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manipulation, and in Rome nervous diseases, especially in some cases of epilepsy, it has been successful." (p. 257.)
Our readers will no doubt by this time be disposed to cry out, "Hold, enough!" But we could multiply quotations of the same character as the above, to an almost indefinite degree.
Before dismissing the subject altogether, it will be asked of us, if we believe that any great discovery has been made by the Swedish gymnasiasts? if, apart from the absurdities and charlatanism which abound in the writings of Ling and of his followers, we have found therein some grains of truth, some golden particles, which, sifted from the rubbish that conceals them, reveal the existence beneath of a mine of scientific research, and which may lead to a revolution in our present treatment of disease, or may at least modify its details? Is this new system one, like hydropathy, that contains elements of good—one that, under due medical superintendence, may really aid us in the alleviation of the maladies that afflict our frame? or is it, like its ally homoeopathy, essentially negative, nugatory, and false?
All who have been engaged in the active practice of their profession, will have met with individuals labouring under the countless forms of dyspepsia and its consequences, who, when exercise was strongly urged upon them, as a means of recruiting their energies, have replied, that they were incapable of the least active exertion, that they had not strength to run, to ride, to swim, or to undertake a pedestrian excursion in search of health. These are men who have spent their lives in study, or in the absorbing pursuit of wealth, sitting all day in close counting-houses, or ensconced in easy chairs before a library-fire, who have taken little or no care about the purification of the skin by repeated ablutions of the whole body, and while indulging in the pleasures of the table, have neglected almost entirely that active muscular exertion which is requisite for keeping open the pores of the skin, and preserving the activity of the secreting and excreting processes of the body. Or they are females, who have worn out their strength in crowded assemblies, and in the exhausting chase of fashion, to whom muscular exertion has become a myth fit only for dairy-maids and stout country wenches, but not to be thought of for the pale votary of Almack's. There is, too, the poor pining milliner's apprentice, working twelve, fourteen, and sixteen hours out of the twenty-four, in close ill-ventilated chambers, to whom the fresh air of the country is only pictured as a dream of her childhood, long since vanished, and never to return. In many of the above subjects, debility has really advanced so far, that aotive movements are at first out of the question, and for such, passive movements, as in the operation of shampooing, may be substituted with unquestionable benefit, when oombined with attention to the secretions of the skin, and to the disordered state of the internal organs.
As an adjunct to medical practice, a well-ordered and scientifically managed system of gymnastic exercises would be accepted readily by the profession. The value of active and passive muscular movements in promoting absorption, and in increasing the activity of the excreting organs, has long been recognised; and had the successors of Ling confined themselves to this alone, had they refrained from seeking alliances with the hydropath and the mesmerist, they would have had no cause to complain, as they now loudly do, of the seeming apathy of the medical world. It was only when Ling overleaped the bounds of his own sphere, and invaded the territory of legitimate medicine with an army of wild theories and empiricisms, that Retzius and bis brethren shrank from his absurdities, and refused to identify themselves with a system repugnant to common sense, and unsupported by physiological or pathological argument. If there be blame to be attached to these fathers of the profession in Sweden, to these men who have won honourable laurels in the field of scientific investigation, it is that, perhaps cowed by popular outcry, and awed by the royal favour, in whose sunshine kinesipathy now basks in Sweden, they did not show a bolder front, and meet the enemy, like Baron Diiben, face to face. A few more such critiques as those of Malgaigne, and of the last-named author, would annihilate this so-called science in its present empirical garb; while, under legitimate control, the science of muscular movements and of their effects might be securely and cautiously investigated, free from the monstrous theories and absurd practices which characterize the doctrines and treatment advocated by Messrs. Ling and Branting.
The Registrar-General's Report on the Mortality of Cholera in England, 1848-9.
This elaborate work, drawn up from the official returns of the deaths in England and Wales, is the production of Mr. Farr, to whom the Registrar-General entrusted it.— Mr. Farr was assisted especially by Messrs. Haramack, Thornton, Clode, Cocke, Sowray, and Angus. We think it right to mention these names, as the work is one of firstrate character, and in point both of magnitude and importance, is indeed, to use the common phrase, a national one.
