maligne et contagiosa, imprimis febres putridæ, malignissimæ et purpuratæ, plurimisque lethales.'

P. 101.

Having now demonstrated, beyond all possibility of dispute, the existence of a typhoid form or species of Dysentery, it only remains to be stated that this, the worst and most destructive, variety of the disease is not, like the remittent or intermittent form, limited to the Summer and Autumnal months, but may continue its ravages throughout the Winter; "being dependent, not so much on the seasons as on the febrile contagion, and continuing so long as the causes of the fever continue to operate.' "This fever," continues Dr. Harty, may be either originally a malignant typhus, or it may have been a remittent of bad character, converted by the peculiar circumstances of the sick into one of a contagious continued type." The reader will excuse us if we call his attention to the position here laid down; viz. that the accompanying fever of epidemic dysentery may be of a periodic type at first, and subsequently-from the operation of various insalubrious circumstances-assume that of genuine typhus. By bearing this fact in mind, he will be able to reconcile much of the conflicting, and seemingly contradictory evidence that has been adduced on the question of the infectiousness of particular epidemics.

Surely then, from all the facts and testimonies that have been adduced, there is good reason to believe that the division of Dysentery into three species, according as the intestinal affection is unattended with idiopathic fever, or as the accompanying fever is of a periodic or of a continued type, is one that is amply borne out by an impartial examination of the history of the disease, as given by the most experienced writers upon the subject. Hoffman, more than a century ago, had pointed out this three-fold division, as is evident from the following statement at the close of his description of an epidemic dysentery in 1726. "Three classes or grades of the disease might be observed. The first was very mild, attended with only flying rigors and heats, and did not always necessitate the patient to keep his bed; the second, somewhat malignant, was accompanied with fever, this being either of a quartan or of a semi-tertian type; and the third, of a genuinely malignant character, was associated with an acute, and, as it were, inflammatory fever; the symptoms being of the most violent description: this form was highly infectious, and proved rapidly fatal in a very large majority of cases.' Of this last-mentioned form he afterwards

* It would seem, from the following passage in Diemerbroeck's treatise de Peste, that he took nearly the same view, as to the nature of this disease, with that which our author has expressed in the passage now quoted. From this account it appears that, "after an intensely hot dry Summer, a pestilential fever broke out at Nimeguen and other places in Gueldres, causing great mortality. In Autumn, the heat and draught still being excessive, various febrile diseases, such as small-pox, measles, and dysentery, all of a malignant and putrid character, made their appearance in different parts; but chief and foremost was the pestilential fever which, daily becoming more widely diffused, gradually assumed a more aggravated character, until at length in apertissimam pestem transiret.” The intimate connection (says Dr. Harty) of the three diseases-Fever, Dysentery, and Plague-almost simultaneously raging, is here well and clearly marked.

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says that the accompanying fever, "more dangerous than the dysantery itself, was of a malignant petechial description.'

The testimony of Sir James Macgregor confirms the strict accuracy of Hoffman's division; for, in the account which he has given of the dysentery which prevailed among the British troops during the Peninsular campaigns, he distinctly asserts that, in some cases the disease, from its commencement, appeared to be unattended with fever, and, in a short time, ran into the chronic stage. In very many cases, the disease was connected with intermittent fevers, and these indeed were frequently observed to terminate in dysentery. "The type of fever, however," he continues, "accompanying dysentery was very much modified by that of the prevailing epidemic. In the hospitals in the Alentijo and Estremadura in 1812, intermittent fever prevailed or accompanied dysentery, and remittent fever, when the army advanced so rapidly and remained some time stationary in the two Castiles, in July, August, and September. Every case of dysentery which appeared in the battalions of the Guards in 1812 and 1813 was accompanied by the typhus gravior, and very generally had a fatal termination, as did many at Ciudad Rodrigo, &c., where the same form of fever was prevalent." At that place, the situation of which is unhealthy, aggravated by the interment of 20,000 bodies in the course of a few months, the mortality was great.

Granting now that the position with which we started-viz. the threefold division of Dysentery, according as it is unattended with idiopathic fever, or is associated with periodic or with continued fever-has been satisfactorily made out, it will not be necessary for us to occupy any space with proving that it is the last-mentioned form or species of the disease which is liable to exhibit infectious properties. A few short extracts from two or three of the leading authorities will be all that we can afford room for. Zimmermann has, in one place, remarked that "it appeared that our dysentery in general became contagious purely through nastiness and the crowding many people together in a small space, but was by no means so itself; for, though many were attacked with it at once, this seems to proceed from a more universal and widely-different cause, which operated at once upon every one."

