A Differtation on the Inflammatory, Gangrenous, and Putrid Sore Throat; alfo on the Putrid Fever, together with their Diagnof tics and Method of Cure. By T. Penrofe, Surgeon., 8vo.' IS. Owen. A S there is nothing of greater importance in the art of healing, than a perfect knowledge of thofe figns, termed diagnoftic, by which any one difeafe is diftinguished from all others, every attempt to elucidate this branch of medicine deserves attention. It may poffibly be fuppofed, after what hath been already written upon fore throats by Huxham and Fothergill, that nothing farther is wanted to enable every perfon employed in curing those diseases, to treat their patients with propriety and fuccefs. Nevertheless it will be in our power, from this pamphlet, to extract feveral obfervations, founded on experience, which may probably be of advantage to many of our medical readers. Sore throats have hitherto been generally divided into inflammatory and gangrenous, or putrid. Thefe, viz. gangrenous and putrid, our Author confiders as two diftinct. fpecies, attended with very different fymptoms, and requiring different treatment. He firft confiders the inflammatory fore throat, and then proceeds to the gangrenous; but there being nothing new either in the defcription or method of treatment of thefe diforders, we fhall turn to page 15, where the Author begins his obfervations on that fpecies of fore throat which frequently attends putrid fevers, and which, though often mistaken for the gangrenous, is found nevertheless to differ from it, in being fymptomatic, not infectious, very common, and rarely appearing in the beginning of the diforder; whereas in the gangrenous, the uvula and tonfils are affected from the first. The gangrenous fore throat frequently destroys the patient in a few days; but the putrid fometimes continues above a month, and proves fatal at laft. Thefe fymptoms, the Author thinks, will fufficiently diftinguish these two fpecies from each other; but as there may be fome danger, in the beginning, of confounding a putrid fever with an inflammatory, he gives us, chiefly from his own obfervation, the following defcription of the former: The perfon, when first feized, often mopes about the first two or three days, with little complaints, perhaps little chills, often fucceeded by alternate heats, liftleffnefs, pain of the head, &c.—and tho' these are also symptoms which generally attend the beginning of an inflammatory fever, yet there is commonly this difference, that in the inflammatory cafe they come on moftly at once, and with great violence, whereas in the putrid one they increase by flow degrees, unless the diforder is uncommonly fevere. In the beginning of a putrid fever the urine is of a natural colour, and and if left to ftand twelve hours, depofites a mealy or woolly fediment; fometimes quite pale and clear, at other times, though not often, of fo dark a colour as if blood was mixed with it, but then it generally lets fall a fediment after ftanding. Whenever I am called in at the beginning of a fever, if I find a fediment in the urine, I obferve it to be of a bad kind, and generally of long ftanding, more particularly if it is of a natural colour.' This laft fentence is unintelligible. As in an inflammatory cafe we do not find the crifis to take place till. the urine begins to be cloudy and to depofite a sediment, fo in the putrid one there is feldom or ever an alteration for the better till the urine becomes clear; and if it had been pale, of an higher colour. The blood, if drawn away at this time, is of a loose texture, though fometimes never feparating any ferum. The pulfe, at the beginning, differing but little from that of a perfon in health, though for the most part quick and small. The tongue generally furred a great deal, often black and dry; very often, after the fever has continued fome days, this fur comes off in a flough and leaves the tongue quite red, in appearance as if the skin had been pulled off, but foon gets again dry and rough, and upon putting your finger upon it feels like a grater. The breath full and hot. After fome days continuance of the fever they often complain of a diforder in their throat, as a heat and burning, with fome difficulty of fwallowing; but this laft fymptom is not near fo troublefome and violent as what we often meet with in an inflammatory cafe. On examining the mouth and throat, we often find the uvula, tonfils, &c. covered with ciniritious or white efchars, having the fame appearance with those of any fleshy part that has been lately burnt; at other times covered over with white fpots, or aptha.' After mentioning the different methods of treatment required