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the progress of the disease had been checked. The authoralluded to several cases of acute glossitis, related in variouswell-known works and in the pages of the medical journals, inwhich local depletion or incisions had been followed by verybeneficial results; at the same time, he remarked, there wereevidently two forms of the disease,-one, more circumscribedin extent and tending to suppuration ; the other, diffuse andleading to extensive serous infiltration of the affected tissues,and running rapidly into a condition attended with imminentdanger to life. In the latter class of cases the author moreparticularly recommended the treatment above alluded to,together with the prompt exhibition of nourishment and stimu-lants-a point not always dwelt upon in the published cases ofthe disease in a manner which its importance required.

FRIDAY, JAN. 18TH, 1861.Mr. PRESCOTT HEWETT narrated a case of

PURULENT INFECTION IN CONNEXION WITH DISCHARGE

FROM THE EAR, WITH REMARKS.

The particulars of the case were as follows :-The patient, ayoung lady aged eighteen, had discharge from the ear as asequence of measles. About four weeks after its occurrenceshe was seized with severe rigors, which were followed by muchfever, a furred tongue, and typhoid symptoms, with snppres-sion of the discharge. The rigors continued, and when seenby the author the skin had assumed an earthen hue, and thefever was intense. There was no pain in the head, and theintellect was clear; but there was pain extending down the side- vf the neck along the course of the jugular vein, and the headinclined to that side. There was swelling at the base of theneck. The diagnosis formed was that phlebitis was present; andin eight days matter appeared in one of the sterno claviculararticnlations. In the course of a few days one knee became in-volved, and symptoms of pneumonia appeared, but ultimatelysubsided. No suppuration occurred in the knee, the puffinessand effusion disappeared, but the joint remained stiff, thoughit finally recovered. In about seventeen days from the com-mencement of the phlebitis, swelling and pain occurred overone of the hip-joints; a deep abscess formed, which was openedearly, and the joint escaped being involved. The patienteventually recovered, under treatment by wine and morphia.The author was led to the diagnosis by the course and cha-

racter of the pain, which had occurred in connexion with casesof fracture of the skull with similar results, and the same hadbeen observed in some cases narrated by Dr. Gull in the"Medical and Chirurgical Transactions." Mr. Hewett thenremarked on the three possible sources of the infection, statingthat the matter may have formed in the mastoid cells, andthence spread to the lateral sinuses; or it may have originatedin the tympanum, and then extended to the jugular vein; or,more probably, there may have been phlebitis of the minuteveins leading to the lateral sinus, which latter origin of thedisease afforded a more favourable prognosis than either of theother two. If the mastoid cells were affected, there wasgenerally caries of the bone, and then the issue to be expected must be very unfavourable. With respect to the prognosis,the author observed that eight out of nine or ten such casesgenerally terminated in death, from deposits (secondary) taking ’,place in important internal organs; but that where such de- ’,posits were confined to the surface and external parts, a favour-able prognosis might be given. All these views were illus- i,trated by appropriate cases. ’

EPIDEMIOLOGICAL SOCIETY.

MONDAY, JAN. 7TH, 1861.DR. GREENHOW IN THE CHAIR.

DR. MILROY read a paper on

THE INFLUENCE OF CONTAGION ON THE RISE AND SPREAD OF

EPIDEMIC DISEASES.

The author stated that the term Contagion is used to desig-nate the property of a disease being communicable or transmis-sible from a sick person to one in health, the transmissionbeing either direct or immediate from the sick to the healthy,or occurring through the intervention, and it may be by theconveyance to a great distance, of an object which has becomeinfected with the materies morbi.The simplest kind of contagion is that where a disease is

communicable in one way only-namely, by the transmissionof a palpable poisonous matter conveyed from the body of thesick and applied to that of the healthy person, either imme-diately or through the medium of anything which has been indirect contact with the sick-as, for example, his bed and bodyclothes. The itch, some forms of porrigo, syphilis, gonorrhcea,and hydrophobia are in this category. The idea of the atmo-spheric dissemination of the poison of any of these diseases isscarcely recognised in the present day, although in formertimes it was widely entertained in reference to one at least ofthem, as mentioned in Dr. Simpson’s paper on Syphilis, readat the first meeting of this Society in the present session.

Dr. Milroy inquired-Do any of the above diseases occurspontaneously-i. e., quite independently of all discoverabletransmission of the poison from an antecedent cause ? And ifsuch be the fact, what proportion do such instances of self-engendered disease bear to the instances of contagious propa-gation ? The question of the generatio de novo of diseases whichmay afterwards propagate themselves from the sick to thehealthy is a difficult one, but it is obvious that it must befairly and minutely looked into in all attempts to investigatethe influence of contagion on their development and diffusion.It seems more than probable that some at least of the diseasesmentioned may thus arise. For example, the occurrence ofhydrophobia de novo in the canine race can hardly be doubted;if so, a remarkable illustration of the new development of a

