ficiently regarded by professional inquirers. But, admitting its importance, there are yet some circumstances connected with lay evidence requiring that we should sometimes receive it with reserve. One of these drawbacks consists in the impression so common amongst citizens, that their city or town forms an exception to the rule of unhealthiness; indeed, they receive any intimation to the contrary as an impeachment (stigma is the term they use,) of the character, moral as well as physical, of their favorite locality; and so strong is this feeling, that men of the highest integrity and intelligence will be found continually to deceive themselves, and, unintentionally, they will endeavour to deceive others on such points. . . . . . But laxity and want of accurate observation is not exclusively confined to the lay community; for sometimes we have an exordium of the following character from quarters whence a more exact information might be expected: "This town, I consider, upon the whole, one of the healthiest towns in the kingdom.' Again, of another town (like the last), most unhealthy, we have it reported, that the general condition of the town is comparatively healthy at the present time it may be considered in a very healthy state.' It is but justice to state, however, that, in general, throughout the entire extent of my personal examination, I found the medical witnesses alike intelligent and humane." (vol. ii, p. 129, seq.)

Mr. James Smith notices another "element" of hinderance; it is singular that he alone makes the observation.

"There is another element which presented itself as a serious barrier to the carrying out of local works by the authorities as at present constituted—namely, party divisions. At Hull, when I visited the town, and paid my respects to the may or as a public officer, without knowing or thinking it my duty to notice of what political party he was, and made inquiries of the municipal officers, and perambulated the poorer districts with, I found that this very innocent act of mine was regarded, by very respectable persons, but an anti corporation party, as taking a side.'" (Ibid. p 163.)

The most remarkable portion of Mr. Smith's report is his essay on the application of sewer water to agricultural purposes. He proposes to irrigate the arable land, around our large towns with it, as a substitute for guano, using pipes and steam power for distributing it. In making an estimate of the cost, Mr. Smith observes:

"I have confined the district to be supplied to an area of four square miles, containing 2560 statute acres I have supposed the whole to be laid off in 10-acre fields, and have put down the position for the service-pipes in such order, as to effect the distribution of the water over each area of 40 acres by a hose-pipe, 312 yards long The main piping I have assumed at the length of the side of the square, with one mile added to clear the suburbs of the town. The main is taken at 12 inches in diameter, which will be sufficient to pass the quantity of water required for a great extent of land; and the service pipes are taken at 4 inches diameter, which is very ample, as never more than two or three jets will be playing from one service pipe at the same time. The main pipes I have estimated as of cast-iron, the service pipes as of fire-clay, as I have ascertained that such can be had at one third of the price of cast iron pipes, and I have seen such proved to a pressure of 600 feet. They will certainly stand a pressure of 300 feet. These pipes I suppose to be sunk two feet under the surface, with a plug opening for attaching the hose for each four fields or 40 acres. The hose pipe and jet must in all cases be worked by persons employed by the sewer-water establishment, who will apply the liquid at such times, in such manner, and in such quantity as the farmer shall desire, under proper regulations. Part may be delivered by jet, part for purposes of irrigation; and it is evident that any farmer would be greatly benefited by appropriating a portion of his farm as meadow, to be irrigated by the sewerwater for the production of early and abundant crops of grass." (Ibid. p 176.)

From various data he calculates, that the cost of manuring one acre with sewer-water, in strength equal to 24 cwt. with guano, costing 11., or to fifteen tons of farm-yard manure costing 37., will amount only to 12s. 9d. The net income from the sewer-water of a town is estimated at nearly 17. per head.

"Taking a general view of the subject, we may safely assume a clear revenue from the sewer-water of all towns of 17. for each inhabitant, either in a direct money return, or partly to the inhabitants in a reduced price from the increased abundance of produce; and it is obvious, that such income, annually accruing, will provide a sufficient fund for the improvement of all towns, in a manner corresponding to the most enlightened views with respect to sanatory regulation and improvement of the present time, and will remain as a source for accomplishing such further improvements as science and practical experience shall from time to time suggest." (p. 478.)

An insuperable bar to the accomplishment of Mr. Smith's views will be found, we suspect, in bucolic stupidity.

We here terminate our notice of the labours of the health of towns commission. The four volumes present an invaluable repository of facts bearing on public hygiene, collected at a great expense, by most competent observers, from some of the largest and most important towns and cities in the world. As books of reference they are essential to the practitioner's library; none should be without them; and no practitioner should neglect their perusal, because, sooner or later he will certainly be called upon to act in his professional capacity, in respect of one or other of the numerous matters and things bearing on the public hygiene of his country.

ART. III.

Lectures on the more important Eruptive Fevers, Hemorrhages, and Dropsies, and on Gout and Rheumatism, delivered in the University of Pennsylvania. By N. CHAPMAN, M.D., Professor of the Theory and Practice of Medicine, &c. &c.—Philadelphia, 1844. 8vo, pp. 448.

