this subject the requisite information can seldom be given to the Registrar, except by the medical attendant of the deceased person; and that even if the Registrar be a medical practitioner (which in many instances will be the case), yet will he often be unable to ascertain the truth in this respect, if he is to depend solely on the reports of persons ignorant of medicine and of the names and nature of diseases; and it cannot be expected that from his own knowledge he will be able so far to correct their errors as to ensure a statement worthy of credit. The requisite information must therefore be supplied either directly or indirectly by the medical attendant of the deceased person; that is to say, if such medical attendant is not applied to by the Registrar, he must afford the requisite information to those other persons to whom the Registrar must apply." *145. In the following observations we cordially agree, referring to the importance of uniform statistical nomenclature. "The advantages of a uniform statistical nomenclature, however imperfect, are so obvious, that it is surprising no attention has been paid to its enforcement in bills of mortality. Each disease has in many instances been denoted by three or four terms, and each term has been applied to as many different diseases; vague, inconvenient names have been employed, or complications have been registered, instead of primary diseases. The nomenclature is of as much importance in this department of inquiry as weights and measures in the physical sciences, and should be settled without delay." 145. The worthlessness of vague information can not be more strikingly exemplified than in statistical inquiries. We would gladly see Miss Edgeworth's maxim in letters of gold in every hospital and in every sick room. "He that would make his knowledge useful must first be at the pains to make it exact." This want of exactitude in observing and recording offers in truth the greatest obstacle to the attainment of the highest results of a general registration. Mr. Farr remarks that many of the entries are incorrect-many not furnished by medical men, and in vague and ill defined terms, such as “decline-fit-inflammation-visceral disease-cold-long illness!" &c. So also local terms are employed which appear to denote different diseases in different parts of the country. This suggested the necessity of introducing, as far as might be found practicable, the use of a uniform intelligible nomenclature, and under the head" statistical nosology" a nomenclature will be found obviously framed with great care and judgment, and we think it upon the whole tolerably complete and satisfactory, and even were it less so, the importance of adopting uniform nomenclature throughout the country in reference to these returns is so great, that we strongly urge upon the profession a strict adherence to this statistical nosology-nor will time be thrown away in a careful perusal of the notes appended to the various classes of disease, with references to the authors whose writings represent the prevailing medical opinions which in a great measure guide the English practitioner, and who are cited therefore, either because they have given summaries of the present state, or have extended the domain of our knowledge in those particular branches by original investigations. As the object has been to refer to writings easily accessible, the names of few foreign or ancient writers have been given, and it will be found that the writers at the end of each class have generally treated more especially of the diseases of the class. At the conclusion of the nosology, a well-digested paper is given, headed Analysis of Morbid Phenomena-Nomenclature," in which Mr. Farr passes rapidly in review the elementary phenomena of disease, and considers more particularly how "The numerous, and, in some instances, apparently arbitrary species have been distinguished by original and systematic writers; for without admitting the assertion repeated by Cullen, that species are created by nature, genera by the human mind,'-as our ideas both of species and genera are creations of external nature and of the percipient mind, the determination of these primary elements of generalization is unquestionably more important than the subsequent steps in the process, because an error here will be irreparable. The species in the statistical nosology occur in the registers as well as in all the systematic medical works; and my object is not so much to propose anything new, either in the names or the species, (it being the very nature of an arrangement of the facts observed by all the practitioners of a country, to follow, as the observers themselves follow, the discoveries of pathology), as to point out some of the principles which have guided us in the distinction of species, and in the formation of the other divisions of the classification." 186. The following observations give the key to the whole of the nosological arrangement advocated by the writer. "In the constitution of species, more attention is now justly paid to structural than to functional changes; the former are often the proximate causes of the latter; but some pathologists, led astray by a principle of classification applicable to natural history,* or pre-occupied by their anatomical studies, and the recent discoveries in morbid anatomy, have denied the existence of dynamic disease; and, by a violent and improbable hypothesis, have assumed that every case, for instance, of insanity, convulsion, or syncope, is the symptom of a congestion, inflammation, or some other evident anatomical lesion. It would be as reasonable to assume that the needle of the mariner's compass never loses its magnetic properties but by evident oxidation. 