of his death, on the 31st of August 1832. The number of men annually discharged from the service at this time, on account of ulcers of the lower extremities, was very great. Abroad, and especially in the West Indies, such complaints proved the most troublesome surgical cases which it fell to the lot of the army medical officer to treat ;-many men were every year sent home to the general hospitals-others had their limbs amputated-and not a few lost their lives. According to Sir E. Home, all ulcers were at this period treated in the same manner. If in a foul state, poultices were used till the sore assumed a healthy aspect, when it was dressed;"the same kind of poultices is used to all foul ulcers, and the same kind of dressing is used to all those which put on a more favourable appearance." The object of this work, therefore, was to afford juster views of the pathology of ulcers, and to establish some general principles for the guidance of practice in such cases. Reviewed.-Critical Review, vol. xxi. p. 266. 1797. An Inquiry into the Nature and Causes of the great Mortality among the Troops at St Domingo; with practical remarks on the Fever of that island; and directions for the conduct of Europeans on their first arrival in warm climates. By Hector M'Lean. London, 8vo. Dr M'Lean was assistant inspector-general of hospitals for St Domingo. The first part of his work embraces a great variety of miscellaneous subjects, referring to sundry topics connected with pathology, the doctrine of fever, and the causes and treatment of tropical diseases. He says that young soldiers should not be sent to the West Indies, being more liable to fever, and because the "chance of living in a warm climate increases as we advance from thirty-five to fifty."* In reference to the yellow fever, he thinks that it is a non-contagious disease-that the yellowness which characterizes it is owing not to bile circulating in the blood, but to some alteration in the serum-and that the yellow fever of St Domingo was not a new or peculiar disease, but simply the endemic remittent applied to the European constitution. Regarding, therefore, the inflammatory diathesis as the predisposing cause, he advises that soldiers, during the voyage, should be kept on short allowance, and should have no stimulating liquors. He alludes to a scheme for habituating British soldiers to do duty in the heat of the day; • Extended experience has shown that this, though formerly a common, is an erroneous notion. "Although," (says Mr Marshall) "young lads are unfit to surmount the fatigue of warlike operations and long marches so well as full-grown men, it has been satisfactorily ascertained that, in time of peace, and when they are not exposed to much physical exertion, the ratio of mortality is invariably lower among young than old soldiers. This result obtains in all climates where British troops are employed; and it would appear that the mortality rises in nearly an exact ratio with the age of individuals." On Enlisting, Discharging, and Pensioning of Soldiers, 2d edition, p. 14. See also the table illustrative of this point at p. 58. and another for inuring them to unhealthy stations in the West Indies. He also adverts to the salubrity of different military posts in St Domingo; to the means of preserving the health of newly-arrived troops; to miltary hospitals; and to certain anomalies in the constitution of the Army Medical Department of that time. Reviewed.-Monthly Review, vol. xxix. p. 455. Annals of Med. vol. ii. p. 184. 1798. An Outline of the History and Cure of Fever, Epidemic and Contagious; more especially of Jails, Ships, and Hospitals, &c., and the Yellow Fever. With observations on Military Discipline and Economy, and a Scheme of Medical Arrangement for Armies. By Robert Jackson, M. D. Edinburgh, 8vo. This volume contains the result of further investigations into the subject of fever, which were made while the author was surgeon to the 3d regiment or Buffs in Flanders, and while principal medical officer for St Domingo. This more extended experience has given him an opportunity of confirming many of the opinions expressed in his former publication, while in other cases he confesses himself to have been in error. In addition to what relates to fever, the work contains some short notes on the health of the troops in Flanders, and on the topography and diseases of the troops in St Domingo. Editions.-Edin. 1798, 8vo. 1808, 8vo. The second edition also contains "A Refutation of the Strictures of the late Dr Currie on that part of the work which relates to the Affusion of Cold Water on the Surface." Reviewed. Critical Review, vol. xxx. p. 395. British Critic, vol. xv. p. 10. 1798. A Few Facts and Observations on the Yellow Fever of the West Indies, by which it is shown that there have existed two species of fever in the West Indian Islands for several years past, indiscriminately called yellow fever, but which have proceeded from very different causes; with the success attending the method of cure. By James Anderson. Edinburgh, 8vo. Reviewed. Annals of Medicine, vol. v. p. 38. 1798. Hints on the Ventilation of Army Hospitals and Barrack-rooms; also Observations on Regimental Practice; on Matrimony as it regards the private soldier; and on Regimental Education. By W. H. Williams. London, 8vo. The author was surgeon to the East Norfolk Militia, and seems to have paid considerable attention to the subjects of which he treats. His observations are given in a series of letters, the first of which is on ventilation; and, after pointing out the inefficiency of the methods usually employed, he proposes a plan of his own for securing this desirable object. Reviewed. British Critic, vol. xiv. p. 192. 1799. Practical Observations on the Diseases of the Army in Jamaica, as they occurred between the years 1792 and 1797; on the Situation, Climate, and Diseases of that Island; and on the most probable means of Lessening Mortality among the Troops and among Europeans in tropical climates. By William Lempriere. London, 2 vols. 8vo. In these volumes Mr Lempriere gives the result of eleven years' experience in the army in warm climates, in six years of which he served in the West Indies. Five leading subjects are brought under consideration: 1. A general account of the climate and diseases of Jamaica, and the relative degrees of health enjoyed by different classes of the inhabitants. 2. A description of the military posts, and the local sources of disease peculiar to each. 3. On the health of several regiments stationed in Jamaica. 4. On the more common diseases of that island. 