In another passage he observes:

"The benignant species of dysentery becomes contagious, malignant, and extremely dangerous, when many sick people are crowded together in a small space, or when peculiar external or internal causes produce malignity in particular persons: and he adds, that he does not see that camp dysenteries are in themselves more malignant than those that happen in cities, although in the army and military hospitals they become excessively malignant and contagious from several circumstances: the same, however, takes place in cities, when a great quantity of people, attacked with this disease, are crowded together in a small space, or where the other different causes subsist of a peculiar or general malignity.' And in p. 151 he says: When hospitals are filled with dysenteric people, some of the assistants are attacked only with dysentery, and others with the gaol or hospital fever, that ends in bloody and gangrenous stools.'

From

all these observations, made partly by me, and partly by other physicians, I conclude,' says Zimmermann, that the dysentery is very often only accidentally contagious,' but that it also frequently becomes essentially so just before the death of the patient." P. 134.

Hillary, after describing the endemic dysentery of Barbadoes, and attributing it to the atmospheric vicissitudes of that climate in particular months of the year, goes on to say:

"It is also probable that it may be sometimes produced by infectious miasmata, exhaled from diseased bodies, and floating in the air, which are received into the mouth when we breathe, stick there to the saliva, and are carried with it down into the stomach and intestines, where they produce all the above-mentioned symptoms, when they meet with a constitution fitted by the above-mentioned causes to receive those infectious effluvia, and to produce the disease." "And thus the disease becomes both epidemical and contagious, though it was not the latter at its first invasion, or seizing the first patient. This I have often observed, especially when great numbers have laboured under it at the same time, as often happens among the negroes." P. 116.

Diemerbroeck, who unequivocally maintains that the dysentery, which prevailed in Nimeguen at the same time with the pestilential fever, of which he has given so accurate a description, was malignant and infectious, subsequently mentions another epidemic of the same disease, whose spread was (he says) owing not to infection, but to an unhealthy character of the season, in conjunction with the bad description of food that the lower classes lived upon. Frank very distinctly attributes the infectiousness (when present) of dysentery to the nature of the fever with which it happens to be associated: in other cases, the disease is, in his opinion, not communicable from one person to another. The late Dr. Fergusson, whose experience of the disease in different climates was very extensive, says: "Dysentery, I believe, I can declare to be in no case contagious. I never saw anything like it except in Holland, after the weather became cold, when it was seen as a local symptom, or irregular form of typhus fever: but more could not then be said than that it was about to be swallowed up in the prevailing epidemic, and formed a combination rather than a distinct type of disease." The same sentiment is reiterated in the article on Dysentery in his recently-published posthumous volume, entitled "Notes and Recollections of a Professional Life." Another of our late army physicians, Dr. Somers, has expressed an entirely similar opinion. He denies a specific contagion to the disease, and states that he "never witnessed the production of contagion by pure unmixed dysentery." He had, however, met with some cases "in which low fever and chronic dysentery were co-existent in those, unquestionably, there was contagious disease; but, this evidently arose from the superinduction of typhus upon dysentery."

These passages will doubtless suffice to convince every candid reader that Dysentery is liable, under certain circumstances which have been specified, to become infectious, or transmissible from one individual to another. It will be seen from the following extract that, the views maintained by Dr. Copland on this important subject, are not exactly those for which our author contends:

"Dr. C. endeavours indirectly to negative the propositions I have been contending for, that the combination of dysentery with typhus is the special cause productive of contagion in the former disease:

* Medico-Chirurgical Transactions, Vol. 2.

