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thus acquired and recorded by the student." The task which Dr. Lyons has here imposed upon himself does not give scope for much originality of view, which would, in fact, constitute a fault in its execution, inasmuch as the end to be attained is the exhibition of undisputed facts, and of methods of investigation generally recognised as satisfactory. Nevertheless, such a work affords abundant room for the display of extensive and well-digested information, sound practical knowledge, and cultivated powers of observation; and none but an accomplished practical physician could execute it with credit to himself and real benefit to the class of readers for whom it is intended. The manner in which Dr. Lyons has acquitted himself of this difficult and useful, though unambitious task, is deserving of all praise.

The work is divided into two sections, the first of which contains "Directions for the Clinical Examinations of Patients," and the second "Post-mortem Examinations."

In the first section, all that relates to the history of the case, the general physical and mental condition of the patient, the state of the circulatory, respiratory, cutaneous, digestive, and urinary functions, is minutely and judiciously set forth; and we consider as worthy of especial commendation the attention bestowed on those points which collectively form the subject of Medical Physiognomy,' one of the most important, and we may add, most neglected, departments of medical science.

The regional anatomy of the thorax and abdomen is very accurately mapped out, and excellent directions are given for the manual examination of the viscera contained in the latter cavity. The subject of auscultation is very judiciously and practically handled, and divested of those frivolous minutia by which practical men (and students are often very practical men in their way) are apt to be disgusted, and to imbibe a mistrust in a means of diagnosis which, when kept within due limits, is of inestimable value.

Full directions are given for the examination of the urine; but we think the inspection of the intestinal excretions, and of matters ejected from the stomach, is passed over in too cursory a manner, and might be advantageously dilated upon in the next edition.

The second section, On Post-mortem Examinations,' is of equal value with the first, and the directions given are such as might be expected from an able and practised anatomist. We may instance those for opening and exploring the cavities of the heart cess which is too often conducted in a bungling and unsatisfactory


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There is an appendix, containing directions for writing prescriptions, and a short glossary of medical terms. Forms are also added for reporting cases in accordance with the directions contained in the work.

We can conscientiously recommend this Manual as one which, on the whole, fulfils all that it promises; and Dr. Lyons has even contrived to mitigate the inevitable dryness of so condensed a work by occasional lively remarks, which may render it more acceptable to the youthful reader.

ART. IX.-Summary of New Publications,

IF we determine the priority of claim of any department of medicine. to a mention in this Summary by the number of works in our quarter's list devoted to any particular subject, we must, in the present instance, yield it to State Medicine or Sanitary Science. And right glad are we to see that this most useful branch of medical science not only holds its own, but is daily enlarging its sphere of operations and commanding greater attention.

The Medical Officers of Health of Westminster, Islington, St. Giles's, and St. Pancras have issued the Reports on the work done in their respective districts; and the Metropolitan Association of the Officers of Health have allowed the appearance, under their sanction, of Sanitary Tracts for the purpose of diffusing useful information on sanitary matters. The first, entitled 'Vaccination,' is by Dr. Ballard; the second, 'Our Duty in Relation to Health,' is by Mr. Rendle. With these we would mention the admirable publications that appear under the auspices of the Pure Literature Society, and which for variety and impressiveness may serve as a model for all popular writers. Dr. Greenhow's paper 'On a Standard of Public Health for England' is a workmanlike production in the field of Sanitary Science; with it may be mentioned Mr. Fox's inquiry into 'The Vital Statistics of the Society of Friends.' A work on 'Primary Pathology and the Origin and Laws of Epidemics,' by Dr. Knapp, comes to us from Philadelphia; A Sketch of the Medical Topography of Bengal,' by Mr. M'Clelland; a 'Report on the Jails of the Lower Provinces of the Bengal Presidency,' and, The British Soldier in India,' both by Dr. Mouat; the reprint of Miss Nightingale's paper on Hospitals, read before the Association for Social Science; the Custom-house Commissioners' Report on the Customs, including Dr. M'William's Medical Report, deserve special attention. Nor may we leave unmentioned the Réforme Agricole, which, in July, contained an article by its editor, M. Nérée Boubée, 'On the Purification of the Thames,' in which the author proposes artificially to substitute a new bottom for the river, its clay-bed being, according to the writer's theory, the main cause of the decomposition of the putrescible matters conveyed into the stream. The Commissioners in Lunacy present us with their Thirteenth Report; the subject of Lunacy in its State relations is also considered by Dr. Arlidge in a work entitled 'On the State of Lunacy, and the Legal Provision for the Insane.' We conclude this part of our summary with Archdeacon Stopford's pamphlet on the circumstances attending the recent religious revival in Belfast, entitled 'The Work and the Counterwork.'

