration, and abscesses are found in different parts of the substance of the lungs.

Sometimes the inflammation leaving the mucous membrane, and extending to the deeper seated parts, excites tubercles, and the patient dies, with all the symptoms of pulmonary consumption.

There may be other ways in which the disease terminates, but these at least seem to be ascertained from the dissections given. On the whole, I am disposed to conclude that whenever Chincough proves either dangerous or fatal, it is by the degree of inflammation in the natural seat of the discase, or by that inflammation extending, or being translated to other parts. p. 192.

These deductions, we believe, will be found to contain a pretty correct summary of our knowledge of Chincough. Whether the disease is in every instance an inflammatory affection, is a question on which we are not prepared to give a decisive opinion; but as it is a circumstance of great importance with regard to the treatment, we must recommend it to the observation of those who have leisure and opportunity for the inquiry. Our limits do not permit us to follow Dr. W. through those pages which he has devoted to the consideration of the remedies which have been employed in Chincough, nor does the subject require it. Much novelty cannot be expected on such a subject; but those who may be induced to consult the work, will find what is more valuable, a great deal of judicious practical information and candid remark. We are, however, inclined to suspect, that he has in some instances rather over-rated the value of some of the less active remedies which have been employed in this disease. To his general views of the treatment we most

willingly give our cordial approbation, and the junior members of the profession will, we are convinced, receive much valuable instruction from an attentive perusal of this part of the work. His observations on the employment of bleeding, of purgatives, and emetics, are, in our judgement, excellent, and are the result of diligent and accurate observation; while, on the less prominent points of treatment, he has presented his reader with much minute and detailed information, as well original, as collected from other sources.

The Appendix to this work contains the results of an inquiry into the relative mortality of the different diseases of children, and into the numbers that have died under ten years of age, in Glasgow, during the last thirty years. The existence of a very high degree of mortality in the early period of human existence, is one of those mournful facts, which had been long established on the most unquestionable evidence; but as much of that mortality was known to be connected with the universal diffusion of small-pox, the introduction of the great discovery of vaccination, (the greatest blessing ever conferred by human agency on the human race,) had created a natural and confident expectation, that the destinies of our species would experience, in this respect, an almost incalculable melioration. We regret to state, that this cheering hope appears, from the documents collected and arranged by Dr. Watt, to have been hitherto most severely disappointed. The small-pox has indeed become comparatively extinct as a source of mortality; and we may be allowed to hope, that it will, at no remote period, be utterly annihilated; but the measles have, in the meantime, that is, since the introduction of vaccination, become infinitely more fatal than at any former period. The Glasgow tables, which Dr. W. has taken the pains to collect, embrace a period of thirty years, from 1783 to 1812. Dividing this period into five portions, of six years each, the mortality of small-pox is found to have borne the proportion of 19.55 per cent. to the whole number of deaths in the first, and of only 3.90 in the last of these periods. A most important diminution certainly, and demonstrably occasioned by the establishment of vaccination. The measles, however, the deaths by which, in the first of these periods, was so low as .93 per cent. and which in the fourth amounted only to 3.92; in the last period of six years, rose so high as 10.76 per cent. a ratio of increase which, to whatever cause it is to be referred, is not a little extraordinary. We did hope, when we first became acquainted with this statement, that it might have been connected with local and temporary circumstances; and, that however indisputable the fact might be, it would have no direct bearing on the great advantages to be expected from the universal adoption of vaccination. An examination, however, of the London Bills

of Mortality, by Sir Gilbert Blane, published in the 4th volume of the Medico-chirurgical Transactions, compels us to hesitate. The results obtained by this candid and philosophical physician, from that in the Metropolis also, during the period which has elapsed since the introduction of vaccination, has been marked by a great increase in the mortality from measles. If we divide the London Bills for the thirty years (commencing with 1783, and terminating with 1812) into three periods, the total amount of deaths from small-pox, for each period, will be 17037—18189— and 11532; a diminution of mortality, from this source, much less than that of Glasgow; but vaccination has not been so generally practised in London as in Glasgow. The increased mortality of measles, however, in these periods, is considerable, being, for each period of ten years, 2415-2796—and 5747; the mortality in the last ten years being more than double that of either of the preceding periods. And if we advert to the mortality by measles for particular years, it is found to have exceeded 400 only in seven instances during the last century, while it has exceeded that number in eight of the last ten years comprehended in the examination of Sir Gilbert Blane.

We are aware, that to appreciate accurately the value of these statements, it would be necessary to examine them with reference to the population, which is known to have greatly increased within these periods; but into this investigation we are not called upon to enter, nor would our limits permit us to do so, merely to give a little more perspicuity to the general statement which it is our object to make. The fact itself appears to be clearly established, and the painful conclusion is forced upon us, that the sum of human mortality has not yet been diminished in the degree which might have been calculated upon, from the great discovery of our own times. We are, however, by no means prepared to agree with Dr. Watt in his conclusion, that the increased mortality of measles is a direct consequence of that degree of extermination of small-pox, which has been already effected; and that an effect must have been produced on the constitution by the latter disease, favourable to its power of resisting the destructive tendency of measles, or other maladies. We regard this conclusion as hasty and premature; and we notice, with peculiar satisfaction, the fact which Sir G. Blane has given in a note, on the authority of Dr. Stanger, physician to the Foundling Hospital, that of 131 children in that establishment, who had been vaccinated before they had the measles, two only had died; and that of an equal number who had gone through the small-pox before they had the measles, eleven had died.

This evidence is conclusive, as far as it goes. Dr. Watt has certainly laid open a curious and interesting subject of inquiry,