the disease itself. It is a maxim as old as Celsus, that the same cause, applied to different subjects, produces different effects, and that there must be more than one cause for à fever; on which account that which predominates and gives the character to the disease should be considered as the cause. In the present instance, the climate gives the character to the disease, and is the indication for the mode of treatment. Whatever, therefore, the other cause may be, this is the one to be principally considered. Though what we have now said is not necessarily connected with the statistical pathology of Clifton, yet we could not easily pass it over without some animadversion. We shall now follow the author in his first inquiry.

"It will appear, (says he,) by the table of diseases admitted into the Clifton Dispensary, from 1st January, 1813, to 31st December, 1816, that, of 1699 cases of disease, only 16 were typhus, or only 1 in rather more than 106. This fact of itself is an extraordinary one, when the circumstances of the indigent inhabitants are considered, among whom it has been universally supposed peculiarly to prevail. But, when it is further known that these 16 cases occurred in situations and houses sufficiently well aired, open, and clean, and in persons by no means remarkable for sordid habits; whereas, in the various courts and alleys wherein the air is corrupt for want of due ventilation, and wherein also the rooms and persons of the in'habitants were such as to render them highly offensive, not a single case of typhus appeared, at least not one was reported at the Dispensary; the inference seems reasonable, that filth, &c. are not the causes of typhus, but that it proceeds from a specific virus introduced."

It is much to be regretted that practitioners of such standing as Dr. Chisholm should still require to be reminded of certain well-known facts, which, if constantly kept in view, would solve many, if not all, these difficulties. Dr. C. remarks of the inhabitants of the close alleys, that their persons are squalid; by which, we conceive, is meant their countenances unhealthy, or, if we understand him, that, though not ill enough to prevent their customary occupations, they are by no means free from disease. Is not such often the case with prisoners and gaolers, when the prison is not reported as infected with gaol fever? Yet, under such circumstances, have not the court and jury been infected sometimes to a degree so alarming and so general as at once to shew the cause? Let us then only suppose that an inhabitant of the higher and healthier parts of Clifton, less accustomed than Dr. Chisholm to morbid effluvia, should visit some of these houses on the river-side, or receive one of these squalid inhabitants in his every-day dress. Can any

*Vid. Prefacionem.

thing be more probable than that the effluvia from such a source should induce fever? The proper inquiry should be, whether fever, from such a cause, spreads in the higher parts of Clifton in the manner it is known to do in ships, in gaols, and in confined neighbourhoods? Is it not necessary, then, that the parties should be placed in a "peculiarity of circumstances?" and is it not absolutely necessary that such peculiarity of circumstances should be accurately traced before any inference can be drawn relative to contagion, infection, pestilence, or miasma? We may further remark, that, though those fevers which occurred at Clifton are called typhus, and probably might have the low type which ought to characterise that disease, yet we have no proof that there have been no other causes for such fevers. Is not the despondency which lately pervaded so many classes sufficient to induce fever, and fever of such a description?

Dr. Chisholm proceeds to make some remarks on the various and incorrect manner in which the word typhus is often applied. Of this we have said enough on many former occasions. Some remarks follow on the Bristol Infir¬ ̈ the return of sick for three years, and the proportion > mary, of fevers called typhus, but which Dr. C., with much propriety, conceives arise from miasma of soil more than any of the common causes of infectious fever.

An account follows of St. Peter's Hospital, which, as far as we can judge, is similar to what the London Work-house ought to be, namely, a receptacle for those poor who cannot claim a settlement, or who are not in a condition to be removed to it. From the care taken to preserve order and cleanliness, infection has never been generated in the house"-an expression which implies, that, with less care, such an event might have occurred. Ever since the docks, have been formed, this hospital has been more subject to sickness. This is very reasonably imputed to the want of that drainage which the building formerly received from the flow of the tide instead of the stagnant water.

