and how consistent the observations of Hippocrates are with what passes around us in the present day. Although our subject strictly confines us to the study of Meteorology in its relation to disease, yet inasmuch as we have to deal not only with bodies prone to take on disease, but with a poisoned atmosphere; and as we know that unless the latter be very strong, it ofttimes fails to victimise the robust and healthy; in fact, as two conditions are necessary for the full development of an epidemic fever, viz. a predisposition in the body to take on disease, and a poison in the air sufficiently energetic to resist the natural endeavours of the system to throw it off when it has been imbibed,—I think it will be better first to describe the nature of that predisposition, and its different sources, and then proceed to speak of the poison which acts as the exciting cause. Fevers are called zymotic diseases, from the idea that their spread through the system is brought about by a fermentative process (un-a ferment or leaven, from "éw-I seethe or boil). In a healthy condition of the body, all the disintegrated tissues, the result of use, are carried off by the different emunctories so soon as they get into the blood: the purification, then, of this fluid is constantly going on, so long as the different excreting organs do their work healthily. On the other hand, should there be any barrier to the elimination of this putrescible matter from the blood, on account of either the liver, the kidneys, the skin, or the mucous lining of the intestines, being unable, from disease or obstruction, to fulfil their respective duties,-an effort will be made by nature to get rid of the difficulty, by making one organ take on the duty of the defective one for the time being the skin may be relieved by the kidneys, these organs may be relieved by the bowels, and so on: but it must be evident that such a state of things cannot last long: the disorganised result of the waste of the tissues accumulates in the blood, and thus poisons it, rendering it capable of taking on a : process supposed to be identical with fermentation, should a leaven from without, in the form either of putrid emanations from diseased bodies, or decayed animal and vegetable matter, come in contact with it, either through the medium of the stomach, lungs, or skin. Deficient action, therefore, of the scavenger organs of the body is one source of the accumulation of deleterious matter in the blood. It will be perceived upon a little consideration, however, that this is not the only condition of the body that brings about a retention of effete matter in the system. All the organs may act well, and yet not be able to depurate the blood sufficiently fast: this would be the case after over physical fatigue, during which there had been a great waste of tissues, which, were time given, would be duly eliminated: at the time, however, that the excess of effete matter remains in the blood, this fluid is highly susceptible of those exciting causes which form our subject. Again, excessive potations of alcoholic liquors have a tendency to increase the fermentable state of the blood, by impeding, to a great extent, the elimination of the products of disintegration. During fatigue from bodily exercise which may have been carried to excess, there is a general depression of the nervous system, which reacts upon the excreting organs, rendering them less active sufficient alcoholic stimulus to arouse the body from this depression, and thus augment the depurating powers of the various emunctories, would not be contraindicated; although excess under such conditions would be highly injurious, and it could not fail shortly to increase the general depression of the whole system, and thus supply every necessary element for the accumulation of noxious matters. : The uterus after parturition undergoes rapid disintegration, and the products of this process render the blood excessively susceptible of puerperal fever, typhus fever, or erysipelas. I will now compare these facts with the texts from Hippocrates that I have placed at the head of this article. Fatigue and Subsequent Excess in the Ingestion of Alcoholic Liquors. Hippocrates could not help considering that these two antecedents had something to do with the attack of epidemic fever that his patients laboured under: he therefore gave them a prominent place in his history of the cases. I have before alluded to his observation that free livers suffered greatly from the prevailing fever; and in his detail of cases (we cannot imagine that he registered every case that came under his notice) he appears to have picked out specimens of what were daily passing under his eye.