we have observed before, the number of deaths from dysentery invariably rises towards its maximum whenever cholera and diarrhoea are prevalent. (c) Diarrhea: Season.-This disease, together with the one just named, prevailed epidemically during the summer and autumn of the second year of this constitution (κατὰ δὲ θέρος καὶ φθινόπωρον). In the Aphorisms, sec. iii. xxii., diarrhoea is enumerated among the summer diseases, and we find in the same place that our author also notices the prevalence of sudamina (dpwa) during this season,-whether, however, as a distinct disease, or the precursor of some other, is a matter of doubt: some are inclined to give the miliary sweat a distinct place in nosological arrangements. Galen seems to incline to the idea that these sweats accompany certain eruptions on the skin; he does not, however, enlighten us upon the passage regarding diarrhoea, except that it was wont to succeed bilious vomiting.* Hippocrates, however, distinctly says that those affected by the above complaints (ἱδρῶτες πᾶσι πάντοθεν πουλυς πλάδος), sweated much, for there was abundance of moisture everywhere.† Excessive sweating, we shall find further on, accompanied the different fevers that prevailed, but without relief. The symptoms that were present in those attacked by the diarrhoea of this constitution resembled much the usual autumnal cholera of this country, such as was described by Sydenham, who wrote fully on this subject. Take, for instance, the epidemic of 1669, and compare it with the description given by Hippocrates. With regard to the season, Sydenham says, "Intra Augusti limites se continens, vix in priores Septembris hebdomadas evagatur. Adsunt vomitus enormes (εμετοι χολώδεες, φλεγματώδεες, καὶ σιτίων ἀπέπτων ἀναγωγαι—vomiting bile and phlegm, as well as bringing up undigested food) ac pravorum humorum cum maxima difficultate et angustia per alvum dejectio (èíápporαι * Gal. Op., Kühn, vol. 17, b, p. 619. + Euv. d'Hipp. Littré, tom. ii. p. 619. χολώδεες, λεπτοῖσι, πολλοῖσιν, ἐμοῖσι, καὶ δακνώδεσιν ἔστι δ' οῖσι vdarúdees-bilious dejections, or diarrhoea, with abundant thin, crude matters, attended with griping, and in some the stools were watery): sudor (idpures-sweats). It is evident that the form described by Sydenham was of a much severer character than that which attacked the Thasians, for he goes on to detail symptoms which Hippocrates certainly would have noted had they been present at the time. "Ventris ac intestinorum dolor vehemens, inflatio et distentio; cardialgia; sitis; pulsus celer ac frequens, parvus et inequalis; æstus et anxietas; nausea molestissima; sudor; crurum et brachiorum contractura; animi deliquium ; partium extremarum frigiditas, et similia, quæ ægrum in viginti quatuor horarum spatio interimunt."* I have thus given at length the description of autumnal cholera by this celebrated physician, thinking that it must prove useful as well as interesting to the student of the present day; since, if he practise in our metropolis, he must be a witness of the fearful havoc that the present form of the disease periodically commits amongst us. Speaking of the season at which cholera generally showed itself, Sydenham said, "eam anni partem, quæ æstatem fugientem atque autumnam imminentem complectitur (unice ac eadem prorsus fide, qua veris primordiæ hirudines, aut insequentis tempestatis fervorem cuculus) amare consuevit."+ It must be kept in mind that I do not desire, in thus drawing a comparison between the cholera of Sydenham and the diarrhoea of Hippocrates, to lead the reader to suppose that I believe them identical; my object is to show how closely allied the two are in their symptoms; and on referring to the experience of all who have witnessed these dreadful scourges, we hear the same opinion echoed, that they go hand in hand,-often, however, is diarrhoea the advanced guard of the enemy. For a description of cholera by Hippocrates, see further on, under the Pestilential Constitution. On looking over the black list of the Registrar-General, * Sydenhami Op. Om. Soc. Syd. p. 577. we are soon convinced that the latter part of the summer and the beginning of autumn is still the time of the year most congenial to the development of diarrhea. About cholera we shall have more to say when we are discussing the connection between the grander pestilences that have assailed mankind, and their abundant meteorological phenomena. I have selected the above years on account of the great mortality from diarrhoea during them; the totals place the seasons as follows, in the order of their proneness to favour the development of this disease :-1, summer; 2, autumn; 3, spring; 4, winter. This subject will be again referred to in connection with cholera. Temperature.