hazardous calling of snaring the sea-fowl. I was informed on the island that during the last thirty-five years five men have experienced a similar fate. Two women are said to have died in childbirth. In the report of the Registrar-General for Scotland published in the spring of 1861, the proportional number of deaths attributed to this cause in the insular districts of Scotland, is one in forty-eight, while in the case of women residing on the mainland it is not more than one in one hundred and forty-five. The frequent occurrence of death from this cause among a population in other respects healthy and remarkably long-lived, and the numerous instances in which, even though the result proved favourable, instrumental interference was called for, repeatedly struck me while residing in the Hebrides. I could never divest myself of the idea that it was mainly to be attributed to the heavy creels of peat, potatoes, and seaweed, which it falls to the lot of the women to carry on their backs. The chief weight of this creel or wicker basket rests upon the lower portion of the spine, which the rope passing round the chest rather assists in balancing, than materially lessens. If we consider the early age at which the young women apply themselves to these burdens, before the ossification of the pelvic bones is yet completed, it seems not unnatural to suppose that the bones may to some extent yield, causing a mechanical obstruction, and so contributing to the difficulties of parturition.

Another curious fact connected with life at St. Kilda, which again speaks to the influence of employment on health, is the remarkable disproportionate longevity between the male and female inhabitants. It has been frequently remarked that in the case of the men sixty years is a limit of life but rarely passed, while the women not infrequently attain an age of fourscore years and upwards. The old factor to whom I have before referred as being long connected with St. Kilda, informed me that during his prolonged acquaintance with the island he could not, with one or two exceptions, recal to mind any males who succeeded in reaching the far side of sixty years, while a green old age on the part of the women was of not infrequent occurrence. The food and dwellings common to the two sexes would naturally be the same; hence, however objectionable, they would not necessarily appear a bar to length of days when once the constitution had become hardened to their influence. The difference, therefore, must probably be set down to the calling of the men, in the prosecution of which they are frequently suspended during several hours by a rope attached round their waist. That the continued strain, both bodily and mental, to which the system is thus exposed, should tend to congestion, and eventually to organic disease of some of the more important internal organs, may readily be believed. While on the island, moreover, I myself observed in the case of two men, but little past the prime of life, marked indications of dropsical effusions, and was informed that similar indications of disease were by no means rare among the men. From tubercular diseases the inhabitants enjoy, as it appears, a remarkable immunity. One woman indeed, seventy years of age, is registered as having died of consumption, though her death might probably with

more truth be attributed to chronic bronchitis. The answers I received to my inquiries respecting the occurrence of true tubercular phthisis from the more intelligent persons, convinced me that the few cases they associated with the symptoms of that disease were confined to the old and invalided. I may here remark, in reference to pulmonary consumption, the extreme rarity of which disease among the Hebrides I endeavoured to point out in an article in this 'Review' for October, 1860, that the word by which it is expressed in the Gaelic language literally signifies a "wasting" or "decay," and hence, though all cases of phthisis are probably entered in the register under that heading, numerous other pulmonary disorders are included in so general a term. We may therefore, I think, infer that favourable as is the testimony of the lately-published returns of the Registrar-General for Scotland respecting the prevalence of phthisis in this portion of the kingdom, they may still be considered as unavoidably overdrawn. Of the remaining deaths two are attributed to croup, a frequent and fatal disease among these islands; and one to cancer. Of the latter disease, a second fatal case had occurred immediately prior to my visit to the island.

Before bringing my observations on the ten-year register to a close, I would direct a passing remark on the apparently trivial circumstances to which, among rude states of society, fatal results may be traced. In many respects, on a cursory survey, at any rate, the habits of life which prevail at the Faroe Isles are not very dissimilar to those at St. Kilda. From the fact, however, of the inhabitants of the former being well supplied with materials for fertilizing their soil out of doors, the necessity of preparing a substitute by closing all the apertures in their houses, was never forced on their minds. The consequence is that they breathe both by day and by night a wholesome and renovating air; and from this cause, probably, more than any other, are, in spite of their nauseous food, and the open sewers round their huts, the longestlived community with which we are acquainted, their annual rate of mortality being only 12.5 in every one thousand persons. In St. Kilda, on the other hand, the poisonous atmosphere tells with such fatal effects, that out of a population of 105, in the course of the ten years to which I have so often alluded, 64 deaths occurred, exhibiting a yearly death-rate of 60.9 in the 1000; nearly twice as great as that observed in the most unhealthy manufacturing districts in England and Wales.

