Clinical lectures on the contagious typhus epidemic in Glasgow, and the vicinity, during the years 1831 and 1832 / by Richard Millar.

  • Millar, Richard
Date:
1833
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Licence: Public Domain Mark

Credit: Clinical lectures on the contagious typhus epidemic in Glasgow, and the vicinity, during the years 1831 and 1832 / by Richard Millar. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    9S was illustrated at some length in the former, and practical part of the lectures. Did it require farther confirmation, I might quote here in its aid, the authority of the Irish physicians, whose experience in typhus, under all its modes, and combin- ations, has been so frequent, and ample. Thus Dr. Grattan tells us, that, after long, and attentive, observation, he had at last come to the conclusion that in pneumonia joined to typhus, no bleeding should ever exceed eight ounces.* In a sub- sequent report, when instructed by farther trials, he informs us he found it expedient to reduce this quantity, to little more than one-half. Thus, of 316 patients affected with pectoral inflammation, he says, 116 were blooded, but the average measure taken was no more than five ounces and a half. He adds that of 268 head cases, the temporal artery was opened in 98, while the evacuation was only five ounces, which how- ever he found quite sufficient for his purpose.] Now what is the fair, and legitimate, conclusion to be drawn from these premises ? Suppose in place of typhus, had been joined to pneumonia some other equally, or more, violent, phlegmasia, say phrenitis, what would be the nature of this new complication, and how ought it to be treated ? You will no doubt answer, of a nature the most inflammatory, and to be encountered by the most active, and unsparing depletion. But when typhus is joined to pneumonia in place of phreni- tis, what is the quality of the distemper, and the appropriate mode of practice? Your reply will be equally ready, that though there exist sthenia, here, yet in consequence of its union with low fever, it is reduced to an inferior grade, and by no means calling for the copious blood-letting requisite in the other instance, while if venesection be employed at all, it must be on the most reduced and moderate scale—instead of thirty ounces, five ounces, or five ounces and a half, as practised by the experienced Grattan. Now, does not this circum- stance throw as it were a blaze of light on the true nature of typhus, when we find it thus bridling the well known sthenic disDosition of pneumonia, as it will invariably do that of every * Dub. Hosp. Rep. Vol. i. p. 477. f Il«. Vol. iii. p. 408.
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