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'Many writers,' he says, 'conceive that the asthenic varieties are complications of simple dysentery with different kinds of fever, and that when they are infectious it is not the dysentery but the fever which possesses this property. Some authors suppose that the typhoid variety especially is a complication of this description. But if such,' he adds, 'be the case, wherefore should the disorder which is communicated be always dysentery and not fever? Moreover, this form of dysentery is often present where a case of typhus cannot be found.' He then summarily disposes of the whole question by asserting the fact as incontrovertible, that the asthenic forms are direct and necessary, and uniform results of certain diversified but concurrent causes, and not contingent associations of two diseases capable of separate existences.' The fact thus laid down as 'incontrovertible' being not merely a petitio principi, but the very assertion of the questions at issue, I shall pass it by, and proceed to examine his two arguments; and first as to the inference he would have drawn from the questions above quoted: "Wherefore should the disorder which is communicated be always dysentery and not fever?' The question is doubly erroneous, inasmuch as the disease sometimes communicated is the fever and not the dysentery; as, for example, when, according to Zimmermann, hospitals are filled with dysenteric people, some of the assistants were attacked only with the dysentery, and others with the gaol or hospital fever; and that 'this fever may attack people in health without being attended with the dysentery, though it arise from the putrid and confined vapours of that distemper.'* Again, the dysentery that is communicated is not dysentery merely, but dysentery in combination with the fever. This assertion of an incontrovertible fact' is amply borne out by the multifarious authorities already quoted, such as Pringle, Hoffman, Zimmermann, Vignes, Grimm, Frank, &c. His second argument consists in the statement that this [the typhoid] form of dysentery is often present where a case of typhus cannot be found.' Now for this statement no authority is given, such as might be investigated; but is not Dr. C. well aware that, under favourable circumstances (such as those recapitulated by Frank and others), there is no disease more readily superinduced or spontaneously generated than typhus, a position fully supported by the several authorities already quoted in illustration of this very typhoid variety, and which I have myself further illustrated in my work on the Epidemic Contagious Fever of Ireland (see p. 161, et seq.) All these authorities distinctly shew that the circumstances under which contagious dysentery rages, are the same with those which give origin or aggravation to the prevalence of typhus." P. 140.

We have left ourselves no room for any observations on the Treatment of Dysentery, although the consideration of this part of the subject is necessarily fraught with most interest. But as no sound therapeutic principles can be laid down in reference to any disease, unless we have clear notions as to the real nature of the enemy that we have to contend with, the preceding pages will not be without some interest to the practical physician, if they serve in any degree to teach him how to discriminate, with greater accuracy than before, the kind of dysentery which he may be called upon hereafter to treat. At all events, they will enable him to account for many of the conflicting statements to be found in the

"Nous ferons remarquer," says Vignes, "que l'infection d'une maladie ne produit pas toujours la meme espece d'affection: l'infection de la dysenterie peut, par exemple, occasionner une indisposition bilieuse ou une fievre adynamique, &c.; de meme qu'on peut etre affecté de celle-ci (la dysenterie) par toute autre exhalaison deletere que celle des dysenteriques."

writings of different authors, upon some of the most important points in the general history of the disease. They will show him the reason why a rigid antiphlogistic treatment may be required at one time or in one set of cases; why at another time, and in another locality, no cure can be effected without the aid of bark; and why, in a third set of cases, the chief reliance must be placed upon the adoption of such hygienic measures as will secure cleanliness, pure air, a regular supply of light, nourishing food, and, it may be, the cotemporaneous use of wine and other cordials. For particulars upon these matters, we must refer the reader to Dr. Harty's work, which, we hesitate not to say, should be carefully perused by every member of the profession without exception, from the experienced veteran to him who is just entering upon the duties of active practice. To the young physician it furnishes an admirable pattern of what a medical book ought to be; not the hasty offspring of an impatient ambition, eager for notoriety, it matters little how obtained; but the well-considered production of a studious and philosophic mind, whose chief aim has been to benefit medicine, and promote the welfare of mankind.

ON WOUNDS AND INJURIES OF THE ABDOMEN AND THE PELVIS. Being the Second Part of the Lectures on some of the more important Points in Surgery. By G. J. Guthrie, F.R.S., 8vo, pp. 72. Churchill, 1817.

&c.

In fact this second portion of the work we had a short time since occasion to notice so favourably, has never appeared in the form of "Lectures," or enjoyed the very questionable advantage of being interred amidst the masses of unreadable matter, which fill up the overgrown columns of our weekly cotemporaries. We much regret, however, to find that the nondelivery of the lectures was occasioned by the occurrence of a domestic calamity, which temporarily unhinged the robust mental constitution of our veteran surgeon. Happily he was possessed of ample materials for the illustration of the subject he had contemplated lecturing upon, and the arranging these for publication served at once to beguile away his Winter evenings (how much is expressed in these few words those who have suffered from bereavements alone can tell)—and to present another useful work to the medical public. Like its predecessor, it chiefly consists of succinct accounts of cases which came under the author's observation during his campaigns, with subjoined commentaries and practical deductions. He has however availed himself likewise of the labours of other writers upon military surgery, so that his work presents us with a brief epitome of what is known upon the subject. We prefer presenting the general conclusions, with which he terminates it, to our readers' notice, before offering any comments upon any of them. They are as follow :—

"1. Severe blows on the abdomen give rise to the absorption of the muscular structures, and the formation, in many instances, of ventral hernia; which may in some measure be prevented, during the treatment, by quietude, by the local