specific contagious poison is at once presented to our notice.What is true of one may be reasonably presumed of someothers. Besides this point, there is another which deservesmention. Are there not good grounds for supposing that thepoisonous matter of one or more of the diseases already enume-rated may at times be transmitted from the infected to healthypersons, without direct or indirect contact with the palpablevirus, and through the agency of atmospheric dispersion ? Inthe case of gonorrhceal and other kinds of ophthalmia, it hasbeen more than once remarked that the simple visit to a wardwhere a number of patients with the disease have been congre-gated has occasionally been followed by an attack of themalady, when every precaution has been taken to avoid con-tact with the sick or with any articles near them.Whatever doubt there may be as to the twofold mode of

transmission of any of the preceding diseases, there are somediseases which are certainly communicable in both ways-viz.,by direct and palpable contact or application, and also by theatmospheric dispersion of the materies morbi, and its absorptioninto the skin, the lungs, or the alimentary passages. Small-pox obviously belongs to this class. The teirible epizootic dis-ease of glanders, according to the best veterinarian authorities,is another illustration. The true oriental plague was, in thetime of Dr. Mead, when he wrote his celebrated essay " OnPestilential Contagion," and for forty or fifty years subse-quently, generally considered transmissible in both ways-thecontactual and the effluv ial or atmospheric. In the last quarterof the last century, and until within twenty-five or thirtyyears ago, the strange belief that the plague was communicableonly by direct contact, and never by atmospheric dissemination,held possession of the schools. Since the scientific investigationof the disease in the epidemic of Egypt during 1834-35, thenature and mode of action of the contagion of the plague havebeen found to be quite similar to the contagion of typhus fever.In other respects, too, the two diseases have been shown to beclosely allied in their predisponent, exciting, and favouringcauses, and to be controlled by the same sanitary and hygienicmeans.

Are such diseases as glanders, the plague, and typhus, liableto occur quite independently of antecedent cases? In otherwords, are they liable to become developed de novo. Few, ifany, physicians in the present day will doubt that typhus iscontinually occurring spontaneously under certain tolerablywell-known conditions, and apart from all suspicion of trans-mission from previous cases. Dr. Murchison has recently con-tributed some valuable papers illustrative of this subject, andhas greatly strengthened the conclusions of former writers.The most experienced veterinarians are agreed, that glandersis both a self-engendered and a contagious disease. The lec-tures of the late Mr. Youatt afford important evidence onthis head. Like typhus, the glanders is a disease which hap-pily is much under the control of judicious hygiene. If not the

offspring, it is at least the foster-child, of filth, overcrowding,and neglect.That the plague is liable to be developed de novo, is proved

beyond doubt by its recent appearance on the Barbary coast,after an absence of many years in that district, and while the dis-ease was altogether unknown in any other part of the Ottoman

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dominions. That yellow fever is, under certain circumstancesof insalubrity, apt to manifest contagious properties, cannot bereasonably denied, as in the case of the Eclair at Boa Vista,and in the convict hulks at Bermuda in 1853, as well as inother instances. In pure dwellings, with attention to cleanli-ness and due ventilation, the contagiousness of the diseaseceases to maintain itself. In upwards of a thousand cases treatedim the Quarantine Hospital at New York, no instance occurredof discoverable communication from the sick to the well. Thecontagious power of malignant cholera seems to be as muchfeebler than that of yellow fever, as its power of migratorydiffusiveness is much greater. Transmission from person toperson has certainly been noted not unfrequently in limitedgroups of cases, occurring generally in close unventilatedrooms, or in overcrowded wards of hospitals, lunatic asylums,&c.; but the general spread of the pestilence in a community isas certainly not explicable in such a manner. Personal conta-gion plays but a small and subordinate part in its diffusion.That both yellow fever and cholera may now and then becomedeveloped de nozo in certain climates and regions of the world,can scarcely be doubted by anyone. The contagion of influenzain a limited and partial degree is recognised by most writers onthat disease. In the "Annals of Influenza," by the late Dr.Theophilus Thompson, published by the Sydenham Society, theevidence is fairly stated. That certain kinds of angina orcynanche are also to some extent transmissible in this way, isgenerally admitted; and the recent inquiries respecting diph-theria by the Privy Council and by the Epidemiologioal Societyhave served to show that this disease is occasionally contagious,although contagion cannot be regarded as the principal, farless the ouly, cause of its spreading.Dysentery affords a well-marked instance of a disease which,

not primarily communicable, is apt to become contagious under- circumstances unfavourable to healthy existence. That it is

generable de novo, is beyond doubt. Dr. Latham’s Reports onthe Millbank Penitentiary afford strong evidence on bothpoints. Erysipelas also belongs to the same category. Certainforms of puerperal fever are amongst the most communicable offevers, and their history affords much subject of illustration tothe present inquiry. The best ascertained facts have been wellstated by Dr. Tyler Smith. The exanthemata are the onlydiseases which remain to be noticed. No one can dispute theeminently contagious property of these fevers, and of whooping-cough generally associated with them. The power of trans-mitting from the sick to the healthy belongs more essentiallyand inherently to these diseases than to any others. They have,moreover, other features which distinguish them, as respectsthe time of life at which they usually appear, the infrequencyof second attacks, &c. Their development and spread are cer-tainly much less under the control of sanitary measures thanmost of the other diseases mentioned ; they being, on thewhole, more independent of place or localities than the latter,and dependent rather on poisons or individual diathesis. Dc

any of them ever occur independently of antecedent cases 1’Perhaps not; but the question has not been examined in all it,.details with sufficiently searching care. Whooping-cough hascertainly appeared in some countries where it would be difficult to trace its origin, and it is a curious circumstance thaivaricella seems occasionally to manifest itself in the same way