66 Upon an examination of the registers of the fatal diseases in the first years of registration, made, as is evident, from the instructions, without any preconceived notions on classification, it was found that, exclusive of epidemic diseases, a majority of the cases had been referred to particular organs, which were named or unequivocally indicated by the nature of the lesion. In other cases, such as hæmorrhage, dropsy, abscess, mortification, and cancer, the seat of the disease was seldom mentioned. The first class was arranged in groups, as sporadic diseases of the nervous, circulating, respiratory, digestive, urinary, generative, locomotive, and integumentary systems; the second, as diseases of uncertain seat "Pour que chaque être puisse toujours se reconnaitre dans ce catalogue, il faut qu'il porte son caractère avec lui: on ne peut donc prendre les caractères dans des propriétés ou dans des habitudes dont l'exercice soit momentanée mais ils doivent être tirés de la conformation: Cuvier-Règne Animal, tome i. p. 7. The problem in natural history is or was-Given one of many thousands or millions of individuals, what is its name and place in the catalogue?' As the specimen is often dead, or, as in fossils, has been only partially preserved, the superior importance of characters derived from the most permanent structures of the organization is obvious. Recognition is not a main object of any classification of diseases; and the most expert anatomist would, in numberless instances, find it impossible to divine from the after-death appearances the previous pathological phenomena." (de incertis sedibus.) This mode of viewing the facts is common in England; it has been adopted in the treatises on the practice of physic which are most generally in the hands of practitioners; and, what is of more importance, by the authors who have devoted themselves successfully to research, and have naturally contributed most to the formation of the reigning medical opinions. The Library of Practical Medicine has followed this arrangement; and we have the original works of Abercrombie and Marshall Hall, on the Diseases of the Nervous System; Hope, on the Diseases of the Circulating System; Williams, on the Diseases of the Chest; Abercrombie, on Diseases of the Stomach and Intestines; Prout and Sir Benjamin Brodie, on the Diseases of the Urinary Organs; Willan and Bateman, on Cutaneous Diseases; not to mention others, and the treatises on midwifery, or the surgical treatises on the diseases of the joints and bones. Upon the other hand, there are essays and papers by Carswell, Watson, Sir James Clark, Mueller, Carmichael, and Walshe, on hæmorrhage, dropsy, tubercle, cancer, with a subordinate reference to the parts affected. The French writers, Laennec, Andral, Chomel, Rostan, Lallemand, and Louis, from whom we derived so much, have cast their practical works in the same mould. This mode of grouping and considering the different types of sporadic disease appears to be practically the best-to involve few errors in carrying it out, to lead to useful results, and to be in conformity with the general principles upon which diseases have been constituted and named. "It will be observed that the different heads in the statistical nosology are numbered and sometimes subdivided; they may be called species, provided the term be not understood in the strict sense it bears in natural history:* with the technicalities of which medical science should not be encumbered, as it has principles of its own, and can derive more advantage from the methods of chemistry and natural philosophy." 190. We have no hesitation in recommending this paper to the attention of all practitioners. It comprises observations on the causes and nature of diseases-a portion of which we have just quoted-on sporadic diseases of uncertain and variable seat-on inflammation-local diseases-diseases of the nervous system-of the circulatory, respiratory, and digestive organs -of the diseases of the urinary and locomotive organs-on diseases produced by poison-epidemic, endemic and contagious diseases-which he proposes should be called zymotic diseases for reasons given-viz. "It must be admitted, with respect to all the forms of these diseases, that the body, in the cycle of external circumstances through which it passes, may run into them spontaneously (in this they differ from the class of diseases referred to external causes); for it is impossible to trace them invariably to infectious sources; it is not à priori more improbable that they than that other diseases should arise spontaneously; and it is impossible to account for their existence in the world upon any other principle than that of spontaneous origin. Still the property of communicating their action, and effecting analogous transformations in other bodies, is as important as it is characteristic in these diseases, which it "La génération étant le seul moyen de connaître les limites auxquelles les variétés peuvent s'étendre, on doit définir, l'espèce la rèunion des individus descendus l'un de l'autre, ou de parents communs, et de ceux qui leur ressemblent autant qu'ils se ressemblent entre aux.— -Cuvier, R. A., tome i. p. 17. With this definition before our eyes, we cannot confound the species and genera of natural history with those of diseases." is proposed therefore to call, in this sense, zymotic. A single word, such as Zymotics, is required to replace in composition the long periphrasis epidemic, endemic, and contagious diseases,' with a new name, and a definition of the kind of pathological process which the name is intended to indicate, persons who have not made themselves acquainted with the researches of modern chemistry can scarcely fall into the gross error of considering this peculiar kind of diseased action and vinous fermentation absolutely identical, or of considering that others entertain that opinion. Liebig draws a distinction between fermentation and putrefaction; the reasons are more urgent for distinguishing the pathological transformations from fermentation or putrefaction, while it is admitted that they are of a chemical nature, and analogous to fermentation; by which they are moreover to a certain extent explained, although so little is known of the series of chemical changes and products in any single zymotic malady, or of the chemical re-actions of the living forces and organs. Small-pox is by hypothesis the transformation of varioline, and certain unknown concomitant chemical changes in the blood and skin; manifesting the important symptoms which fall under direct observation." 