Imagens das páginas

and these only apparent examples of its occurrence at a distance from the coast; the Yemen ulcer, found only on both sides of the Red Sea, and never in the interior of the adjoining countries; the beriberi, in the East Indies, a rheumatic oedematous paralysis, apparently met with only in a certain proximity to the sea; the spedalskhed, or lepra septentrionalis, occurring in Norway, Iceland, Greenland, Kamtschatka, but not in the interior of continents.

Phthisis pulmonalis appears to be rather frequent in islands and in coast districts; a feet probably connected with the great barometric pressure at the sea level, in opposition to the much slighter pressure in elevated regions on the mountains.

Sea-ports have many disadvantages; the temperature is more moderate, the air is damper, the barometric pressure greater, the soil is more frequently alluvial, and moreover, the opportunities lor the importation of diseases arc abundant; all are circumstances favourable to the occurrence of malaria, yellow fever, cholera, phthisis, indolent ulcers, chronic affections of the skin, &c.

Having treated at considerable length of the four climatic regions of Germany, into which part of his subject we shall not follow him, Dr. Miihry divides diseases into three classes, with reference to their epidemic movement; viz., the persistent, the regularly fluctuating (according to the seasons), and the irregularly fluctuating or wandering. To the first class, which in the temperate zone experience no change with the temperature, but occur equally at all seasons, belong the following:—zymotic diseases: smallpox, scarlatina, measles, (hooping-cough, typhus, erysipelas, puerperal metritis), mumps, hospital gangrene, contagious ophthalmia. Those in the parenthesis are slightly influenced by the seasons, typhus being augmented in autumn, the rest in winter. l)yscrasias: tuberculosis, scrofula, cholera, dropsy, furunculosis, anthrax, tendency to gangrene, urolithiasis, helminthiasis, herpes, hemorrhages, hemorrhoids. Local determinations: apoplexy, trismus, tetanus, epilepsy.

The diseases regularly fluctuating according to the seasons.

a. The summer constitution is thus characterized: physiological disposition. The amount of blood in the system, formed in winter, is too great for the exalted temperature, producing relative plethora, which gradually lessens as the organism accommodates itself to the heat of summer. This may perhaps explain the fact, that persons who habitually suffer from vertigo, are more seriously affected with this symptom in the beginning of summer than at any other season of the year. The character of the reaction of the system against hurtful impressions retrogrades from the inflammatory, and approaches to the torpid or adynamic. The tendency to localization is predominantly directed to the digestive apparatus, especially to the liver and intestinal tanal, as well as to the skin, while the lungs and kidneys become freer.

The'more frequent of the summer forms of disease are: zymotic—malaria fever, yellow fever, Indian cholera, plague (although it ceases directly at a temperature over 80° F.), dysentery, aphthae, pustula maligna, indigenous cholera, diarrhoea; dyscrasias— chronic affections of the skin increase, leproid affections appear (on the shores of the Mediterranean), herpes increases'. Pneumonia is rarer; phthisical, arthritic and rheumatic patients are relieved, but plethoric patients and those labouring under cardiac disease suffer more, at least at first.

b. The winter constitution is generally characterized as follows: physiological disposition. The quantity of blood now again increases, and the blood probably gains in fibrin. The character of the reaction of the system becomes increasingly inflammatory. The tendency of localization is chiefly to the respiratory organs, and probably to the kidneys; the digestive apparatus, especially the liver and intestinal canal, become freer. The three terrestrial miasms disappear,'^yellow fever at a temperature under 70°, malaria during the whole winter season, Indian cholera in frost.

To the irregularly fluctuating or wandering forms belong the proper epidemic diseases, which are almost all contagious. Of these some are promoted by heat, as malaria fever, yellow fever and Indian cholera (the three miasmatic diseases), dysentery, pustula maligna, aphthae, plague (to a certain degree of temperature); some by cold, as erysipelas, puerperal metritis, pertussis, croup, from a certain degree typhus, and the atmospheric miasmatic influenza; while others are wholly independent of temperature and seasons, and are all more contagious, especially the most usual, best known, and most dreaded—small-pox, scarlatina, measles, mumps, hospital gangrene, hooping-cough, and typhus.

We shall conclude this article with a few brief remarks on the geographical limits of some diseases.

It is a remarkable fact that, while in the northern hemisphere the polar boundary of malaria, or intermittent fever, corresponds to the isothermal line from 38° 75' F. to 41° F, in the southern the countries south of the isotherm 68° F., are free from this disease.