-Case II. "Silenus lived on the Broadway after fatigue, drinking, and unseasonable exercise, was seized with the fever, and on the eleventh day died." He began with having pain in the loins, urine with a dark sediment, &c. How clearly this description indicates excess of effete matter: the pain in the region of the kidneys, their highcoloured excretion, all betoken excess of disintegrated matter rushing to those emunctories to be thrown off, but not finding a sufficiently speedy outlet went back into the system, and rendered it liable to be attacked by the poison that was floating in every inspired cubic inch of air. In Case VIII. Erasinus was seized after supper; Case IX. Criton was attacked while walking; and Case XII. Hippocrates describes a man as having been attacked after eating supper, and drinking more than enough. With regard to drinking, in the common acceptation of the term, it can no longer be doubted that it induces a fermentable state of the blood; and Dr. Prout has shown that the ingestion of alcoholic liquors diminishes the amount of carbonic acid expired (a product of disintegration), and that this diminution continues until the alcohol is consumed, especially if it be taken on an empty stomach. Dr. Carpenter quotes from the Army Medical Returns the following fact:-"That when the 84th Regiment, which is distinguished for its sobriety, was quartered at Secunderabad in 1817-8, it lost only 39 men out of 1139, or 34.2 per 1000, the average mortality of the other stations in the presidency being about the same as usual. On the other hand, the 63rd Regiment, which was far from deserving a reputation for temperance, had lost 73 men during the first nine months of the preceding year, or at the rate of 78.8 per 1000 during the entire year."* Now we know that the Thasians were altogether, at least so far as regards the men, a loose, drinking set, fond of excess and venery. Such habits undoubtedly tended to increase the mortality during the prevalence of an epidemic. It is, perhaps, within the recollection of many who witnessed the progress of the cholera in 1849, how brandy was then looked upon as an amulet against this disease,—how fearful an error it proved to many. Never was Bridgewater in a lower state of moral degradation than at the time its inhabitants were suffering from pestilence. Brandy and its sequels were sought after morning, noon, and night; and to this excess I mainly attribute the great mortality that took place,—a mortality that exceeded that in the worst districts of London during the epidemic of the years 1854 and 1849-viz. 210 deaths to 11,000 inhabitants. One spirit-merchant alone sold upwards of a hogshead of brandy per week in his retail department. Soldiers have been observed to be more liable to take on dysentery, fever, and cholera, during, and for some time after, the fatigue of a march, than at other times.† Parturition and Puerperal Fever.-It will be noticed, on perusing the cases of childbed that took place whilst the women were labouring under fever, that many died of subsequent fever; but that girls, on the contrary, when attacked, were relieved by the appearance of their menses, and not one died who experienced this critical state of things. In both cases. we see an evident excitement of the uterine system, which in the one set of women was followed by relief: not so, however, with the * Dr. Carpenter, Hum. Phys. p. 553. + Registrar-General's Weekly Return, vol. xv. p. 547. other, who, at a time when the air was impregnated with the ferment of disease, had their blood in a most fermentable state, in consequence of the disintegration which commenced in the uterus directly it had been relieved of its burthen. Again, we know that where there is a tendency to puerperal fever, the ferment-germ of typhus, or erysipelas, will often increase it, and set up a commotion in the system, which generally ends fatally. Whether the cases recorded by Hippocrates were those of genuine puerperal fever, can only be decided by a comparison between the symptoms that he noticed, and what are now considered to be characteristic of this disease. The time of the Invasion of Puerperal Fever.-Dr. Denman believed that the third or fourth day after delivery was the most usual time for the disease to appear, although he adds that there is reason to believe that in some cases it has been formed before delivery, and at every intermediate time until five or six weeks afterwards. The first thing that attracts notice is a shivering fit, although before the rigor some slight wandering pains are felt in the abdomen, which at last fix themselves in the hypogastric region. Case IV. The wife of Philinus was seized with rigor and pain in the cardiac and right hypochondriac region on the fourteenth day after delivery. Case V. The wife of Epicrates was seized three days before her confinement, &c. Case XI. The wife of Dromeades had rigor and acute fever the second day after parturition. On reading the descriptions of this dreadful disease in the works of Denman and Hulme, we shall have no hesitation in classing the above cases with those of decided puerperal fever :--the premonitory pain in the hypogastric region and genitals, the rigor and subsequent fever, the cessation of the lochia, the looseness of the bowels, the exquisite pain over the abdomen, the return of the rigor with exacerbations of the symptoms, the thirst, hot dry state of the skin, great anxiety, the rare breathing, the thick state of the urine, the pain in the extremities, the obstinate vomiting of whatever is ingested, the delirium, twitchings of the limbs, cold |