Under the head of Medicine proper, we have to enumerate a new and revised edition of Dr. Wardrop's work 'On the Nature and Treatment of the Diseases of the Heart.' A work by Dr. Heale On Vital Causes;' a reissue of the first volume of Dr. Thomson's Life of Cullen,' which appeared in 1832; and the completion of the second volume of the same work by Drs. Allen Thomson and Craigie. With Dr. Thomson's

name we may appropriately couple that of Dr. Wilks, who has just published his Lectures on Pathological Anatomy, to which we shall soon recur. A fourth edition of Dr. Lee's work on 'The Watering Places of England' is before us, with a memoir by Dr. Dufresse de Chassaigne 'On the Value of the Thermal Waters of Bagnols.' Dr. Ayre presents us with a Memoir on his well-known Treatment of Asiatic Cholera, which was read before the French Academy; together with the Report of the Members of the Section of Medicine and Surgery. Dr. Black's Researches into the Pathology of Tuberculous Bone;' Dr. Brinsmade's Addresses delivered before the Medical Society of New York; Mr. O'Ferral's introductory address On Hospital Instruction; and Dr. Addison's Gulstonian Lectures on Fever and Inflammation,' each merit perusal. The January number of the 'Indian Annals,' and the last number of the Transactions of the Medical and Physical Society of Bombay,' are before us, and, as usual, contain much interesting matter. A monograph by Professor Hecker, of Freiburg, 'On Elephantiasis,' with numerous illustrations, discusses the pathology and anatomy of this disease. The 'Ophthalmic Reports," edited by Mr. Streatfield, continue to appear in quarterly numbers. The only work on our table which surgery can claim exclusively is Dr. Williamson's Notes on the Wounded from the Mutiny in India,' well illustrated by drawings of preparations in the museum at Fort Pitt.

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Obstetric science brings us the 'Contributions to Midwifery and Diseases of Women and Children,' by Drs. Noeggerath and Jacobi, of New York, the greater part of which is a report on uterine and infantile pathology in 1858, after the model of our own reports. From the pen of Dr. Barnes we receive a Clinical History of the Eastern Division of the Royal Maternity Charity during the year ending September 30th, 1858;' from Dr. Donkin an essay on Placenta Prævia;' and from Dr. Madge 'Remarks on the Anatomical Relations between the Mother and Fœtus.' Books that do not come under the four heads under which we have classed the foregoing works, and that have yet to be adverted to, are Professor Greene's Manual of the Subkingdom Protozoa,' excellently illustrated; Dr. Bull's 'The Sense Denied and Lost,' in which blindness is considered under all its aspects by one who lost his eyesight; an essay, jointly by the Rev. J. J. Halcombe and Dr. Stone, entitled The Speaker at Home,' containing some admirable advice for all (and who is not?) likely to be called upon to address an audience; Mr. Lister's further Contributions to Physiology and Pathology researches by Dr. Davy On the Causes of the Coagulation of the Blood;' and last, not least, the translation by Dr. William Moore for the New Sydenham Society, of Schroeder van der Kolk's work on the Spinal Cord.


Original Communications.

