REVIEW III.

1. Handbuch der Historisch-Geographischen Pathologie. Bearbeitet von Dr. AUGUST HIRSCH, in Danzig. Erste Abtheilung: Acute Infectionskrankheiten.-Erlangen, 1859. 8vo, pp. 300. Manual of the Geographical History of Disease.

By Dr. AUGUST HIRSCH, of Dantzic. First Part: Acute Infectious Diseases.Erlangen, 1859. 8vo, pp. 300.

2. On the Influence of Variations of Electric Tension as the Remote Cause of Epidemic and other Diseases. By WILLIAM CRAIG, Consulting Surgeon to the Ayr Fever Hospital.-London, 1859. 8vo, Pp. 436.

3. Report on the Nervous System in Febrile Diseases and the Classification of Fevers by the Nervous System. By HENRY FRASER CAMPBELL, A.M., M.D., Professor of Anatomy in the Medical College of Georgia, U.S.-Philadelphia, 1858. pp. 172.

THE increased attention which of late years has been bestowed upon everything which bears upon the causes of epidemic and contagious diseases, the circumstances under which they originate, and the means by which they may be prevented, demand from us a notice of the works now before us. The first on the list is truly a great undertaking, and displays an extraordinary amount of labour and research. The present volume constitutes the first of three parts into which the work is to be divided; the other two, which have not yet appeared, being destined to treat of chronic constitutional diseases and diseases of the individual organs. This first part is dedicated to the Epidemiological Society of London, in acknowledgment of their labours for the promotion of public hygiene; and if this society wrought no other good than the stimulation to labour of such men as Hirsch, its existence would be amply justified.

The diseases treated of are the following, in the order here given: 1, Malarious Fevers; 2, Yellow Fever; 3, Cholera; 4, Typhus Fevers; 5, Furuncular Plague; 6, Small-pox; 7, Measles; 8, Scarlet Fever; 9, Erysipelas; 10, Sweating Sickness; 11, Dengue; and 12, Influenza. In studying the geographical distribution of each of these diseases, the author has referred to almost every memoir and document bearing upon the subject. Copious references are given to the works of every author quoted, and this circumstance of itself greatly enhances the value of the work. We propose to make a few brief observations under the head of each of the above diseases.

I. Malarious Fevers.-The relative prevalence of these affections in every quarter of the globe is considered, as also their varying prevalence at different periods of time. The author then goes on to show that no race or nationality enjoys an immunity from malarious fevers, but that the natives of malarious countries are the subjects of these diseases less frequently and in a milder degree than strangers. The influence of season of the year, atmospheric moisture and temperature,

the winds, the elevation of the country, the geological and mineralogical characters of the soil, and terrestrial moisture upon the production of malarious fevers, are severally considered. The article on these diseases concludes with several arguments in opposition to the view that malaria are the product of decomposition of vegetable matter. These are classified under three heads:

1. Several instances are mentioned of moist swamps, in countries presenting all the climatic and terrestrial characters of other regions where malarious fevers abound, and yet which are exempt, or almost so, from these diseases. Such are several localities in Peru, the Pampas of Rio de la Plata, many places in the delta of the Mississippi, and Negapatam in the Presidency of Madras.

2. In countries where malarious fevers are endemic, their prevalence varies greatly in different years without any variation in the causes which favour the evaporation from marshes; and their prevalence has also been observed to differ greatly in adjoining districts in the same year, without any difference in the causes assigned.

3. There are instances of malarious fevers breaking out in countries where formerly they had been unknown, without any apparent change in the physical characters of these countries.

The author does not deny that external agencies may exercise a strong influence over the production of malarious fevers, but he thinks many observations are still wanting before the true essence of the disease is discovered. It is not a little curious to notice that he does not make use of the argument against the production of malaria from vegetable decomposition, which in this country is most frequently resorted to-viz., that malarious fevers may be met with quite independent of either moisture or vegetation. It is much to be doubted if either this or the author's arguments will stand the test of a severe critical examination; but space will not allow us here to enter into the question.

