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portance of changing the therapeutic management of diseases, which he nevertheless designates by the same name-that of pleurisy, for instance-according as this or that state of medical constitution prevails.

"We cannot help groaning over the miseries of our nature, when we reflect that those who, under a new kind of superstition, thus believe, without reserve and serious examination, in this sort of medical astrology, which they have adorned with the name of the doctrine of medical constitutions,' are the very same persons who deny truths of which the most evident and convincing demonstrations are daily given them.

"As for ourselves, who for twenty-five years have passed our life by the bedside of invalids, and have been entrusted with clinical instruction for more than twelve years, we have neglected no means of ascertaining to what point we may believe all that certain practitioners affirm, respecting the influence of the medical constitution upon the effects of remedies in general, and in particular on the treatment by bleeding in the phlegmasiæ. Well, we declare, with the greatest sincerity, and with a mind free from all systematic prejudice, that these assertions rest upon no solid grounds, that they are for the most part in direct opposition to sound experience (an experience which must not be confounded with that which, till lately, we have been contented with,) and that the different phlegmasiæ, when treated according to our formula, all the other conditions being at the same time alike, håve been uniformly cured with the same success, however different may have been, according to some practitioners, the medical constitutions which have prevailed during this tolerably long space of time."

Very different is the experience of all our best physicians from that of M. Bouillaud. At present we shall only point to what Dr. Wilson has said upon the subject, as quoted at page 89 of the present number of this Review.

We must reserve to a second article our examination of the other contents of this Medical Nosography. The work is a large and bulky one, demanding no little patient fatigue in its critical perusal, with the view of communicating to others its leading principles and features. It would have been much more agreeable to us if, in the exercise of this labour, we could have conscientiously bestowed praise instead of dealing so much in censure. But the duty we owe to the medical public forbade the former, and, in our judgment, imperatively called for the latter; and we have the less hesitated to express our disapprobation of M. Bouillaud's pyretological opinions, seeing that the subject involved is one not only of prominent theoretical interest, but of the most immediate and paramount practical importance. More lives are annually sacrificed to the pestilence that is generated in our dense and populous towns, the offspring of filth and want, of sorrow and fatigue, and to that which is exhaled from the marsh, the swamp or the desert, than to all other maladies put together. How necessary then that medical men should make themselves thoroughly acquainted with everything appertaining to the history of Fever; so that, under the guidance of Divine Providence, they may be blessed to be the means of at least mitigating the severity and limiting the extension of the disease, if they cannot hope either to prevent its outbreak or suddenly to arrest its attacks. In the following article, we shall examine one of the most interesting questions connected with this truly important subject.

I. NOTES AND RECOLLECTIONS OF A PROFESSIONAL LIFE. By the late William Fergusson, Esq., M.D., Inspector General of Military Hospitals. Edited by his Son, James Fergusson. 8vo. pp. 248. London, 1846. Longman & Co.

II. INAUGURAL DISSERTATION ON YELLOW FEVER, AND ON THE TREATMENT OF THAT DISEASE BY SALINE MEDICINES. By G. F. Bone, M.D., Assistant Surgeon to the Forces. 8vo. pp. 85. Edinburgh, 1846. Black.

III. CORRESPONDENCE ON THE SUBJECT OF THE "ECLAIR," AND OF THE EPIDEMY WHICH BROKE OUT IN THE SAID VESSEL. Presented to the House of Commons by Command of Her Majesty, in pursuance of their Address of the 23d January, 1846. Folio, pp. 94.

DR. FERGUSSON was one of the most active and intelligent medical officers which our army has produced during the present century. He had seen a great deal of service in different parts of the world from the year 1794, when he joined the 90th regiment, as assistant-surgeon, at Ghent, in the unfortunate expedition under the Duke of York. Two years afterwards, we find him at St. Domingo, where he remained several years in active employment. On the final evacuation of that colony, he received thanks in public orders for his services. In 1801, he accompanied the expedition to the Baltic as Staff-surgeon of the troops embarked, and was on board the Admiral's ship on the occasion of the famous attack, under Nelson, upon Copenhagen. In the Peninsula, he was present at the taking of Oporto, and at the battles of Talavera and Busaco. In 1815 he accompanied the expedition against Guadaloupe, and then remained in the West Indies for two years. In 1817, he settled as physician at Edinburgh; but in 1821, finding the ground entirely pre-occupied in the northern metropolis, he moved his quarters to Windsor, where he eventually acquired an extensive and very lucrative practice, and where he continued to reside till the period of his death in January of the present year. Throughout the whole of his busy career, he had been an ardent and zealous writer upon medical matters; more especially upon those appertaining to the subject of Fevers, Contagion, Quarantine, &c. Many of his communications appeared in the pages of our respected cotemporary, the Edinburgh Medical and Surgical Journal. For some years before his death, he had formed the plan of collecting together his scattered writings, extending and enlarging them, and adding others, with the view of publishing them all in one substantive volume. This he was not spared to complete. The first half only of the present work was revised and corrected by the author; the other half consists entirely of re-published papers. The former is chiefly occupied with articles on subjects strictly military; as Military Tactics; the Exercises, Dress, and Arms of the Soldier; Barracks and Barrack-Life; Military Hospitals and Staff; and Diet and Rations; there are also short

