Page images

ages long gone by. And he accepts the theory of De Maistre, that the savage in no respect represents the primitive man, but is degenerate, and that the most civilized man of to-day is to the primitive what the untutored savage is to him. He holds, in fine, that man, as we know him, is proved, by the facts we possess, not to be cosmopolite, but to possess faculties of acclimatization “essentially • limited, though varying notably according to race.”

Substantially we accept these opinions of M. Boudin. We differ, perhaps, as to the degree of the faculty. He has shown, that at any rate it is with great difficulty, and at great cost, that man adapts, or attempts to adapt himself to the climatic and other influences of countries removed from the one of his birth. And this, after all, is the point of practical value, both to the physician and the political economist, and to both a question demanding the most serious consideration.

The geography and statistics of disease form the subject of the fourth book, and the natural introduction to the next, which occupies 400 pages, finishes the work, and contains the geographical and statistical history of fifty-six endemic and other diseases and infirmities, interesting in this point of view. These the author has arranged alphabetically, in order to increase the facility of reference.

“Man is not born," says M. Boudin, "does not live, does not suffer, does not die in the same manner on all points of the earth. Birth, life, disease, and death, all change with the climate and soil, all are modified by race and nationality. These varied manifestations of life and death, of health and disease, constitute the special object of medical geography."

The comparative pathology of races, and the geographical distribution and migrations of disease, occupy the rest of M. Boudin's work.

“Like plants, of which some are found in almost all countries of the globe, while others are in a manner endemic in certain Jocalities more or less circumscribed, so also the diseases of man are either spread over the whole surface of the earth, or are fixed to certain zones—to certain localities."

While the study of this distribution of disease throws light on the influence of climate, soil, nationality, and race in the production of disease, it at the same time

“Guides the physician in the choice of localities best adapted for the sojourn of the invalid; it indicates to the hygienist the places he ought to seek or avoid ; it furnishes an experimental base to the laws of quarantine; and it makes known to governments the military aptitudes of a country.”

In the investigation of this question, he compares the diseases which produce death in one country with those which do so in others; and he does this for most of the countries of Europe, and for some hot countries. He then compares the causes of death in the armies of France, Sardinia, Belgium, Prussia, Sweden, Russia, the United States, and England at home and in her numerous foreign possessions. Such a document cannot fail to be interesting and instructive. In doing this, he finds many diseases to be endemic (or at any rate to be exceptionally frequent) in certain localities, which are not usually regarded as being so. Among these, hernia, epilepsy, myopia, &c., occur. On the other hand, he appears to establish the non-endemicity of other affections hitherto regarded as endemic.

According to the researches of M. Boudin, cholera has not yet passed 64° N. and 21° S. latitude; marsh fevers in the North hemisphere have kept within the isothermal line of 5° C., and in the South they do not reach the line of 15° C.; yellow fever has never passed 48° N., nor 270 s. latitude, and the longitudes of Acapulco and Leghorn have been its other limits. Cretinism and goître belong to mountainous localities. In elevated regions marsh fevers change their type, going further and further from continuity as you ascend. Verngas may be said to belong to Peru; the pinta to Mexico; the plica to Poland; hydatids of the liver to Iceland; the tania to Abyssinia; croup to some parts of Sweden, &c. Cancer is very rare in Egypt; gout almost unknown in Brazil, Peru, or Nubia;

phthisis is little known in Iceland, in the Feroë Islands, and in the steppes of Kirghis

, and in the same places the same is true also of scrofula. Goitre belongs to calcareous districts; and cholera "Shows a marked preference for tertiary and alluvial soils, and rapidly deserts the ancient formations. In several parts of the United States and of Switzerland, the disappearance of . marsh fever (resulting from drainage of the soil) appears to have been followed very soon by the appearance or increase of pulmonary phthisis.

The sea (“the soil of the sailor") has also a modifying influence on the character and fatality of the disease. M.'Boudin holds it to be preventive of phthisis ; curative he does not assert it to be. And he founds this chiefly on these figures.

