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that this number gives only about two-thirds, or so, of the entire amount, in consequence of the number of insane persons dwelling in boarding houses, convents, &c."

M. Boismont calculates the number of the insane in France at nearly 30,000.

THE GEOGRAPHY OF DISEASES.

During the course of the present year, there has been published in Paris a work, entitled An Essay on Medical Geography, or Studies of the laws which preside over the Geographical distribution of Diseases, and of the Topographic relations existing between them; the Laws of Coincidence and Antagonism, &c.

The subject is certainly a good one for a clever man to write upon, as the field is scarcely at all pre-occupied, and the information communicated may therefore be expected to be more novel and attractive than what forms the staple of most modern medical works. We are indebted to the pages of the Gazette Medicale for the following notice of M. Boudin's Essay.

"The history of diseases has its Chronology as well as its Geography. On the first of these points, M. Pariset has recently made some very ingenious observations, in the way of preface to his Exposition of the Modern Origin of the Plague. Some of the German physicians have enlarged much on the doctrine of morbid metamorphoses or transformations, and have endeavoured to apply its principles to the elucidation of the development and diffusion of other diseases.

"The domain of Medical Geography is already rich and extensive, and travellers are yearly adding to its resources. M. Boudin, the author of the work before us, first announced the germ of his ideas in his Treatise on Marsh Fevers, and it is most gratifying to know that there seems to be every probability of these being now fully carried into effect, since the recent institution of " medecins-voyageurs" by the Royal Academy.

Botanical writers may justly claim the merit of having first directed the attention of philosophers to the importance of geographical position as an important element in scientific enquiries, by pointing out the influence of climate on the distribution of plants, and thereby proving the sympathy, so to speak, of some, and the repulsion of other, general species for each other.

M. Boudin frankly acknowledges the source whence he derived the first hint of his ideas; and he adopts nearly the same division of geographical causes or agencies in reference to diseases, which several botanists have established in reference to the vegetable kingdom. These are-1, the Latitude and Longitude; 2, the Elevation above the level of the sea: and, 3, the Geological character of the soil.

The first of these causes-the latitude and longitude of a place-exercises a very marked influence, not on the character or form only, but even on the very development and existence, of certain morbid phenomena.

The Yellow Fever, the Plague, and the Cholera, have their peculiar and welldefined theatres of action, at least in their state of endemicity: these theatres being the deltas of three great rivers, (the Misissippi, the Nile, and the Ganges,) in the hot regions of the earth. With certain modifications, the peculiar nature of which has not hitherto been well explained, the embouchures of other rivers, and generally indeed all marshy countries, are observed to be the seat of certain fevers which are characterised by having an intermittent or remittent type. It is for this reason, among others, that M. Boudin has been led to conclude that there must be a sort of family resemblance, so to speak, between the Yellow Fever, the

Plague, and the Cholera on the one hand, and Paludian Fevers on the other; and he goes so far as to conjecture that all these diseases are to be regarded only as different manifestations of one and the same morbid agency. Among other circumstances, he points out a very curious feature of resemblance which is said to be common to them all, viz. their power of excluding pulmonary consumption and typhoid fever-diseases which, en revanche, exercise their destructive sway over regions that are not marshy or burned up with a tropical sun.

The great Humboldt has remarked, in his most valuable work on South America, that the highest limit of the melastomatous tribe of plants is likewise found to be that of the Yellow fever: it would therefore seem, that its morbific germ does not reach higher than a certain elevation above the level of the sea.

The plague, too, shews a somewhat similar character; for it has been remarked at Cairo that, while the lower quarters of that city are grievously afflicted with it, the citadel is usually quite exempt from its influence.

At Constantinople, also, it is noticed that it seldom reaches as high as the elevated points of the seven hills, on which this Empress of the East is built. Nearly the same thing may be said of the Endemic, but certainly not of the Epidemic, Cholera.

These facts, therefore, clearly prove that the elevation to which the morbific germs of certain diseases are usually carried in the atmosphere, is by no means considerable. If space permitted us, we might here show that the germs of other diseases are limited to a very small circuit around the foci of their action, unless, indeed, their diffusion be promoted by the agency of the wind, or by direct transport. This subject, however, we cannot enter upon at present.

As to the influence of the Geological character of the soil on the development and diffusion of diseases, the Plague, like other marsh-maladies, has been observed to shew a marked preference to districts of an argillaceous formation. Pulmonary consumption and follicular Enteritis are said to be most prevalent in chalky countries; Goitre and Cretinism too have been alleged to be most common upon such formations; and some go so far as to tell us that it is from this circumstance that the latter name is derived."

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"The character and composition of the water in any place should always be taken into account in studying its prevailing diseases. The water at Oran in Algeria is found to contain nearly twenty times as much matter dissolved or suspended in it, as that of the Seine. Surely such a circumstance as this cannot fail to have a decided influence on the health of the inhabitants: may it not account for the great frequency of dysentery in the former place?

