ON THE CAUSES OF EPIDEMIC FEVER IN THE METROPOLIS, ESPECIALLY AMONG THE LABOURING CLASSES. BY HOLT YATES, M.D. THIS small brochure contains a meritorious attempt to draw the attention of the magistracy, and other authorities, to one of the chief causes of fever among the poor in this overgrown city; namely, malaria arising from filth of various kinds. Low fever has prevailed to such an extent, of late, that the fever-hospital cannot give admission to one-tenth of the applications, and it appears that some of the general hospitals have determined not to take in cases of fever. This is a strange resolution, and we suspect that the governors and subscribers will hardly continue to sanction it. The class of diseases in which the subscribers are most interested, whether occurring among their own servants, or their poor neighbours-is fever. Besides, as every inflammation of an internal organ is attended by fever, how will the nature and seat of the malady be ascertained till after reception? Will the diagnosis be left, on all except receiving days, to the discrimination of the apothecary? Or, if no topical inflammation be apparent, is the poor wretch to be turned from the hospital as a dangerous inmate labouring under typhus? The regulation is monstrous! "The hospitals have now come to the determination not to admit, in future, fever cases at all; and I would ask what, under these circumstances, are the industrious classes to do? However ill they may be, they cannot be taken into the workhouses. Shunned by their neighbours, perhaps, and having parted by degrees with nearly all they possess, we find them, many at least, destitute of the most common necessaries of life. They are sick and dejected; several members of the same family are to be seen lying on the floor, upon a bed of straw, with scarcely any covering, no change of linen, no nurse, no friend to help them to so much as a cup of water to slake their parching thirst; and this is not always the result of intemperance and dissipation. The most formidable disease will suddenly make its appearance, and steal insidiously from room to room, and from door to door; its course and progress may be regularly traced. I have known the same fever attack, in succession, different families that have occupied the same apartments, the result partly of contagion, and partly of the continued operation of the same causes. There is no mystery about it, nor is there any thing imaginary in it, as those will see who take the trouble to investigate the fact. I repeat, it is the existence of these causes which we have to thank for the prevalence of fever in the metropolis." Dr. Yates proceeds to investigate these causes, warning the medical officers of public charities, who are obliged to visit the dens of dirt and foci of fever, to be on their guard against the pestilent air that surrounds them. He deplores the want of a “Council of HYGEIA," or " Board of Health,” in this country, as it exists in many parts of the Continent. We have plenty of "parish officers," "relieving officers," " visiting committees," "guardians of the poor," &c. but what is every body's business is nobody's! The chief sources of impurities of the atmosphere are-defective ventilationthe existence of noxious vapours, dust, and other extraneous bodies-combustion, and the respiration of animals-and, lastly, the presence of disease itself. The habitations of the poor too often disclose all these different sources of malaria and febrific miasmata. In many parts of the City there are no sewers at all; and the stench arising from cess-pools, privies, and drains, is often intolerable. Will it be believed, that, until within these few months, there were no sewers even in Cheapside, Fore-street, Barbican, &c.? What must be the state of the lanes, alleys, and courts, in the densely populated parts of the metropolis. The annual mortality of Middlesex, which is comparatively open and drained, has been found to be one in 36, whereas it is only one in 73 in Cardiganshire. The author proceeds to describe scenes and localities infested with fever, which would make the higher classes shudder, even at the perusal. The places of interment are mischievous sources of disease too, and are disgraceful to this metropolis. But we are unable to do justice to Dr. Yates's pamphlet, which we hope will circulate widely through the public at large, especially through those districts of the metropolis where poverty and destitution-filth and fever-so abundantly prevail. OBSERVATIONS ON THE ORIENTAL PLAGUE AND ON QUARANTINES, &c. By JOHN BOWRING, ESQ. pp. 45. Edinburgh. Tait, 1838. THE substance of this brochure was read before the British Association last year, at Newcastle. The longer we live, the more we see, and the deeper we reflect, the less faith have we in the degree of contagion attributed to plague, and in the efficacy of quarantines, as preventives of the diffusion of the poison. This cumbrous, costly, and vexatious system of sanatory, or rather of insanatory laws, is one of the worst relics of the dark ages of medicine. We very much doubt whether it ever did or ever will prevent the introduction of a single particle of plague contagion into this country. Of local origin, this pestilent fever rises every year, and prevails more or less according to season and many modifying agents. It is occasionally epidemic-and perhaps, like all endemics and epidemics, it may acquire a contagious quality, and be propagated under peculiar circumstances. But that it has neither inclination nor power to travel from the Bosphorus to the Thames, we firmly believe. What language could more accurately depict the rise and progress of the late cholera than the following, applied by an eye-witness to the plague of the East? "I discovered at every step that the contagiousness of the plague was always assumed, as the groundwork of all discussions,-and that the most extraordinary absurdities, the most amusing inventions were resorted to, in order to account for its outbreak where every precaution had been taken to avoid contact with any human being, or any supposed infected or susceptible objects. Wherever I had occasion to witness the introduction or progress of the disease-its introduction was