Oar readers know exactly the kind of returns which are made to the RegistrarGeneral. Liable to fallacy, and imperfect as they are in many ways, they yet embody a multitude of facts of the highest importance. In the case of the Cholera epidemic, the fallacies arising from erroneous returns and incorrect diagnosis were probably less numerous than they are in other diseases, whose characters are less clearly defined. What errors also may have occurred, must be, to a certain extent, lost in the vast numbers, or compensated for by the great preponderance of correct returns. We coaceive ourselves justified, then, in receiving, with Mr. Farr, the official returns of the district registrars as sufficiently accurate to be used in a statistical inquiry.
At the close of the epidemic, a list of every death from cholera and diarrhoea in 1840, was transcribed from the registration volumes; the deaths from these two diseases amounted to 72,180, and it was calculated that simply printing the list would fill an octavo volume of 2500 pages.-. In order to present a concise view of the main facts, the abstracts, and the prominent facts relating to each locality, were condensed, and are now presented to the public with a running commentary, by Mr. Farr, and with various tables and diagrams, prepared by his coadjutors.
Mr. Farr's commentary is full of interest; there are, of course, many points on which he must expect differences of opinion, and there are others which he has evidently not had time thoroughly to consider. But taking it altogether, his portion of the work is admirably done.
We shall give a short abstract of it in order. As might be expected, great stress is laid on hygienic conditions, and the report on cholera is preceded by two or three pages, in which reference is made to the usual rate of mortality in country and town districts. Then passing to cholera, Mr. Farr alludes to the outbreaks in India, and to the prevalence of summer cholera in England in 184C. He then passess to the epidemic of 1848-49 in London, and refers the first cases.of the "new form" to the end of September. The weekly returns, and remarks on the spread of the epidemic throughout England, are then appended. And next we have sections on the following subjects:
1. Influence of Sex on the Mortality from Cholera.—Cholera in 1849 killed, in England and Wales, 26,108 males ; 27,185 females. Corrected for population (as there is an excess of females) one male died out of every 331; one female in every 333; so that, on the whole, males suffered slightly more than females. In some districts, however, the proportions were different. At the beginning of the epidemic the deaths of males were in excess, but at the height the deaths of females exceeded those of males.
2. Influence of Age.—Cholera was fatal at all ages, but the middle period of life suffered most. The diarrhoea, on the other hand, which Mr. Farr looks upon as " cholera with the striking but not essential symptoms suppressed," was more fatal to children and old persons. Classing the cholera and diarrhoea deaths together, it appears that men of the age of 25-35 were twice as liable in this cholera epidemic to die, as those 10 years younger (15-25). From this period the danger increases with age.
3. Duration of Fatal Cases of Cholera.—The mean duration of fatal cases was, in men, 49.44 hours; in women, 50 44 hours. It appeared to diminish ns life advances; thus the duration in both sexes at the age of 15-35, was 50.904 hours; at the age of 35-55, it was 46.896 hours ; and at the age of 55 and upwards, 47.352 hours. Fata] diarrhoea lasted much longer—viz., 16.044 days in males, and 16.692 days in females.
4. Course of the Epidemics of 1831-2 and 1848-9.—The two epidemics followed generally the same track. In London, Portsmouth, Bristol, Shrewsbury, Wigan, Liverpool, Leeds, Hull, and Merthyr-Tydfil, the mortality was greater in 1849 than in 1832. In Exeter, Plymouth, Gloucester, King's Lynn, Norwich, Nottingham, Sheffield, Carlisle, Newcastle-upon-Tyne, and Sunderland, the mortality was less in the last than in the first epidemic.
Each epidemic lasted 15 months, and commenced in October [end of September?]. The epidemic of 1831-2 had a first eruption, lasting from October to May, when the mortality descended to the lowest point; and during this time, out of 1000 deaths occurring in the whole epidemic, 174 took place, or 17 per cent, of the total deaths. From May to December was the second eruption, which reached its intensity in August; and during it, 826 deaths occurred out of every 1000 distributed over the whole period of the epidemic. The epidemic of 1848-9 had a first eruption, which reached its height in the fourth month, and descended to the lowest point in May, 1849 ; it caused 29 per cent, of the total deaths. The second eruption reached its height in September, and caused 79 per cent, of the total deaths.
In Paris, also, each epidemic had two eruptions.