The plague is limited both by heat and cold, and also geographically. This consagious disease possesses, moreover, a certain singular endemicity, the centre of which is found in Egypt, while its southern boundary does not exceed the isothermal line of 77° F. Towards the cast the plague, with few exceptions, does not pass a meridian line drawn from the Persian Gulf to the Caspian Sea, and on the west it has never reached America. Dr. Mtlhry adduces several reasons for believing that towards the west also there exists an "endemic meridian boundary of the plague." The plague is extinguished in the frost of an European winter.

Gout is almost entirely absent in the torrid zone, and even Europeau arthritic patients residing there soon lose their symptoms.

It might be supposed that in consequence of the increased action of the skin, and of the vicarious or alternating relation between the two organs, diseases of the kidneys should be comparatively rare in hot countries. The majority of the reports quoted by Dr. Muhry appear to favour this view.

Obesity is rare in very dry countries, as in the elevated regions of the Andes, Abyssinia, and Thibet, in South-eastern Arabia, the interior of North America, and at Sydney, in South-eastern Australia; on the contrary, it is frequently met with in highly saturated climates. Thus, in Madeira, Mittermayer found it in boys and girls.

Wounds have been said to heal with difficulty in some tropical countries, as Brazil and the West Indies, while the contrary has been stated of other regions, as Guiana, presenting similar physical characters.

Carcinoma is reported to be rare in Guiana, Sierra Leone, Egypt, Syria, New Zealand, and the East Indies.

The whole subject of climatology and medical geography, of vast importance as it undoubtedly is, is still only in its infancy, yet it is one which must receive an immense impulse from the means of rapid intercommunication which science has lately placed at our command, and which the progress of the age is from day to day more fully developing. Meanwhile, we gladly hail the appearance of such important contributions as Dr. Muhry's work, and of so useful and carefully prepared a compendium as Dr. Pickford's " Hygiene," on which we have yet to say a few wrords.

Dr. Pickford's work is by no means confined to the subject of climate; it contains, in a comparatively small space, and in an accessible and readable form, an immense amount of information on the principal topics connected with the important and, just now, much-ventilated questions of " Sanitary Reform" and the "Public Health." The part already published " embraces the physics of the atmosphere, the seasons, tempera lure, rain, winds, and pressure; the respiration of plants and animals, the circulation of the blood, the chemistry of respiration, and animal heat; infection, contagion, malaria, sewerage, drainage, ventilation, and climate in connexion with disease." The interesting observations of Dr. Roscoe are noticed, which show "that the beneficial action of the brick and mortar walls of our dwellings is not confined to the mere absorbing from, or restoring moisture to, the atmosphere, but that it extends to a very large diffusive interchange between the carbonic acid gas of the apartments and the external atmosphere; that, in fact, brick walls are powerful aids to ventilation. Dr. Roscoe ascertained that in a closed space, the air of which contained 16 per cent, of carbonic acid gas, 3.25 per cent, escaped in two hours through the solid brick." (p. 219). On the other hand, "the unhealthiness of iron, or new and damp houses, is probably

partly accounted for by the absence of all diffusive interchange through iron and through

wet walls." (p. 220.)

Dr. Pickford naturally discusses the questions of " sewerage" and the "Thames;" but vitally important as these topics are, they do not strictly belong to the main subject of this article. Much that he states in his excellent and comprehensive chapters on "climate" and on "climate and disease," we have already drawn from the work of Dr. Muhry.

Review VI.

1. Anatomy, Descriptive and Surgical. By Henry Gray, Lecturer on Anatomy at St. George's Hospital. The Drawings by H. V. Carter, M.D., late Demonstrator of Anatomy at St. George's Hospital. The Dissections jointly-by the Author and Dr. Carter.London, 1858. pp. 750.

2. Handbuch der Systemischen Anatomie des Menschen. Von Dr. J. Henxe, Professor der Anatomie in Gottingen. In drei Biinden. Mit zahlreichen in den Text eingedruckten Holzschnitten, Braunschweig.—1855.

Handbook of Systematic Human Anatomy. By Dr. Hrnle.

3. A Treatise on the Human Skeleton {including the Joints). By George MurRay Humphrey, Esq., M.B. Cantxb., F.R.C.S., Surgeon to Addenbrooke'a Hospital, Lecturer on Surgery and Anatomy in the Cambridge University Medical School, Cambridge, pp. 620.

