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218 less vitiated by decaying organic substances, combined with moisture, these appear to have acted as localizing causes of cholera. 5. That poverty alone had little influence in predis- posing persons to cholera, for many of the victims were, if not wealthy, at least in comfortable circumstances. 6. That the mere overcrowding of houses, and the defective construction of streets, as regards their ventilation, appeared only to aggravate the disease, so far as they increased the above-named localising causes. 7. That mere elevation or lowness of site, apart from the existence of some other cause, had no effect on the disease; North-street, with an elevation varying from sixty to seventy feet, and Reid-street, with an elevation of 110 feet, in both of which the pestilence prevailed in its worst forms, having suf- fered much more severely, in proportion to their population, than Duke-street, Clive-street, Bell-street, or Liddle-street, whose average elevation is under twenty-fi ve feet above the tidal datum. 8. That where cholera is impending, it may either be averted, or, at least, the visitation be much mitigated by active precautionary measures; and that probably sound sani- tary arrangements which provided for the complete and rapid removal of all the excretse and other exuvise of towns, would so improve their condition as to remove the local sources of atmospheric impurity which would appear necessary to the full development of cholera in a pestilential form. Lastly. The correctness of several of the preceding conclusions appears to be confirmed by the singular immunity from cholera enjoyed by the troops, and, although less perfectly, by the inhabitants of the village of Tynemouth in 1849, and by the entire borough in 1853, as well as by a converse series of facts which show the tendency of the pestilence to return upon its former foot- steps, and to re-appear at a subsequent visitation, not only in the same localities, but even in the same houses and rooms which it formerly visited, provided no essential improvement has, in the meantime, been made in their condition. Dr. MILROY said that the late Dr. Gillkrest, author of an excellent treatise on Yellow Fever, had remarked, at one of the meetings of the Society, that no man is qualified to write a history of that disease until he had witnessed, and carefully studied, its characters, on at least three different occasions. The observation of a single epidemic is insufficient to justify a writer in drawing general conclusions respecting either its natural history or its treatment. What Dr. Gillkrest had said of yellow fever held true of cholera also. It was for this very reason that Dr. Greenhow’s observations were entitled to great respect. They served to show, in a striking manner, the inti- mate connexion between the virulence and fatality of cholera, and the existence of local causes of unwholesomeness. This great practical truth was proved, on the one hand, by the almost invariable discovery of some nuisance or another within or near to houses where the disease had prevailed, and, on the other hand, by the comparative immunity of a locality which had once suffered severely upon subsequent visitations, when the locality had been much improved in its sanitary condition. Dr. Sxow said that the remarks of Dr. Greenhow respecting the water supply of North Shields and Tynemouth entirely confirmed his views respecting the propagation of cholera. When this disease was communicated by means of a supply of water containing the evacuations of the patients, it extended at once as far as the water supply reached, and attacked all classes of the community; whereas, in Tynemouth and Shields, where the water supply was not contaminated, the epidemic cdnsistecl of a number of separate outbreaks in distinct localities. In Newcastle and Gateshead, on the contrary, in the autumn of 1853, when the epidemic was propagated by the impure water, it extended amongst all classes of the people throughout both towns. If it was rather worse in the crowded habitations of the poor and dirty than in the houses of respectable people, this was because, in the former, the disease spread also from person to person, besides- being communicated by the water. He considered that Dr. Greenhow did not attach sufficient im- portance to the communication of cholera. There were several striking cases of its propagation from person to person in the paper, affording the only real explanation of the disease, ancl it was probable that the cause was the same in the instances where it could not be traced. Mr. G. R. BuRNELL, after making some observations on the difference of opinion which existed amongst medical practi- tioners respecting the nature of cholera, expressed his belief that sufficient attention had not, in this country, been bestowed upon the influence which the geological constitution of a district must have upon the diffusion of that disease. Dr. Greenhow’s observations, as well as those of certain French authorities, appeared also to show, that the elevation of a locality had less influence, in this respect, than Dr. Farr was inclined to believe. He (Mr. Burnell) also thought that the occurrence of the greatest number of fatal attacks of cholera in the beginning of the week proved that moral causes had a large degree of influ- ence over the spread of the disease. After a few remarks by Dr. M’WiLLlAM, Mr. TUCKER, and Dr. DONALD FRASER, Dr. GpEENEOw replied, and the Society adjourned. Reviews and Notices of Books. Practical Treatise on the Diseases of C7tilclreiz and Infants at the Breast, inclueling the Hygiene and Physical Ed1&cat’ion of You72g Ckilcl1’en. Translated from the French of M. BOUCHUT, with Notes and Additions, by PETER Ilrr; cKES BIRD, F.R.C.S., Author of the Jacksonian Prize Essay for 1849-" On Erysipelas." London: John Churchill. 1855. pip. 776. BUT few years back, and we were sadly deficient in scientific treatises on the pathology of early life. "Mothers’ Guides," on the one hand, and Dr. Underwood’s frequently re-edited and metamorphosed pages, on the other, were almost the only sources of instruction on the hygiene and medical treatment of the infantile frame. The little broclaure of Dr. Coombe, and the later editions of Evanson and Maunsell, were the first steps towards a scientific elucidation of the two de- partments named. The cotemporaneous publication in the serials of the day of some lectures of Drs. West and Willshire (physicians to the Infirmary for Children) more directly, how- ever, attracted the attention of the profession to the necessity of bestowing a little more favour on the subject of paediatrics than had hitherto been the case. The most important progress, however, was made when Dr. West collected his lectures together, and published them as a substantive volume. This has become the standard work in our language upon its peculiar, subject, and most worthily so, as it is the result of very great. practical experience and extended knowledge of the medical literature of Germany and France. In the interim, also, (it should be mentioned,) we were presented with a valuable scientific compilation by Dr. Churchill, of Dublin; and special care seems to have been, and is yet, taken, by the British and, . .Foreign -3fedico- Chirurgical Ra’iew, that the important subject of the diseases of children should receive that attention which it merits. We point out these details, because it is but fair to recognise the source of such endeavours to elevate the depart- ment of medicine we are discussing to a position amongst our. selves equal to that it has long since maintained in the medical schools &c. of the continent. At the latter, M. Bouchut’s treatise enjoys a good reputation; it has reached its second" edition-and this is saying much, when we consider how well supplied French literature is with works on our present: spécialité, and how formidable a rival the classical volumes of MM. Rilliet and Barthez constitute to all intruders into their field. The introduction of M. Bouchut in an English dress is one that should be cordially welcomed by both student and practitioner: It is a complete encyclopaedia in its way, and we believe it may prove no mean opponent in fighting for some. of the honours now claimed by the lectures of Dr. West.. Indeed, we think it possesses certain recommendations that constitute it the best work in our language for the student and young practitioner. It should be borne in mind, however, that M. Bouchut’s teachings only relate to the pathology &c. of infccncg, while other treatises often neglect this period, and : specially refer to later childhood. M. Bouchut is not without’ his faults, is open to some severe criticism occasionally, and . rides certain hobbies rather too hard; but, on the whole, we. are satisfied the present volume, as presented to us by Mr. Bird, l is deserving of becoming a favourite and established handbook. : The hygiene of young children is most ably treated, as is also ’ the subject of their " General .PeAoo." The chapters on ; Lactation, the Diseases of 1Vw’ses, on Growth in its Relations , to the D:scctse3 of Chilcl1’en, and on Syphilis, are unequalled by’
