the value of M. Sales-Girons' invention by MM. Pietra-Santa, Réné Brian, and Champouillon. The former of these observers asserts, from investigations upon "pulverized" water at the "Eaux Bonnes," that the chemical elements of the "pulverized" water are not carried over in the spray, and consequently not inhaled by the lungs. M. Brian caused two or three of the lower animals to inspire a solution of pulverized perchloride of iron, and after killing them, could detect no traces of that substance in the bronchi or air-passages of the lungs. M. Champouillon caused a patient with bronchitis to inhale the spray of a similar solution, and on testing his expectoration could detect no traces of iron. With regard to the first of these objections, the evidence of MM. Patissier and Ossian Henry, who are at least as good chemists as M. Pietra-Santa, shows distinctly that the spray of the "pulverized" water at Pierrefonds contained all the elements of its sources of origin (toutes les substances propres à l'eau), and they state that so far the object of M. Sales-Girons is attained. Upon the second question at issue-viz., the passage of the medicated spray into the air-passages, we think that the experiment of M. Brian proves little or nothing, as it is perfectly possible that the spray, unless carefully carried to the aperture of the larynx by means of a tube, might have been all condensed on the walls of the mouth and nares of the animals experimented on, and have thence passed by swallowing into the œsophagus. We have found, after repeated trials with M. SalesGirons' apparatus, that if the solution employed is sufficiently strong, and the spray carried, as we have mentioned, by means of a tube to the back of the fauces, most distinct evidence of its passage into the lungs may be obtained.* This is not the place to enter into details on the subject, but we are bound to add that the penetration of the spray into the air-passages, though it does occur with careful managemeut, is by no means so easily demonstrated as M. Sales-Girons seems to assume. Although the first few inspirations cause a little cough, the trachea soon gets accustomed to the impression of the fluid, and the inhalation may be carried on without difficulty for a considerable time.t

The following experiment by MM. Ossian Henry and Flubé may be cited in contradiction of the statements of M Brian. A young pig, whose nostrils had been previously stopped up, and whose mouth was open, was exposed for half an hour to the spray of a pulverized (we must apologize for using the word which M. Sales-Girons has appropriated to designate his process, but which it is easier to cavil at than to replace) solution of a salt of iron. The animal was then killed and opened, and the deeper bronchi showed, on applying the appropriate tests, that the ferruginous spray had penetrated into them. Indeed, it is as difficult to conceive how, if the particles of the fluid, mixed up with air as they are, are once carried into the mouth or nostrils, they can fail to pass into the trachea, as it is to suppose that the spray of any given liquid, which may be completely dissipated in that form during the process, can do otherwise than exhibit all the elements which the liquid in its original condition possessed.

↑ Since the above was written, a communication has been made to the Académie de Médecine of Paris by M. Démarquay (Bulletin de l'Académie,' Sep. 24, 1861), on the subject of the penetration of "pulverized" liquids into the respiratory passages; and the results obtained by that gentleman are so decisive that we have thought it desirable to insert a note of them here. The experiments of M. Démarquay were instituted at the Maison Municipale de Santé of Paris, with the assistance of M. Lecomte, and in the presence of MM. Mialhe, Sée, Pietra S inta, Giraud-Teulon, and the students of the establishment; and they were undertaken in consequence of the "happy results" which M,

In stating our conviction, from personal experiment, that the particles of spray do pass into the trachea, we are far from wishing to prejudice further inquiry into the value of M. Sales-Girons' invention. On the contrary, the whole subject requires a much more thorough investigation than it has yet received, the results of which will, we have no doubt, place the therapeutic utility of the "pulverizing" process, so far as its respiratory employment is concerned, on a much more satisfactory footing than that on which it stands at present.

