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The following sentence does not correspond with our obą servations and experience.
“ Parents considering the measles as a disease almost inevitable, have wisely chosen to expose their children to the contagion at such auspicious times ; (when they are epidemical and mild ;) so that the disorder may be once well over, and all further anxiety at an end."
We firmly believe that parents would be wise in doing so, especially in mild seasons of the year, for surely these must be the great modifying causes; but we have very rarely seen this wisdom manifested by parents. They generally like to put off the evil hour as long as possible, in this and in most other of the eruptive diseases.
On the question why contagious diseases at one time assume a mild type, and at another appear under an alarming aspect, our author offers some ingenious remarks, which we are very far from thinking quite hypothetical or devoid of solid foundation, Dr. M's explanation is this :-that instead of an epidemic constitution of the air, there is an epic demic constitution of the human system prevailing at the time. But he shall speak for himself.
6. In the absence of all other explanation, it has generally been agreed to attribute this difference of type to some occult quality of the air ; for we are not more advanced now in our knowledge of the subject, than they were in the days of Sydenham. The constilutio aeris is still appealed to as necessary, if not to generate, at least to cause the universal diffusion of contagious fever. But if instead of employing so vague and unmeaning a term, we were content to speak of a constitutio epidemica, or that peculiar state or condition of body, into which a great number of people are brought by having been subjected to the operation of the same physical and nioral causes, something more distinct and intelligible would be expressed.
“ These causes are very numerous, and various in their character; as previous hot, cold, or damp weather, deficient or bad diet, fatigue, grief, anxiety, &c. Being all similarly predisposed, it is not strange that if a number of people should fall into the same dis
“ H the opinion that this poison, like the other infections, is the result of an original unextinguished contagion, be correct, does it not point out a simple method of extinguishing it in this country, viz. by adopting measures siinilar to those of the strict quarantine, to which we are indebted for our present exemption from the horrors of the plague?” P. 27.
In what possible way, we ask, could the laws of quarantine be put in execution against mad dogs ? Before they become mad we know nothing of the business, and afterwards they generally run away,
case, they should have it in the same way, whether mild or severe, in other words, that an epidemic constitution should prevail.” 32.
The only remark we shall make on this explanation is that as this prevailing constitution must have been produced by the physical agents around us, so it seems to matter little whether these agents modify the constitution, the contagion remaining the same-or modify the contagion the constitution remaining the same. Is it not probable that both the contagion and the constitution are modified by the surrounding agents abovementioned ?* We have no direct proof for or against either position.
Dr. Macmichael's observations on the contagion of typhus fever need not detain us. We do not see any thing new in them. We cannot agree with him in his opinion that “typhus fever does not now originate in any individual.” As a proof of this Dr. M. brings forward two passages from Dr. Lind. The first was an on dit of the celebrated doctor. The surgeon of the Panther told him that during the prevalence of scurvy on board that ship the sick birth was dreadfully crowded, but that no contagious fever was generated. Such might be the case.
We know that the great prevalence of one disease sometimes indeed generally, precludes the appearance of others.
The converse of the above-viz. the proof of imported contagion is thus stated :
“ The company of the Loestoffe were in perfect health during the eight months they were in America, and until a few days before their departure from Quebec. At that time six recovered marines came on board from Point Levi hospital, and in forty eight hours afterwards, among her company of two hundred people, fifty were seized with fevers and fluxes! In some the sickness began with a flux, in others with a fever; but the flux was generally moderate and gentle. The fever continued commonly from five to ten days; two patients were distressed with it for a whole month.” .44.
We ask Dr. M. whether it coincides with his experience of typhus contagion, that it produces fever in forty-eight hours after exposure to it-and that when conveyed through the medium of recovered men ? If so, it is contrary to our experience. The whole of Dr. Lind's statement is founded on that most fallacious kind of evidence-post hoc ergo propter hoc. If the six marines bad not come on board 48
* This seems to have been the opinion of Dr. W. Heberden, who remarks, “That the presence of infectious matter is not alone sufficient to make the plague epidemical, but that some concurrent state of the air, and of the human body, is likewise necessary."-Increase and Deerease of Discases, p. 95.
hours before, the fovers and fluxes would have equally appeared. Their causes were longer in operation than two days; but it was far easier for the surgeon to place the whole to the account of the six marines, than to investigate the etiology of the fever and flux. We have seen enough of these short cuts to the origin of diseases to make us very indifferent to such on dits as the above tale of the Panther.
CHAP. III. Scarlet Fever. It is in this chapter that the jet of our author's essay comes out in form.