I have thus run over some of the principal causes of death which I found recorded in the ten-year register, with a few passing remarks on the circumstances under which they arose. They contain, I think, considerable interest, as occurring spontaneously from natural though preventible causes, and as being altogether unconnected with that great family of disease to which man, in proportion as he goes more out into the world, and comes into more frequent contact with his brother man, appears to render himself obnoxious. Since the outbreak of the small-pox at St. Kilda, to which I have referred, neither that disease, nor measles, nor scarlatina have, as far at least as I was able

to discover, been introduced upon the island. In regard to diseases of this class, though not directly connected with my subject, I may perhaps be allowed to remark that peculiar facilities are afforded in islands for observing the circumstances under which they arise. In large towns, and even in country districts, in many instances, it is obviously impossible to say how far any particular outbreak of sickness is due to directly contagious influences, or arises from cosmical or malarious exhalations. The assertions of patients suffering from one or other of these affections, that they have not come in contact with persons similarly indisposed, are all of comparatively little value. In large cities especially, the street-cabs, the "four-wheeled fever-traps" of the metropolis, after depositing one passenger at a hospital, and the next at a ball, add largely, it may be readily believed, to the tale of infectious disease. In islands, on the other hand, and especially in such groups of islands as the Hebrides, the advantages of isolation are aided by the fears entertained among simple societies towards the sufferers from contagious disorders. Hence it is frequently possible to estimate with a degree of certainty unknown in more populous places, how far any disease is strictly contagious, in other words, communicable from man to man, or originates in malaria or the variable conditions of the atmosphere; and this inquiry is the more important at the present time, inasmuch as there is, I think, among many sanitary reformers, a tendency to look upon almost all diseases as preventible, and the most specific contagious poisons as capable of being artificially produced. Thus, for example, among some writers, even such a disease as small-pox is spoken of as capable of being spontaneously generated where the requirements of cleanliness are systematically violated. That such, however, is not the case is both proved by the fact that this, and several other now prevalent disorders, were unknown to the ancients, among whom, could they originate in filth, the conditions favourable to their development most undoubtedly existed; and further, by their non-appearance, except when accidentally introduced, among the inhabitants of islands. I may refer to the island of Raasay, in which I myself resided for the greater portion of upwards of seven years, for an illustration to the point. It is situated immediately to the east of the Isle of Skye, and at one point the width of the sea which separates it from the latter is not more than three-quarters of a mile. During the last fifty years, as I have ascertained from elderly persons resident at Raasay, no single case of either measles or scarlatina has occurred in that island, while both these affections have, at various intervals of time, been prevalent in Skye. Moreover, some of the hamlets in the latter island, in which the disease more especially prevailed, have been those immediately opposite to Raasay. But while scarlatina and measles were, during all this time, absent from the island, sporadic cases of hooping-cough, even to my own personal knowledge, might be often observed: nevertheless, these three disorders are frequently associated in one category in respect to the nature of the poisons which may lead to their production.

Whether the causes for the trismus and heavy general mortality I have ventured to suggest be correct, may soon be satisfactorily tested.

By the visit of the Porcupine in the spring of 1860, the condition of the island and the manner of life which prevails among the people were more prominently brought out. A violent hurricane in the early part of the following October swept into the sea the roofs of the houses and destroyed the greater part of the winter stock of food. It was fortunate for the inhabitants that this visitation was witnessed by Captain Otter, R.N., who was stationed off the island at the time it occurred. His influence and representations caused the loss the poor people had sustained to be replaced by other and more wholesome provisions. The improvement of the landing-place likewise, carried out under his supervision, owing to the greater facility afforded for fishing, opened a new channel for employment and food. Whether as a consequence of these changes or not, I am unable to state, but from inquiries I have lately made, I find that since the first visit of the Porcupine, the "boat cough" has not reappeared on the island. It is not improbable that the days of the trismus are in like manner drawing to a close. During the summer of 1861, by the direction of the proprietor, the old cabins were being rapidly demolished, and neatlyconstructed felt-roofed cottages rising in their stead. With all these changes we may reasonably expect that the frequent occurrence of this once fatal disease may soon be altogether stayed, and its ravages known only as a thing of the past.