spontaneous,-indigenous,-endemic,-its progress never traceable from patient to patient; it broke out in districts remote from one another, between which there had been no communication, and while my own observation surrounded me on one hand with thousands and tens of thousands of cases, in which the most intimate intercourse with persons ill or dead of the plague-the dwelling in their houses-the wearing their garments-the sleeping in their beds, were not followed by disease in any shape, I was called on the other to listen to stories as evidence of the contagiousness of plague, so puerile, so ridiculous, that nothing but oriental credulity could by possibility be satisfied by them." Some of these" oriental credulities" were actually equalled in this country, during the cholera-phobia panic of 1832-3. We shall give an instance of the oriental type. "In an instance where a very timid person, an alarmed contagionist, who was attacked and died of the plague, had shut himself up in his chamber; it was found that his son had, for his amusement, let up a kite from the roof of the house, and it was supposed that the kite-string had been touched by a bird, which bird was imagined to come from the infected quarter of the city; the plague entered the house down the string of the kite, and the son's father became the victim." Our readers will see, in a late Number of our northern contemporary, a paper of nearly 100 pages, on cholera in Scotland, exhibiting numerous proofs of contagion, about as forcible and philosophic as the above? So strong is the conviction, or rather the prejudice, respecting the contagion of plague in the East, that medical men are afraid of declaring their real sentiments, lest they should be denounced, not merely as unorthodox, but as dangerous persons, who do not take the proper precautions, and the regular purifications. But even amongst the contagionist physicians of the East, the efficacy of quarantine is very much doubted. Clot Bey has thrown off the belief in contagion, and is about to publish on the subject. Most of the Egyptian physicians, too, appear to be following his example. We need hardly add that the Mahomedans, almost to a man disbelieve in the contagion of plague. Dr. Bowring lashes severely the Lazarettoes, Boards of Health, and other appendages to the quarantine system; but as one of our contemporaries has copied nearly the whole of the pamphlet into his Journal, we need not make any extracts in this place. We are glad to learn that the Emperor of Russia and King of Prussia have sanctioned the formation of a congress to investigate the nature of plague and the advantages or disadvantages of quarantines. The congress is to be composed of distinguished physicians and politicians, chosen by the different maritime states of Europe. Such a congress should be held in some place where plague is an annual visitor, and where authentic evidence could be obtained on the spot. The parliamentary inquiry in this country led to nothing, as few of the examined had ever seen the plague, or been in localities where it is endemic. Even of the few who had been in the East, it is very doubtful whether any of them had ever actually treated a case of plague, or done more than peep through the window or key-hole of an infected ward or lazaretto. Dr. Bowring deserves the thanks of society at large, and of the mercantile world in particular, for this pamphlet. THE MEDICAL ANNUAL, OR BRITISH MEDICAL ALMANACK, 1839. Edited by THE Almanack for 1839 retains its character. It is an useful compilation. Its great aim is to further medical statistics. Mr. Farr is quite an enthusiast in that way. It contains the usual amount of information with respect to the medical corporations, societies, hospitals, and schools. Besides these matters it presents some papers of a miscellaneous character. Of these the more remarkable are:Remarks on Hospital Medical Staffs, by the Rev. C. Oxenden.—History of the Medical Profession, and its influence on public health in England. By the Editor.-Statistics of the Kent and Canterbury Hospital. By John M'Divitt, M.D., Physician to the Hospital.-Facts illustrative of the Pathology of the Heart. By J. Clendinning, A.M. and M.D.-Temperance in the United States of America. By J. C. Warren, M.D., Professor of Anatomy in Boston.-On Cholera-The Laws of Mortality and Recovery in that disease. By William Farr.-Abstract of a Report of the Diseases of the Army. By Captain Tulloch. -Report of the Medical Committee of the University of London-Proposed terms of Graduation. We shall pick out a few facts, or statements for quotation. 1. ON HOSPITAL MEDICAL STAFFS. The Rev. Charles Oxenden, of Bishopsbourne Rectory, has devoted his attention to the subject of hospital medical staffs. He shews that, in provincial hospitals particularly, no constant or rational proportion obtains between the numbers of the medical staff and the patients. By referring," he says, "to the second and fifth columns of my annexed table A, you will find, that, while in the year 1830, when my Statistical Report of Provincial Hospitals was printed, four medical officers had the care of ninetynine beds at Leicester, of one hundred beds at Northampton, and of one hundred and seventy beds at Gloucester; the same number of officers were appointed at Hereford to attend upon fifty-two beds, and at Bury upon fifty only. Again, while six medical officers were deemed ample for one hundred and five beds at Norwich, for one hundred and seven at Salisbury, for one hundred and twentyfour at Leeds, and for about one hundred and fifty at Shrewsbury ;-six were also required for the charge of eighty-five beds at Sheffield, of seventy-nine at Derby, of sixty-five at Canterbury, and of sixty-two at Bath (General Hospital.)" We need not follow Mr. O. in his examination of the causes of disproportions of this kind, but conclude by presenting his estimate, which appears to us a fair one, of what the medical staff of a hospital should be. "But it will be asked, what is the best proportion for a medical staff? And this, I must allow, involves some difficulty in the reply. But though difficult, I do not think it desperate. For I am well persuaded, that, though it may be impossible to lay down a