in the inflammatory and putrid fevers, our Author proceeds to the recommendation of antimonials as a specific in the cure of the latter; but of all the various preparations of antimony, he recommends the vitrum antimonii ceratum as the most efficacious, and particularly ferviceable in abating the diarrhoea which often attends putrid fevers. He begins with two grains, joined with cordials and alexipharmics, every fix hours, increafing the dose to ten or twelve grains, or till it makes the patient fick, With regard to the bark, he affures us from repeated experience, that he always found it aggravate the fymptoms if given before the decline of the diforder. He then relates a few cafes in confirmation of his doctrine, and concludes his pamphlet with the three following aphorifms: 1. Where a patient, being of a fanguine habit, is feized with the fymptoms of an inflammatory fever, with great pain and difficulty in fwallowing, continually increafing, even so as to threaten fuffocation, the tenfils, uvula, &c. appearing red, tense and and smooth, the furrounding parts being alfo inflamed, the pulse trong, the fpirits high, the urine high-coloured and crude; there can be no great danger in declaring it to be of the inflam matory kind, and to be treated accordingly. 2. Where the patient is attacked with a great fwelling, which on its first appearance, is lax and uneven, with a stiffness and emphysematous fwelling in the neck, together with an efflorefcence on the fhoulders, extending down the arms; when in a little time the fwelling of the tonfils, &c. fubfides, and alters to a white, or ash-colour, with a quick small pulfe, dejection of spirits, and anxiety, this fore throat may be declared to be of the gangrenous kind, and requires warm, aromatic fomentations, vapours, cataplafms, and inwardly bark, cordial and alexipharmic medicines, abftaining from all evacuations, even from blifters. 3. When the patient has laboured under a putrid fever for fome days, with a small and quick pulfe, his urine loaded with a great fediment, and generally of a natural colour, complains of a fore throat, tho' feldom with very great difficulty in swallowing, the tonfils, uvula, &c. covered with white ciniritious or afh-coloured floughs, aptha or white blifters, affecting not only the parts of the throat, but also the whole mouth; we may then declare it to be a putrid fore throat, and muft abftain from evacuations of all forts, and likewife from preparations of the bark, till the putrefcence of the juices is abated, after which it is often found to be of great use in recovering the patient. The medicines to be given must be alexipharmics and cordials, together with antimonials, which feem to be fpecifics in this diforder. We have been the more particular in our account of this pamphlet, because the subject is really important, and because, notwithstanding a few inaccuracies in point of ftile, it contains fome new and ufeful, practical obfervations and hints, which some of our medical readers may poffibly improve to the advantage of those who may labour under thefe dangerous diforders. Travels through France and Italy; containing Obfervations on Character, Cuftoms, Religion, Government, Police, Commerce, Arts and Antiquities, with a particular Defcription of the Town, Territory and Climate of Nice: To which is added, a Register of the Weather, kept during a Refidence of eighteen Months in that City. By T. Smollett, M. D. 8vo. 2 Vols. 10s. Baldwin. RAVELS, more than any other fpecies of writing, feem calculated to afford both inftruction and entertainment; and yet nothing can be more infipid, tedious, and uninteresting interefting than the remarks of the generality of travellers. The English are beyond all doubt the greateft travellers in the world; for in all places on the continent, which are frequented by ftrangers, we find the number of Englishmen greatly to ex ceed that of all other nations taken together. Hence it were natural to expect a conftant inundation of written travels, especially through France and Italy. Nevertheless we have but few books of this kind, in proportion to the number of travellers; and among thefe few books, very inconfiderable is the number of those which are worth reading. The reafon is plain our travellers are in general young men of fortune, and are led by their tutors; and both of them, from the youth of one and the narrow education of the other, are as incapable of observation as if they were conducted through France and Italy blindfold. For want of that knowlege, fteadiness, fagacity, and penetration, which can be only founded on study, and ripened by experience, they traverse the continent in a continued