M. Boudin, having discussed the various topics now alluded to, proceeds to examine the curious subject of the latency or incubation of many diseases—which may thus break forth at a distance from the point where their germs were developed. The period of concealment or abeyance, so to speak, of morbific poisons, within the human constitution, varies a great deal in different cases. That of Hydrophobia it is well known, may extend to three, six or even twelve months; that of marsh miasma for the same or even a longer period of time; and the malignant fever of Marseilles has been observed, in many instances, to be lying dormant for several months after the exposure of the person to the exciting

causes.

The last Chapter of the work is occupied with a consideration of the Laws of Geographic Coincidence and Antagonism; more especially in reference to the alleged reciprocal repulsion of phthisis and typhoid fever on the one hand, and of marsh fevers on the other. This subject has of late excited very great attention in France, and has been repeatedly canvassed in the Royal Academy and other medical societies. M. Boudin is disposed to admit the correctness of the idea in question, and he has taken much trouble to shew, by an elaborate

appeal to statistical reports, the extreme rarity of pulmonary Consumption and Typhus in all districts that suffer much from remittent and intermittent fevers. The long-established celebrity of d'Hyeres has been supposed to be owing, in a great measure, to the marshy character of the surrounding country.-Gazette Medicale.

Remarks. While reading the preceding observations, more especially those which refer to the influence of the water, soil, &c. upon the diseases most prevalent in any district, we were strongly reminded of the admirable instructions given on this very subject by Hippocrates in his treatise "De aere, aquis et locis." Great stress is laid upon the necessity of paying due attention not only to the times and seasons of the year, but also to the situation and locality of any particular city or place; its exposure to the East or West, or to certain winds, &c.; the character of the surrounding country, whether this be marshy or dry, high or low; the quality of the water that is used as drink, and the general diet of the inhabitants; &c. The old Coan was much wiser in his generation than many of our modern philosophes, who, in their vain attempts to raise medicine to the rank of an exact science, seek to lay down certain fixed rules or principles to determine the treatment of diseases in all seasons and places alike.-(Rev.)

DR. PEREYRA ON THE TREATMENT OF PHTHISIS: USE OF COD-
LIVER OIL.

The author of this brochure has been one of the physicians of the St. Andrew Hospital, at Bourdeaux, for the last eight or ten years, and has had his attention particularly directed to the pathology and treatment of pulmonary Consumption. This sad scourge of France, as well as of our own country, seems to be exceedingly common in that city and its neighbourhood, in spite of the prevalence of ague and other marsh diseases, which arise from the damp character of

the soil.

The chief object of Dr. Pereyra's pamphlet is to recommend, to the notice of his professional brethren, the use of Cod-liver oil in the advanced stages of Phthisis, as a remedy that promises unquestionable benefit in many cases which have resisted every other known medicine. It is but fair to the author to state that, judging from his writing, he seems to be not only a practised stethoscopist, but also an intelligent and observing physician. There is no air of quackery about his statements; they are uniformly fair and candid.

In several of the cases related by him, in which a very remarkable suspension of the morbid degeneration of the pulmonary parenchyma took place, there were present all the symptoms (auscultatory as well as natural) of one or more tuberculous caverns in the upper lobes of the lungs.

The plan of treatment usually pursued was to exhibit the oil in doses of a table-spoonful or so, twice or thrice a day, and to put the patients on a nourishing and tonic course of diet.

Dr. P., also, in most of his cases has recourse to some artificial drain, established near the seat of the chief lesion-either on the parietes of the chest, or in the flesh of the shoulder. This is unquestionably good practice and deserves to be more generally adopted than it is.

A young prostitute was admitted Here is a brief account of one of the cases. into the hospital with all the symptoms of confirmed phthisis-hectic fever, night-sweats, purulent sputa, pectoriloquy, accompanied with a cavernous souffle, in two places over the upper part of the right side of the chest.

Under the treatment which we have menioned, the girl recovered her health astonishingly, and. after the lapse of three months, was so well as to leave the

hospital. "I auscultated the chest at that time, and ascertained distinctly the existence of the two caverns; the crude tubercles seemed to me to be less extensive than they were some time ago, and over several parts of the affected lung the respiratory murmur was much more natural." Three years after this date, Dr. P. had the opportunity of repeating his examination, and then found that the pectoriloquy was still very audible over the same points that it had been -but the caverns now seemed to be decidedly smaller in their extent; and, as there was no longer any tuberculous bruit heard during respiration, he inferred that the surrounding substance of the lungs had partially recovered a more healthy condition.

It is quite unnecessary to adduce the particulars of more of the cases. In several of them, the accuracy of the diagnosis was entirely confirmed by the appearances found on dissection. This fact naturally gives us more confidence in the other statements of the author.

Even in the more successful cases, he distinctly warns his readers not to suppose that a complete cure, or restoration to a perfect state of health, took place, if there was any cavernous excavation in the substance of the lungs.

The excavation still continued, but the progress of disorganisation seemed to be arrested, and the indurated state of the surrounding pulmonary parenchyma was sensibly diminished.