4. T7te Master-Builder's Plan; or the Principles of Organic Architecture, as indicated in the typical Forma of Animals. By George Ogilvie, M.D., Lecturer on the Institutes of Medicine, &c., in the Marischal College and University, Aberdeen.—London, 1858. pp. 192.

The work of Mr. Gray is likely to become very popular in the schools of anatomy, for it is carefully written, correct in detail, and both well and copiously illustrated. But we do not think that the author has quite done himself justice, nor realized by this production the position of which his earlier works gave such high promise. Perhaps, however, he has contented himself with writing up to the mark of requirements at the present examining boards, an union of examiners and teachers constituting an anomaly scarce known out of the medical profession.

First as to the illustrations. They are of larger size than usual, and decidedly well executed, some as faithful representatives, others as diagrams. But we often recognise "old friends" throughout the volume—the Osteology being after Holden, the Venous System after Breschet, the Lymphatics after Mascagni. And although we do not deny the legal right, nor absolutely ignore the practice of any one thus to appropriate literary property, still we could have wished that one so justly respected as Mr. Gray had not so frequently followed the precedent. Look at the occipital bone in Mr. Holden's work (p. 56) and the same cranial element in Mr. Gray's work (pp. 19 and 21); the bones of the hand (Hofden, pp. 154 and following); with Mr. Gray's delineations (pp. 104 and 106). It is but just to say that the references are acknowledged in the preface.

The drawings of the skin (p. 542), of the tongue (p. 548), or the nose (p. 553), &c., present no novelties; but we anticipate the reply, that a truly accurate anatomical drawing cannot vary, though repeated from the subject a hundred times. Let us, however, turn to what we may praise. The drawings of the bones, although after Holden, are doubtless well done, and perhaps on an improved plan; the outlines are clear, and the margins of articulation carefully indicated, as well as the attachment of muscles. The process of development is greatly elucidated by such diagrams as in pages 70, til, where one may also see at a glance how arrest of development may be followed by fissured sternum (drawing 61). The plan of development of the foot (p. 131) is particularly clearly executed, and may be studied with advantage.

If we turn to the chapter on the muscles, we see that the same care has been exhibited throughout. For instance, the quadrilateral and triangular spaces formed by the humerus, the long head of the triceps, and the teres major and minor muscles (p. 279) can be comprehended by a glance at figure 154; and there the student may see how the long head of the triceps separates the two latter muscles. The passage of the flexor tendons of the palm of the hand with the ligaments binding them in their place is shown in a very good drawing at page 265. Indeed, we may go on multiplying these examples to the end of the work; and we conclude with saying that, although some are diagrams, as contrasted with nature, all are instructive and tell their own story, and by far the greater portion are equally creditable to the anatomist as to the artist.

And now for the text. Upon considering the object which Mr. Gray has had in view, namely, that of producing a work which should assist the student of anatomy in his attempts to learn the proper kind and amount of information required by the usual examining boards, we must say that he has succeeded. Such material, delivered in the form of lectures, would naturally command the attention of the class.

What right have we to complain that, amidst so much that is good, space is devoted to the fact of announcing that bones are long, short, a^id. flat, irregular or mixed, that they are united by sutura vera, sutura notha, sutj»-§^lentata, serrata, limbosa, squamosa; by harmonia, schindylesis, gomphosis,;sPtlirodia;, enarthrosis, ginglymus; diarthrosis rotatorius. Such statements have not yet received an open condemnation as "rubbish," and therefore Mr. Gray has done quite correctly in introducing them in their proper place; but with a quiet sarcasm he couples explanations to these expressions of elucidation. He tells us, for instance (p. 137), that diarthrosis rotatorius means " articulation by a pivot process turning within a ring, or ring around a pivot; as in the superior radio-ulnar articulation, and atlo-axoid joint," and so forth.

The practice of introducing surgical remarks into such a work as the present, is of very questionable advantage, if we consider the matter in a purely scientific light. But then for students there is something attractive in having the mind relieved from the weariness of anatomical detail, by the presentation of some wellknown practical point upon which may chance to bear the very information that they have been laboriously acquiring in the dissecting-room. The drawing, explanations, and references are doubtless from the experience of St. George's Hospital, or from the pathological collection in the museum, and must therefore bear the proper stamp of value.

That this work will be in large demand we entertain no doubt, and we sincerely trust that Mr. Gray will he repaid for the time and labour which he has devoted to the subject. Of the mode m which the work is "got up" it is impossible to speak in too high terms.