-Diseases of the class which we are now discussing seem to rise with the wave of temperature; death in his relentless course seeming determined to have his average number of victims, although, as it were to relieve monotony, he is allowed to change his weapons, at one time with heat and moisture, at another with cold and dryness, now with the east wind, then with the south, does he wage war with those who have death as their curse ;-and in all this we see the wise hand of Providence. Were death limited in his resources of destruction in our land as he is in some others, where would be the pre-eminence consequent on the due admixture of temperament? Have not those nations excelled most in the arts, sciences, and war, whose inhabitants have been ever subject to variability of climate, where death makes no distinction of persons, where all classes and all temperaments are at one time or another of the year liable to the invasion of the particular diseases of the well-marked seasons? A nation that has a well-defined climate, with well-defined diseases dependent upon a certain train of meteorological causes, can never rise to so great a height in psychical development as those whose inhabitants have to contend with the vicissitudes of weather. We know that certain temperaments are more liable to take on one class of diseases than another: were the climate of the country to which any set of people hed migrated only inimical to a certain set of diseases, then should we find that those who remained would resemble each other, and give a certain character to their posterity, who would possess in the execution of their affairs a peculiar mental bias, which would characterise them as a nation, but never raise them to pre-eminence in the world's fame for a continuance. Whereas in a climate such as that which Greece enjoyed, there was every element for keeping up the balance of mind and body among the inhabitants, variable like our own, during one season the hopeful, the imaginative, the ardent, were assailed; at another, the thoughtful, grave, and phlegmatic; so that a balance was struck to a certain extent at the end of the year, and the next generation did not suffer, but rather improved, under the skilful pruning of death. Happy is it for England that she has the like advantages, only to a greater extent: her inhabitants are variable as her climate, and it is this amalgamation of all shades of mental and bodily temperament that has made the Englishman so far superior to the other citizens of the world.-But to return to our subject. We have now to consider the effect of temperature in raising or depressing the mortality in diarrhoea; and we shall find that while bronchitis and pneumonia descend in the scale of mortality as the year rises in temperature, diarrhoea goes and retires with the wave-tide of heat. The Tables III. and IV. will more fully show what I shall now endeavour to explain by a reference to the numbers of the Registrar-General. Although, as we have said before, diarrhoea has been observed to rise in the amount of its fatality as the temperature of the year increases, yet it must be remarked that, in taking the weekly averages for the last ten years, we find this disease pursuing a very steady and depressed course between the eleventh and twentieth weeks inclusive, although during that time the mean temperature ranged in an almost gradual ascent from 40° to 52°; after this, until the thirty-second week, about the middle of August, it gradually increased until the weekly average of deaths arrived at 130 in number, the mean temperature for the same period being 620,-the highest point to which the mean temperature of the year arrived, if we except the twenty-eighth week, when it was 63°: after this period, both the thermometer and the disease, as a general rule, seemed to decline. With regard, however, to the present year, 1854, in which diarrhoea and cholera have been so fearfully fatal, it will be necessary to make a few remarks before we dismiss this subject. The temperature of the weeks of this year in which diarrhoea raged so much above the average, was far from being higher than usual; in fact, from the seventeenth to the thirty-sixth week the weekly mean of the thermometer, with but five exceptions, was considerably below the mean of the last ten years: immediately before the seventeenth week, and at the commencement of the year, however, the temperature was rather higher than the mean of the corresponding time had been for ten years, and the number of deaths from diarrhoea was proportionally high. When the fatality from diarrhoea was at its height, in the thirty-fourth, thirty-fifth, thirty-sixth, and thirty-seventh weeks, during which 965 died from this disease alone in London, the thermometer stood considerably higher than the mean: thus, 1854, 61°, 65°, 59°, 60°; mean, 60°, 59°, 59°, 57°. |