The vessels being steamers, and the season not generally productive of the disease-did the heat requisite for the production of steam, precipitate the evolution of the cause. No degree of heat alone can excite West Indian fever, or any other fever in the right sense of the word. But the question is-did the heat here, co-operating with the endemic morbific influence of the spot, so act upon the structural parts of the vessels, as to call into action the cause of the disease, which, but for that high beat, would not have been evolved then, and, under other circumstances, might not have been evolved at all? The question is important in itself, and involves another still more important, to the following effect. If, as there is reason to believe, a high degree of heat is necessary to the production of the disease in ships, in so far as it is derived from an internal source; and if high degrees of heat have the power, as there is also reason to believe, of precipitating, and more speedily perfecting the cause of the disease, as acting more energetically on their structural parts, contributing the results of certain decomposable materials to that effect, might not the knowledge of such facts be acted on for the prevention of the disease, in so far as it has an internal origin, and is occasioned by changes effected in the materials of the ships themselves? The preventive measure which suggests itself is, the application of a certain degree of heat for a certain time to the wooden materials of ships, or perhaps more appropriately to the wood of which they are to be constructed-say a temperature of 160 degrees for a month. It is reasonable to infer, that such a degree of heat, applied for such a time, would dissipate the decomposable matters, on which West Indian fever on board ship, in many cases, must in some way depend. It does not appear probable that the process would act detrimentally on the woody fibre, and impair its durability; nay, it might improve the one, and increase the other. That, in many cases, and the worst cases, West Indian fever is essentially connected with some agency in the interior of ships, altogether independent of personal communication, or collections of extraneous matters, all discriminative experience shows. As in the Report from the South American station, we are presented with several Tables for the seven years, from 1830 to 1836. The first shews the total number of cases; the number of all diseases and injuries, in classes; the number of cases sent to hospital, invalided and dead; with the ratio of each per 1,000 of mean strength. The Reporter observes, in reference to this Table, that the annual rate of mortality, on an average of seven years, was, from all causes, diseases and external injuries, 19.6 per 1,000 of entire force; and from disease, independent of injury, 18.1 per 1,000. It includes, besides the mortality on the station, the deaths which occurred in home hospitals, from disease contracted within the limits of that station; so that 33 invalids having died in English hospitals, the mortality from disease on the station was in the ratio of 17.5 per 1,000 per annum. Comparing the mortality in and from this command with that resulting from service in South America, it will be found to be, from all causes of death, more than double; from disease, distinguished from external causes, as 18.1 to 7-7, the proportion of death from disease, in relation to accident, being much higher in this command, than in the other. Yet something more than doubling the mortality of South America is not No. LXVI. Ꮓ productive of formidable results; nor in this command, the greater part of which is constituted by the West Indies, and which had epidemic cholera, though to trifling extent, added to the ordinary causes of death, will mortality at the rate of 18 per 1,000 per annum appear excessive. When the nature of West Indian fever is considered, and the rate at which it sometimes prevails, and proves fatal, the rate of mortality will rather, and in opposition to generally received impressions, appear small. The most fatal year was 1835, when the ratio of deaths, from all causes, rose to 37.5 per 1,000 of force, and from fever to 30.6. The following year it fell to 9.2 per 1,000 of force, from all causes, including external injuries. The annual ratio per 1,000 of sick and hurt was 1486-3, the total number placed on the surgeons' lists being 34,982, and the numerical force of seven years 23,531. The number invalided was also high, viz. 926, being in the ratio of 40 nearly per 1,000 per annum of force. The reduction of active force in the command was, from invaliding and death, nearly 59 per 1,000 per annum; so that, though the loss by death, keeping in view the nature of the climate, was small, the total reduction of number was considerable. Comparing, he adds, these ratios of attacked and invalided with those in South America, it will be seen that they are considerably higher, though that of attacked, considering the great difference in mortality, is less so than might have been anticipated. The annual ratio of sick and hurt per 1,000 in the South American command was 1310.7; that of invalided 28. Hence, while the reduction of force, by death and invaliding, in the West Indies and North America, was in the ratio of 58.9 per 1,000 per annum, in South America it was only 36.9. Had South America possessed the advantage of hospitals, it may be inferred that the loss, by invaliding, would have been considerably less than it actually was. The second table shews the total number of cases, the number of all diseases and injuries, in classes; the number invalided