Observations on the Outbreak of Yellow Fever among the Troops at Newcastle, Jamaica, in the latter part of 1856. By ROBERT LAWSON, Deputy Inspector-General of Army Hospitals, and Principal Medical Officer at Jamaica.

AN opinion has long prevailed that the severe forms of tropical fever could not originate, or spread, at a considerable elevation above the sea. The grounds for this opinion seem to be the statement of Humboldt that yellow fever was confined to the low country on the coast near Vera Cruz, and that it did not pass the farm of l'Encero, elevated 3045 English feet above the sea, "the heat there being insufficient to develop its germ;" ;"* and that of Fergusson, with reference to the varieties of fever occurring at different elevations in St. Domingo. The remarks of these authorities were no doubt correct for the time and place, but it must not be thence concluded that all the conditions requisite for the production of those forms of fever, except that of suitable elevation, were present in the cases they adduce. Their deductions, therefore, require to be applied cautiously to other localities, and may, under certain modifications of the conditions, be even found inapplicable to the same localities at another time.

With that disposition so common among us, however, to help out preconceived notions by an appeal to the authority of a great name, rather than to correct them by a careful deduction from facts, the opinions of Humboldt and Fergusson have been pushed much beyond their legitimate bearing; but we know too little of the actual causes of severe tropical fever to be able to say with certainty where they may be produced in sufficient intensity to develop the disease, far less to define the point beyond which their production is impossible.

There is no certain test for the presence and operation of the efficient causes of fever but its occurrence among men or the lower animals; but observations on the latter are too few and desultory to admit of frequent application. For all practical purposes, therefore, observations on bodies of men, under conditions sufficiently varied, afford the only means of extending the information on the subject and deciding doubtful points.

In Jamaica there are military stations which have been in existence for many years, the records of which are available for elucidating some

* Political Essay on New Spain, vol. iv. p. 170. English translation, 1822. 48-XXIV.


of the laws of the disease. Taking Kingston as a centre, the following stations are included within a circle of about eleven miles radius-viz., Port Royal and Fort Augusta, at the level of the sea, and nearly surrounded by it; Up Park Camp and Spanish Town, at moderate elevation above and some distance from the sea; Stony Hill, eight miles from the sea, and 1360 feet above it; and Newcastle, nine miles from the seaboard and about 4000 feet above it. On the north side of the island lies Maroon Town, about twelve miles from the sea coast, and elevated about 2500 feet above it. With the exception of Newcastle (which was first occupied as a military post in 1841), these stations were garrisoned many years, and the returns for them are given in the statistical reports on the health of the troops in Jamaica from 1817 to 1836 inclusive.

The following table, taken from these data, shows the average mortality from fever per 1000 of mean strength, at each of the stations above mentioned, together with the extreme annual variations:

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These results form the best approximation to a numerical expression of the activity of febrific causes in the different localities for the period they embrace. From them it is obvious that on the average the stations surrounded by the sea were healthier than those at a short distance from it, and near the same level; while in the case of Stony Hill,* and still more of Maroon Town, elevation has been attended with a great diminution of the activity of the causes of febrile disease, though not by their entire disappearance. It is manifest, too, that these causes had very different degrees of activity in different years at the same station, though the periods of increase and decrease were nearly contemporaneous at them all; thus indicating the presence of an epidemic constitution at certain epochs, whatever the nature of that may be.

In 1840 an epidemic period commenced, which continued with variable intensity to the beginning of 1842. It commenced at Maroon Town, and twelve deaths occurred from fever originating there, or thirty-six per thousand of the mean strength within the annual period. In the year 1841-42 there were twenty-four deaths at this station from fever; of these, two in May and five in June, were in men of the 68th Regt., which corps had not been away from the station; the remainder were in the 82nd, which arrived there in the end of June, and many of them were attributed to the low ground. This outbreak was

* Since this was written, I have found, on personal examination, that there is a considerable amount of marshy ground actually among the buildings at Stony Hill, and a considerable portion of the surface seems to be kept wet by springs coming to the surface at various places.

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