The following table will show at a glance the relative mortality in the different months of the two epidemics ; the numbers representing the per centages of the total mortality in each epidemic respectively.
Influence of Temperature.—A table is given showing the temperature of London during the year 1849, and the deaths from cholera. In May, June, and July, the temperature and the mortality from cholera gradually rose; the former reached its acme in August, the latter in September. Mr. Farr evidently attaches great weight to the influence of temperature on cholera.
Influence of Locality.—The influence of locality on cholera was extraordinary, and is well illustrated by the fact, that 46,592 of the 53,293 deaths from cholera, in the year 1849, occurred in only 184 out of 623 districts. To put this in other words, 46,592 deaths occurred in an area of 7839 square miles, on which four-tenths of the population dwelt, while only 6701 deaths occurred on an area of 49,228 square miles, on which dwelt six-tenths of the population.
Eighty-five districts in England escaped the cholera altogether. These districts lie generally high, and are thinly peopled. Their population has scarcely augmented during the last 10 years; the average mortality in all during the 10 years has been very low—viz., 1.75 per cent.
In 73 other districts, there was no cholera, but some diarrhoea. In these districts, the average annual mortality for 10 years has been 1.905 per cent., and the population during that time has only augmented 3 per cent.
The cholera was three times more fatal on the coast than in the interior; and on further analysis it appeared that the fatality was greatest in the chief seaport districts. Thus 26,773 deaths, or more than half those of the whole country, occurred in London, Liverpool, Hull, Bristol, Plymouth, Portsmouth, Southampton, and Tynemouth. Setting aside London, the sea districts may be divided into three groups:—
(a.) Including the Larye Ports.—Here a dense population is crowded on the low alluvial soils of the mouths of rivers; and the deaths from cholera were as 125 to 10,000 persons living.
(b.) Including the Secondary Ports.—The mortality was as 47 to 10,000 persons living.
(c.) In the other Coast Districts, which included only small ports, often inaccessible to ships, the mortality was only as 15 to 10,000 persons living.
On comparing more particularly sea-coast and inland districts, it is found that in 47 districts on the river and sea-margins, there were 85 deaths from cholera in every 10,000 inhabitants; while in 41 inland districts, comprising the large towns (except London), whose aggregate population and whose average mortality are both greater than those of the 47 coast districts, there were only 38 deaths to 10,000 persons living. The fatality in the two groups was in fact as 2} to 1.
In the rest of the kingdom, after the abstraction of these two groups, the mortality was only as 12 in every 10,000 inhabitants.
This great prevalence of cholera and mortality in the coast districts, has always been a strong argument for the contagionist's doctrine, which referred the disease to intercourse with other infected ports. It is, however, extremely probable, if not certain, that too much stress has been laid on this argument, and that prevalence of mortality in the great ports is due in great measure to the low level in which they stand, and to their position on alluvial soil. The influence of elevation on cholera will appear mare fully in considering the causes of the mortality in London.
The coal districts suffered considerably; the deaths being 46 from cholera, and 18 from diarrhoea, to 10,000 inhabitants. The marshy districts of Lincolnshire and Cambridgeshire suffered very little; North Witchford, Whittlesey, and Wisbeach escaped, so also did some of the marsh districts of Essex and Kent. In the Romney marsh only one death o6curred.
Geological formation appeared to influence it in some degree; the districts on the Granitic, Silurian, and Devonian systems nearly escaped. Herefordshire in the old red sandstone escaped, while Cornwall and part of Devonshire on the same formation suffered severely ;—still other circumstances were in play here, and the influence of geographical formation cannot be very great.
Before alluding more particularly to the influence of locality, we pass on to the
Causes of the Mortality in London.—A very curious and interesting chart (plate iv.) is given in the appendix, by which the mean temperature of any week, and the mortality in London of the years 1840-9 inclusive, can be ascertained. Some curious relations which would be estimated with difficulty by figures, are brought out with great ease by this admirable plan, and the chart in question deserves very attentive study. Its chief fact is, that in London there are two healthy and unhealthy seasons; April, May, June, and the greater part of July, constitute the first healthy season—i. e.( the deaths are under the average; then, in consequence apparently of the temperature remaining above 60° (Fahr.), August and September are unhealthy ; in October and November the deaths are again below the average. In December, January, and February, if the temperature remains below 40°, the second and more unhealthy season occurs, and the deaths are considerably above the average. The cholera both in 1832 and 1849 caused a great increase of mortality in London, at a period of the year usually unhealthy—viz., in August and September. The first cases occurred south of the Thames, and throughout the epidemic the mortality was greatest in this district.