and dead; with the ratio of each per 1,000 of attacked. The most striking result brought out by this Table is the mortality from fever, especially when compared with the mortality from the same cause in South America. In this it is in the ratio of 11.2 per 1,000 per annum of strength; in that it was 1.3 per 1,000 per annum. The mortality from fever was therefore nearly nine times as much in this command as in the other. Whereas in South America it was as ! to 7; in this command it is considerably more than half of the total mortality, which amounted to 19.6 per 1,000 per annum, though malignant cholera, a new disease here, occurred to augment the mortality from other causes. Had the command been confined to what is commonly called the West Indies, to the Carribean Islands, and adjacent shores of the Spanish Main, and Gulf of Mexico, and to the Bahamas, not united, as it was, with North America, the rate of mortality would have been much higher; it may be assumed that it would have risen to 15 per 1,000, by fever, of the employed annually. The mortality from fever was confined to the southern, or West Indian, portion of the command; on the other hand, a large proportion of the mortality from original inflammatory disease was in the northern, extra-tropical part of it. The total number of cases treated under the denomination of fever was 4,932; but the great majority were trivial febrile attacks. The aggregate force of the seven years being 23,531, the annual rate of febrile attacks was 209.6 per 1,000. Of the whole number affected, 1,124 were sent to hospital for treatment, 70 on account of imperfect recovery were invalided, and 264 died. The annual ratio per 1,000 of the first is 47.8, of the second 2.9, and of the last, as already stated, 11.2. Of the fatal cases, three were in home hospitals; the subjects were invalided for the effects of fever, but the name of the primary disease was retained; hence the anomaly of deaths in England by West Indian fever. There were 519 cases of inflammation of the lungs, and their membranes; of which, 99 were sent to hospital, 26 terminated in a state which led to invaliding, and 22 ended fatally. The annual ratio of attacks was 22 per 1,000, of hospital cases 4.2, of invalided 1.1, of dead nine, of mean force. Comparing these ratios with those in South America, it appears that, while that of attacked is lower, that of invalided nearly the same, that of dead is nearly double. It is probable that frequent sudden transitions from high to low degrees of temperature, in this command, contributed to increase of severity, and fatality in result. The mortality from inflammation of the liver was less by a half in this station than the South American. The annual ratio of deaths from disease of the liver was one in 5000 of the employed. Under the head of "consumptive diseases of the lungs," 114 cases were treated; of which, 52 were sent to hospital, 56 were invalided, and 44 terminated fatally, 28 on the station, and 16 in home hospitals. The ratio both of attacks and of deaths is much higher than in South America; in this command the attacks are 4-8, the deaths 1-9, in that the attacks were 3.2, the deaths 1.5, per 1,000, per annum, of strength. After fever, consumption was much the most fatal form of disease in the command; after that again, inflammation of the lungs was most fatal. Two hundred and eighty-seven cases of dysentery were treated; of which 42 were sent to hospital, 15 were invalided, and six ended in death. The ratio of attacks and of deaths is low, the last strikingly so, when it is considered that a large portion of the command is within the tropics. The mortality is not a third of what was suffered from the disease in South America, though it was not severe there. The ratio of attacks of delirium tremens, as well as of deaths, is nearly double of what occurred in South America. It is remarkable that a great portion of them were in one year, 1832. A Table is given of the frequent, but not often futal diseases. Numerous, says the Reporter, as were superficial inflammations of the extremities in South America during the seven years of this Report, they were greatly more numerous in the West Indies and North America. Whereas they were in the ratio of 166.9 per 1,000 per annum of force in that command, they were in the ratio of 228-3 in this, the number treated being 5,372, and amounting to nearly a sixth part of all the cases placed on the surgeons' lists. Out of the whole number, one, from change of character, or superinduced disease, terminated fatally. Though the rheumatic cases were less numerous in this command than in the other, they were much more detrimental to force. Here the ratio of attacked was 69 per 1,000 of force annually, there it was 72.3; but here, in addition to 133 sent to hospital for treatment, 121 were invalided; whereas there no more than 24 were sent to hospital on the return of ships to England, and 43 invalided. In South America the annual ratio of invalided was 2.5 per 1,000 of force; in the West Indies and North America it was 5.1, or more than double. It is difficult to account for such difference in results from this disease; the difference of structure in the two commands, as to temperature, suggests itself; but then it does not appear why it should not act in augmenting the frequency, as well as the severity, of attacks in the West Indies and North America. The same number of cases terminated fatally in both commands, viz. four; the ratio of death to force is, of course, a little lower in this command than in South America, while in relation to attack it is higher. The ratio of attacked by catarrhal