"All the morbid changes observed, are consecutive to the development of mental derangement, except those in the brains of idiots, which are primary, and connected with the paralytic state." Chronic cerebral irritation and paralysis, may be effects of such changes. The changes of the thoracic and abdominal organs arise out of accidental circumstances. Finally, the majority of cases exhibit no cerebral changes whatsoever. This chapter, also, contains some interesting enquiries into the extent to which dissection will carry us in the investigation of diseases, and its fallacies. This book is pretty nearly the best on the subject, not because it abounds in novelty, but, because it consists of dense and genuine experience, and of extensive pathological evidence, viewed and combined with sound physiological judgment, which has enabled the author to develope mental diseases, simply and lucidly, from their dawn to their downgoing. We have in it, a final arbitration of many difficult points. Almost every page has been duly analysed, and the most valuable parts are extracted, and presented to the reader in aid of his practical conduct, whenever these unfortunate maladies form the object of private care. II. A new View of the Infection of Scarlet Fever, illustrated by Remarks on other Contagious Disorders. By WILLIAM MACMICHAEL, M.D. F.R.S. Fellow of the College of Physicians; Physician Extraordinary to His Royal Highness the Duke of York; and one of the Physicians to the Middlesex Hospital. Octavo, pp. 100. London, Sept. 1822. THIS little essay is divided into four chapters-the first containing, Observations on the improved Value of Life; on the Causes of Epidemic Diseases; on Pellagra; Ergot; and Malaria. The second chapter treats of the Contagions of Small-pox, Hydrophobia, Measles, &c. The third, is on Scarlet Fever; and the fourth, is on the Treatment of the different Forms of Scarlatina. We shall give a brief analysis of these chapters as they stand, interweaving a few observations of our own as we proceed. Chap. I. It is an interesting fact, now well established, that the ratio of mortality in England, has decreased nearly one third within the last forty years. In 1780, the calculation was 1 in 40 annually; whereas, it is evident, from the population returns to Parliament, that the annual mortality is now only one in fifty-eight. This change may very fairly be attributed to the bettered condition of the poor-the increase of temperance in all classes-the disappearance or mitigation of many fatal diseases-vaccination-improved medical practice. But, while the sum total of human affliction has been reduced, there is considerable disparity of reduction in the different items. Thus, rickets and scrophula, according to Dr. M. have decreased, while gout, consumption, palsy, and mania, have increased in fatality. Certain forms of scrophula and rickets may have been reduced in number, from the greater cleanliness and better diet of the poor; but, as we consider the prominent character of phthisis to be scrofulous tubercles in the lungs, it may be questioned whether scrophula, on the whole, has declined. On the other hand, we are doubtful that gout is increasing. Or, if it be, how are we to reconcile this with the acknowledged increase of temperance in all ranks of society? That the great class of the NEUROSES, with their host of consecutive evils have, for several years past, been on the advance, there can be no doubt. The wide spread of intellectual excitement-the revolutions, political and moral, with which Europe has been torn-the sudden elevations and depressions of fortune-the anxiety and perturbation attending a hazardous and excessive spirit of mercantile speculation-the fanaticism of some, and the atheism of others, (for extremes approximate,) may explain the greater prevalence of mental diseases now, than formerly. The increase of palsy, our author attributes to "the less general use of blood-letting" now than formerly-especially at spring and fall, when our forefathers regularly got blooded. That something may be attributed to this last cause we are not inclined to deny ; but we are far from considering it as the principal cause. The circumstances which we have pointed out as predisposing to maniacal and other affections of the brain and nervous system, will equally conduce to the production of paralytic and apoplectic complaints.+ Our author has surely been rather inconsistent, when, at page 2, he alludes to the prevalence of temperate habits, "throughout all orders of society," and then, at page 3, speaks of the indulgences and vices of civilized life, as accounting for the increase of gout. If the latter be increasing, which we doubt, it must, we believe, be owing to sedentary habits and mental anxiety operating on the digestive organs, and through their derangements, inducing gout and other diseases. + Dr. Dovar, (inventor of the P. Ipecac. comp.) who, by the way, was one of the most canting old quacks that ever perpetuated his own disgrace by becoming an author, states, in his Physician's Legacy, that Vol. III. No. 12. 5 A Our author properly remarks, that the more obvious causes of those disorders which affect great numbers of people at the same time, in other words, of epidemics, must be sought for in unwholesome or defective diet-noxious exhalations from the earth-human contagion-and atmospheric influence. We agree with Dr. Macmichael, that improvements in agriculture, by furnishing a greater abundance of the necessaries of life, counteract the first of these causes; and, that quarantine has probably kept our shores free from visitations of plague; but, we are disposed to think, that plague would make little progress, now-a-days, in England, even were it regularly imported to this island. Although, therefore, we should not vote for the total abrogation of quarantine laws, we attach far less importance to them than our author, and we hope to see them greatly modified, even in our own time. "The universal practice of vaccination, (says our author,) would certainly completely exterminate the small-pox." This we doubt, though we are unequivocal advocates for vaccination; and strenuously recommend its universal adoption, if possible. PELLAGRA. Several accounts of this curious disease have been published in England; but it has not hitherto been noticed in this Journal. We shall give some short account of it here. It has been principally observed in those provinces of Italy, lying between the Alps and the Po. It is a cutaneous affection, confined to the peasants employed in the cultivation of the soil; and, especially, in the raising of the vine, maize, rice, and millet.. "In the early stage of the complaint, red spots, with slight elevations of the cuticle, resembling lepra, are observable; the skin becomes dry and sealy; vague and irregular pains are felt; and in its inveterate form, the disease assumes an appearance not unlike Icthyosis. The malady then abates; but as the summer of the following year approaches, it recurs with increased violence; spasms, anxiety, depression of spirits, cachexy, idiotcy, and mania are the last symptoms." 