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Popular Science Monthly/Volume 2/February 1873/Romance of Medicine

< Popular Science Monthly‎ | Volume 2‎ | February 1873

THE ROMANCE OF MEDICINE.
By FREDERICK ARNOLD.

IN once more gathering up the threads of this subject from other years, and endeavoring to address a lay audience from a laic point of view, one would naturally desire, according to the limited measure of one's ability, to grasp some medical subject for which we all have an affinity, and which may be of usefulness to some. But in these papers I enter into an implied bargain with my readers to tell them something picturesque and odd—something that may even be romantic and sensational: but I am also troubled with the uneasy idea that I might ventilate some matters that might be for the health and happiness of some of us. I am like some honest citizen who has only got some modest extent of garden-plot, which he feels bound to lay out with flowers, but at the same time he has some yearnings toward homely but esculent vegetables; or, to vary the simile, just as mathematicians have their pure and applied mathematics, so in discussing questions of medical life and science, one desires not only to look at the subject on its abstract and literary side, but to aim at some concrete good. I will propose, lector benevole, that we attempt a compromise; that while, in random, discursive talk, I am permitted, as heretofore, to cull some anecdotes, thoughts, and illustrations, such as outsiders may care to gather from a particular science, I may yet dwell on matters that may be of essential home interest to us, and hope there may be a somewhat serious design and meaning underlying our olla podrida.

In Medicine, the first object of interest and attention is the medical man himself. An author is to me something more interesting than any thing he does in authorship; a great classic's works are only the fossil remains of a vanished world of intelligence. When patients ponder on pills and potions, I the rather wonder why they do not examine into the nature and idiosyncrasy of their medical man. They may depend upon it that, if he is worth much, he will be examining into their nature and idiosyncrasy. The great question for the patient to solve is, whether his doctor has got the mystic gift. He may be chuckful of science; tap him anywhere, and there will be a clear-running stream of fact and comment; but the practical question is, whether he will prove a healer to me. High science may leave a man very stupid for practice. The knowledge of things is but an adjunct to the knowledge of ends. The physician, aware, in the first instance, of all the dangers his patient is liable to, should, then, from his own knowledge, select the best means of obviating them; but, though he had the whole materia medlca by heart, he would not be nearer his mark if he knew nothing of disease; and this is essentially the full-gotten knowledge of good and evil impressed on him through a susceptibility of his mind altogether distinct from the acquisition of natural history and chemistry. To remember well the pains and the moments of relief of all the sufferers he has witnessed is the first requisite of a physician; to couple these with their attendant circumstances, and to store them up too, is a further extension of the practical intelligence. On this foundation he ought to build a store of Nature-knowledge, of book-knowledge, and of logical acumen. As a man, prudent for himself, should remember adequately all his own pains, so a man, skilfully prudent for the sick, should remember all their pains and weaknesses in the first instance; his head should be more full of misery than the box of Pandora, and his only solace should be the hope at the bottom. This is a wise set of sentences, which I have found stored up among my medical notes and reflections, and, I believe, goes pretty deep into the heart of things medical.

If a medical man shows at great advantage in your home or in his own, there is one place in which he is too often uncomfortable, and makes other people uncomfortable as well. This is the witness-box. There is hardly any great trial for murder, but doctors and counsel come into fierce collision; there is the conflict of medical testimony, and the common-sense of judge and jury is frequently insulted. It would be a golden rule for a medical man never to use a scientific term if a popular term would serve his use as well. The medical man not only states facts, but obtrudes his explanations and theories about them, and does so in highly technical language. The legal mind revolts against the assumption of the medical mind, and in this way much prejudice is done to science. The lawyers are pretty unanimous in holding that a medical man is the worst possible witness. He cannot plead privilege, like the lawyer or the confessor, and his best plan is to tell his story at once, in the most intelligible and straightforward way that he can. The eminent German physician, Caspar, who for many years was forensic physician to the Berlin justiciary courts, is very severe upon medical witnesses: "How often have I heard physicians talking to the judge and jury of 'excited sensibility,' 'reflex movements,' 'coma,' 'idiopathic,' etc., without for one minute considering that they were using words and expressions wholly unintelligible to unprofessional parties!" Caspar's work is a perfect thesaurus of odd incidents and cases; and, if read, it ought to be compared with Taylor's "Medical Jurisprudence," that we may compare the difference between the English and the Prussian systems. The Prussian plan of having an accredited medical officer attached to a court, who in some sort of way is a minister of justice, is certainly an improvement on a scene not infrequently witnessed in English courts, where a criminal trial is turned into an arena for the conflict of scientific testimony.

