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*, Iསྨན།

M. DUPIN, in his Narrative of a Tour through Scotland in 1817, (see last Number, p. 437,) having alluded to a contrivance at Leith for launching vessels, the invention of an ingenious ship-builder,-we are desired to mention, that the principal object of this invention is not to launch vessels, but to bring them out of the water for the purpose of repairs, which is done with expedition, facility, and safety. We hope to lay before our readers a full description of this machinery, with engravings, in an early number.

Days.
Jan. 1819.

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NOTICE.

The Correspondents of the EDINBURGH MAGAZINE AND LITERARY MISCELLANY are respectfully requested to transmit their Communications for the Editors to ARCHIBALD CONSTABLE and COMPANY, Edinburgh, or LONGMAN and COMPANY, London, to whom also orders for the Work should be particularly addressed.

I ;.

1. 1

TERMS, &c.

Jan. 1. New Year's Day.
9. River Tweed opens.
13. Old New Year's Day.
27, Duke of Sussex born.
30. King Charles I. mar.

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It has long been a matter of regret to us, that we have never been put in possession of a regularly connected series of facts illustrative of the internal history of the various hospitals of the empire-particularly of the noble charity that has so essentially contributed to the high character which our school of physic has so long and so justly maintained. The practice and precepts of clinical medicine also, as pursued in British hospitals, have been principally recorded in the fleeting and desultory pages of the student's note-book, or in the medical records of the establishments themselves, which to the public in general are nearly as inaccessible as the memoranda of private individuals. In one of the publications before us, Dr. Duncan, junior, has presented us with a plan, which, in a small compass, appears to us to combine many of the points requisite to be noticed in the documents, the want of which we lament; and notwithstanding the modest quotation from honest old Kirkton, prefixed to his book, "I think, better I had ane imperfect account

1

transmitted, than none at all," we are convinced that a perusal of it will convey to his readers, whether mediof the results of that benevolence and cal or not, a satisfactory view of some skill, which have for nearly a century distinguished the medical practice of the Royal Infirmary of Edinburgh.

The causes which led to Dr Duncan's publication were, first, the parliamentary inquiry which had recently been instituted into the state of fever in the metropolis of England; and secondly, the example set by the hospitals of Dublin, Cork, Glasgow, and London, in the admirable descriptions of the reigning epidemic, which have been communicated to the public by the physicians of these institutions. We shall present to our readers, in the course of our observations, some of the more interesting facts connected with the "Statistics of fever, if we may adopt the expres sion, contained in these communications. The results of the inquiry in parliament, we shall not at present enlarge upon, our views being in no shape directed towards the neglects, or alleged neglects, of any institution; but we shall merely state, that, while some of the hospitals of England, content themselves with giving a meagre annual detail of the numbers of sick that have been admitted or died within their walls, others do not publish even these unsatisfactory notices, and some, from keeping no records, possess not the means of affording any information whatever on the subject.

Independent of the urgent calls which the indigent sick naturally have

upon our humanity, and the satisfaction we enjoy, in a consciousness of having discharged a paramount duty to these unfortunate fellow-creatures, we have a more personal and tangible interest in the institution of public hospitals. This interest divides itself into immediate self-preservation by the removal of the diseased poor from our own doors; and the less urgent, but scarcely less important, precaution of separating them from the general mass of their fellow, citizens in a similar class of society, with whom, either directly or indirectly, we hold communication almost every hour of our lives. Besides these advantages, we look up to public hospitals as affording practical schools for the education of those, to whom we entrust the health and the lives of ourselves and our families, and we view them as a central point from which may emanate all such improvements in medicine, as may have passed the ordeal of impartial trials on numerous individuals, instituted by humane and scientific men ;-a field of experiment which no private practice, however extensive, can afford. All these, but very especially the last, we conceive the public have a right to look for, as a return for the liberal support which they bestow on such establish

ments.