12. The peasants abovementioned, live in extreme misery, not during an extensive practice of forty-seven years duration, he never met with but two cases of apoplexy. This was in the beginning of last century. We may here mention, that the commentator on Dr. Dovar's Legacy states, his having cured epilepsy several times by the misletoe of the oak, j. thrice a day. We believe that the remedy is not generally considered as having been discovered so long ago as one hundred years, for this particular complaint. withstanding the great fertility of those provinces-having little animal food, and their bread (of maize) being ill-fermented and deficient in salt. The cure, as may easily be supposed, consists of generous food, wine, tonics, and the warm bath. ERGOT. Rye is subject to a disease called Ergot-in English horned or spurred rye. Bread made of it has a nauseous acid taste, and has been thought to be the cause of a spasmodic and gangrenous disorder. This epidemic, which was also called the ignis sacer, raged in Sologne about the year 1650, but was probably owing more to starvation than to the use of injured corn. The disease was accompanied with lassitude, debility, torpor," swelling, and sense of burning heat and excruciating pain in the lower limbs, which became shrivelled, and at length gangrenous. Another disorder ascribed to the ergot, was attended with general convulsions of the muscles. It was from this circumstance, we believe, that ergot was first tried to excite uterine action by one of our continental or American brethren. MALARIA. Marsh effluvia, our author properly enough thinks, is too confined a term for Malaria, since there are many marshy: districts where ague does not prevail; while, on the other hand, intermittents and fevers of that type are often seen, though the soil be dry, and the ground elevated. There are very few places, we believe, however, of this last description, that prove to be malarious, unless they are in the vicinity of some marsh, or unless they consist of a bibulous soil that quickly absorbs the moisture, and afterwards gives it out to the action of the sun, imbued with decomposed animal and vegetable matter. Of the exact nature indeed of this invisible agent termed malaria, or vegeto-animal miasma, we are entirely ignorant. Its effects are very conspicuous in several parts of Italy, especially in that part called the Maremma, a district that stretches from Leghorn to Terracina, varying in breadth from thirty to forty miles, and being in length about 192 geographical miles, lying near the sea. The greater number of places in this line are dry, airy, and elevated; nor does the victim perceive any visible sign of the presence of the destructive poison he is inhaling, "for the tranquillity of the air and the freshness of the verdure around him, would lead him to suppose he was in the most healthy region. Even in such places, there can be no doubt that the deleterious material, whatever be its com position, must issue from the earth. We all know that the atmosphere preserves its general constituents under all circumstances, and in all kinds of locality; it is only from the earth that contamiation can arise, however it may float about afterwards through the medium of the air. That some cause operating under ground is productive of malaria in Italy, is, we think, fairly indicated by its gradual and progressive march in certain directions-thus it every year comes closer to, and reaches some part of Rome where it was before unknown. CHAP. II.-Contagion. How the contagions of small-pox, hydrophobia, measles, plague, &c. first originated, Dr. Macmichael does not attempt to explain. He thinks they existed anterior to any tradition or historical record-that they were perpetuated from age to age and from year to year-that they were confined in the first instance, to some remote district, and were gradually disseminated over the earth by war, conquests, political revolutions, commercial intercourse, and the accidental visits of travellers. This appears to us to be viewing contagions as plants or animals, which never can arise from any cause or combination of causes except specific propagation. For our own parts we think it far more likely that the same causes which produced these contagions in the first instance, may have many times since done the same thingand that this is the case even to the present time, in several of the contagions, as hydrophobia, measles, scarlatina, &c. Our author, for instance, thinks that hydrophobia can only be produced "by communication from one rabid animal to another." That it has no relation to the heat of the weather is proved, he thinks, by the disease being prevalent in Russia, and unknown in India. As to Russia we cannot say; but there is no part of the world where hydrophobia is more prevalent than in India. Can Dr. Macmichael have forgotten the great noise which the practice of blood-letting in hydrophobia, first instituted in India by Messrs. Tymon and Shoolbred, made among the profession here? We cannot understand Dr. Macmichael's reasoning in the same page, where he proposes the laws of "strict quarantine" against hydrophobia.§ * P. 24, 25. + P. 27. ↑ Vide Ed. Journal, vol. 9. Lest we may be supposed to misrepresent Dr. Macmichael, for which we should be extremely sorry, we shall give the passage in his own words. |