Weekly average number of Deaths from Diarrhoea at different degrees of The above tables are only calculated up to the forty-fifth week, and probably, were the figures of the returns for the few remaining weeks of this year appended, some slight difference might be observed; they would not, however, disturb two facts that are self-evident to anyone who glances over the above statistics: 1st, that diarrhoea is materially influenced by heat; and 2ndly, that during this year, 1854, the number of deaths from this disease has been considerably above the average. It will appear from the tables that the effect of the rise in temperature was not immediate, for the number of deaths did not swell considerably above the average of the winter quarter until between the 55° and 58° in this year, and not until the 60° in the average for ten years; neither did the disease decline synchronously with the temperature, for we find it at its acme, viz. 276 per week, when the mean temperature was 6° below the mean average for the year; and the average maximum height, 130, was at the : thirty-second week, when the thermometer indicated a gradual decline. These facts seem to point out to us the means by which diarrhoea is affected by heat; its effect is not immediate, as we have seen those of the easterly and south-westerly winds were in pulmonary complaints; heat seems to act upon the living by means of the dead in the spring and early summer it clothes the world with verdure, prodigious quantities of vegetables are brought into cities for man's use, all are not consumed, what remains dies, is acted upon by heat, and putrefies, sending forth its pestilential exhalations. The waters teem with vegetation; it takes some time, however, to raise their temperature, but when it has once reached a certain degree, the putrefactive process goes on; and can man expect to escape, who drinks this poison? Besides decayed vegetables, there is ever a large mass of dead animal matter for heat and moisture to act upon and corrupt; and in proportion as the emanations from these sources are concentrated in the water we drink and the air we breathe, so will the number of victims be. The reader has only to turn to the faithful record of death published by the Registrar-General, to see what tremendous havoc water can produce in a locality when containing the germ of fermentation. Modern authorities-for instance, Crampton and Forbes*-give as one of the causes of diarrhoea an atmosphere simply cold and wet, as impregnated with putrid exhalations. With some persons, they say, exposure to warm and damp air is productive of the same consequences; and alternations of temperature are often equally effective, as in the case of a hot day being succeeded by a chilly evening: therefore they recommend as a remedial agent removal to a mild and dry climate. Chronic diarrhoea, for instance, is one of those diseases in which a change to a warmer and drier climate than ours is found most beneficial. With regard to the diarrhoea that prevailed at Thasos under this constitution, many of the cases might have been brought on by eating fruit, which, from the con * Enc. Pract. Med. vol. i. pp. 556 and 566. tinued wet and cloudy state of the weather might have been prevented from coming to perfect maturity. Fevers, &c.-The ardent fevers were not very prevalent this year. The intermittent type was the most important; but these, with the others, will be treated of under the Third Constitution and elsewhere. Some of the fevers seemed to be of an exanthematous character, as there were ('Etavonμara σμuкpà) small eruptions with swellings about the ears (which, however, did not come to a crisis, παρα τὰ ὦτα οιδήματα μολυνόμενα, και ουδεν ἀποσημαίνοντα). The eruptions were not in proportion to the severity of the fever, which seems to have attacked children just weaned, up to adolescence; convulsions were often the sequel and attendant during these attacks. Persons of every age suffered, however, although the mortality was greatest among children. The fevers, Hippocrates says, were attended with coughs (Bñxes μèv παρείποντο τοῖσι πυρετοισιν),* which would give this eruptive disease somewhat the character of measles, although the swellings about the ears and elsewhere, connected with its great mortality, seem to point to scarlet fever. Perhaps an epidemic miliary fever prevailed during the progress of the intermittents and remittents. Third Constitution. General Remarks.-We have just been discussing a wet northerly constitution, and its attendant diseases, which principally affected the organs of digestion; we have now before us a series of seasons characterised, like the last, by a northerly direction of the wind, but by absence of rain and great droughts. From such a different state of weather we may rationally expect to meet with a different class of diseases; and we are not disappointed, for during this constitution, although we find dysentery and fevers, still the latter were of a most severe character, and their occurrence bore a distinct relation to the surrounding atmospheric causes. Again, diseases of the nervous * Euv. d'Hipp., Littré, tom. i. p. 626. system were prevalent: thus paraplegia, apoplexy, abortions, and various severe puerperal disorders, all of which will require a separate notice. The year in which these diseases occurred was remarkable for its great dryness: there were droughts in the winter, spring, and latter part of the summer, relieved only occasionally by slight rains; the wind remained northerly, and until the dog-days the weather was remarkably cold. There was snow in the winter. Paralysis, Paraplegia. The winter The winter was northerly and droughty, cold, with rough winds and snow: then paraplegia (apoplexy, &c.) began to show itself, and attacked many, and some died suddenly; otherwise, the disease became epidemic (éπídnμov). Such is the simple but interesting statement made by Hippocrates: let us compare it with what Dr. T. Moffat has observed and recorded.+ "Of the number of cases of apoplexy which occurred in the years 1850 and 1851, fifty per cent. took place on days of decreasing readings of the barometer, and fifty per cent. happened on days after such readings; one hundred per cent. occurred with fall of temperature, and they all took place with a direction of wind from SE and SW points of the compass; of seven sudden deaths, five occurred with wind from NW, with hail showers." Now with regard to a southerly wind influencing this disease, we must bear in mind that the latter part of the autumn which immediately preceded this northerly winter was characterised by a few southerly rains, the transition from which to an opposite state Galen considered as the chief cause of apoplexy being so prevalent. It must be remembered, however, that the former part of this autumn had been northerly, and this wind was accompanied by frequent storms of rain. Dr. Moffat has observed that apoplexy, epilepsy, and sudden deaths, invariably * Euv. d'Hipp. t. ii. p. 640. + Assoc. Med. Journ. 1853, p. 129. Galeni Op. vol. xvii. pp. 161, 162. § Ass. Med. Journ. 1853, p. 747. E |