If you take the volumes of Caspar, and Prof. Taylor's book, and throw in a little more sparkling literature, like "Christison on Poisons"—Christison, like the Fat Boy, will make your flesh creep—you will have the materials—a veritable huge quarry—out of which you may hammer all kinds of sensational and romantic stories. You may read up the murderers, just as old Boffin read up the misers. There is the eccentric Miss Blandy, of Oxfordshire, who poisoned her father as a means for promoting her matrimonial projects; the highly luxurious and wealthy people who have tried to poison, not with vulgar lead and arsenic, but with silver and gold; the aberrant wife who poured poison down her husband's open mouth as he was sleeping. Then there are cases where a three-volume plot might easily be elaborated—where a man or woman had actually taken poison, and secreted poison about the effects of an innocent person, that suspicion and punishment might be directed toward the innocent person. These are cases out of Christison. That learned professor gives a word of caution against a practice that has received considerable laudation. Some preparation of antimony "is often foolishly used, in the way of amusement, to cause sickness and purging, and likewise to detect servants who are suspected of making free with their mistress's tea-box or whiskey-bottle; and in both of these ways alarming effects have sometimes been produced." It is curious to see the race between sin and science: how the tests of the chemist even more than keep up with the craft of the murderer. Some of our most celebrated poisons are of comparatively recent date. Prussic acid was discovered, not so very many years ago, by Scheele—though poisoning by cherry-laurel was a well-known process; and the late Mr. Palmer, of Rugeley, first brought strychnine into such felonious popularity. The toxicologists can count up their martyrs to science. It is curious to observe how each advancing wave of time blots out the records of crime. The crime that was a national event becomes a tradition—is lost in a black abyss of forgetfulness. There, so far as we are concerned, let such traditions rest.