In the reports now before us, Dr. Duncan takes a much wider range than a bare narration of cases; he enters upon the consideration of some very important points of medical po lice; and in doing so, he professes to "have quoted no authorities, and entered into no controversies, but merely to have attempted to give an abstract of what he saw and of what he did ;" and if every clinical physician would but follow this example, and in a simple, condensed, and even popular form, submit to the public the results of his views and his professional exertions, we are convinced that he would, in discharging this act of duty, confer a most important benefit on society. Indeed, we con ceive, that one of the most judicious regulations that could be introduced into the management of all public hospitals, would be to provide not only for a periodical account of the expenditure of their pecuniary funds, but also for a summary view of the results of their medical practice, em

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bracing a general account of the admissions, recoveries, and deaths, with a particular detail of the nature and extent of the principal diseases, especially if epidemic, their modifications by season, situation, sex, profession, and modes of living, the extent and more obvious operation of their contagious qualities, and the respective merits of the different plans of cure adopted, with the comparative success which has attended their a doption at various periods. Nor is this a visionary or Utopian scheme; it has been required from, and executed by, the physicians who attend the fever establishments recently instituted in Dublin; it is followed, as we are informed by Dr Duncan, in all the military hospitals throughout the empire; and since its introduction into them, under the auspices of our distinguished countryman Sir James M'Grigor, we are assured, from the best sources of information, that it has effected more in three short years for the improvement of the army me dical practice, than had been attempted for the preceding quarter of a century, the period from which may be fairly dated, the general introduction of scientific men into military employments in our islands.

Among the numerous advantages which may be derived from such reports, those peculiarly the product of emulation, are by no means the least considerable. To a superficial observer, the palm of superiority might appear due to that hospital within whose walls the fewest deaths occur; but a proper degree of reflection will at once point out to us, that many more circumstances are to be taken into view; and unless a general statement of these accompanies the reports of an hospital, it is quite absurd to think of calculating correctly on its utility to the public. The leading circumstances which strike us as necessary to be attended to, are,

1st, The numbers which receive relief from the establishment. These again are to be considered with a view to determine the mildness or severity of the cases, their acute or their chronic nature. Thus more deaths will happen among cases of a severe contagious fever, than in less serious complaints; and it is equally obvious, that the injuries which occur from the powerful machinery employed in.

large cities, and unhealthy manufac- the subsequent ones should be added turing towns, will be more danger- a faithful statement of every import ous than ordinary accidents among ant change which may have occurrobust inhabitants of country vil- red in their intervals. A com lages. Nor should we omit in our prehensive meteorological register calculations, the more important o- should also accompany the report, not perations of surgery, to which fatal merely containing an account of the effects so frequently succeed. A very number of days which were hot or few such consequences, would at once cold, dry or rainy, with the winds turn the scale of mortality against an which blew at each period, and the hospital which had the highest pre- forms assumed by the clouds; but an tensions to general excellence; for, account, as far as had been observed, as Dr Duncan well observes, 66 a high of the influence of these changes of mortality may depend upon a proper the weather on the number and naselection of dangerous cases, as well. ture of the diseases treated. as upon improper management and unskilful treatment."

2d, The shortness of the period employed for the cure of the patients taken into the establishment; still keeping in view the nature of the cases received, and, above all things, taking care, that while every practicable and salutary indulgence be granted to the actually diseased, neither the lazy, the vicious, nor the chronic incurable, become a burden upon the hospital funds, to the exclusion of the patients, and, in cases of sion of real and urgent sufferers. contagion, their residence also; the cause, or supposed cause, the commencement, crisis, duration, and result of the disease, with notes upon its mode of treatment. It is not our intention to follow him through out the purely medical part of his observations; but we shall present to our readers some of the information elicited by his tables on the important subject of our epidemic fe ver, in which every individual is more or less interested.

The whole number of patients admitted into the clinical wards of the Royal Infirmary, with epidemic fever, during the six months of Dr Duncan's attendance, were 89, viz., 28 males and 28 females in 'winter, and 19 males and 14 feinales in summer; they were of all ages, from 5 to 69; he has not been able to give much information as to their professions, or whether their occupations were se dentary or active, carried on in confined apartinents, or in the open air, whether they were servants in or out of place, or whether married or single; these points, however, should all be ascertained in future tables. Their residences, also, should be distinctly marked, in order, as Dr Duncan well. expresses it, to form a record by which we might trace with certainty

3d, The expence of each patient received into the establishment. This involves a multiplicity of inquiries, and can only be fairly calculated, when the prices of bedding, clothing, food, furniture, medicines, and medical materials, are fully taken into

view...

Lastly, That hospital will evidently be the best, which receives the greatest number of severe cases, and dismisses the greatest number of them cured, with the least expence to the funds of the establishment, and the least liability to become a burden upon them again by relapsing.