ART. II.

An Analysis of Two Hundred and Twenty Cases of Pulmonary Consumption. By WILLIAM ROBINSON HILL, M.D. Edin., Physician to the Eastern Dispensary, Bath.

(Concluded from p. 512 in previous number.)

Treatment. In the treatment of cases of consumption there are two main points to be borne in mind; 1st, the general treatment of the disease, and the fulfilment of those conditions which are likely to restore and maintain the health and strength of the invalid; and 2ndly, the special treatment of those more prominent and dangerous symptoms or occasional accidents of the disease which arise in certain

cases.

The first point will be attained according as we become acquainted with the hygiene and therapeutics of phthisis, and according to the accuracy of our knowledge with reference to its causes.

It is clear that those supposed to be hereditarily or otherwise predisposed to pulmonary phthisis should be protected by adequate clothing, avoiding exposure to sudden cold or wet; and hence it is manifest that those climates which are least liable to changes in temperature and weather, are the most suitable for such invalids. They should also endeavour to avoid everything of a mentally depressing nature, such as attendance upon a sick room and numerous other things that might be mentioned; and, finally, should abstain from everything that is physically debilitating, whether this consist in irregularities of life and lack of out-of-door exercise, or whether it depends

upon insufficient food and the breathing of a pestilential atmosphere; the latter causes, alas! far less easy to obviate in most cases among the humbler class of patients than the former.

With regard to the therapeutics of the disease, no specific has yet been discovered for pulmonary phthisis, nor, as I anticipate, ever will be. A variety of therapeutic agents have been vaunted and tried from time to time, as if possessing peculiar efficacy in the arrest or cure of the disease, one of the most recent of which is the substance phosphorus in combination with potash and soda or lime, as the hypophosphites of these bases, which has afforded an example of the danger of the à priori mode of reasoning in medicine, always praiseworthy in the extreme, if correct, but prejudicial and hazardous in its results, if blindly carried out when based upon data of a merely ideal character.

The very doubtful efficacy of these salts in the cure or even amelioration of phthisical patients, has been demonstrated by the impartial investigations of Dr. Quain.* The results at which he arrived show that of 22 cases only 6 experienced amelioration, whilst in five of these six the improvement was merely temporary.

There being, then, at present no drug known to exert a specific influence over the disease, there would seem, as is proved by general experience, to be an indication for the administration of those which are known to invigorate the system, increase the appetite, and aid the digestive powers, and for this purpose iron, quinine, and vegetable bitter infusions will be found suitable. From general observation, I believe alkalis to be more beneficial in the majority of cases than acids. Small doses in conjunction with hydrocyanic acid and infusion of gentian, will be found of marked service in the dyspepsia of phthisis.

Cod-liver oil has now for a long time maintained a high place in the professional and popular mind for its efficacy in consumption, and deservedly so. Whether its action is therapeutic or merely dietetic, I do not undertake to say. It is remarkable that fatty and oily substances generally are not only disliked by consumptive patients, but they for the most part disagree with them, and yet this oil, after the first few doses, usually agrees well and is even relished by them, and thus the necessary element of fat, which is avoided in their ordinary dietary, is by this means supplied to the system.

The beneficial effects of the oil will be satisfactorily seen in the analysis of my cases, which may, I think, be looked upon as being very reliable, inasmuch as the oil was not expressly given with the view of testing its merits, but was supplied indiscriminately to one batch of cases, whilst it was withheld indiscriminately from another batch, a note being merely taken of the fact at the time; and on looking over the 174 cases in which such a note was taken, and comparing the general result after a certain period of treatment, averaging about three months, I find that the proportion of those who derived positive benefit during the time they were under treatment is decidedly the

* See Lancet, March, 1860.