5. On the duties of regimental surgeons in the West Indies. He gives a concentrated view of the most valuable observations of former writers in reference to the diseases of the West Indies, with such as he had himself made during his service in that climate. In the case of all diseases, but more especially those of the tropics, it is more useful to point out the means of prevention than the method of cure; hence, while he fully discusses the history and treatment of disease, he directs particular attention to the prophylactic measures necessary to secure the health of newly-arrived troops. His remarks on this subject are submitted to the consideration of the Duke of York, to whom the book is dedicated. In proof of what may be done in order to prevent disease among soldiers in the West Indies, he gives a short account of the 13th regiment, as furnishing a notable example of the advantages of superior discipline and interior arrangement. Several tables are added, showing the rate of mortality in different corps, and in different parishes, as also the result of different modes of treatment. Reviewed.-British Critic, vol. xiv. p. 1801. 663. An Essay on the Malignant Pestilential Fever introduced into the West Indian Islands from Boulam, on the coast of Guinea, as it appeared in 1793, 1794, 1795, and 1796. Interspersed with observations and facts, tending to prove that the Epidemic existing at Philadelphia, New York, &c., was the same fever introduced by infection imported from the West India Islands; and illustrated by evidences founded on the state of those Islands and the information of the most eminent practitioners residing on them. By C. Chisholm, M. D. London, 2 vols. 8vo. This is a second and very greatly enlarged edition of a book pub lished in 1795; and after five years' additional experience in a wide range of practice, Dr Chisholm had seen nothing in the history or treatment of the disease which might induce him to alter his views. Reviewed. British Critic, vol. xvii. p. 371. 1801. Observations on the Nature and Cure of Fevers, and of Diseases of the West and East Indies, and of America; with an Account of Dissections performed in these climates, and general Remarks on Diseases of the Army. By Thomas Clark. Edinburgh, 8vo. This work is interesting on account of the object of its publication. In 1798 Dr Ewart, as physician to H. M. forces in India and Ceylon, issued orders, directing all surgeons to keep medical casebooks, which were to be transmitted at stated periods for his inspection. Shortly after the receipt of Mr Clark's, Dr Ewart sent him "a long dissertation," in which he reprobated his practice, "and even went so far as to assert that one of the patients must have been actually poisoned by the medicines he received, and he required that the mode of practice should be entirely altered." In consequence of the order having been generally disregarded by all the surgeons in India, a case-book was no longer sent from the 19th regiment, of which Mr Clark was surgeon; but on this coming to the ears of Dr Ewart, he was put under arrest for disobedience of orders, and after being a prisoner for three months, was released without a trial. His health, however, had become so impaired in consequence of this unhappy suspense, that he was compelled to come to England on a half-pay of two shillings a-day, but was not allowed to sell his commission, which he had bought. He was therefore induced to publish this book, with the view of vindicating his own reputation as a medical practitioner, against an attack which had proved "highly injurious to his health and fortune." He has several peculiar theories as to the nature of fever and other diseases, but his monthly abstract of the sick would show that his practice had been by no means unsuccessful. 1801. A short Account of the Royal Artillery Hospital at This pamphlet had been drawn up soon after the introduction of many changes into the ordnance medical department, by Dr Rollo, after his appointment as Surgeon-General of Ordnance in 1794. From instructions which are here published, it appears that in the course of that year he had called for stated returns of various descriptions, which were regularly transmitted to the board, and to the surgeon-general of ordnance. Reviewed. British Critic, vol. xvii. p. 651. (To be continued.) VOL. LXIV. No. 164. I ART. VI.-Inquiry into the probable Cause of the continued Prevalence and Fatality of Small-Pox. By JAMES STARK, M.D., F. R.S. E., Fellow of the Royal College of Physicians of Edinburgh. MUCH alarm has been created by the outcry raised by some writers in this country and on the continent that small-pox is increasing in consequence of vaccination losing its effects, either from a degeneration of its virus, or from its wearing out of the system after a certain number of years, or from its being but an imperfect preservative against that disease. To check these supposed causes, it has by one class been proposed to go back to the cow for a fresh supply of vaccine matter every two or three years; and Sonderland, Bousquet, Girard, Estlin, Ceely, and others have exerted themselves successfully to procure fresh supplies from that animal. By the other class it has been proposed to repeat vaccination every ten or twelve years; and the Prussian, Hanoverian, Russian, and other governments have actually so far listened to this proposal as to have had their whole standing armies re-vaccinated. While the third class have even seriously proposed to return to the fatal, and now, it is to be hoped, for-ever-exploded plan of inoculating with the small-pox. Having paid no inconsiderable attention both to small-pox and vaccination; having collected notes and observations for a period of more than twelve years; and being thoroughly convinced that the continued prevalence and fatality of small-pox over all the kingdoms of the globe are owing to an entirely different cause, and as all are aware that the proper preventive means cannot be used unless we know the true cause, I shall, in the development of my views, consider the subject under the four following heads : 1st. Is small-pox a fatal disease at the present day, and has it increased of late years? 2d. Is the prevalence and mortality of small-pox owing to failure in the protective power of vaccination? 3d. Is the prevalence and mortality of small-pox owing to the neglect of vaccination? 4th. Does vaccination afford as perfect protection from small-pox as it is possible to obtain-as perfect immunity from danger as if the person had once passed through the natural or inoculated dis ease? 1st. Is small-pox a fatal disease at the present day, and has it increased of late years?-Before the introduction of vaccination, small-pox was one of the most fatal scourges of the human race; and it was calculated that in Great Britain and Ireland no fewer than between 40,000 and 50,000 were annually cut off by it. In London alone, on an average of fifty years, 2018 died annually from small-pox before the introduction of vaccination. The following |