The disease observed as more particularly produced by the exhalations from the almost stagnant water of the river, thus become a floating harbour, is a low fever, partaking much of the nature of synochus, but marked with indistinct intermissions. The number of cases of typhous or infectious fever has been 50, during >the period from 1st January, 1813, to 31st December, 1816; and of these sixteen have died, or one in rather more than three, a proportion far exceeding what has happened at the Bristol Infirmary, during the same period, and which seems only to be accounted for by the symptoms of the disease acquiring more violence 'from the ipsalubrity of the situation for some years past, and by the condition

of many of the subjects when brought into the house. The result, however, furnishes an additional and satisfactory proof, that the virus of typhous infection is specific; for no establishment of the kind can be kept in a more perfect state of cleanliness and ventilation, and, in every instance, the infection appears to have been traced to a source foreign from the house itself. Since the beginning of the present year, i. e. from 1st January to 12th March, 1817, about twenty cases of typhus have occurred. The infection was introduced by a wretched coloured man, found destitute in the street, and received into the house, without the nature of the disease he laboured under being ascertained."

The reader will regret with us, that the fevers and their causes are here too much confounded. However, it would appear, that by great cleanliness the infectious fever, when introduced, may be prevented from spreading, and that it becomes more fatal and more general by the accumulation of filth. We are not now offering our own opinion, but what we conceive the fair inference deduceable from Dr. Chisholm's statement; for we are very far from being satisfied with the confused manner in which the first string of inferences is drawn.

"The foregoing facts tend to establish only one partition of the proposition, viz. that typhous infection is not the offspring of filth, crowded unventilated rooms, &c.—it remains to adduce facts which go to the establishment of the other partition, viz. that typhus infec tion does exist, and may be propagated in places the most clean, most freely ventilated, and in all respects the best regulated. If such can be adduced, then the proposition, I apprehend, may be deemed proved, that typhus infection is specific, and not the produce of adventitious circumstances. In this last respect, Bristol is by no means exempted from infection; but, of many instances which could be given, I shall select the following from among public schools, in a charitable foundation, as it seems to place the subject in a particularly clear light.”

Now, in our opinion, filth should not be confounded with want of ventilation, as we find it in the beginning of this proposition. Next, we would ask, if typhous infection may be propagated in clean and well ventilated places, what is meant by the word propagation? If only that it may be communicated, we have already admitted as much. But may not its further propagation be arrested by cleanliness and free ventilation, and has not the establishment of St. Peter's been brought as a proof of this? May we not further ask, is there any kind of cleanliness or ventilation that will prevent the propagation of small-pox? On the contrary, does it not extend with more certainty in the pure air of a village than in the corrupted air of a large town.

If we understand Dr. Chisholm, no want of ventilation,

no

no filth, are sufficient to generate that condition of the atmosphere which produces infectious fever. In answer to this, we are ready to admit two things, first, that fever is most commonly introduced into such places, and, even when we are ignorant of such an introduction, it may have existed. But it is certain, that fever from such a cause spreads only in crowded and ill-ventilated communities; and, also, from the frequency with which it is found in camps, fleets, and prisons, and from the circumstances under which it occurs in such places, there is every reason to believe that it is generated by such circumstances. Justice to Dr. C obliges us to insert the whole of the following long paragraph.