The chief elements which may be supposed to influence the mortality of an epidemic, and which we have the means of investigating, are, the water supply, the drainage and elevation of soil, the density of population, and the poverty of the inhabitants.
(a.) Water-Supply. The Thames supplies a great portion of the water; it collects streams from 0160 square miles of country, and receives the sewage of several millions of people. From this vast and polluted river, a great amount of evaporation goes on, especially, of course, when the temperature is high. The amount of this evaporation is almost incredible; it is estimated by Mr. Glaisher as annually 1,523,242,991 gallons of water from a surface of water of 2245 acres in extent, which is the estimated surface of the Thames; or, in other words, 18,000 tons of water are raised from the Thames daily, and diffused more or less over the town. This vapour carries up, it is presumed, organic matter, but the quantity of this is undetermined.
In the six districts supplied by water from the Thames at Kew and Hammersmith, the mortality was as 15 in 10,000 inhabitants. In 20 districts, supplied from the Amwell, the Lea, and the Ravensbourne, 48 in 10,000 died of cholera.
In 12 districts, supplied from the Thames between Battersea and Waterloo-bridge, 123 in 10,000 died of cholera. .
Of course this difference is not due solely, or even in any great degree, to the water-supply; because other more important elements have to be taken into consideration, and one of the most striking of these is the
(b.) Elevation.—Of all the causes influencing the spread and the mortality of cholera, none has so great an effect as elevation. This fact, known for a long time, has been worked out by Mr. Farr so perfectly, that it may be received like the solution of a mathematical problem. We shall quote verbatim as much as possible of Mr. Farr's statements on this point, referring to the book itself for the tables, and for the various proofs and calculations on which they are based:
"The mortality [and therefore, presumably, the prevalence, Rev.] from cholera is in the inverse ratio of the elevation. The mortality of the 19 highest districts was at the rate of 33 in 10,000; and of the 19 lowest districts, 100 in 10,000. The elevation in the two groups was as 71 to 10 feet above the high-water mark of the Thames, or as 7 to 1, while the mortality was as 1 to 3, or in the inverse ratio. In the two groups of the six disiricts supplied with the waters of the Thames at Kew and Hammersmith, the mean elevation was 35, and 175 feet, the mortality from cholera 19 and 11 in 10,000. In the two groups of 12 districts supplied with the Thames water betwen the Waterloo and Battersea bridges, the mean elevations were , foot and 10 feet, the mortality 168 and 77 in 10,000. In the two groups of 20 districts, supplied with ihe waters of the New River and the sea, the mean elevation was 24 and 59£ feet, the mortality from cholera was 59 and 37. While the effects of the water and of the wealth of the districts are apparent, they do not in this analysis conceal the effects of elevation. Cholera was excessively fatal in all the four districts which lie on a level with, or below, the Trinity high-water mark; it destroyed 144, 161, 164, and 205 in 10,000 inhabitants. In the five districts which lie two to four feet higher, on an average, the mortality was at the rate of 68, 97, 120, 153, and 181 in 10,000. In 10 districts of an elevation of 50 feet and upwards, the mortality from cholera was not higher than 8, 8, 17, 19,22, 22, 25, 35, 35, and 53, in 10,000. The last mortality occurred in St. Giles, in which the beneficial effect of elevation was neutralized by other causes." (pp. 61-2.)
On further examination it is evident, that notwithstanding disturbing causes, the mortality from cholera bore a constant relation to the elevation. Thus, on arranging the districts into 7 terraces, the first under 20 feet of elevation, the second under 40, the third under 60, and so on, it is found that the mortality on the ground under 20 feet being estimated by 1, the mortality of each successive terrace may be represented by i, J, }, J, J, or the mortality on each successive altitude of 20 feet, was \, f, f, J, |, <fcc, of the terrace immediately below it. The following table will make this point clearer. The highest terrace (340-360 feet) is Hampstead: