so, it appears further to be probable, that the employment of remedies of an opposite nature, such as tonics and stimulants, which are generally had recourse to in such cases with a chlorotic character, and with swelled extremities, would not only have proved unavailing, but, in all probability, have aggravated the disease.

"I am disposed to attribute much of the advantage received in this case to the strict confinement of the patient to the horizontal posture for such a length of time. I was induced to insist upon this, from knowing the effect which the erect posture of itself has in quickening the pulse under all circumstances; and, particularly from observing the great distress the patient suffered from every bodily exertion,

"August 1815. I am now, after the lapse of ten months, enabled to state, that the patient has continued to enjoy perfect health."

[The remainder of the papers will be noticed in our next Number.]

Edinburgh Medical and Surgical Journal, No. LI. July, 1817.

Art. I.-On the Statistical Pathology of Bristol and of Clifton, Gloucestershire. By C. CHISHOLM, M.D. F. R.S. &c. &c. and Senior Physician to the Clifton Dispensary.

"I WAS induced (says Dr. Chisholm) to contemplate the subject of the following paper, as it relates to facts abstracted from speculation, by the result of four years' observation of the diseases of Clifton, as they passed in review before me at the Clifton Dispensary. The facts which further investigation of the subject brought into view, appeared to me highly important, and almost, if not wholly, conclusive, as to the question whether the infection of typhus is specific or not? In the adduction of facts, I have carefully avoided those of a doubtful nature, and have given preference to those of which I acquired a knowledge from the information of gentlemen connected with, or in the immediate medical management of, large hospital, dispensary, or public school establishments, within the limits of the city of Bristol.

"There is, perhaps, no mode of acquiring a knowledge of what may be called statistical pathology so perfect as a parochial or district dispensary. The objects of such an institution are confined to that description of people who are most exposed to the action of local causes of disease, whilst their mode of life removes them from those of an artificial nature. Luxury, with all its attendant evils, has no place in their domestic establishments-superfluity, of every kind, they are unacquainted with, unless it may, unhappily, be that of distress and poverty-whatever morbid causes proceed from the nature of situation and soil, from the changes of the atmosphere, from imperfect ventilation, from the accumulation of filth, from crowded

small

small rooms, and from poor and scanty diet, these people are the subjects of; and hence a correct and well digested register of their diseases becomes a faithful record of the pathology of such parish or district."

Nothing can be more just than this general proposition, so far as it relates to the knowledge of a district, of the prevailing diseases, and the general inferences deduceable from the whole. The theatre of our author's present practice is so generally known, and, for the most part, so similar to that of other large towns, and their extensive suburbs, that we need only mention a few local peculiarities connected, with the period at which these observations were made.

Respecting climate, we are ready to admit, that, in the higher parts of Clifton, it is, if possible, more inconstant than in most other parts of our island, The westerly winds, which, in many places, are mild, arrive here fresh from the ocean, and have a most unfavourable influence on vegetation, as well as on the human frame. The increased population has been chiefly in the more exposed parts, and confined to those individuals whose circumstances are easy. These, therefore, must be left unnoticed when speaking of typhus. "Such local advantages," continues our author, “would be effectual in excluding a morbid constitution, had the inhabitants themselves contributed their own exertion. But here are the unpleasant features of the picture. Nearly threefourths of the population of the parish are confined to that part called the Hot-well Road, extending about a mile in length along the western bank of the Avon." This description is continued for some length, and with a detail of every disadvantage. Yet, in the midst of the whole, it is im possible not to remark, that three-fourths of a population of 9000 is less than 6000 which extended for the length of a mile along the banks of a rapidly-flowing river, however narrow the space occupied by their dwellings may be, they can never be considered as destitute of free ventilations. That the effluvia from these houses will often be unpleasant to those who are accustomed to the luxuries of better life, cannot be questioned; but the air cannot stagnate for any length of time, especially when we consider the cheapness of fuel as far as that river extends. Add to this, where there is a disposition to "religious observances, and to the perusal of religious books," there must exist a degree of order which implies cleanliness, at least on the return of each weekly festival. In all this account, therefore, we see no cause for the production of typhus; for we perfectly agree with Dr, Chisholm, that the emanations from putrifactive matter are not the causes of infectious fever. For arguments in proof

of

of this, we are referred to the Doctor's paper, Edin. Med. and Surg. Journal, vol. vi. p. 389; and, to prove our acquiescence in the same, we refer our readers to our xxivth vol. page 422. We shall hereafter show our opinion of the effects of vegetable and animal putrifaction on the human health; but we do not conceive that they make any necessary part of an inquiry into the origin of typhus fever.We should beg Dr. Chisholm's pardon, and congratulate ourselves in discovering, that this learned author seems dis posed, at least for the present, to divest himself of the term typhus, and to substitute another, in which we most heartily accord with him.

"In such a state of things, (says he,) were we to form our opi nion by the usual speculations, founded on imperfect ventilation, on the accumulation of filth, on crowded habitations and rooms, and the squalor of the persons inhabiting places subject to such supposed causes of disease, we should infer that the Hot-well Road, or town, was the very abode, the very centre of infection. It will appear, however, from the appended table of diseases, that, although much disease has existed, the supposed offspring of the circumstances I have stated, typhus, or a fever of infection, has scarce a place. How can this be reconciled with what we hear and read of the ravages of such diseases in many of the larger cities and towns of the United Kingdom? It must be confessed, indeed, that the fluctuation and instability of opinion respecting infection, have been as great as they are unaccountable. We may, however, trace their origin to prescriptive ideas. Filth and infection seem closely allied, seem to bear the same affinity to each other as cause and effect; and hence it results that a belief prevails that the accumulation of filth, &c. must necessarily be the cause of typhus,—a belief handed down, not inquired into, and, consequently, converted into an established fact, an axiom in physics. Little research is instituted, and mankind continue to think and act on a faith not sanctioned by true philosophical principles."

