der the arch of the pubes,* if it were poffible to make the head emerge from there; or thirdly, should we not bring the convex edges in this manner, we should be obliged, were we to bring them otherwise, to make the face of the child come uppermoft.

The prefentation we have chofen to illuftrate our point, is by far the most frequent of the two mentioned; but Dr. Denman's rules can only be useful in the fecond. Befides, there are other fituations of the head, in which thefe rules would apply with even lefs propriety. I mean, where the ears of the child are turned towards the fides of the pelvis. I have purposely left the examination of two aphorifms, (which in order, should have come before,) until the prefent time, as I can at one and the fame time point out their fallacy, and expofe the imperfection of his rules for the application of the forceps.

Dr. Denman, in aphorifm xvi. p. 16. fays, "The ear of the child that can be felt, will be found toward the offa pubis, or under one of the rami of the ifchia," and in aph. xvii. that "the ears are not turned to the fides of the pelvis, till part of the hind head has emerged under the arch of the offa pubis, when the use of the forceps can very feldom be required."

I have already adverted to Dr. Denman's omiffion of feveral material prefentations of the head, and specified two, deemed important; I fhall again infift on this here, and show that both the above aphorifms are far from practical truth. The two inftances of presentation I noticed fome time fince, as not having a place in Dr. Denman's varieties of natural labour, were, first, when the vertex or pofterior fontanelle is to the pubes, and the anterior fontanelle or bregma is to the facrum; and fecondly, where the bregma is to the pubes and the vertex to the facrum. In these presentations the ears are originally placed toward the

For we are directed to place the left hand blade behind the pubes, and the right hand blade between the child's head and perinæum, confequently in this presentation, the concave edges of the inftruments will be towards the face of the child. Aph. ii. 7.

fides of the pelvis, and the head advances with them in this way, until it arrives at the inferior ftrait; confequently, in neither of these cafes can the ear be felt "under the rami of one of the ischia," and are, therefore, turned toward the fides of the pelvis, before a part of the hind head has emerged from under the arch of the pubes. In labours of this kind, where the forceps may be neceffary, what information for their ufe, can be derived from the aphorifms?

The other aphorifms belonging to this fection are commonplace, but proper always be kept in remembrance; we have, therefore, only noticed thofe we deemed effential. Those of fection III. though subordinate to the second, fourth, and seventh, of section II. are judiciously conceived and well expressed.

I will now dismiss this fubject, which has already far exceeded the bounds I had prefcribed to myself; if, fir, they come within your plan, they are much at your service.

I am, fir, yours refpectfully,

November 13th, 1804.

WILLIAM DEWEES.

Obfervations on Dyfentery. By the late FRANCIS BOWES Sayre, M. D.

T length, my dear Sir, I have found time to attend to your request. It has, indeed, often occurred to my remembrance; but, fince I last had the pleasure of feeing you, the greater part of my leifure hours have been stolen from me in a manner which, though I cannot describe it, appears to have been unavoidable: even now, I cannot fit long enough to arrange and methodize my ideas: you will, I fear, find them "Ruda indigeftaque moles." However, I thought if there was any thing peculiar, you would difcover it, and felect what

was worth remembering, as eafily as if the moft exact method had been preserved.

The fituation of Bordentown is lofty, upon a narrow neck of land, washed on each fide by two confiderable creeks which empty into the Delaware. Along these creeks is a good deal of low ground, great part of which is regularly overflowed by every tide, and pretty generally covered with vegetable productions.

- After a fummer uncommonly dry and hot, the dysentery appeared in Bordentown early in August, during the whole of which month it continued to spread rapidly through the town; about the first of September it began to decline, and ended in the first weeks of October. The difeafe was abfolutely confined within the limits of Bordentown, (except in one instance about two miles diftant, of a young man whose businefs it was to cart wood, and who had frequently been into the town, the whole of September,) and the country every where was uncommonly healthy: not an inftance of cholera; the remittent fever unheard of, and but very few cafes of ordinary fever and ague.

