of the chest owing to the displaced diaphragm. Fraentzel complains that the diagnostic importance of these considerations is insufficiently estimated.

As regards auscultatory signs, our author agrees with Skoda in his estimate of œgophony. He regards it as an unimportant variety of bronchophony, and by no means characteristic of pleuritic effusion.

The subject of treatment is very fully handled, and a large space is devoted to a consideration of the lately revived operation of puncturing the chest. This proceeding, which dates from the time of Hippocrates, was long ago strongly recommended by Trousseau, in France, but has only of late years been accepted in Germany. Fraentzel is a warm advocate of its employment where the effusion is very large, or its absorption long delayed. He gives minute directions for the best mode of practising it, and a description of the precautions to be used, so that not a single bubble of air or infective germ can find entrance into the pleural sac. His experience of its usefulness has been both large and favorable, and he thinks that where adverse testimony has been borne respecting it, there have been faults in the time and mode of its performance. But we cannot regard the question as settled when we find that such careful physicians as MM. Behier and Peter, of Paris, state that during the last six years the mortality from pleurisy in the hospitals of that city has doubled, and are inclined to refer the increase to the free use of this mode of treatment. When the effusion is distinctly purulent, as proved by exploratory puncture, Fraentzel has recourse to the radical operation as he styles it, or that by incision, followed by irrigation of the pleural sac. It is a formidable measure, but its use is justified by the results which have been obtained. Of eleven cases operated upon at the time of his writing, complete recovery ensued in five, and a favorable issue was hoped for in a sixth, then under treatment.

We here close our notice of these excellent volumes, the study of which may be confidently recommended. A few verbal errors and local peculiarities of expression have crept into some of the translations; they will doubtless be rectified in a second edition. The publication is in every respect creditable to the firm which has undertaken it.

II.-The Diffusion of Cholera.1

THOUGH much information has been collected of late regarding the manifestations of cholera in different parts of the eastern and western hemispheres, in its various diffusions, yet from many extensive tracts there is scarcely more than a meagre notice, without specification as to the time of appearance or cessation, the, space occupied, or the connection with outbreaks elsewhere. The value of more detailed evidence on these points will therefore be readily appreciated by every one who has examined the subject, and every addition to the existing information, whether from a country the epidemics of which have not been fully described, or from one where their appearance has not hitherto been recorded, will be regarded as an important contribution to our knowledge, and as adding to the stock of materials which may ultimately enable us to arrive at a trustworthy explanation of the rapid and extensive migrations of this disease.

To promote this object, in 1870 Mr. Netton Radcliffe, then honorary secretary to the Epidemiological Society of London, through Bishop Tozer, invited the co-operation of Dr. Christie, physician to the Sultan of Zanzibar, in collecting facts regarding the epidemic in that locality, which was just disappearing. This gentleman, in response to Mr. Radcliffe's application, transmitted two papers, which were read at the Epidemiological Society in January, and February, 1871; and a favorable notice of these in the 'Lancet' induced him, subsequently, to investigate the tracks of the various epidemics mentioned in them, for which his position at Zanzibar, and inquiries as to the trade routes in Eastern Africa he was engaged on at the time, offered unusual opportunities. "It was not till then," he says in his preface, "that I had any conception that remarks regarding the track of a cholera epidemic, in a country such as East Africa, could be possessed of any possible interest."

The works of Livingstone, and other travellers in East Africa, will have familiarised some of our readers with the course of trade in that part of the world; for the information of others, we may mention that Zanzibar is the centre of mercantile transactions on that coast, the point to which the imports from other countries converge, and from which they are distributed to the

1 Cholera Epidemics in East Africa. By JAMES CHRISTIE, A.M., M.D. London, 1876. 8vo, p. 508.

Report by Mr. NETTEN RADCLIFFE on the Diffusion of Cholera, and its Prevalence in Europe, during the Ten Years 1865-74. In Report of the Medical Officer of the Privy Council and Local Government Board. New Series, No. V. London, 1875.

various towns on the mainland, north and south of it, from Cape Guardafui to Cape Delgado, where they are either sold to the native consumers in the vicinity, or are sent by caravans to variable distances into the interior, and then disposed of to those tribes who do not visit the coast. Dr. Christie informs us that

"There are generally three leading men who have a pecuniary interest in the caravan-an Arab of high standing in Zanzibar; an influential coast-man, such as the native Governor of the coast town; and one or more Banyan merchants. One or more Arabs often accompany the caravan, but the real leaders thereof are usually Wasawahili, or Wazalia-domestic slaves born in the family. They are always men who have been long in the trade, and who are thoroughly acquainted with the general features of the country; the people thereof; their language, and their manners and customs. One of the leaders of the caravan from Pangani to Laikepya had made fifteen journeys among the Masai, the other nine" (p. 222).

These men possess great shrewdness and powers of observation on all points coming within their immediate cognizance, or bearing on their interests, and most of the available information regarding the tribes occupying districts which have not been visited by Europeans has been obtained through their agency. By comparing the statements of several of these, at Zanzibar, Dr. Christie found a substantial agreement among them on the points he was investigating; and by engaging his friends at other points of the coast to prosecute similar inquiries there, he ultimately obtained an amount of evidence as to the appearance of cholera in different localities, which seems fairly reliable, and is of much interest. Besides these sources of information his position at Zanzibar brought him in contact, not only with several Europeans who had travelled in the interior, but, through the native merchants resident there, with traders from every point of the coast, who were often able to mention circumstances that otherwise might have escaped notice altogether.