THE present volume is precisely of the character of the former one, by the same author, reviewed in our Thirty-seventh Number. It contains much good matter of various kinds, the results of great experience and reading, and many sound practical observations; but the whole is enounced amid such confusion of style and arrangement, that the task of perusal, and even of comprehension, becomes irksome and difficult. But we shall not dwell on these defects, but proceed, as on the former occasion, to glean from the heterogeneous mass such things as may be most interesting and useful to our readers.

SMALLPOX. Dr. Chapman writes with some authoritativeness of the comparatively modern origin of this disease. "From the historical evidence," he observes, "it results that the disease, probably, was developed at the siege of Mecca, for the first time, though under what peculiar circumstances generated we have no real information." But if we allow that the disease appeared from time to time during the three centuries which elapsed between the time of Mahomet and Rhazes, although no clear

description of the phenomena which it presented has come down to us, it surely requires no stretch of credulity to suppose that undescribed visitations of the disease may have existed during many centuries previous to the birth of Mahomet. Ozanam, no mean authority, considers the description of Aëtius sufficiently characteristic of the disease; and whatever diversity of opinion may exist regarding the time when Aëtius flourished, no one will place it later than the fifth century. The description by Eusebius of a febrile distemper, as occurring A. D. 311, rendering thousands of women and children blind, -the reference of Hippocrates to some fevers which are pustular and dreadful to behold, οἱ δὲ πεμφιγώδεες ἰδεῖν Seiro,-and the tradition of various eastern nations regarding the ambiguity of the disease, independent of allusions in various classical authors to some at least similar affection,-give plausibility to the opinion, that a wish to connect the ideas of moral and physical evil, rather than a studious regard to accuracy, led authors to fix the origin of the disease on the era of Mahomet, and authorise us in discountenancing all dogmatical attempts. to settle a question involved in obscurity, which no illumination of modern learning can be expected to dissipate.

Of the circumstances attending the rise and spread of smallpox, Dr. Chapman, from his own experience, writes as follows:

"In 1823, when smallpox appeared in Philadelphia, after a long interval, it could not be traced to any imported or derivative source of contagion. Cases sprung up, as it were, spontaneously, at a distance from each other, independent of any probable intercourse, wearing universally a most formidable character, and the failures of variolation, and especially of vaccination, were numerous, with some few examples of the disease previously had in the natural way, affording no security. As further proof of the dominant epidemic influence at the time, it may be said, that in the whole compass of our experience, never was exhibited such a tendency to cutaneous affections-every disease, whatever might be its nature, displaying in its course some eruptive appearance, and often of the most anomalous character and aspect." (pp. 25-6.)

Notwithstanding the plausibility of the conjecture which such facts countenance, that the contagion of smallpox is sometimes generated anew, our author is not disposed to adopt it.

"To me," he observes, "it seems probable that the semina of contagion, like those of plants, or ova of animals, and especially of insects, may remain dormant for an indefinite period. As the latter are hatched into existence by a proper degree of temperature and other propitious circumstances, so it is required, to bring the former into activity, a peculiar constitution of atmosphere. We are not wanting in proof that the seminal principle, in each of the instances cited, will endure for a long term of years in a latent state, waiting, as it were, for the vivifying impulse to be supplied and may it not be equally true in regard to contagion? The musquito, the locust, not to enumerate more examples, disappear for a protracted season, having deposited their eggs, to be awakened into life at some favorable conjuncture. Every agriculturist is aware of the reversions of certain plants, at remote and irregular periods, the seeds of which must have remained in the soil. As clearly does it seem, that the material of this, and all other contagious diseases, is governed by a similar law. Much reliance, I am aware, has been placed on the doctrine of equivocal generation, in the explana tion of some of the preceding phenomena; but can it be reasonably credited, that any fortuitous combination of elements, which this doctrine supposes, is productive of such definite results?" (p 27.)

We cannot avoid remarking that some of the analogies noticed in the above paragraph possibly involve truths calculated to illustrate the phenomena of epidemic diseases. Among all the hypotheses yet constructed to explain the origin of some of the most remarkable epidemics, we believe it may be said that the animalcular is the only one capable of being reconciled with the singular phenomena which attend the visitation of these diseases. Dr. Chapman concurs with Heberden and Haygarth in the opinion that the contagious property of variola does not occur till after the appearance, and perhaps maturation, of the eruption; but thinks it probable that, as in the instance of the vaccine affection, the contagion may exist in the vesicle as well as the pustule. He differs from those who believe the poisonous effluvia may escape from the lungs as well as the skin, thinking it evident, that, as the lungs are destitute of the eruption, they cannot concur in the generation or emission of the contagious halitus.