The auscultatory phenomena shewed that such was the case; for the pectoriloquy and cavernous blowing were still audible, but the respiratory murmur was more uniform and regular.

ness.

One great drawback to the use of the cod-liver oil is its extreme nauseousMost patients vomit every dose for the first two or three days; but then, if steadily persevered with, it will usually remain on the stomach: it is curious, that young children will often swallow it without much repugnance. When the cough is very troublesome, Dr. P. recommends that the cyanuret of potassium be administered along with the oil: he has seen admirable effects from the judicious exhibition of this medicine. A nourishing diet of animal food, &c. is a powerful auxiliary to the use of the cod-liver oil, in enabling the system to stand up against the enfeebling effects of the disease, and to make an effort to arrest the disorganising process.

This treatment appears to be, on the whole, very judicious. Like every wise practitioner, Dr. P. varies it, as a matter of course, according to the character of the existing symptoms. If, for example, any signs of pleuritic complication come on during the use of the tonic regimen, he at once discontinues it, and has recourse to leeches, cupping, &c.—to resume it, however, when the inflammatory affection subsides.

He is a great friend to the use of counter-irritants, especially of issues and setons. He says: "In almost all my patients I establish a drain in the arm: this usually exerts a very favourable action upon the entire system. I always advise them to keep it open for several months after leaving the hospital, as it assists most powerfully in confirming the salutary check that may have been made on the disease. Those, who have had the discharge too soon dried up, speedily found that their cough, &c. became more troublesome; and many have therefore come back to have it re-established."

If diarrhoea be present, the cod-liver oil must usually be discontinued for a short time, and the strong diet be changed to one of a milder nature-such as rice, eggs, &c. The acetate of lead is one of the best remedies for internal exhibition under such circumstances; it serves also to check the night-sweats. Whenever the patient has a decidedly chlorotic look, Dr. P. recommends that steel medicines be freely given.

The following remarks by our author on the frequent coincidence of ague and

consumption at Bourdeaux, deserve especial notice at the present time, when his countrymen make this question quite the " cheval de bataille" of their academic controversies.

"I must here," says he, " mention a complication which is perhaps peculiar to our geographical position; viz. a quotidian intermittent febrile condition, which has some points of resemblance with the paroxysms of the hectic fever, that is usually present in all cases of confirmed phthisis. But they may be distinguished by the circumstance of the attacks of the former being always more regular and stated than those of the latter. The shivering of ague usually occurs about the middle of the day, and the strong sweating stage about midnight. Whenever we have reason to suspect the existence of a co-existent ague, we should have recourse to the quinine, without discontinuing the use of the former medicines and regimen. Usually the patients bear the quinime remarkably well, and its effects are so speedy and decided that, after the lapse of a week or so, we are enabled to dispense with it.

"Intermittent fevers are so prevalent in and around Bourdeaux, that they constitute more than a fourth part of our diseases. Their presence in the system decidedly promotes and accelerates any tendency that there may be to tuberculous deposits.

"As we have already explained, whenever we have reason to suspect the existence of such a complication, we should at once get rid of the ague by the administration of the quinine, either alone or in conjunction with opium.'

Dr. P. mentions it, as the result of wide observation, that "one of the most frequent causes of phthisis among the youths in Bourdeaux is the depraved habit of masturbation. There are few young men, who have not confessed it to me; and I have strong reason to believe that those of the other sex, although less willing to acknowledge their fault, are quite as culpable.”

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The question as to the communicability of consumption from one person to another has usually been decided in the negative. Our author however intimates his doubts upon the subject; having seen so many cases in which the disease appeared to have been transmitted to persons who have been in constant attendance upon the sick. Often has he observed strong robust women begin to exhibit phthisical symptoms not long after the death of their husbands from the disease; and occasionally also the reverse of this. It is therefore only a wise precaution to avoid, as much as possible, inhaling the breath of any one labouring under the advanced stage of consumption. Dr. P. alludes also to the well-known circumstance of many famous chest-doctors-for example, Laennec, Bayle, Delaberge, Dance, &c.-having fallen a sacrifice to the disease, and thinks it not at all unreasonable to suppose that their continual and often very prolonged visitation of phthisical patients may have had something to do with the origin of their ailments. He therefore strongly advises those physicians and students, who may have any hereditary tendency to the disease, to be more than usually cautious not to inhale the breath of such patients, and to avoid unnecessary delay in their visits.-Du Traitement de la Phthisie Pulmonaire, par E. Pereyra, pp. 84. 1843.

Remarks. That so penetrating and active a medicine as cod-liver oil-which unquestionably possesses, according to all accounts, no ordinary remedial powers in many forms of scrofulous disease-may be of decided benefit in certain cases of pulmonary phthisis, is far from being unreasonable. It appears to be a general stimulant, in a moderate degree, of every part of the system, and, from the small portion of iodine present in its composition, it is well suited, we should think, for persons of a strumous habit. Whether a due combination of this potent substance with some of the vegetable balsams, such as the Peruvian or

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