Though the dyfentery attacked indifcriminately all ages and both fexes, it was remarkable that among the fatal cafes, four out of five were boys, from two to fourteen years of age. There were fewer flight cafes than I ever faw among an equal number-almost every one that was feized, had the difeafe, especially on its first appearance, feverely. Great debility of the stomach, weak pulse, great prostration of strength, coldnefs of the extremities, pale, funken countenance, uncommon restlessness, brown tongue, a most diftreffing tenefmus, and, in fome cafes, difficult and painful micturition, were the most preffing and dangerous fymptoms.

From the beginning of the disease, every substance, whether food, drink, or medicine, conftantly aggravated the nausea, and was pretty certainly rejected. This circumftance deprived me of the use of some medicines which have been fre

quently administered with good effect: had there been pain in the epigastric region I fhould have suspected inflammation.

The beginning of the difeafe was not, as is frequently obferved, a disordered state of the bowels; univerfal laffitude, fucceeded by flight rigors and a fever immediately fupervening, marked the attack. The pulfe, from the first was very frequent and very weak, the one seeming infeparably connected with the other: intermiffion and inequality in the pulfations might be discovered early in the difeafe, and were more remarkable in the progrefs of those cafes which terminated fatally. The exacerbations of the fever obferved a tertian type; there being every other day a remarkable increase of all the fymptoms, which, contrasted with the intermediate days, gave to those days a fallacious appearance of amendment.

On the first days, the strength seemed withered as if by a ftroke of lightning, marking the highly feptic nature of the disease: the mind alfo fuffered nearly in the fame degree with the body. It was truly surprising to see the young and vivacious, fuddenly deferted of all their sprightliness and fortitude, given up a prey to the most abject defpondency. It would, perhaps, be difficult to affign a reason why this disease should peculiarly affect the mental faculty; but, in the cafes before us, it could not fail ftriking the fenfes of the most inattentive obferver.

Not only the extremities, but most parts of the body were deficient in natural warmth: the legs and arms especially, were cold from the beginning, and continued fo during almost the whole progrefs of the disease. The skin, when pressed by the finger, fo as to empty the fubjacent veffels, remained white a confiderable time, indicating a languid circulation in the capillaries. Over the whole body, but most remarkable in those parts which were coldeft, was a clouded appearance, very much resembling the paler kinds of marble. I am not clear to which this ought to be referred, whether to the petechia or vibices, or if to either, as it does not exactly answer their description. From this ftate of the minutest veffels, I was induced

to try the effects of warmth, and in fome cafes encouraged a diaphoresis which it was always difficult to induce, and still more fo to preferve for any length of time, owing to the almoft constant neceffity of the patient's rifing. I could not observe that the sweating produced the least abatement of the malignity of the disease: the stools were indeed lefs frequent, but, in the fame proportion, the anxiety increased.

Though the countenance was in every inftance pale, it furprised me to see the little alteration produced upon the eye, which I do not remember to have feen in any other disease. Is it common for the eye, in dysentery, to retain its luftre until within a very few hours of diffolution?

The anxietas præcordiorum was from the earliest stage of the disease an urgent symptom, and afforded the worst presage. The patients complained of intolerable oppreffion—were almoft conftantly in motion, turning from fide to fide of the bed-now attempting to rife up, then falling back, spent with the fatigue of the exertion. No inftance of delirium that was confiderable in fome of the worst cafes there was a picking at the clothes and a motion of the hand as if driving away flies, but the patient, whenever spoken to, was rational.

The tongue was at first whitish with a tinge of the yellow. Two or three days from the commencement of the disease, thetongue, very low down, appeared brown, which gradually extended to the tip, the colour darkening in those parts where it was first discoverable, and fucceffively, until the whole became almost black and abfolutely dry. Aphtha were seen in feveral of the fatal cafes. In those who recovered, deep fiffures, extending through the brown cruft and into the very fubftance of the tongue, rendered it exceedingly fenfible to every irritation, occafioning much distress.

A thin discharge, of not much smell, refembling water in which meat had been washed, appearing very corrofive, ex-, coriating the parts and occafioning violent and almost continual tenefmus, occurred in feveral cafes. This kind of difcharge I constantly found attended the most violent, and, too