II. Yellow Fever prevails in three different regions of the globe: America, Spain, and the West Coast of Africa. Elaborate tables are given by the author, showing the dates and localities of all the great American epidemics. As regards the susceptibility to yellow fever among non-acclimatized individuals, it is found that this is greater in proportion to the distance from the equator of the place of their nativity and previous residence, and less in proportion to their length of sojourn in the yellow fever zone. No length of residence, however, will confer complete immunity; but it seems an established fact that negroes, and even Europeans who have the slightest admixture of black blood, are much less prone to be affected than whites. The influence of season of the year, atmospheric temperature, moisture, and electricity, and the physical characters of the soil upon the production of yellow fever, are dwelt upon at considerable length, and then follow some observations on the relations which are supposed to exist between yellow fever and the bilious remittent malarious fevers. The arguments which have been urged in support of the view that these two are merely modifications of one disease, and gradually pass into one

another, are combated; and the conclusion is arrived at that the two affections are as distinct as yellow fever is from typhus.

III. Indian Cholera.-Under the head of this disease we have an elaborate history of its origin and progress, and the effects of the various atmospheric and terrestrial agencies upon its prevalence are carefully considered. Numerous authorities are quoted to prove the intimate connexion between moisture and the spread of cholera-as shown by the fact, that in towns it has very generally been observed to be most prevalent in those localities which border upon the seashore, or on the banks of rivers and canals. This is a circumstance which is also strongly insisted upon by Mr. Craig, in the second of the works upon our list, as confirmatory of his views, to be presently alluded to.

IV. Typhus Fevers are treated of under five different heads— Simple Typhus, Typhoid Fever, Sinking Typhus, Recurrent or Relapsing Typhus, and Bilious Typhoid. These several affections, however, the author regards as varieties or modifications of one diseased process rather than as distinct species.

By Simple Typhus is meant the true typhus, as characterized by the presence of the measly eruption. In tracing the history and geographical distribution of this disease, the author has omitted to mention that the first epidemics, upon the accounts of which we can place any reliance, occurred in Italy at the commencement of the sixteenth century, and were most accurately described by that celebrated physician, Fracastorius of Verona. The author also has been a little too hasty in stating that true typhus is met with in the East Indies. The statement rests solely on the observation of two cases at Simlah by Dr. Allan Webb, the author of the 'Pathologica Indica;' but in these cases we have no evidence that the eruption noticed was anything more than petechiæ, which are far from uncommon in the ordinary low remittent fevers of the tropics, which fevers, by the way, sometimes assume a general character very similar to that of typhus. It is true that we frequently hear of "typhus" occurring in India; but the term has too often been applied without any reference to its real nosological meaning. Dr. Morehead, in his recent work 'On the Diseases of India,' maintains that typhus is unknown in that country; and this, too, has been the result of our own observation, and of a correspondence with other medical officers in the Indian service, who are acquainted with the distinctions between the different species of continued fevers, as seen in this country. Indeed, as far as our knowledge at present extends, true typhus in Europe appears to be confined within the limits of 40° and 60° north latitude; and in the New World between those of 32° and 50° north latitude; and to exist in no place where the mean annual temperature rises above 62° Fah., or falls below 40°.

With regard to the so-called typhoid fever-that which is accompanied by disease of Peyer's glands-its distribution is not so limited, or rather, it is less limited in the direction of the equator, though probably more limited towards the polar regions. There is every

reason to believe, that cases of this disease are far from uncommon on the continent of India; but the author is scarcely justified in putting down as examples of it all the cases which have been described by authors under the appellation of typhoid fever. We could point to instances quoted by Hirsch (some of which indeed came under our own observation), in which we know that there was no evidence to prove that the fever alluded to was the fièvre typhoide of Louis. The only cases as yet on which implicit reliance can be placed are those which have been recorded by Scriven* and Ewart;† but they are quite sufficient to decide the question.

Typhus syncopalis, or sinking typhus, we only know as a variety of the true typhus, characterized by a tendency to rapid death by syncope, and originating from a concentration of the causes which give rise to the ordinary forms of the disease. Such were the cases observed during the famous siege of Saragossa, in 1809, and elsewhere during the wars of the first Napoleon; although in the work before us the only cases referred to appear to be American.