Dr. Christie describes among Epidemics of Cholera in Eastern Africa' those of 1836-7, of 1858-9, of 1865, and of 1869-70. • Allusion is made to an epidemic in 1821, soon after Mauritius and Bourbon had been affected, but no details of it are now available; and there seems to have been another in 1852,1 which

In a parliamentary paper, dated Board of Trade, 20th August, 1860, entitled "Abstracts of Returns of Information on the Laws of Quarantine which have been obtained by the Board of Trade," and which by a note appear to have been compiled by the Quarantine Committee of the National Association for the Promotion of Social Science, at page 78, it is stated, Zanzibar and other places on the east coast of Africa suffered first from cholera, and afterwards from smallpox in 1852.”

has escaped Dr. Christie's notice. The first of the four epidemics mentioned above is stated by Captain Burton to have occurred at the end of 1835 and commencement of 1836, and Dr. Christie gave the same years in his first paper communicated to the Epidemiological Society, but he altered this in the subsequent one to 1836-37, in conformity with the date of a letter sent from Zanzibar to Captain Mohammed bin Hamees, who was then resident in London, intimating the death of his grandfather from cholera. The details of this epidemic are but scanty; it was first heard of in the Somali ports (Worsheik, Mukdeesha, Merka, and Brava), and it is said to have been carried along the coast during the north-east monsoon, by the native trading vessels, to Zanzibar, and from that onwards to the boundary of the Mozambique_territories, where it ceased. When Somalis from Merka and Brava were questioned by Dr. Christie as to whether the cholera ever originated in their country, they maintained that in every case it had been conveyed to them from without. Further on he states, "It was impossible to ascertain whether the epidemic of 1836-37 reached the Somali ports by sea or by land. I met with no one who at the time of invasion had reached the years of manhood, and all statements on the subject were evidently conjectures" (p. 103). Though we may accept the evidence of ordinary observers as to the dates of appearance and cessation of cholera, in various localities, so far as they may have come under their cognizance, we fear that many of the inferences they introduce into their recital of these facts are fairly open to the criticism which Dr. Christie applies to his Somali informants; and, in dealing with such statements, we must always be careful to separate simple matters of fact from the conjectures which the human mind seems so prone to mix up with them.

Dr. Christie is inclined to the opinion that this epidemic was an offshoot of that experienced at Mecca early in 1835, and that it might have been conveyed to Berbera by returning pilgrims, and thence, southwards, by the regular channels of communication through the Somali country, or by sea by trading vessels after the commencement of the north-east monsoon in November. "This," he says, "would have exactly fitted the date of the epidemic originally given me, and that also described by Captain Burton; but I am unable to resist the evidence that the epidemic really occurred in 1836-37." To meet the latter date he says, "It need scarcely be stated that cholera may have lingered about Southern Arabia and the Persian Gulf from the close of 1835 till the end of 1836," and then have been carried southward in the manner indicated above. In submitting these views it appears to us Dr. Christie has inadvertently

fallen into the same error he remarked on in the case of the Somali; and, when we mention that there was a severe epidemic of cholera in the low districts of South Abyssinia in 1834, he will find still another difficulty to surmount.

The next epidemic of cholera dealt with by Dr. Christie is that of 1858-59. In the autumn of the former year cholera had prevailed at the Arabian ports of the Red Sea, Gulf of Aden, and Persian Gulf, having trading relations with Zanzibar. With the disease present at these points at the very opening of the north-east monsoon, when the great annual stream of commerce was setting in, it was scarcely possible, he says, for Eastern and Central Africa to escape. It is usual for native craft from the Arabian ports to call, not only at the chief places (named above) on their way to Zanzibar, but also at several intermediate ports of less importance on the mainland and islands along the coast, to procure cargo and passengers. Lamoo and Mombassa are commonly visited in this way, and even by dhows from Bombay and Cutch. The epidemic seems to have broken out early in November, and the first intelligence of it received at Zanzibar was that it had appeared at Merka; it was nxet noticed as being at Lamoo; and the first case which reached Zanzibar was in a dhow that came from Brava and Lamoo at the end of November. Subsequently the disease extended southwards along the coast as far at least as Kilwa, and a very graphic description of its ravages there is given by Captain Burton, who visited that place in February, 1859, when it was at its height. The epidemic is said to have extended from the coast inland three or four days' journey only, but Captain Burton states that at Kilwa, although there were no precautions of quarantine, the contagion did not spread to the interior. The mortality along the coast seems to have been very great; at Zanzibar it continued from the end of November till the beginning of March, and it was estimated that 20,000 died in the island, of whom from 7000 to 8000 were in the town and suburbs.

Dr. Christie alludes to the conversation Mtesa, chief of Uganda (west of Lake Victoria Nyanza) had with Captain Speke, in April, 1862, regarding cholera, and is under the impression that he must have had some very recent occurrence in his mind, and expresses a strong conviction that this must have been the epidemic of 1858-59, which "had spread to Uganda direct from the coast to the north of Victoria Nyanza, by the old caravan route" (p. 116). This may be so, but it is in opposition to the evidence that it had extended inland only three or four days' 1 Kirk, Transactions of Medical and Physical Society of Bombay,' No. vi, (1843), p. 24.