In conclusion, Dr. Milroy strongly urged the importance ofar greater exactitude and comprehensiveness in observing an(recording facts respecting the development and diffusion oepidemic diseases than have generally been adopted.A discussion followed the reading of this paper, in whicl

Dr. Patrick Fraser, Dr. Greenhow, Mr. Radcliffe, and DrM’William took part.

Reviews and Notices of Books.A System of Surgery, Theoretical and Practical, in Treatises by

various Authors. Edited by T. HOLMES, M.A. Cantab.,Assistant-Surgeon to the Hospital for Sick Children. InFour Volumes. Vol. 1.: General Pathology. London : J.W. Parker and Son, West Strand. 1860." A SYSTEM of Surgery, in Treatises by various Authors" !

The title is a taking one. That various authors may write a

body of treatises on Surgery no one can doubt. That the bodyof treatises so produced should form a System of Surgery in thebest sense of the word is open to discussion. Cyclopædias apart,the instances are rare in which truly great works, equally well

wrought throughout, and their several parts duly balanced,have been manufactured by associations of literary men. Allsuch books exhibit the defects that a little reflection wouldshow to be inherent in enterprises of this kind. The " Systemof Surgery" is no exception. The advantages of such associa.tions are soon told. We may expect from a division of labourgreater rapidity of production; hence, as in a work of the kindbefore us, since all the parts may be put in hand simultaneously,all should equally possess the polish of the latest intelligenceand the most modern researches. We have heard that vene-rated surgeon, Samuel Cooper, affirm that his magnum opus,the Surgical Dictionary," had cost him more midnight oilthan would suffice to float a man of war, and more ink thanwould make a broad mark around the world. This was but a

quaint way of expressing the fact, that it had taken many,many years of unswerving industry to complete his work. Ofcourse those who wanted his book had to wait. They wererewarded with so:nething worth the while. We have fallen

upon days of joint-stock literary adventurers and limited lia-bility. We shall not again have a Samuel Cooper, nor, we fear,a Dr. Copland. The giants of literature are gone by. Thetask achieved by the Hercules of Surgery is now undertakenby a host of men, each burning a little oil and expending alittle ink, the whole representing a lesser aggregate labourthan that of the great author of the "Surgical Dictionary."Nor is the product one broad mark of equatorial embrace; butrather a series of broken lines, incapable of being united to-gether so as to constitute a uniform girdle. Looking at thegreat variety of mental power and skill in the various handsemployed, we may expect to find that one man will trace abold masculine stroke that will guide the student unerringlyon his path; that another will make a feeble and devious

scratch, difficult to follow; another, nothing more than asplutter; in which all system and method are irrecoverably lost.This we should expect, and this we find. It would even bean error to conclude that the scheme of associated literarylabour is favourable to the production of the highest order ofmonographs. The difficulty of adjusting the relations ofmatter in the several essays presents an almost insurmountableobstacle. Each author must constantly find himself crampedby the fear of repeating, or anticipating, or otherwise clash-ing with the essays of his colleagues. The " System of

! Surgery" is even more conspicuous for the disadvantages, thanfor the advantages, of the joint-stock plan. Seeing that the

’ volume before us is only the fourth part of the projected work,and remembering the long and irregular intervals which have

marked the appearance of Todd’s " Cyclopaedia of Anatomy. and Physiology," we must not be too confident that the " Sys-tem of Surgery" will be an example of the one great merit ofassociation, rapid production. Dr. Todd had frequent occasionto complain that his work was delayed through the want off zeal or the breaking down of one or other of his contributors.This first volume, being devoted to " General Pathology," pre-

sents the fairest opportunity, and, we may add, calls with thegreatest urgency, for unity of design and harmony of execution,and in these two essential qualities of a " System," it mostundoubtedly fails. We have, indeed, a series of essays on In-flammation, on Abscess, on Sinus and Fistula, on Gangrene, onUlcers, on Erysipelas, on Pysæmia, printed in consecutive order,but scarcely the faintest traces of those physiological and patho-logical connexions which would bind all into a system, if

grasped by one competent mind. The book is rather a con.

glomerate than a regular system. To bind together under onecover a batch of isolated essays, turned out of moulds so dif-ferent as the minds of these " various authors," and to call theresult a " System," is like tying together a number of sticksof different lengths, and calling the bundle a tree. You mayhave the same aggregate amount of timber, but the sap thatpermeates and gives life to every twig of the tree is not there.We gather from the Preface, that the arrangement adopted

in the work is as follows :- -