perfectly mathematical scale of proportion, adapted equally to all places and circumstances; yet it is possible to approximate to such a scale, as will be calculated to insure a fair promise of beneficial results. This scale, however, must, to a limited extent, be made variable, by reason of certain district peculiarities, which operate to the increase or diminution of labour. In some hospitals, for instance, surgical cases will be found to predominate, but in most (including I. P. and O. P.) medical; while in others they will nearly balance. Again, in some localities hospital disease is more generally acute, than in others; requiring therefore more daily attendance, and occupying of necessity more professional time during treatment, and hence justifying a more extended division of labour. But, as a general system for adoption, I am disposed to think that hospital staffs, formed after the following scale, would best subserve the welfare of the patients, and facilitate the operations of the boards of management. Whether, or not, it would square with the interested speculation of individuals, enters not into my calculation : Proposed Number of Medical Officers for an Hospital, containing 76 125175200 2 1 In those neighbourhoods (in certain manufacturing districts, for example,) where surgical cases predominate, I should be disposed to add one surgical officer. And when out-patients (a large majority of whom will generally be found to be medical) are excessive, as at Bath, an additional physician would be advantageously appointed. Under any arrangements also for visiting home patients, further staff appointments may become necessary. These, however, are exceptions to, and do not militate against the principle of, my general scale." 2. THE BARBER-SURGEONS, AND SURGEONS NOT BARBERS. The following memorandum of these two classes, now happily disjoined for ever, may amuse. Among the various uneducated classes accustomed to use edged tools, who practised surgery, the barbers were distinguished at an early period. The first charter was granted, in the 1st Edward IV., to the freemen of the mystery of barbers (Misterae Barbitonsorum) of the City of London, practising surgery (facultate sirurgicorum) in wounds, lesions, and other infirmities; in letting blood and drawing teeth. The alleged grounds on which the charter was granted were the ignorance, and negligence of the freemen themselves, and of other foreign surgeons (sirurgicorum forinsecorum) not free of the city, daily flowing into London. It is evident from this charter that in 1461 surgeons existed in London; and this is confirmed by the 32 Henry VIII., c. 42, A.D. 1540, where two distinct companies of surgeons are mentioned; the one called the Barbers of London, the other the Surgeons of London; the barbers incorporated, the surgeons without any manner of corporation. The relative position of the barbers and surgeons of London is somewhat obscure; it is illustrated by the state of things in France. Several Surgeons in Paris, with Jean Pitard, surgeon to St. Louis, at their head, separated from the faculty of medicine in 1271, and formed a distinct college; the members were allowed to marry, enjoyed the same privileges as masters of physic, and wearing the same long robes, were called chirurgeons de robe longue; or, to distinguish them from the barbers, chirurgiens lettrés. They studied medicine two years, and underwent strict examinations. The Faculty of medicine discountenanced the surgeons, and in 1505, to encourage the barbers, undertook to provide them with lectures in the French tongue. The barbers, supported by the faculty, were constantly embroiled with the surgeons; and the latter at last wearied with the strife, sacrificed themselves to the supremacy of the doctors of physic; chirurgiens jurés were incorporated with the chirurgiens-barbiers, and sank at once into insignificant rivals of the umbrageous faculty. William of Salicet, Lanfranc of Milan, Gui de Cauliac, raised surgeons to a higher rank, and better educated men than the barbers became indispensable; but these elevated surgeons attended the middle classes in sickness, and aspired higher. In England the same course seems to have been taken; the barbers, evidently supported by high authorities, attempted to suppress educated surgeons; they then tempted them into a degrading connexion, by the offer of common privileges and funds, and lands, and tenements. 3. TEMPERANCE SOCIETIES IN AMERCCA. The following statements are from the pen of Dr. Warren, Professor of Anatomy in Boston. In 1813 a society was formed at Boston, called the Massachusetts Society for the suppression of Intemperance. The individuals who combined for this object were distinguished statesmen, clergymen, and physicians. The means employed were the annual distribution of discourses showing the great evils produced by the use of alkoholic drinks. The efforts of this society were met with ridicule and abuse for some years; their opinions, however, gradually extended among the people, and in the year 1826 the American Temperance Society was formed in the same city, and immediately began a train of active operations. About this period, the clergy, the judges, and the medical faculty united in their opposition to alkohol. The results of all these movements appeared in the year 1835, from the following facts:-About 2,000,000 of persons who had been in the habit of using alkohol had abandoned it. More than 8,000 temperance societies had been formed, embracing 1,500,000 members. Of these societies twenty-three were state-societies, comprising all the states in the union but one. Four thousand distilleries had been stopped. More than 1,200 vessels sailed without ardent spirits, and the price of insurance lessened on these vessels. About 12,000 drunkards had been reclaimed, and more than 200,000 persons had abandoned the use of all intoxicating drinks. Since the year 1835 the numbers above stated have been increasing, and other important results have shewn themselves. The bills of mortality exhibit a decrease of deaths in the places where reform has been extensive. The inmates of poor-houses, compared with the increase of population are diminishing; the amount of crimes is decidedly |