In the Royal Infirmary of this city regular journals of the practice have always been kept; but to this species of diurnal detail Dr Duncan strongly recommends the addition of a tabular scheme, into which the leading par ticulars might be entered, so as to present the results of a multitude of insulated cases in one uniforin 'view. The plan which he himself recom mends, is one which embraces the disease, name, age, sex, and profes

A valuable addition to the reports which we so much desire, would be an ample account of the medical topography of the place where the hospital is situated, with a full description of the accommodation for the sick, the nature of the building, and size of its rooms; its means of venti lation and cleanliness; the number and extent of its offices, its kitchens, wash-houses, baths, &c. &c.; and a full account of the diet of the sick, as to quantity and quality, with the average expence per diem for each class. This information might form a principal part of the first report, for the purposes of after reference; and to all

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the commencement and introduction of such diseases, their progress, and their decline, their favourite haunts, if we may use the expression; and furnish the magistracy and police with information by which they may be enabled to take measures to prevent the introduction, or at least to counteract the diffusion of contagious dis

cases."

We were anxious to examine into the causes, or alleged causes, of the fever in these 89 cases, and accordingly we find, that 30 were from contagion, (of whom 5 relapsed, 2 of them twice,) 10. from cold and wet, (one of whom relapsed,) 4 from cold and fatigue; 2 from coldalone; 1 from cold and intemperance; 1 from wet alone; 1 from wet and exhaustion; 2 from heat and fatigue; 1 from fatigue alone; 1 from intemperance alone; 1 from distress; from relapses in their own houses; and 31 from causes unknown; (one of whom relapsed twice.) It is highly probable, however, that several of these causes were frequently combined.

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The average number of days the patients were under treatment in the hospital was 25 for the men, and 27 for the women during the winter quarter, and IS for the men and 21 for the women during the summer; from which it appears, that men were sooner discharged than women, and that both sexes remained a shorter time in hospital in summer than in winter.

of the valuable and carious matter that might be collected from tables such as those suggested, and in part drawn up, by Dr Duncan, if a regular and uniform plan were instituted, and acted upon in all the hospitals in the empire. Neither our lnnits nor our plan allow of our going along with him in his medical observations, nor of examining the cases which are contained in an appendix; and which illustrate the facts stated in the body of the work."

Of the 89 cases 7 died. The comparative mortality of the men in the winter months was 1 in 28; of women during the same period, 1 in 14; of men in the summer months, 1 in 63; of women, 1 in 14. Average in both periods, 1 death in 11 of the men, and 1 in 14 of the women, or 1 in 12 5.7 of both sexes; viz. 1 in 183 in winter, and 1 in 8 in summer.

"This mortality," as Dr Duncan observes," is certainly sufficiently great to show the severity and dan ger of the disease; but the numbers are much too few, and the circumstances of the clinical wards too peculiar to afford a fair average of the rate of mortality." We shall find, however, that the greater mortality among the males than among the females, is ren dered still more obvious, by the result of similar inquiries at Glasgow.

We apprehend, that, from even this sketch, our readers will be convinced

In this appendix, also, are given some valuable dissections, interesting on many accounts, but particularly so as having been performed by that lamented physician," whose warm heart, with all its generous and open vessels, is now compressed into a clod of the valley."To me," says the author, alluding to these documents, "they are particularly interesting, as being the last fruits of my professional intercourse with the late Ur John Gordon, whose zeal and science as a pathological anatomist, qualified him so eminently for the situation he filled in the hospital, and whose private virtues made him most beloved by those who knew him best."

There is every reason to suppose, that it is to the influx of Irish labourers to this country we chiefly owe the present fever, and it is probably from us that it has passed, in various instances, into England. That the disease originally proceeded from po verty, and its concomitants, hunger, cold, and rags, aggravated by filth and intemperance, all pressing on the desponding inhabitants of overcrowded and insufficient lodgings, there can be little doubt. Of its progress, some idea may be formed from the following facts: The Fever Hospital of Dublin, which was opened in 1804, and admitted that year only 422 cases; in 1810, when fever became very general all over Ireland, admitted 1774; and in the year 1817, 5745 patients! The Hardwicke Fever Hospital of the same city, increased, between the years 1813 and 1817, from 1842 patients to 8915!

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In an excellent report on the Fe ver Hospital of Dublin, by Dr Stoker,

• Dr Duncan alludes to one singular case, where the skin of a native of Bengal had become almost entirely white without the agency of obvious disease.

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