But if the object which M. Sales-Girons had in view in devising his new method of treatment must at present be considered as still sub judice, the invention of M. Mathieu stands on a less questionable footing. Starting from the idea that in a common bath of mineral water, the only portion of the fluid which is of any utility is the thin stratum which is immediately in contact with the surface of the body, and which is only slowly and imperfectly renewed, the end which he proposed to himself was the invention of a process which should renew indefinitely the fluid in contact with the skin, whilst it at the same time economized the quantity to be employed. With this view he has constructed an apparatus which accomplishes, though by a different process, the same result as the pulverisateur of M. Sales-Girons—viz., the reduction of the fluid to a state of fine mist or spray; and he introduces the spray so formed into a small chamber, in which the patient to be exposed to its action is seated, naked. By this means, it is stated in the report on the subject to the Académie de Médecine, the body of a patient may be exposed to a bath of fine spray for an hour with the expenditure of only three or four litres (five to seven pints) of fluid, and that costly medicinal agents may be administered at a comparatively trifling expense. M. Hardi, of the Hospital of St. Louis, has made an extensive series of researches on the comparative physiological action of this and of the ordinary system of bathing, and has found that they resemble one another closely, both in the Démarquay had obtained from the application of the "pulverizing" process in the treatment of chronic affections of the pharynx and larynx. In the first series of experiments a number of rabbits were made to inhale the spray of a "pulverized" solution of perchloride of iron. At the end of five minutes some of the animals were killed, and in almost every case the ferrocyanide of potassium revealed the presence of iron "in the larynx, trachea, bronchi, and pulmonary parenchyma." Of the rabbits which were not thus killed, nearly every one died within twenty-four hours of violent broncho-pneumoniaa clear proof that the liquid had reached their lungs !

In the second series, a number of dogs were subjected to the same treatment, with very similar results. In one case a piece of paper saturated with perchloride of iron was introduced by an artificial opening, into the trachea of a dog which had been made to inhale a "pulverized" solution of tannin; when drawn out again, it gave satisfactory evidence of the penetration of that agent into the trachea.

In the third series, M. Démarquay and the students of the establishment convinced themselves by the sensations experienced in the chest, after inhaling a “ pulverized" solution of tannin (as we have ourselves done), that the spray of that liquid really enters the air passages.

Finally, a patient with a permanent tracheal fistula was made to inhale by the mouth a pulverized solution of tannin, the presence of which in the trachea was unmistakeably detected at the fistulous orifice by the appropriate tests. These experiments, undertaken by a competent observer, and performed in the presence of some of those who had previously denied the fact of penetration, are so decisive as to leave no doubt that, so far as the possibility of introducing medicated liquids into the lungs is concerned, M. SalesGirons has fairly accomplished the object which he had in view.

sensations experienced by the bather, and in the effects produced upon the pulse and urine.

The evidence as to the therapeutic efficacy of M. Mathieu's system of balneation is very satisfactory, and the more so as it does not depend upon the testimony of himself or any other interested person, but is mainly derived from an eight months' trial at the Hospital of St. Louis by M. Hardi. The observations of M. Hardi have been laid before the Académie de Médecine of Paris, and a report founded upon them has been drawn up by M. Gavarret. From this it appears that spray baths of starch, sulphide of potassium, iodide of potassium, natural, mineral, and sea waters, as well as of other medicated fluids, have been used in the treatment of various diseases of the skin and scrofulous affections, with very marked success, and that after the patients had been submitted to the ordinary methods of treatment without any improvement. But it is especially in affections of the face and scalp that the spray-baths have most exhibited their therapeutic efficacy, inasmuch as the mildness of their action allows the patient to expose the entire head to them for a considerable time without any inconvenience. In the brochure published by M. Tampier we have also a series of cases in which the spray-baths have been employed under the superintendence of many of the leading medical men in Paris; in the majority of these the beneficial results obtained were very decided, especially in secondary syphilitic affections of the skin which had been treated by mercury without effect.

By M. Mathieu's invention the administration of baths of natural mineral waters is brought home to the very door of the invalid, who may now luxuriate in the waters of Ems, Vichy, and Carlsbad without leaving his own place of residence. It is to be hoped that a more extended experience of its application will confirm the belief expressed in M. Gavarret's report, that the new system of balneation is "a real therapeutic conquest."

We have devoted greater space to the notice of these new plans of medication than we otherwise should have done, chiefly in consequence of their having as yet received little or no attention in this country; and we shall feel that we have not done so without effect if our remarks should lead those who may have the opportunity to give them a fair trial to examine their pretensions with the view of bringing them fully and fairly before the profession.

We hope to return to a more complete consideration of these spraybaths at a future time, when their physiological action has been more thoroughly investigated than it has as yet, and when their therapeutic efficacy shall have been tested by a wider experience. Meanwhile, we feel justified in expressing an opinion, that whether the invention of M. Mathieu shall eventually realize the anticipation of M. Gavarret, or not, both that and the process of M. Sales-Girons constitute an entirely new step in medical treatment; and we have little doubt that, even if their direct utility should prove to be less than their originators expect, they will indirectly lead to other results of no small importance.

We have already so far encroached upon the space at our disposal, that we must postpone to another opportunity the consideration of the recent contributions to our knowledge of the effects of two other varieties of "bath" whose therapeutic employment has but lately come into vogue; we refer to those of compressed and heated air.