This subject is continued through several paragraphs; but, as we have never considered putrifaction the cause of infectious fever, it is enough that we have shewn there is no want of ventilation, or even of that change in the condition of the air which a weekly cleanliness must, to a certain degree, produce. That, however, the inhabitants do not enjoy vigorous health, is evident, from their " squalid appearance," which, we suppose, is not completely changed by their Sunday ablution and change of dress.

"Fevers of infection," it is afterwards remarked, "are. more prevalent in manufacturing than in commercial towns.' The reason of this will be considered hereafter. At present we shall only stop to remark, that, if such is the case with fevers of infection, we shall hereafter shew that with some

other

other epidemics the contrary will be found to take place. Nor can we impute this difference to the causes assigned by the author, namely, "that the unnatural state in which the inhabitants of manufacturing towns are placed, may dispose to the generation in their systems of that unknown virus, or poison, called typhous infection; whilst the active bustling, and more natural condition of the inhabitants of commercial towns, preserves a due balance in their systems, by throwing off those secretions, useless in the organization of the human body, and injurious to its health when retained."

It is extremely difficult to follow Dr. Chisholm.' The following sentence, however, is so precise, that we may fairly quote it as his fixed opinion. "Indigence and sloth," says he, "are often found in the same person, and, when they are, then the retribution necessarily attached to such an unhappy union may be perceived, and may be felt. Such an union I conceive to be the parent of typhous infeetion: such an union, therefore, it is the business, and ought to be the duty, of the enlightened and humane, and more especially if placed in authority, to prevent by all possible means; for, although it may not always be destructive to the individuals themselves, in whom it originates, it must, and is always so to all who come within the radius of the infection which emanates from it." Here, then, we have the author's decided opinion of the origin of that substance which induces the infectious fever. Let us now attend to his account of the manner in which its influence spreads.

"Thus, then, (continues he,) the first set of the first class of causes is the effluvia emanating directly from human bodies infected with contagious or pestilential diseases, or from substances to which the basis of these effluvia has attached itself; the second proceeds from human effluvia arising from healthy persons, but, from the peculiarity of the circumstances in which they are placed, in a state of morbid concentration, and capable of generating a principle similar to that produced by infectious and pestilential effluvia.”* ¡

By this passage it appears, that, when healthy persons are infected with this air, the effluvia arising from them is only capable of generating a similar principle "from the pecuharity of circumstances under which they are placed." All this is different from the contagions, for small-pox and measles produce their effect in every possible situation, and the only security is, not the circumstances in which the persons are placed, but under which they exist; that is, a susceptibility, or a want of susceptibility, which last is only acquired by having previously gone through the disease. We are glad, therefore, to find the author avoiding the word contagion; but we conceive it would have been much better

to

to have confined himself to infections, without the addition of pestilential, because, in philosophical language, no two words should be considered synonymous.

But, though this infectious fever can only be conveyed under certain circumstances, yet those circumstances, in Dr. C.'s opinion, are no otherwise connected with climate than in modifying the character of the disease.

"A close and discriminate attention to facts and circumstances render it evident that typhus does exist within the tropics, varying only from the same disease in other climates, in as much as a high temperature in the former generates a peculiar modification of its specific nature, and, in many respects, of its symptoms; and that the malignant pestilential, or what has been most improperly called "yellow fever," (an impropriety productive of all the mistakes, all the controversy, all the warmth of discussion, exhibited by the writers on the subject,) was really and truly the typhus of temperate and cold climates, assuming a monstrous, a new, and most destructive form, through the agency of a tropical climate."

Here how much we have to regret the introduction of the word typhus in the above passage: for, if the fever assumes a new form, its character is new, whatever may be its origin; and not only the nosological character, but the whole historia morbi, as given by Cullen, of typhus, is different from this "monstrous new and most destructive form.' "If we understand Dr. Ch. the error is two-fold, first in calling a fever typhus, which neither answers the description of, nor is to be treated like, the typhus of authors; and, next, in asserting that it cannot be yellow-fever, because its origin is dif ferent from the cause which most commonly induces the fever known by that name. For, if climate is sufficient to give a new character to the disease, and that new character so nearly resembles the fevers of the tropics, it would, in our opinion, be at least safer to name the disease according to its symptoms, and the mode of treatment, than according to its origin. We would ask, whence has the confusion concerning yellow-fever arisen but from the similarity of symptoms? whence the error in the treatment but from the identity of names as often as the word typhus is used? The origin of a disease is part of the inquiry into the means of preventing its extension, and, as far as its character and symptoms assist in that most important part of therapeutics, the name is certainly an object of attention! but, if the symptoms of a disease arising from local miasma, and from infectious atmosphere, are similar, so much of the name as depends on a similarity of symptoms is convenient for all the purpose of diagnosis and treatment. The origin is a different inquiry, and ought never to be confounded with

NO. 222.*

I

the