The insusceptibility of some individuals, and even families, to the contagion, is worthy of notice:

"Foderé mentions the very remarkable instances of those of both of his grandfathers having escaped, and that he himself, though in advanced age, and often subjected to its contagion, had never had the disease. It has, indeed, been calculated, that one in fifty has such a constitutional immunity. But this estimate seems too large, and in no instance is an exemption from it to be confidently relied on. Examples are numerous of persons who, after escaping for a term of years, where affectability being awakened by some mysterious change of condition, the disease attacked, and for the most part, fatally." (pp. 24-5.)

His suggestions on the treatment of smallpox do not claim any particular comment. He justly observes, that it must be adapted to the condition, whether inflammatory, congestive, or mixed. He attaches considerable importance to the use of emetics where not distinctly contraindicated in variola, as in all eruptive fevers, and relies mainly on laxatives and a cool temperature, employing bleeding or cupping when the fever is of an inflammatory character. We differ from the professor as respects his recommendation of the use of diaphoretics, such as antimony and acetate of ammonia, remedies which we consider calculated to increase the quantity of eruption. It is an interesting fact, that the cooling practice in smallpox was distinctly recommended by Rhazes, but was superseded by the dogmas of a false pathology. John of Gaddesden recommended the patient to be wrapped up in red cloth. Sennertus, in the fourteenth century, urged the importance of a warm chamber, and Diemerbroeck advised his patients to use the thickest blankets, and avoid the risk of change of linen. It was reserved for the sagacity of Sydenham to rectify the error, and dictate a return to the ancient practice. Dr. Chapman, considering that, especially in the confluent state, the condition of the skin resembles that of a burn, occasioning nervous inquietude and death, in a similar manner, suggests the application of flaxseed mucilage, and in the asthenic condition, camphorated or Kentish ointment.

Our veteran author dwells on the importance of preventing the marks which are so detrimental to female beauty. After enumerating the numerous suggestions and practices noticed in books, as mercurial ointment, camphor ointment, calomel ointment, a corrosive sublimate wash, covering the face with gold leaf, puncture of the pustules, &c., he adds:

My own practice has been to subdue inflammation as far as possible by cooling lotions, to open the pustules as soon as they fill, and wash them with milk and water, taking care also as far as posssible to keep the face covered. __ It appears, however, that the most effectual means is the exclusion of light. Experiments made some years ago, at New Orleans, if they can be relied on, and I know of no reason why they should be distrusted, are very satisfactory on this point.

To try the effect of this expedient, a certain number of patients, during the eruptive and maturative stages of the disease, were confined in a dark ward of an hospital, and not a pit or scar, or other deformity of the skin, was left, though some of them had the disease most violently, even in the confluent form. These experiments were originally performed by Dr. Picton, a graduate of the University of Pennsylvania, and were contained in his inaugural thesis, which I had published on account of its merits. Notices of their confirmation I have lately seen in the medical journals of several of the European countries." (pp. 43-4.)

Medicus, Meige, Professor Schroider of Gottingen, Odier, of Geneva, Schevanke, and some other respectable authors, are of opinion that inoculated smallpox is not contagious.

"To this question,' says Walkinson,' I have paid particular attention since the establishment of a dispensary for general inoculation, and can with truth affirm that not a single instance has occurred in that charity in which the contagion was spread by an inoculated patient. Where the chance of spreading it has been apparently great, I have been very strict in my inquiries.' He adds, that some inhabited narrow streets, or little courts, and ground floors, the doors of which were kept open, and though surrounded by persons obnoxious to the disease, and especially by a set of children, who continually played before the houses, a few yards only from the sick, all escaped infection. Exceedingly strong is the testimony of Mr. Holwell, at least in regard to India. Living in that region for thirty years, and during the period inoculating multitudes, he affirms positively that it never spread the infection, as is commonly imagined in Europe." (pp. 45-6.)

Dr. Chapman observes that this opinion is supported by various analogies, especially by that of the vaccine affection, which,

"While contagious, is totally void of infection, and as it is probably modified smallpox, it may be rationally conceived, that by inoculation such a change is wrought in the latter disease as to bring it into the same category." (p. 46.)

The professor claims for his own country much credit in the establishment of the practice of inoculation.

"In 1721, when it had only been adopted in England in a few instances, and these chiefly malefactors, whose punishment by death was commuted, and a load of prejudice still existed against it, Boylston of Boston, a name deservedly high in the annals of American medicine, against the unanimous opinion of the other physicians of the city, and in direct contravention of an edict of the municipal authorities, carrying with it heavy penal consequences, had the intrepidity to inoculate two hundred and eighty-six persons, of whom six only died. The disease was prevailing extensively at the time, and out of 5759 persons, who took it in the natural way, 884 perished.

"To escape from the conviction of the inestimable advantage of the process was impossible after so successful an experiment, and when the result transpired in England, doubt and hesitatation were rapidly removed, and the practice in no long time came to be generally adopted." (p. 49.)

The reader will admire the very natural complacency of our author, who concludes his review of the obstacles opposed to the spread of inoculation in many other countries with this remark: