conducive to its development; and such, in fact, is the case, for we find that exposure to cold and moisture is one of the most frequent atmospheric causes. The year in which the gangrenous form took place is described by Hippocrates as being excessively damp, and the season that preceded the one in which this complaint began to rage was very winterly; the air was also calm and stagnant, and thus became loaded with emanations from those who had already been attacked. We have already seen that the year 1838 was remarkable for its coldness and humidity, and its excess of deaths from erysipelas. The year 1848, in the winter quarter of which the number of deaths in the metropolis rose to 195, nearly double the amount of the average, was southerly, and distinguished by a large fall of rain, which coincides exactly with the observations contained in the table at pp. 110 and 111. The winter quarter of the present year, 1855, is remarkable for the excess of deaths from erysipelas, and we must attribute it to the very low temperature that has characterised the three first months of the year. The year 1848 must be considered a pestilential year, for in many parts of England the cholera had begun to show itself. Of erysipelas there died 3616, of cholera 1908, of diarrhoea 11067. The contagiousness of erysipelas has been acknowledged from the most remote period of the history of medicine, and this character is what renders it so fearful a disease when it presents itself either in a hospital or a prison. During the months of winter and spring, when the windows and doors of the wards are kept closed in order to keep out the external penetrating easterly wind, the atmosphere thus pent up gets loaded with animal emanations, is thus rendered poisonous, and soon begins to show its virulent character if any of the patients be unfortunate enough to have ulcerated surfaces. In the year 1848 it attacked the cases in some of the London hospitals that had been operated upon, and often with fatal results; at the same time hospital gangrene and peritonitis (of a low form) after operations for strangulated hernia occurred. In some parts of Scotland it raged with unexpected severity, attacking almost every wound, however slight. At Inverness, for the last nine months of the year (1848), erysipelas was very prevalent. The application of a blister, an irritating liniment, or a wound, however trifling, were, in five cases out of ten, sure to be followed by this disease. Many persons died of erysipelatous sore-throat and inflammation of the lungs, all unyielding to depletive remedies. In the infirmary of that town, the dread of erysipelas was so great for a considerable time as to deter many persons from entering it. By some it has been thought that the epidemic described by Hippocrates was identical with the pestilence that afflicted Athens in the time of Thucydides. Certainly this physician was then alive, and probably about thirty years old, but had he been a witness of such a disease he most certainly would have recorded it:-in all probability the year in which the plague occurred was a pestilential one, and capable of producing several epidemics, which varied with the locality in which they raged. In England, whilst cholera was devastating some districts it was absent in others, when typhus or some other equally fatal scourge thinned the population: so might the plague have raged at Athens, and gangrenous erysipelas coincidently at Thasos, or wherever Hippocrates was practising at the time. The distance is so short between Greece and Egypt, where the plague is by some considered endemic, that a southeasterly wind could soon bring the dreaded scourge to its shores; thus Thucydides,† in his masterly account of the plague at Athens, traces it from that part of Ethiopia that lies above Egypt, to Persia, Lemnos, the Piræus, and thence to Athens. It appeared in the winter of the second year of the Peloponnesian war, which was the second or third year of the eighty-seventh Olympiad, B.c. 430. it Carbuncles (ävepakɛs) also were noticed to be common; and may be well just to make a few remarks on the disease now *London Journal of Medicine, No. 1, P. 115. Lib. ii. § 47. called by that name,—especially as it has increased of late years: thus the total number of deaths in the metropolis from this cause stand in the following order :-1840, 2; 1841, 1; 1842, 5; 1843, 6; 1844, 5; 1845, 9; 1846, 3; 1847, 15; 1848, 20; 1849, 15; 1850, 19; 1851, 19; 1852, 50; 1853, 70; 1854, 91. Now this disease, we see, seemed to make a sudden leap at the approach of the pestilential year 1848, and to have gradually increased the number of its victims until the cholera year of 1854, when 91 deaths were registered, the order of which, according to the season, was as follows:-winter 25, spring 25, summer 19, autumn 22. Whether this disease has an epizootic origin, or whether it is dependent for its development upon certain atmospheric combinations, or whether the system has become more prone now than heretofore to throw out morbid matter in the characteristic form of a carbuncle or boil, is a subject which I cannot enter upon here, for I have not sufficient facts before me to warrant me even in giving a most general opinion in the matter. With this introduction I shall now proceed to make some remarks on the Table, in which I have grouped all the characteristic meteorological phenomena mentioned by Hippocrates as having been observed during the fatal year whose melancholy history he has so well and beautifully told. We find, on referring to the above Table, that four out of the five seasons which it comprehends were characterised by copious rains, southerly wind, a cloudy sky, and a gloomy state of the atmosphere; and that, after the winter solstice, the weather, instead of being fine and clear, was winterly and out of season, and thus ushered in the spring, which, in this pestilential year, was so fatal a season. I will now analyse the Table, and in doing so I think it will be the best place to discuss the several phenomena separately, instead of treating them generally. Previous Seasons.-Hippocrates, we must remark, was not content with merely giving a description of the condition of any one particular season in which an epidemic prevailed, for full well did he know that much depends upon the state of the seasons that precede those in which any peculiar disease shows itself. Epidemics require time to become matured, and their development is often going on at a time when we least suspect it, simply because we do not see any cases of it. By and bye it is, however, to be hoped that a more extended study of meteorology in its relation to disease will teach the physician what class of epidemics to expect, and thus, being "forewarned, he will also be forearmed." It is highly necessary, in writing the history of a particular constitution, to take into consideration the state of several of the preceding seasons, for, without doing so, we should be often at a loss to account for the occurrence or increase in the number of many diseases, which might otherwise be well accounted for by a reference to some of their more salient meteoric antecedents. The effect of the seasons upon vegetation is also worthy of especial attention, so well as the appearance of certain insects, which are often not only the forerunners of disease among plants, but too frequently harbingers of ill to man. "For oft engendered by the hazy north, Myriads on myriads insect armies warp The sacred sons of vengeance; on whose course Rain, Moisture, and the South Wind.-We shall consider these three characters of the "Pestilential Constitution" together, inasmuch they are so frequently inseparable companions. The South Wind (Eroç vóriov, čπоμßрov.†)-The Table at page 110 shows at a glance that this direction of the wind was prevalent during the preceding autumn and early part of the spring in which the epidemics appeared. This south wind, perhaps, had much to do with the pestilential character of the year; and we *Thomson's Seasons-" Spring," line 119. + Epid. iii. 3. see on comparing the Tables of the Second and Third Constitutions, that in those years the north wind was the prevalent one,— and even in the First Constitution, where there is the appearance of a southerly tendency, yet that the year was preceded by an opposite and northerly state of the weather. It must be remembered that the Etesian winds are northerly. The south wind hardly ever gets a good epithet, either from the poets or prose writers of antient times. Aristotle* says that it is a moist and heavy wind (ὑγρὸς γὰρ καὶ βαρυς ὁ ἄνεμος); and Plinyt uses nearly the same words: "Austro humido scilicet et graviore vento." Horace calls it "plumbeus Auster;" and Ovid,§ in his description of the plague that devastated Ægina, mentions this wind as prevailing at the time : "Letiferis calidi spirârunt flatibus Austri." I will now endeavour to trace the south wind in its various relations to the epidemics both of the countries of the northern boundary of the Mediterranean and of the western parts of Europe. The plague is said to be endemic in Egypt; and Fodéré|| says "that there only is it engendered; and that in other regions it is always an alien." It will be also found related by Dr. Joseph Browne, ¶ that "the vernal equinox is the period of the greatest fatality of the disease [plague]. About this time, we learn, southerly winds blow with great violence; they last ordinarily three or four hours, and are frequently renewed daily for fifty successive days. They are very warm, passing over the burning deserts which border Egypt in the south, and they are moreover loaded with putrid emanations exhaled from the animal and vegetable substances which are decomposed in the lakes formed by the retiring of the waters of the Nile, or in the cemeteries * Lib. viii. Hist. cap. xv. + Lib. x. 33. Ser. ii. 6. § Met. lib. vii, line 332. Dict. des Sc. Méd. vol. xli. p. 87. |