And now we are going to quarrel with Mr. Gray—not as an individual—for he has long .been highly esteemed by his professional brethren as a man of industry, originality, and science. But, as a teacher of anatomy of no inconsiderable weight and experience, we ask him wherefore he has so completely ignored the revelations of homology and comparison in his present work? Should he not maintain his place among the pioneers of science? Should not the student be taught in such a work, so laboriously and expensively prepared, something higher than would be fitted for a dissecting-room manual, however accurate in detail the latter might be?

In the description of the lumbar vertebrae (p. 10), Mr. Gray tells us (and we believe for,the first time in such a work) that a tubercle projecting backwards from each of the superior articulating processes is the representative of the transverse processes in the dorsal and cervical region; but why not add that the lumbar transverse processes, of common anatomical works, are the representatives of the ribs—that they should, in fact, be named the lumbar ribs, and are short as osseous structures, because the abdominal walls, unlike those of the chest, must be soft, muscular, and yielding? Had attention been paid to the homologies of the vertebra, Mr. Gray might have gently simplified the account of the muscles of the back, and thus got rid of one opprobrium to anatomy, for it is quite the fashion to ignore that part of the human body in modern schools. Again, irregularities in the origin and distribution of arteries are merely recorded, accurately it is true, but without any attempt to systematize these deviations from the normal state, and yet there is "a method " in abnormities. The chapters on the surgical anatomy of hernia, and on the perineum, are well worth perusal, and explain some of the more important regions of the body in theif relative co-operations. We are sure that Mr. Gray will take our few objections kindly, because he must feel that he possesses both the talent and the information to render this work, of no slight value in its present form, one of the most complete treatises of the day, when a second edition is brought to light. But in order to do that he must give his talents freer play, and fearlessly attack all that part of the subject which rests upon insufficient or unsound foundations. Human anatomy must not be studied so exclusively, and future systems must partake of the lessons taught us by a Hunter, a Cuvier, or an Owen.

Henle* commences the work before us by enumerating a just and a high view of the human archetype. The human body, as that of the vertebrata, generally consists, as traced to its archetype, of two parallel cylindrical tubes, opposed to one another in their .whole length. The one contains the central organs of the nervous system, wherein reside the functions of thought, of feeling, and of will; organs which raise the animal above the vegetable world. The other tube incloses organs proper to the functions of nutrition and procreation, which are proper to plants as well as animals. Hence one of these tubes is called that of animal, the other that of vegetable life. (p. 1.)

Taking this view of the vertebrate form, it follows that the ribs must be regarded as constituting part of a vertebra, more especially as it has been shown by the skeletons of many of the saurian and ophidian reptiles that the long arched dorsal ribs are represented in the neck by the apices of the transverse processes and the long fixed transverse process of the lumbar region. In fact, the hsmal arch is as much part sof a vertebra as the upper or neural arch. This brings us to the question of what a true vertebra consists.

Mr. Humphrey, admitting Henle's view of the vertebral column, and the principles of Homology generally, proposes to improve upon and to simplify the system as introduced by Professor Owen. He regrets (p. 590) that so much new and difficult nomenclature has been introduced by the learned professor, and yet we find the terms supra and subcentral growths, neural arches, neural alae, transverse aloe, haemal parts, &c., by which we are left in no better condition. We think the following passage would be difficult of comprehension to a beginner :—

"Their shape (L e., the bodies or centra of the vertebrae) usually approximates to that of a sphere, but sometimes deviates from it very considerably. One of the modifications is caused by out-growths from the superior or inferior surface of tie centrum. Those in the former situation, such as the posterior clinoid processes of the sphenoid bone, and crista galli of the aethmoid, may be called supra-central," &c. (p. 591.)

We may remark, en passant, that ethmoid should not be spelt with the diphthong, being derived from the Greek word rfifxig, a sieve.

But to revert to the question of nomenclature. Mr. Humphrey retains the expression, "articulating process," in place of Professor Owen's "zygapophysis." Now, in the snake there are many articulating surfaces between each two verte

* We should have presented our readers with an analysis of Henle's work before this, had we not hoped to receive the concluding parts, tho first parts only having reached us. We regret to say that our foreign friends frequently forget to forward the continuations of works appearing In serial numbers, a circumstance that must be our apology for not always paying them that early attention which they might otherwise merit.—Ed.

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