From this we find that the maximum number of deaths took place when the barometer was at its lowest mean. It must be remarked, however, that the average between 29.500 and 30 was arrived at through a greater number of instances than either of the other two, and therefore is more to be depended on. The above facts seem to indicate a degree of relation between the readings of the barometer and the amount of mortality, although we must not forget the irregularities that were pointed out when discussing the circumstances attending the decrease in mortality. Two things, however, seem evident,-that the warm, genial weather of early summer lessens, and the cold and variable season between autumn and winter increases, the number of victims of apoplexy. The excess of heat, however, has an opposite tendency to that first alluded to, for a coup de soleil is often produced by exposure to the scorching sun of summer. As to the wind, it will be observed that the greatest and least mortality occurred under a southerly wind. (b) Hamorrhage.-Epistaxis, during this constitution, was a frequent accompaniment of the fevers that prevailed; they were considered critical,-in fact, the patient was not considered safe until this relief was experienced. There seems, however, to have been a general hæmorrhagic tendency, for blood was poured out in several cases from the bowels: many females had, during the fever, both epistaxis and their menses: abortions were also frequent, and many girls experienced the nisus mensium for the first time.* Dr. Moffat has observed that, in 100 cases of epistaxis, 37.5 occur with increase in the readings of the barometer, and 62.5 with decrease; with ozone, 500; with no ozone, 50.0: he further remarks that the polar current of air is always accompanied by increase in the height of the mercurial column, and that the equatorial, on the contrary, is followed by a decrease. When the barometer is low, and the atmospheric pressure diminished, blood is often poured out from the delicate capillary vessels of the lining of the nose, lungs, bowels, and uterus. It * Euv. d'Hipp. tom. ii. Littré, p. 648. is highly probable that the atmospheric pressure was low during the whole of the year under consideration, although of course we have no absolute data to go upon for this hypothesis. The cold weather of the winter in all probability checked the secretion from the skin, and thus congested the internal membranes -a frequent cause of epistaxis: we can easily imagine the effect that suppression of the cutaneous exhalation would have, when it is known that it is sometimes ten times greater in dry than in moist air, and that it is doubled in passing from 32° F. to 64° F.* (Edwards.) I shall now conclude this subject with one or two interesting facts recorded by Dr. Kerr.† 'Morgagni has handed down to us the record of an extraordinary and, so far as we know, a singular instance of the simultaneousness of epistaxis in a number of persons. It is stated that in the year 1200 there was a great mortality of men in the space of twenty-four hours, in Tuscany and Romandiola, by a flux of blood from the nostrils and Morgagnit has remarked that Clementini, the historian of Rimini, had noted that in the same year a great number of deaths from hæmorrhage had occurred within four-and-twenty hours at Rimini, Ravenna, and in other cities of the Roman province; but from what part of the body is not mentioned. Various conditions of the atmosphere, it is well known, have a powerful effect on the expansive quality of the blood, as well as of other fluids; besides the effect of the stimulus of heat, the plethora ad molem is induced by the same cause; it not unfrequently happens, that passing from a cold into a heated room occasions this kind of hæmorrhage; and a sudden transition in the natural atmosphere occasioned, it is probable, the endemic we have just noticed. The same expansive quality of the blood is evinced by alterations of the atmospheric pressure; and in the ascent of high mountains, an early physical consequence has been a flow of blood from the nose, * Ass. Med. Journ. 1853, p. 747. increasing in proportion to the altitude, and succeeded by hæmorrhage from the ears and lungs, as well as by other very alarming symptoms." Hæmorrhage is hardly ever epidemic, and therefore the above facts are the more remarkable. Hippocrates enumerates bloodfluxes among the diseases of spring; and modern physicians agree with this observation. Some trace an analogy between the "rise of the sap" and the exaltation of the circulation in man. Dr. Copland* says that they occur sporadically, and are more frequent in spring than at any other season, but are scarcely ever epidemic, although at Breslau they prevailed at one time to a remarkable extent,-children having epistaxis, adults hæmoptysis, and the aged hæmorrhoids. M. Chomel remarks that hæmorrhage from the rectum, urinary organs, and uterus, occurs oftener in cold than in warm seasons; and that epistaxis and hæmoptysis take place more frequently in summer than in winter. Copland+ believes this to be the case especially during dry states of the air. Ardent Fevers (Kavroi).-Under this head I shall discuss the various effects that this epidemic produced; such, for instance, as difficult parturition, and abortions (écvoróкEOY dè TλeïσTαι, kai μετὰ τοὺς τόκους ἐπενόσεον, καὶ ἔθνησκον αὗται μάλιστα),† the critical eruption of the menses in women and girls attacked, and the epistaris in men (ἐν τοῖσι πυρεετοῖσι γυναικεῖα ἐπιφαίνετο, καὶ παρθένοισι πολλῇσι τοτε πρῶτον ἐγένετο); its greater mortality among the licentious and free livers, and on those who, after great fatigue, sat to drinking, as in Case II., of Silenus (ἐκ κόπων, καὶ ποτῶν καὶ γυμνασίων ακαίρων). sufficient texts for our purpose, and I The above will form hope to be able to show how distinct a relation is borne between the above facts, *Dict. of Med. vol. ii. p. 65. + Op. cit. Œuv. d'Hipp., Littré, t. ii. p. 646. § Op. cit. t. ii. p. 684. 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 (una ferment or leaven, from ew-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. |