The English army counts annually in the United Kingdom 8:9 deaths by phthisis to 1000 men of the Line, and 12.5 to 1000 of the Guards ; while the losses by phthisis in the navy, from 1830 to 1836 inclusive, amount to 17 to 1000 men, this being an average calculated from all other stations.

On the therapeutic action of climates in phthisis, he holds our information to be much less complete than on the preventive. And he does not indicate any locality as peculiarly beneficial to those labouring under chest affections. The author analyses the statistics of the English Government on the sanitary condition of the troops, and finds that the maximum of deaths by phthisis occurs at home, and that the loss becomes less, not only in warm climates, but also (and in a manner even more marked) in cold countries—as in Nova Scotia, New Brunswick, Newfoundland, and Canada. This is an unexpected result, and still more so is it to learn that statistics show this disease to be nearly unknown in Iceland, the north of Norway, and in the Feroë Islands. As compared with the English, Negroes (out of their own country) are proof against the action of the marsh miasm, but phthsis commits fearful ravages among them. So also is the Negro less subject than the English to dysentery and hepatic affections (which ailments M. Boudin regards as closely allied by geographical ties), and the Sepoy less liable than both. M. Boudin still adheres to his theory of an antipathy between the marsh fever and phthisis

, but we think not so strongly as when he first advanced it. One would hardly expect to find such a disease as hernia endemic, yet such results from the analysis of the causes of exemption from military service in France. The aggregate for a long series of years shows this cause to be very frequent among conscripts from some localities as compared with those from others. But not only does the aggregate show it, but each year of the series shows it steadily affecting the same localities, in a manner that cannot be accidental. It is probable, however, as M. Boudin supposes, that this has to do with hereditary influences rather than with climate or soil. Epilepsy, myopia, and a number of other causes of exemption, present similar results of endemicíty. Such are a few of the more interesting and peculiar facts picked out of this part of the work. A large number of the diseases thus described are little known to readers of ordinary medical literature, and they scarcely concern them. But a knowledge of them may be valuable to those practising in large centres of population, having frequent intercourse with all parts of the world, but more especially to army and navy surgeons, who are called on to change their field of practice continually, and must be prepared to recognise and treat diseases which the ordinary home practitioner has no chance of ever meeting. The work, however, addresses itself not to the medical profession only, but also to the hygienist, to political economists, and to public administrators. It is almost needless to say of such a work, that it rests on a statistical basis. It could not indeed be otherwise. It is clear, as M. Boudin says, “ that the endemicity, the frequence, the gravity of a disease, the salubrity of & country-in fine, the great question of the acclimatization of man, are so many problems which imperiously demand a statistical basis, without which, indeed, the very expressions, frequent, endemic, salubrious, are words without sense.”

To all the errors to which statistics are usually liable, these of courge are sub

ject; and perhaps to more than the usual amount, since they are employed in the elucidation of such complex questions. That they can, however, in such matters be made to yield sound results, is proved by the best of all tests—a commercial onethat derived from the history of life assurance companies. Nor is it any real.objection to their use that in reasoning on them we are liable to error. We learn from this simply the need of a greater caution. In all the affairs of life we unconsciously tabulate our experiences and calculate means. Our oftens, nevers, and seldoms, are nothing but these averages; and in the fact that each of these words may apply to the same set of conditions, according to the temperament of the man who uses it, we have proof of our liability to reason unsoundly. They cannot all be correct. The reasoning is at fault, however, and not the data; and in the ordinary affairs of life, he is styled the sound practical man whose judgment discerns the right interpretation, appreciating the points of value, and separating and dismissing those that are worthless.

But in all cases the precise statement of a per-centage preceding the adjective (or, in other words, the inference), whatever it may be, becomes definite and valuable information, which we can use separately; while the adjective or inference becomes also a thing to be tabulated in the statistics of opinion, and though of less, yet not without value.

Some of the points of greatest novelty are—the medical history of lightning; the influence of race, more particularly as observed in the Jew; the limited faculty of acclimatization possessed by one man; the rarity of phthisis in some cold countries; the endemicity of certain affections not hitherto regarded as such, and vice versá; the probable disappearance of the plague; and the history of a large number of unusual discases or infirmities not elsewhere to be found, brought together and fully described.