disease was much higher in this command than in the South American; it was 181.8 per 1,000 per annum of force here, while there it was 139.8. In the South American there were 25 cases of invaliding, in this there were only nine; but in that command there was only one fatal case, while in this there were three fatal cases. The ratio of attacked by diarrhoea was also much higher in this command than in the South American; here it was 110 per 1,000 annually of force, there it was 80.6. Dysentery, on the other hand, was much more severe in the South American command than in this. An Appendix of Tables concludes this, as it did the former Report, and is sufficient evidence of the indefatigable industry of the compiler. We must defer to our next number the conclusion of this Report. In the mean time we would direct our readers' attention to it, and recommend them to add the facts that it embraces to those contained in the Army Reports. Altogether, those facts are extremely valuable. ON THE HISTORY AND PROPERTIES, CHEMICAL AND MEDICAL, OF TOBACCO, a Probationary Essay presented to the Faculty of Physicians and Surgeons, Glasgow. By Henry Wilson Cleland, M.D., Lecturer on Medical Jurisprudence in the School of Medicine, Portland Street. (A Candidate for Admission into that Body.) Quarto, pp. 68. Glasgow, July 1840. THIS is a book of the right sort. One like Burton's Anatomy of Melancholy, or Henderson on Wines, or, si liceat magnis componere parva, John Knox's (not the reformer's) Curator's Vade Mecum. Dr. Cleland has taken up smoke in a right substantial fashion, and if so light a matter could be made so much of, what could he not do with a weightier! We would recommend the faculty of physicians and surgeons of Glasgow to elect him forthwith. We would bet a pound that the faculties of the whole faculty would be gravelled to produce such another work. Dr. Cleland apologises for choosing tobacco for the subject of his thesis. Upon our honour we acquit him. His essay is worth all the theses we have ever seen. What can a young man know of tetanus, or fever? He can, at the best, but make a dull compilation, and if there is originality it is probably pertness. But tobacco and a pipe may be puffed by the inceptor candidate as well as by the "sad and learned" doctor of threescore, nay, perhaps, a great deal better by young lungs than by old ones. Then make no apology, Dr. Cleland, we beg. The Doctor tells us, in his Preface, that he might, if he had liked, have written a book entirely medical and supremely dull. Or, he might have compiled one with not a smack of physic about it. He has done right to do neither. “We have chosen," quoth he, "to pursue a middle course; and while we hold, as a basis, the medical properties of the plant of which we propose to treat, we will illustrate, as much as possible, details of a purely scientific nature, by those perhaps less instructive, though more brilliant and pleasing passages, which shed such a glow of light over the departments of literature. We are the more inclined to adopt this view, from the splendid and vivid galaxy of literary characters which adorned Great Britain in the latter end of the sixteenth, and the commencement of the seventeenth centuries-the very period at which this drug was introduced, and very much employed in this country. The poetical writers of that time, too, especially those of the dramatic department, were not, as is too commonly supposed, mere imaginative visionaries, who piped on reeds or whistled on straws;' but men endowed with strong powers of observation, of perception, and of judgment; and who had the boldness and hardihood to express whatever they thought, on every subject, in a manner quite unexpected, but no less welcome in those ages of comparative tyranny. Luxury and abuses of every shape were then, as they have always been, the proper objects of satire and reprehension; and these were furnished, as was to be expected, in a direct proportion to the extent into which the former had been indulged, or the length to which the latter had proceeded. Amongst these, none were handled so caustically, or in so complete a manner, as the abuses in medicine; and at no part, it is believed, in the literature of any time, are we so much indebted for insight into medical doctrines and medical practice to the dramatists and satirists, as at that of which we are now speaking; and if it be true what has been said of the great Marlborough, and of the still greater Chatham, that their knowledge of English history was mainly derived from the perusal of Shakspear, it might with perfect safety be averred, that by the careful and rigid study of the works of such men as Jonson, Beaumont, Fletcher, Massenger, and Burton, a mass of medical facts and medical opinions might be obtained, infinitely superior to those contained in the works of the physicians of the times in which they lived, and which, even at this day, might put to shame the passes of the mesmerists, or the infinitesimals of Hahnemann. Indeed, it is to these, and not to the professed writers on medicine, that we must look for our information regarding, not merely the customs and peculiarities of medical men—a subject perhaps treated in a superior manner subsequently by Moliere-but, in reality, respecting the routine of that and of the preceding century, and more especially the opinions of the ancient physicians; for while Helmont, Borrichius, Anthony, Fludd, and a multitude of others, were revelling in all the absurdities of a universal remedy, and of That stone which here below While Riverius and Ferrand were attributing all that they could not with facility |