mift, gaping, ftaring, blundering along, and viewing every object in a false light. This however is by no means the cafe of the Author now before us. He hath not travelled without a previous acquaintance with mankind; and his abilities, as a writer, are univerfally known. Dr. Smollett's travels appear in the form of letters from different parts of the continent, written, or fuppofed to be written, to his friends in England. The Doctor's motives for undertaking this journey we learn from his firft epiftle, which is dated Boulogne fur Mer, June 23, 1763. You knew (fays he) and pitied my fituation, traduced by malice, perfecuted by faction, abandoned by falfe patrons, and overwhelmed by the sense of a domestic calamity, which it was not in the power of fortune to repair. You know with what eagerness I fled from my country as a scene of illiberal difpute and incredible infatuation, where a few worthlefs incendiaries had, by dint of perfidious calumnies and atrocious abuse, kindled up a flame which threatened all the horrors of civil diffenfion. My wife earneftly begged I would convey her from a country where every object ferved to nourish her grief: I was in hopes that a fucceffion of new scenes would engage her attention, and gradually call off her mind from a series of painful reflections; and I imagined the change of air, and a journey of near a thoufand miles, would have a happy effect upon my own conflitution.' Prompted by thefe confiderations, the Doctor, his lady, two young ladies and a fervant, embark at Dover for Boulogne, where, after a rough paffage of eight or nine hours, they arrive early in the morning. Having been impofed on by the fkipper, the Doctor, for the benefit of future travellers, writes thus: When a man hires a packet-boat from Dover to Boulogne, let him remember that that the ftated price is five guineas; and let him infift upon being carried into the harbour in the ship, without paying the leaft regard to the reprefentations of the mafter, who is generally a little dirty knave.' After remaining three days in a bad inn at Boulogne, our travellers removed into private lodgings in the fame place, paying at the rate of three guineas per month for very good accommodations in a house tolerably furnished. Letter II. contains little more than the Doctor's lamentation for the detention of his books, which being stopped at the bureau, were tranfmitted to Amiens to be examined by the chambre Syndicale. This (fays he) is a species of oppreffion which one would not expect to meet with in France, which piques itself on its politeness and hofpitality: but the truth is, I know no country in which ftrangers are worse treated with respect to their effential concerns. If a foreigner dies in France, the king feizes all his effects, even though his heir fhould be upon the fpot; and this tyranny is called the droit d'aubaine.' As to the detention of his books, we imagine it was owing to fome want of management; for we know, from experience, that a trifle of money to the officer will in France, as in moft other places, prevent any examination at all. And as to the droit d'aubaine, it is confidered as a mere ceremony; for the effects of an Englifhman, upon application to the ambassador, are immediately restored. Letter III. dated Boulogne, Aug. 15, begins with an account of an extraordinary experiment tried by the Doctor upon himfelf. Having caught cold a few days after his arrival, he was feized with a violent cough, attended with a fever and ftitches. in his breast, which tormented him inceffantly all night. He had at the fame time a great difcharge by expectoration, with much dejection of fpirits. Knowing there was no impofthume in his lungs, fuppofing the ftitches fpafmodical, and being fenfible that all his complaints were originally derived from relaxation, he plunged into the fea without hesitation. What was the confequence? Death? No. He got a fresh cold in his head; but his ftitches and fever vanifhed. Notwithstanding the effect of this remedy in the prefent cafe, we cannot help being of opinion that the Doctor ran fome rifk in the experiment; nor do we conceive from what theory, concerning the effect of cold-bathing, he supposed this experiment indicated.-In this letter he begins his defcription of Boulogne. Letter IV. Speaking of the climate of Boulogne, he obferves, that in the preceding winter the froft was more fevere, and of longer duration than in England, which he accounts for by the air being impregnated with faline particles in its paffage over the fea; for (fays he) a very great degree of cold is required to freeze falt water. Indeed it will not freeze at all until it has depofited 8 |