The work is got up with care, and considering the masses of figures involved, with average accuracy. It is ably written, and in all respects a most valuable addition to medical literature. The “ frame-voork” is already well filled, but many gaps still exist. These M. Boudin has pointed out. We feel sure that he will himself, if spared, contribute further to the filling up; and when old inferences are affected by new observations, or fresh materials give birth to changed conclusions, he will be the first to point these out.


Medico-Chirurgical Transactions. Published by the Royal Medical and Chirur

gical Society of London. Vol. XL. 1857. 8vo, pp. 238. The volume before us is smaller than those which we have lately been in the habit of receiving, a fact which is attributable not to any shortcoming on the part of the members, but to many of the papers read before the Society having already been published in a new form, under the title of Proceedings.' In the Transactions,' only such papers have hitherto appeared as have been deemed by the Council most fit for publication; but in the Proceedings,' which it is intended to publish every two months, an abstract of all the papers is given; those papers are published in full which the authors do not wish to expose to the risk of being rejected by the Council for publication in the “Transactions. Our own opinion is, that this innovation is one by no means necessary or desirable. We cannot but regard it as an instance of that tendency to the production of an ephemeral literature so characteristic of the present age, and to which we have lately more than once had occasion to advert in terms of disapprobation.

The present volume of Transactions contains fifteen original papers, and is illustrated by five lithographic plates. The first paper is entitled

I. On the Treatment of Aneurism by Manipulation. By WILLIAM FERGUSSON, Esq., F.R.S.-By the term given in the title, the author means" a particular manipulation of an aneurism, whereby the fibrin within may possibly be so displaced as, either in part or in whole, to block up the main artery on the distal side of the disease."

This plan of treatment appears to have been first suggested to Mr. Fergusson's mind by a case, which Professor Turner of Edinburgh was wont to cite in his lectures, of a gentleman with a formidable aneurism of the subclavian artery, who, in spite of all remonstrances to the contrary, would persist in his favourite amusement of swimming in the open sea. On one occasion, soon after his usual indulgence, a change was noticed in the tumour, which continued to decrease in size until it underwent a spontaneous cure.

In this case the cure was attributed by Professor Turner to the artery on the distal side of the aneurism becoming blocked up by a layer of lymph displaced by accident from the interior of the sac. Acting on this suggestion, Mr. Fergusson has attempted to imitate this supposed natural process of cure, by squeezing the blood out of the aneurismal sac, and then rubbing the opposed surfaces of this together. Two cases, both aneurisms of the right subclavian, are given, in which this experiment was practised. In the first patient, a man aged forty, no pulsation could be felt in the arteries of the corresponding arm for several days after the operation; the tumour diminished some what in size, but death followed seven or eight months after the experiment, from bursting of the aneurismal sac. In the second patient, a man aged fourty-four, the operation was certainly followed by a complete disappearance of the tumour; but the manipulation was practised on the 4th of August, and repeated on the 6th of October, 1853; in October, 1854, no perceptible change had taken place in the tumour, and it was only in August, 1855, that it was observed to have disappeared. From the lengthened period which intervened between the experiments and the disappearance of the aneurism, it may fairly be doubted how far the two are to be regarded as cause and effect. Aneurisms, it is to be remembered, may undergo a spontaneous cure.

At the same time, in both of the cases the experiments were followed by symptoms of a most alarming nature, which might have well led the author to hesitate before recommending the practice to his professional brethren. The first patient became temporarily confused, exclaiming that he had been made tipsy, and staggered as if about to fall, The experiment in the second case was instantly followed by left hemiplegia, which lasted for many months. These results, especially in the latter case, were no doubt owing to portions of fibrin becoming detached from the aneurism and plugging up some of the cerebral arteries, in the manner explained by Virchow and Kirkes. The dangerous consequences of this nature, which may result from the mode of treatment recommended by Mr Fergusson, have been urged with much force in a paper recently published by Dr. Esmarch, Professor of Surgery at Kiel, in which he gives an account of a case of embolic apoplexy resulting from the detachment of fibrinous coagula in an aneurism of the carotid.*

