contagious. Yet I have not known or supposed it to be communicable. Its nature in this respect, might be easily ascertained by inoculation. It sometimes affects children debilitated by other diseases, during their progress, or after their termination. In such cases, I think I have found the ulcers to be more obstinate than in otherwise healthy subjects; at any rate, they form a very unfavourable prognosis with respect to the termination of the original disease. Several cases which supervened upon or immediately followed measles, have resulted fatally, within the last year, in the Alms House, (as I am informed.) I was lately called to a child in the lower part of the city, in an advanced stage of the measles, in which the sore mouth was making its appearance. The ulcers were distinctly marked, and though their character was changed, and their progress arrested, by the usual application, yet the child sunk under the original disease. Besides this case, I have seen two others in this city, which originated in private families. The first of these was brought into the Alms House, and recovered; the other, occurred in Augustus-Street, and was carried to the City Hospital, where I saw it in an advanced stage. This case I was told, terminated fatally. From these cases, and some others which have been mentioned to me, I should infer, that this disease must have been occasionally met with by most physicians, who have been for any considerable time extensively engaged in practice, in this city, especially by those who have been much in attendance on the poor. A medical friend writes to me from Philadelphia, that on inquiring of the physicians of the Alms House in that place, he could not learn that any such disease had been noticed there.

In Dr. Underwood's Treatise on the Diseases of Children, under the title of "a gangrenous erosion of the cheeks," he gives a very general account of a disease, which, in its advanced stages and termination, if it is not the same, bears a strong analogy to the one under conside

ration. He states it to be of rare occurrence, and the description he gives, clearly evinces that he had not carefully observed its early stages.

"If neglected, or improperly treated," he observes, "the whole side of the face is often eaten away, together with the lip, so that the bare jaw-bone and inside of the mouth appear. In the end, the entire jaw-bone falls down on the breast, and the whole side of the face is dissolved in a putrid mass."

On this subject, Dr. U. refers to "a Treatise on Dentition, by Dr. Hurlock," printed in 1747, and a "Tract on the diseases of Lying-in Women, by Dr. Dean of Dublin," neither of which works have I been able to find.

On the subject of the treatment of this disease, I shall content myself with simply stating the method which I have universally pursued with very satisfactory success. What I consider by far the most important and indispensable part of duty, is the free application of undiluted nitric acid, to all the ulcerated surface. This remedy was introduced by Dr. Gilbert Smith, formerly attending physician of the Alms House; and its happy effects in controlling, and rendering mild this otherwise dreadful and unmanageable disease, must ever be to him a source of the most pleasing reflection.

Previous to the application of the acid, if any of the teeth have become much loosened, they were taken out, and then, by means of a small piece of sponge, fastened to a wooden probe; every past of the ulcerated surface was carefully touched with the acid. A solution of the sulphate of copper, six or eight grains to the ounce, was given to the nurse, with directions to wash the ulcers three or four times a day. In order to remove any sources of irritation which might exist in the stomach and bowels, an emetic and cathartic were usually prescribed on the first day of the treatment; these were often combined, so as to make one dose answer both indications. The application of the

acid was repeated daily, and the vitriolic solution continued as above, until the peculiar appearance and fœtor of the ulcers were entirely removed; this often happened in the course of the first twenty-four hours, and without a repetition of the acid; but only in such cases as had existed but a short time, and made little progress when the treatment was commenced.

In good habits, and when commenced early in the disease, before the constitution had become much affected, the treatment above described usually arrested the course of the disease without difficulty, and effected a speedy cure. In a very large proportion of the cases which I treated, no other remedies were found necessary.

But when the ulceration has so far progressed as to give rise to much constitutional disorder, manifested by fever of a typhoid character, loss of appetite, diarrhoea, or much general debility; or when it arises in depraved and weakly habits, or those reduced by other diseases; other remedies are required.

Under these circumstances, it becomes necessary to use such means as will support and invigorate the system; and as much as possible allay the irritation under which it suffers. In this state of the disease, analogy would lead us to the use of the various stimulant, tonic, and antisceptic remedies.

As I have treated few cases in which it became necessary to resort to any other remedies than the local applications and evacuants above described; I can say but little from my own observation, with respect to the effects of this latter class of remedies in this disease. I have, in different instances, made use of wine, bark, yeast, and the nitric acid, and, I think, with all the benefit that underthe existing circumstance could have been expected.

The ulcers have in a few instances retained their specific character, under the daily application of the acid and the solution of Sulph: Cupri. for considerable time without

making any perceptible progress, or producing much, if any constitutional derangement. In one case, an ulcer in the cheek continued stationary for two or three weeks, and the patient became feeble and emaciated, notwithstanding the diligent use of the usual remedies; when on extracting two of the molar teeth, with which it had been continually in contact, the ulcer immediately healed, and the child soon recovered a perfect state of health. When this peculiar obstinacy arises from any local obstacles of this kind, the remedy is obvious; when it proceeds from a feeble constitution or depraved habit, the peculiar circumstances of the case must point out the method most proper to be pursued.

REVIEW.

Elements of Medical Logic, illustrated by practical Proofs and Examples; including a Statement of the evidence respecting the Contagious Nature of the Yellow Fever. By Gilbert Blane, Bart. F.R.S. London, 8vo. p. 219.

1819.

ALTHOUGH it may be seriously questioned, whether the practice of dedicating books to those distinguished for their learning, does not, in general, spring more from the desire of recommending one's own production to the public, than from the disposition to bestow an expression of praise or gratitude on those who merit it; yet, in the present instance, we think Sir Gilbert Blane has very properly inscribed his "Elements of Medical Logic" to Sir Walter Farquhar and Dugald Stewart, inasmuch as these gentlemen, and the latter especially, have long stood pre-eminent for their scientific and logical attainments.

The introduction to this volume is replete with judicious reflections. As medicine has for its object the preservation and restoration of health, the author considers it as coming under the definition of an art, a term he says, the import of which consists in the adaptation of means to ends; and he thinks that the faculty by which this is accomplished, forms the best criterion for distinguishing rational beings from brutes.

He replies, by unanswerable arguments, to those persons of a sceptical turn of mind, who allege, that the powers and resources of nature, in the human, as in the brute creation, are all sufficient; that we do not possess such a power over the agencies of nature, nor such a knowledge of their ap