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articles on Fever as an Army Disease, on Disinfectants, and on Dysentery, Ophthalmia, and Syphilis. The latter part of the volume contains the author's papers on Plague and Quarantine, on Yellow Fever, on Typhus Fever and Contagion generally, on Marsh Miasmata, on the employment of Black Troops in the West Indies, and, lastly, his letters on Cholera. As a matter of course, we must pass over the military papers without notice; especially as we have already devoted a good many pages, in the present number, to one of the subjects discussed-that of Military Punishments. We are glad to find that Dr. Fergusson had taken the same enlightened and benevolent views upon the question of Flogging, as Dr. Marshall has done. What we propose to do at present is to select the most prominent facts and reasonings adduced by our author upon the very important subject of Fevers, more especially in reference to their direct transmissibility from one person to another, and the sanatory measures that should be adopted to check their diffusion.

The paper on "Contagion of Typhus Fever and Contagion generally," opens thus :

"The true essential contagions, which, under a gaseous or aerial form, act of themselves independent of, and unaided by, the circumstances of climate, atmosphere, locality, quantity, and accumulation,-do not amount to more than five or six, and may all be comprehended under that class, of which it is the distinguishing characteristic, to occur only once, generally speaking, during the lifetime of an individual; with the exception always of those infections that can only be communicated by inoculation, or the actual contact of matter. I am far, however, from pretending to say that contagion is limited to so confined a range; for the whole class of pyrexia, under every shape and form in which they can be presented to us, including even those of erysipelas and ophthalmia, can be made infectious diseases, through an undue accumulation of human exhalations, and defective medical police, constituting at these times, and under these circumstances, an undoubted well-marked atmospherical contagion of locality,—but of locality alone.

"From the first of this enumeration I have no hesitation to strike out typhus fever, and class it amongst the latter." P. 162.

Typhus fever may be truly called an endemic of the British Isles. It seems to spring up spontaneously with each revolving season, under the operation of "moist cold, when applied to the destitute under circumstances of moral and physical depression." Extremes of temperature appear to resist its development; for it is but little known in tropical regions, except under circumstances of most defective medical police-even the Plague stops at the tropic of Cancer ;—and it is equally rare in very high latitudes. Dr. F. is of opinion that the practice among the Russian peasants of heating their close, and anything but cleanly, habitations so much by the constant use of a stove night and day, as well as of so frequently making use of vapour baths, has unquestionably a salutary effect in counteracting the development of typhus. Besides the endemical cause alluded to, this fever is apt to arise from the mere accumulation of the effluvia arising from the human body, whenever masses of people are crowded together in a narrow space, while cleanliness and due ventilation are at the same time neglected. Hence the frequent prevalence of the disease in prisons, illconstructed hospitals, on board certain ships, &c.: and hence, too, the not uncommon circumstance of its becoming superadded to, and, as it were,

engrafted upon other maladies-such as the various forms of remittent fever, dysentery or diarrhoea, influenza, &c.—if the patients be unfavourably situated or improperly treated. Dr. Fergusson expresses the sentiments of a very large proportion of his professional brethren, when he says: "Diseases, which in their origin are beyond all doubt non-contagious, may temporarily acquire that property from generating a contagious atmo. sphere amid multitudes of the sick, and high concentration of what was the original cause during the progress of an epidemic."

That the contamination of the air with human effluvia will give rise to a truly infectious miasm, is abundantly proved by the history of Hospital gangrene or Contagious ulcer.

"This ulcer is precisely a local form of typhus fever,—a visible incarnation, if I may use the term, of the typhoid poison. It never occurs but under the most distressful crowding of sick and wounded; and it is then so highly contagious, that all other ulcers, or even abrasions of the skin, however healthy before, are speedily involved in its destructive course; and so highly does it impregnate the surrounding atmosphere with its contagion, that it is not even safe to bleed a patient in the same ward where it lies. You may look in vain for its origin under any circumstances in our hospitals, but those just enumerated, as being capable of inducing typhus fever upon the sound healthy inmates; but in the wounded, where the poison finds a nidus and a vent, instead of affecting the constitution generally, it commits its hideous ravages upon the wounded limb.”* P. 164.