An accurate account is given of the various epidemics of the relapsing fever, first described by Rutty, of Dublin, in 1739. This is the true famine fever of Ireland—the hungerpest of German writers.

We scarcely know what the author means by Bilious Typhoid Fever, or Typhus icterodes. Jaundice, it is true, is a very frequent symptom of the relapsing fever; but most of the instances referred to appear to have been cases of either yellow fever or of malarious remittent fever. Here again we think the author has allowed himself to be confused by the varying titles applied by different writers to the same affection.

After treating separately of the geographical distribution of each of these fevers, the author proceeds to consider the influence of season of the year, temperature, and other atmospheric and terrestrial agencies, upon them all collectively. In thus doing we think that he has erred; and if he had proceeded differently, he might have arrived at another conclusion, than that they are all merely varieties of the same disease. For example, we would merely refer to season of the year. This has no influence over the prevalence of true typhus; but the so-called typhoid fever (or, as it has been recently designated, pythogenic fever) is almost invariably most prevalent in autumn, so much so, that in many places it has received the name of autumnal or fall

fever.

V. Furuncular Plague.-A distinction is drawn between the Oriental and the Indian plague-the latter only differing in its frequent complication with pleuro-pneumonia. In the summer of 1836 this Indian plague spread great devastation through many parts of the Bombay Presidency. An historical account is given of the epidemics of both varieties, with observations on the apparent influence of various external causes on their prevalence.

* Scriven: British and Foreign Medico-Chirurgical Review, p. 536, Oct. 1857; and Indian Annals of Medical Science, Part vii. 1857.

† Ewart: Indian Annals of Medical Science, Part vii. p. 65.

VI., VII., and VIII.-Small-pox, Measles, and Scarlet Fever, are all treated of in a manner similar to the diseases already noticed. The author has not been able to discover any authenticated accounts of the occurrence of scarlet fever in India. Dr. Morehead tells us that in Bengal and the North-Western Provinces a fever has prevailed epidemically on several occasions since 1824, remittent in character, and accompanied by a scarlet eruption, and in some instances, by inflammation of the mucous membrane of the mouth and pharynx. None of the medical men, however, who have observed it have considered it as identical with European scarlet fever. Numerous observations are also collected by the author, to prove that in countries where scarlet fever is met with, it is as prevalent and as fatal in the families of the higher ranks living in large houses in open, airy situations, as in those of the lower classes crowded together in small badly ventilated dwellings in narrow streets and lanes. This is a fact of extreme interest, and the truth of which is pretty generally recognised. Indeed, not a few consider that the disease is more fatal among the upper ranks than in the lower.

Hirsch has also ascertained that out of 100 epidemics of scarlatina, 30 commenced in autumn, 24 in summer, 25 in winter, and 21 in spring. Now, in London, and also in several of the other large towns in England, it is found that the total mortality from the disease reaches its climax in October and the beginning of November, but it remains to be shown whether the disease is then more prevalent or more fatal.

IX. Erysipelas is treated under the heads of Simple Erysipelas, Hospital Erysipelas, Erysipelas Neonatorum, and Typhoid or Gangrenous Erysipelas. The last of these is shown to be of peculiar interest, from the fact that during the last ten years it has prevailed to a great extent in an epidemic form in many parts of the continent of North America. A table has been constructed pointing out the precise date and locality of each of these epidemics, and containing references to the various memoirs in which they have been described. Like hospital erysipelas, it is eminently contagious.

X. Sweating Sickness is next taken up, and some interesting observations are made as to the relation between this disease and Indian cholera, which are well deserving of attention, but for which we must refer to the original work. Next we have,

XI. Dengue, or, as it has been also called, Breakbone or Neuralgic Fever, a disease which appears to be peculiar to North America and the West Indies, and which is characterized by acute febrile symptoms accompanied by most severe arthritic pains lasting for a few days, and sometimes followed by a relapse, but by no means fatal. The true nature of this disease requires further investigation. In this country it may be said to be unknown, although it is not unlike in many of its principal characters to what is familiar to us under the name of relapsing fever. As it is scarcely even mentioned in European medical literature, we would refer for descriptions of it to Hirsch's work, as also to that of Dr. Campbell. Lastly,