"Another source of error, or rather of misconception, with respect to the existence of typhus infection among the indigent inhabitants of Bristol, is the occasional occurrence of scarcity of provisions, almost amounting to famine, and the substitution of corrupted or not sufficiently nutritious articles of food. I engaged pretty largely in the discussion of this interesting subject on a former occasion (see Edinburgh Medical and Surgical Journal, vol. vi. p. 412-415); and I have reason to believe the conclusions I there drew are correct and satisfactory. Several instances are on record of epidemics being the consequence of scarcity of provisions and deteriorated food in Bristol; but, from what has been stated in the work referred to, and from the imperfect information I could obtain of the nature of those epidemics, I am induced to relinquish every idea of their originating in infection, although the usual, indeed geheral, opinion entertained is, that they were infections, or typhous fever. In the annals of Bristol, instances are recorded in the years 1597, 1608, 1752, 1765. The most recent happened, I believe, in 1795 and 1799. These were attended with a very fatal epidemic fever. Many afflicting details of the disastrous consequences have been given to me by gentlemen, who, as agents of charitable societies, took a very active part in the investigation of cases of distress, and in their relief. Misery of every description prevailed; but the fever, as far as I could collect from this source of information, was evidently a fever of exhaustion, not of infection. From the niedical gentlemen who at that time practised in Bristol, I could obtain no precise account of this direful calamity,-a deficiency much to be regretted. That famine may sometimes be the precursor of pesti lence, I believe; but it is not so from the mere privation or deterioration of food; it is from the superinduction of infection, to which, under such distressful circumstances, the poor are more exposed. Riverius has observed, Quando magna adest annonæ caritas et penuria, unde vulgare illud, opos μET' Aμor pestis post famen.' It is a vulgar observation, but it is also a vulgar error. A disease, however, equally fatal, does arise from the exhaustion consequent upon famine; and, the symptoms of it assuming the features, in some degree, of typhus, it is thence too frequently mistaken for it, to the ir remediable loss of the unfortunate sufferer. This disease is the

Asthenia abstinentium of Sauvages (Nos. Meth. tom. i. 805)→ Cutis arida, flava, rugosa, os arescebat, lingua et dentes nigresce bant, vox raucescebat, macies magna, nulla perspiratio, dejectio, mictio, &c.—a disease which in Scripture is designated by two words, y, rob mui, fame combusti, which in the English version is translated they shall be burnt with hunger,'-(Deutr. xxxii. 24.) This is the denunciation of the Almighty himself, and is as awful as it is grand. The expression has been variously rendered, according to the conception of the effect of famine formed by different nations. Thus in the Septuagint it is novos μ, liquescentes fame; the Latin version of the Syriac has it conturbabuntur fame; of the Chaldaic, inflati erant fame; but the original in one word comprebends the whole. Although rather foreign to the object of this paper, I cannot forbear giving myself the gratification of directing. the attention of the reader to a valuable paper of Mr. Bacot's, in the seventh volume of the Transactions of the Medico-Chirurgical Society of London, in which a most instructive description is given of this species of asthenia, as it fatally prevailed in a battalion of the guards serving in Spain in 1812-3. I the more readily insert it here, because it is a disease that I believe has never been accurately described before. The patients usually came to the hospital complaining of chilliness, languor, and depression, both of strength and spirits; the countenance wan and melancholy; the pulse small, frequent, and tremulous; and the surface of the body unusually cold to the touch. Giddiness of the head was a frequent complaint, ani a deep and constant sighing was an universal symptom; yet there were none of the common attendants of the first attack of fever, no violent headach, nausea, or thirst, no accession of heat, or marked rigors, in the first instance. I have seen numbers of men brought to the hospital so attacked die in twenty-four or thirty-six hours after their admission, without a prominent symptom, insensible to every kind of stimulus, and never having any accession of heat or increased action of the vascular system, from the moment of the attack to the hour of their death. In many men of very robust habit, the disease assumed more of the common forms of fever, and very soon put on the typhoid character, with parched tongue, low muttering delirium, and terminating, in some instances, in a suffusion of bile over the whole surface of the body.' (p. 379.) This is the disease so often among the poor mistaken for typhus, because frequently whole families are prostrate under its direful influence, Many instances of this occur every winter, but at the periods stated more remarkably, because the cause more extensively and more severely existed. The present year would have pre-eminently furnished elucidations of this fact, had not the consequences of famine been in a great degree averted by the extremely judicious measures adopted by the mayor, and cheerfully acceded to by the more wealthy inhabitants. It may not be irrelevant to remark, that the misapplication of the word typbus, so frequently occurring in this lamentable species of asthienia, may serve, perhaps, as a guide in

detecting