That Typhus fever is apt to become contagious, although it may not be so primarily or intrinsically, cannot be reasonably disputed by any candid and experienced observer. Nevertheless, while we admit the truth of this, it should never be forgotten that the disease will seldom or ever spread when the patients are removed from the original habitat of the evil and placed in airy and clean dwellings. In this respect, therefore, typhus is essentially distinct from small-pox, scarlatina, pertussis, and other intrinsically contagious diseases; which, it is well known, often prevail over the entire extent of a district and among all classes of its inhabitants, unopposed, even in the slightest degree, by any sanatory regulations that can be adopted. Not so with typhus. The risk of infection from it is, cæteris paribus, nearly exactly proportionate to the impurity of the atmosphere, and the absence of personal cleanliness; although we must also admit that the disease appears to be infinitely more malignant and communicable in some seasons than in others.

The mere circumstance of a fever spreading from one person to other residents in the same infected locality is certainly no proof of its contagion; for all are equally exposed to the same morbific influence. Unless the patient can carry the disease to a distance and there communicate it to

*The above relates to hospital gangrene alone, and has no reference to endemic or constitutional ulcers, which, however formidable their ravages may be, are never in themselves contagious. It may, however, reconcile my readers to the above doctrine, to state the fact that ulcers, devastating ulcers, have been seen in many parts of the world to be the substitute for endemic fever. Our army in St. Domingo, during the years 1796-7-8, abounded with such proofs; and in some parts of the East Indies, where I have never been, I understand that examples of it are even more rife."

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others dwelling in a purer air, we cannot fairly recognise the existence of decided contagion. "In this transportability resides the very touch-stone and answer to the question of contagion; to talk of contagion limited to one spot is merely only saying that the spot of ground, and not the person of the patient must be the source of the disease."

It seems probable that, when typhus arises from the effluvia generated in, and proceeding from, the human body in circumstances unfavourable to cleanliness and free ventilation, rather than from any merely endemic or local cause, the disease is much more liable to acquire a contagious character. The following remarks on this point will be read with profit :

"That other form of typhus fever, which I may call factitious, (as being created by ourselves out of causes over which we ought to have exerted due control,) to distinguish it from the endemic, which we cannot prevent, must also be contagious under the same circumstances. Here, however, I believe, in like manner, that the person of the patient, independent of fomites, never gives out at any one time a sufficiency of the typhoid poison to affect another healthy person; and the poison can only be made effective through contamination of atmosphere, under long-continued accumulation of morbific effluvia; and in fine that the atmosphere of the patient is infectious, and not his person, which, if once cleansed and purified, and ventilation restored, may be approached, however ill he may be, with perfect impunity. In this belief I feel warranted, from the knowledge of several important facts, of a character so general as to warrant the greatest confidence in their application. 1st, The Bristol Hospital, for a great many years, has received typhus fevers into its well-disciplined wards, without having ever spread the disease even to the most contiguous beds. 2nd, Several of the great hospitals in London have followed the same example with the same results. 3d, The most pestilentially dangerous to approach when single in the confined dwellings of the poor, have almost everywhere been found devoid of every infectious principle when collected together in numbers, and confined by the hundred within the walls of a well-regulated fever hospital. Upon this point the question of contagion must turn; for, if the evidence here given be not impugned, it will be impossible in human testimony to adduce anything more decisive and conclusive. Reasoning from single individual instances will generally deceive; but well-digested impartial observation upon masses of men can never lead to an erroneous conclusion."* P. 172.

In reference to the admission of fever patients into general hospitals, we may remark that it has been found safer and better to have them scattered as single cases through different wards, instead of congregating them together into one. This plan has been adopted in more than one of the London Hospitals; and we believe that there has been, on the whole, no cause to regret having followed it.

Every one, who has written on the subject of contagion, has recognized the powerfully predisposing effects of whatever tends to depress the energies of the mind and body.

"The author alludes here to what he witnessed more especially at Liverpool, when on the staff of the north-west district, in the year 1804. Typhus fever had, up to that time, proved a most virulent and dangerous contagion to the medical faculty visiting the poor in the lower part of the town, who lived for the most part in cellars or other wretched dwellings: but on the building of an excellent Fever Hospital its character there as a contagious disease altogether ceased,"