We certainly are somewhat surprised that Mr. Fergusson should consider the two cases which he has adduced as illustrating in many respects practically and satisfactorily the views broached in the early part of this paper. On this head we would fain believe that the author has expressed himself more strongly than he really feels; which conclusion seems the more probable, when we take into account the hasty composition of which the paper bears internal evidence. The style is in many places, to say the least, far from elegant; while the word “consultants” has no place in English literature.

• Seo British and Foreign Medico-Chirurgical Review, Oct. 1807.

II. Case in which a Large Cyst was Successfully Removed from the Upper Part of the Neck of a Young Woman, aged Twenty-seven, who was considered ut Birth to have been the subject of Spina Bifida. By SAMUEL SOLLY, F.R.S.This case is one of great interest, whether the tumour be regarded as having been of spinal, or, as is more probable, of intra-cranial, origin. The paper is accompanied by three drawings, showing the size of the tumour at the age of eighteen months, and immediately before the operation, as well as its appearance after removal.

III. On the Determining Causes of Vesicular Emphysema of the Lung. By WILLIAM JENNER, M.D.-The author advocates an expiratory theory of emphysema, in opposition to the inspiratory one maintained by Williams, Nasse, Rokitanski, and others, and which in late years has been so philosophically elaborated by Dr. W. T. Gairdner. Dr. Gairdner urged as the most serious objection to the expiratory theory, that in consequence of the uniform pressure of the external parietes of the thorax upon the whole pulmonary surface, the expiratory act is mechanically incapable of producing distension of the lung or of any part of it. Dr. Jenner, on the other hand, denies that the lungs are uniformly compressed during expiration, and endeavours to make out that at some parts, especially the apices and anterior margins, there is a want of local compression, or that the walls of the chest are more yielding than at others, and that it is these very parts which are most frequently the seat of vesicular emphysema. During violent expiration, he considers that the air is forced from the parts which are most compressed into those which are less so. Our space will not allow us to enter into the arguments which might be brought forward on both sides of this question. We cannot, however, consider that the facts which have been adduced by Dr. Jenner, and handled by him with considerable ingenuity, are by any means conclusive, and still believe that the now generally-adopted inspiratory theory of emphysema is the one which affords the most rational explanation of its production in the majority of cases.

IV. Five Cases of Tracheotomy in Croup, with Remarks on certain Points connected with the Operation, with a Postscript containing Two Additional Cases. By HENRY WILLIAM FULLER, M.D. Cantab. - This is a paper of much practical importance. Of the 7 cases recorded by Dr. Fuller, 3 recovered and 4 died. The first case was a girl, aged eight, in whom the operation was performed on the fourth day of the disease, and was followed by recovery; in the second case, a girl aged five, the operation was performed on the ninth day, and was also followed by recovery; the seventh case, a boy, aged five, recovered, tracheotomy having been performed on the ninth day of the disease. In the other four cases, which terminated fatally, the patients were a girl aged sixteen, a boy aged five, another boy aged four and a half, and a girl aged five; and the operation was resorted to on the sixth, fourth, second, and third days respectively. In none of the cases was the operation had recourse to until collapse had supervened, and the patients were in extremis. With one exception, the operation was followed by great and immediate relief in all the seven cases, and in several, the patients were observed to cough up plugs of white false membrane through the wound.

Appended to the histories of these cases are some valuable remarks on the following important questions :

1st. Whether the operation of tracheotomy is justifiable in any case of croup? Under this head the author considers first the results of the operation as performed in France, where the diphtheritic form of the disease is so common, and by collecting several published statistical statements obtains a total of 168 operations and 56 recoveries, or a proportion of one recovery to every three operations. Hence he concludes that in France the operation is eminently successful, and productive of an enormous saving of life, for before the operation was introduced into practice, the disease was almost invariably fatal when it reached its second stage.

« PreviousContinue »