Scarlatina, Dr. M. observes, is so various in its character, and one form of it is so extremely mild, “that it does most certainly pass through the system unobserved ; and in many more instances under the name of a rash, exciting no alarm." The position which we have marked in italics is meant, we believe, first, to account for the number of people who think they have never had scarlatina ; and secondly, to take away the excuse for not putting children in the way of the contagion, from the vain hope of escaping the disease altogether. Our author, therefore, assumes that scarlatina is as general in affecting the human constitution as small-pox or measles--its non-perceptibility, in some of its forms, accounting for the immunity which some people appear to have possessed.* But in the first place, we fear, Dr. Macmichael can offer us no proof that those who have passed through life without the ostensible forms of scarlet fever must yet bave had the imperceptible form of the disease. In the second place, can Dr. M. assure us that these imperceptible forms, or even the visible rashes will certainly secure us against the more dangerous forins of the disease? We fear he cannot offer us any positive assurance on either of these points; and if he cannot, we imagine that parents will be unwilling to expose their children to the disease, however mild it may be at the time. Again, can we be sure that because the epidemic is mild, generally, it will be equally so in individual cases ? We apprehend not. At least we have seen some children in the same family have the disease in the slightest manner, while others had it in the most terrible form, where the source of the contagion was the same in both cases. +
* “ Adults,” says Dr. Willan, “ are not very susceptible of the contagion (of scarlatina.) Several physicians and apothecaries of London have never felt its effects, notwithstanding their attendance on many hundreds in the disease, often under the most unfavourable circumstances.”-On Cutaneous Diseases.
+ Willan, though he acknowledges that each epidemic has a reigning
Notwithstanding the objections which we have stated, we are disposed to think that could Dr. Macmichael's proposal be put fully and universally into practice, there would be considerably less mortality and ill consequences from scarlatina than there now are-because there would be a greater chance of a mild disease in a favourable season and epidemic, than in contrary circumstances. But although this would be the general or average result, still as individual events would now and then be disastrous, people will never be persuaded to run the risk, lest they should happen to be the victims.*
In giving the following recapitulation in the author's own words, we take our leave of him with every sentiment of respect and esteem.
“ To recapitulate the substance of the foregoing observations, I have to remark, that if they are founded in truth, and warranted by daily experience, we must come to the following conclusions.
“ As the causes producing epidemic diseases are not very numer rous, and are much subject to our own control, the means of lengthening the duration and increasing the comforts of life are to a great extent placed in our own hands.
“ It has been seen that by a strict enforcement of the laws of quarantine, we have been able to banish the plague, and by the employment of vaccination, we have it in our power (if we choose to avail ourselves to the utmost of the benefits of that great discovery) to exterminate the small-pox; a contagion still more fatal than the plague itself. For the latter disease has never yet been known in India, China, North or South America, nor in the arctic or tropical regions; while the small-pox has spared no nation, but has made its appearance in all seasons, and extended its ravages over every climate of the earth.
“ Till we are happily enabled (and the hope ought not to be treated as wild and chimerical, for who would, a few years ago, nave believed in the possibility of a discovery so beneficial as vaccination ?) to extinguish the other contagions, we should watch the favourable types of these disorders, and court rather than avoid their
character very generally conspicuous, yet he adduces as proof that the simple scarlatina, the S. anginosa and S. maligna all proceed from the same source, the following fact—"because under the same roof, in large families, some individuals have the disease in one form, some in another, about the same period."-(m Cutaneous Diseases, p. 281. If this be the case, what security is there of having a mild disease at any one given time by exposure to the contagion ?
Sir Gilbert Blane, in his recently published select dissertations, states as follows :-“One attack of scarlet fever generally secures from a future one ; but I know a case of a young lady who had it distinctly three times." 210.
infection at such auspicious periods. For though it be true that some few persons pass through the vicissitudes of a long life, with-out ever catching the scarlet fever, such an occurrence is by no means common. I have endeavoured to show that its frequency has been, from curelessness and inattention, greatly overrated.
“ The chance, therefore, of such an escape, ought to have no weight in the calculations of prudence and sound reasoning, as in the course of their lives, it is probable, that nine persons out of ten bave undergone scarlet fever, in various degrees and shades of vio"lence, from the unnoticed rash to the virulent form of putrid sore throat.
There is one other remark which occurs to me before I conclude, from which much practical benefit may occasionally be derived. Whenever it happens that a person infected with typhus fever, or any other contagious disease of a malignant character, is necessarily confined in a house occupied by a numerous family, he should be removed to the upper story. The current of heated air is naturally upwards, and the atmosphere loaded with the contagious steams, emanating from the patient's body, will (if he be in a lower apartment) diffuse themselves over the whole house, whereas, if he be placed above, they will have a ready and immediate vent." 100.
Select Dissertations on several Subjects of Medical Science.
By Sir Gilbert Blane, Bart. F.R.S. Physician to the King, &c. Now first collected, with Alterations and Additions; together with several new and original Papers.
Octavo, pp. 398. London, Underwoods, Nov. 1822. These Dissertations are twelve in number, of which eight are republications, (some of them with additions and alterations, and four are now published for the first tinie. On calculating by the pages, the original articles occupy about 100, and the republications 286 pages. Every man has an undoubted right to collect together the fragments of his literary labours, and publish them as a whole; but we question the policy, in such cases, of interweaving new matter. Those who are already in possession of the original essays may con. sider it hard that they must re-purchase eight essays out of twelve, or else be deprived of the other four. We think the better plan, both for the author and for the public, on such occasions, is to publish the old and the new essays separately, and thus suit the circumstances of all classes, This would have been peculiarly desirable in the present case,
because Vol. III. No. 12.