201. On this subject, Mr. Farr has made many suggestions and reflections, if not altogether original, yet sufficiently novel in some of their applications to attract and repay attention. It has been well said, by an eloquent writer, whom the world has lately lost, "who combines anew the knowledge received from other minds, explores its hidden and multiplied relations, and gives it forth in fresh and higher forms, is the rare possessor of an original mind." And, fully agreeing with Sir Philip Sidney, that "thinking nurseth thinking," we strongly recommend the paper as furnishing excellent materials for thought. In describing the different effects of poisoning there is a pithy condensation of known facts and a suggestion for nomenclatures founded upon an hypothesis-that would undoubtedly be attended, in one sense, with many advantages. "In very minute doses poisons have no visible effect, or have a sanative effect on the organization; in large doses their action is generally violent and local (acute); in moderate, long-continued, repeated doses, characteristic series of effects are produced, such as the mercurial salivation, erythema, and tremor, lead colic, and paralysis. If small doses of substances, poisonous in larger doses, are innocent or remedial, food in excess acts by its quantity like a poison, and gives rise to acute indigestion, or to the trains of symptoms indicated by gout, plethora, bloated obesity. The alimentary liquors, of which alcohol is the basis, intoxicate in large doses; and frequent intoxication induces delirium tremens, cirrhosis, and other pathological phenomena, which may be designated * "From Juμow, I ferment: zymosis fermentation, and zyma ferment, may also be employed in English, not in the sense which they have in Greek, but as general designations of the morbid processes and their exciters. Zymosis, and the verb from which it is derived, occur in Hippocrates. See a good note and quotation from Galen, by Foesius, in the Economia Hippocratis, appended to the Gêneva edition (1662) of the works of Hippocrates. Coction appears to have been used by the father of medicine with the same qualification as ebullition and fermentation by Sydenham. See his Treatise on Ancient Medicine, vol. i., ŒŒuvres complètes d'Hippocrate, par E. Littreé, 1839." alcoholia. The privation of the various kinds of fluid and food every day required by the organization, gives rise to acute symptoms (such as occurred, for instance, in the shipwreck of the Medusa), or chronic forms of disease, such as scurvy, and the malady that decimated the Millbank Penitentiary; the body, acted on by oxygen, when it can no longer serve for food, becoming a poison to itself, or falling spontaneously into states of disorganization analogous to the effects of poisoning. The special disease arising from privation might be called pinia rewa, famine, hunger); from high living, obsoponia, (ovorovos, 'elaborately cooking victuals'); from cold, psychria (vxgos, cold); from heat, thermia (egun, heat); without discarding the common terms starvation, scurvy, over-heating, gout, chilblains, frost-bitten (cold?), gangrene, coup de soleil, and some tropical diseases, or replacing the names of diseases which owe their origin indirectly to the excess or deficiency of food and warmth. "Certain matters which have not yet been analysed produce small-pox, glanders, hydrophobia, syphilis, measles, scarlatina, and other diseases; and as it was before proposed to give names to the well-defined diseases produced by poisons, so, for the purposes of reasoning, it will be equally useful to name these specific matters or transformations of matter by which diseases are propagated either by inoculation and contact (contagion), or by inhalation (infection). The following list exhibits the popular and scientific names of diseases in juxta position with the proposed names of their exciters; and it may be assumed hypothetically, that in the blood corresponding bodies exist, which are destroyed, and by the transformation of which the exciters are generated or reproduced. The names in the second column terminate in a, except a few in s. Lyssa (from Avoσa, rabies), the old Greek term, has been restored by Mason Good; I propose, for the sake of uniformity, to call puerperal fever, metria; mumps, parotia; reserving parotitis for simple inflammation of the parotids; croup, tracheia; and the disease from puncture in dissection, necusia, (VEKUS, the dead body.) Diseases. Small-pox Zymotic Principles. Typhus "The existence of gangrenine, ergotine, ophthalmine, tetanine, miliarine, diphtherine, parotine, aphthine, tracheine, may also be admitted. It is maintained by some pathologists, that the same specific poison produces several of these diseases erysipelas, necusia, and metria, for instance; but while the diseases are described as distinct, it will be most convenient to consider their exciters as distinct, although they may be convertible into each other, and be as nearly related as varioline and vaccinine." 200. Into the theory of hypothesis on which the production of zymotic dis |