REVIEW VI.

1. Report of the Proceedings of the Fourth Session of the International Statistical Congress held in London, July, 1860: Sanitary and Vital Statistics of the Army and Navy. 1861.

2. Statistical, Sanitary, and Medical Reports for the Year 1859: Army Medical Department.

1861.

3. Statistical Report on the Health of the Royal Navy for the Year 1856. Ordered by the House of Commons. 1858.

4. Statistical Report on the Health of the Royal Navy for the Year 1857. Ordered as above. 1859.

THE greatest desideratum, unquestionably, in the study of medical statistics is an accurate and continuous registration of all diseases as they occur in any large portion of the community, and specially among the labouring and necessitous classes. Some of the most interesting problems of this science must await their solution until the indispensable pre-requisite of regular statistics of sickness can be had; for obviously the facts must be clearly ascertained before we begin to argue, and our data be sufficiently abundant and varied, as well as be duly arranged and collated, before any trustworthy conclusions can be formed. Hitherto but little has been done-nay, scarcely a sure step has been taken to supply this want even in this country, which has now for upwards of twenty years had a more exact record of the mortality, and of the causes of the mortality, among its people, than any other nation has ever possessed. And who is ignorant of the inestimable benefits which have already flowed to social welfare as well as to medical science from this important work, with which the name of our distinguished countryman, Dr. Farr, will ever be gratefully associated? Has not the health, and therefore the effective strength and the labour-power, of our population been steadily-only too slowly and too partially-improving of late years? This is a great national blessing for which we cannot be too thankful. Deaths have been diminishing; and when we speak of deaths, be it remembered that every death is the expression not only of the loss of one of the community after more or less lengthened suffering and infirmity (the cause, it may be, of much privation to and even the positive destitution of an entire family), but is also the invariable exponent of a no small amount of concomitant sickness and distress in other persons at the same time. For every working man that dies, there are two of the same age constantly on the sick list and off work in consequence, besides a third man who has become permanently disabled,

to a greater or less degree, from the effects of disease in a previous year. "The numbers constantly suffering from acute sickness at any year of age," says Mr. Edmonds,*" will amount to double the number of yearly deaths, and the number of invalids or permanent sufferers from past sickness will be equal to the number of annual deaths." For example, out of a thousand persons of our population, all in their thirtieth year, about ten will die annually, twenty will be constantly on the sick list, and there will be ten permanently disabled from active work from the effects of sickness suffered in previous years.

It is not till we realize these things to our mind that we begin to get a glimpse of the large unknown amount of suffering and sorrow which every item in an obituary represents, or that we can appreciate at its just value every successful effort to reduce the death-rate among a people. Every life saved may be regarded as an index of a threefold saving of constant disablement and loss of labour, in consequence of bad health among the working classes of a community. But this view alone gives a very imperfect idea of the entire amount of sickness to every death, which occurs in the general population. Probably we shall not be far wrong if we estimate that five-and-twenty or thirty cases, at least, of illness take place for every one which proves fatal. Many diseases occasion a large amount of distress, permanent as well as temporary, and contribute nothing to the bills of mortality. Ophthalmia and rheumatism are of this class; maladies the prevalence and the effects of which among the working classes it is most desirable to ascertain, but which scarcely ever figure in a register of deaths. And so it is with most diseases of the skin, with ulcers, &c.; although they always form no inconsiderable a part in the records of dispensary and hospital practice, they add but little to an obituary. Hence the obvious necessity of a trustworthy registration of sickness, no less than of an accurate registration of mortality, for the attainment of the full advantages to be derived from that most important branch of medical study-vital statistics in all its manifold bearings.

The question is, how is this much-desired information to be had? is there any existing channel or ready means by which it might be obtained? or must some new machinery be devised for the purpose? A brave effort was made to this end, a few years ago, by the metropolitan medical officers of health, who worked at it most ably for some time, and with every prospect of doing much good, until their labours were suddenly stopped by the ungracious withdrawal by the Government of the trifling money grant to defray the necessary expenses. Weekly returns of all fresh cases of disease coming under treatment in the workhouses, hospitals, dispensaries, and some other public institutions in London, were regularly arranged and tabulated, with appended memoranda on meteorology, the sanitary condition of localities, &c. These registers, at the time of their discontinuance, contained a record of several hundred thousand cases of sickness, probably the largest and most complete registration of the sort in civil * See his paper on Statistics of Health in the Proceedings of the Congress.'