We come back, however, to the point of departure whence we digressed. The culture of the medical man is also combined with a very large experience of life in its broadest bearings and its intensest moments. The education, instead of being confined to a single school, has very commonly been carried on at several great medical centres. Travel is more than ever becoming one of the marks of a highly-trained medical man. There is a period of leisure for nearly every medical man, which, rightly used, may be one of unspeakable preciousness and importance for him. This is the time that lies between the call to a profession and the obtaining any large share of work. As a rule, all preparatory studies have not done more than to break up the ground, and prepare it for the fertilizing process. The real work is to be done when the mind is released from tutors and governors, and can concentrate itself on the thought and work of maturer years. Travel is the opportunity that best enables a man to combine study, thought, and observation. It is astonishing what a large and increasing space is occupied in medical life by travel. It is now not at all uncommon for English medical students to spend a great deal of time at the medical schools of Paris and Vienna. They generally prefer Paris to Vienna, and London to either. The best medical men more than ever seem to be familiarized with the scientific medical thought of Germany. The custom of going out as medical officer to vessels is very largely on the increase. Many young men go with the steamers that traverse the regular ocean thoroughfares. Men who have risen to, or descended from, eminence have been glad to take positions on the great lines of steamers. They are found a most agreeable addition to all the social arrangements—with the drawback, however, of being obliged to subsist in a chronic state of flirtation. Others take longer voyages, and, generally speaking, seek a more adventurous line of life. Thus there are, among men I have known, those who have gone to the Greenland seas, round Cape Horn, to Australia, to India, and the Pacific islands, and have gone, again and again, induced by the divine passion for knowledge and travel. There would be many competitors for the place of medical officer to travel with some of the expeditions that nowadays go round the world. What such travel might be can be seen, with admiring despair, in Darwin's "Voyage of the Beagle." Then many people, when they travel, are neither easy nor happy unless they can afford the luxury of a "medical attendant." Some of the best specimens of medical literature that we have are due to this interesting class of medical men. A Milor on his travels likes a parson, a doctor, and a traveller's major-domo; but the doctor is least easily dispensed with. In this way, by the medical education abroad, by travelling engagements, and by taking appointments on board ship, we have a travelled class of medical men who represent, perhaps, the most interesting, and certainly the most amusing, section of the profession. Wherever in this wide world the medical man goes, he can carry his work with him and his own letter of introduction. The wants which surgery and medicine relieve speak their own vehement, universal language, and stand in need of no interpreter. The lawyer can do no good with his law when once he is out of England. The clergyman must learn the language of the natives, and find his opportunity and his audience. But the medical man speaks the universal language, inasmuch as he answers a universal need. The philosopher and the parson can never be quite sure that they have done any good; the good is so remote and hidden, and it rarely happens that it is ascertained. But the surgeon goes to a man in a state of positive torture, and by a happy bit of carpentering puts him to rights, gives the intense happiness of a sudden cessation from intense pain, and at once earns a thrilling amount of very transitory gratitude. It would be only reciting truisms to speak of the immense generous good they achieve. The amount of self-denying generosity which a physician can practise, and does, is simply incalculable, and there are, indeed, few of us who could not easily furnish a collection of instances.

The curiosities of medical life and practice are endless. If we hear very often of medical men doing arduous work for very scanty remuneration, sometimes there is an agreeable obverse of receiving very splendid remuneration for very scanty services. We know of a medical man whose duty it is to take lunch every day at a great castle belonging to a noble lord. The household is immense; and there is just the chance that there may be some case of indisposition demanding attention. He gets some of the best company and best lunches in England, and duly charges a guinea for each attendance. There is a very wealthy man near a great city, who cannot bear to be left for the night. There is a physician of great ability who drives out of town nightly to sleep at his residence; he is consequently debarred evening society, and if he goes out to dinner he has to leave his friends before wine. He has to charge his patient a thousand a year; and, I think, he works hard for his money. Sometimes the services are such that money cannot repay them. A friend of mine, a young medicus, had a standing engagement of four hundred a year to look after the health of an old lady. She required to be inspected three times a day, and make an exhibition of tongue and pulse. What made matters so aggravating was, that she was as strong as a horse, while the doctor was a delicate man. She was so selfish and perverse, that he was obliged to tell her that he would have nothing to do with her case. Similarly, I have known the son of a rich man who proposed to pay a clergyman several hundred pounds a year for leave to spend his evenings with him. The parson, however, was obliged to tell his rich friend that he talked such intolerable twaddle, that he could not accept his company on any terms that could be named! But the oddest of these arrangements is the following: A medical man has been attending a patient several years, and yet he has never seen his patient. The gentleman firmly believes that he has an œsophagus of peculiar construction, and that he is accordingly liable at any moment to be choked. That help may be at hand whenever any sudden emergency may occur, he has a physician in the house night and day. The physician, being human, must needs take his walks abroad, and it becomes necessary to provide a substitute for him two hours a day. Accordingly a doctor attends daily from twelve to two, fills up his time by disposing of an admirable lunch, and finds the gold and silver coin, in their usual happy combination, neatly put by the side of his plate, in tissue-paper. Up to the present date he has never had the pleasure of exchanging words with his interesting patient.

It is in medical biography, or, rather, medical autobiography, that we must look for our most valuable and authentic instances. Medical literature is not rich in this way; some half-dozen volumes would nearly include the whole. It is to be regretted, indeed, that the best medical men write the least; those who have obtained the highest rank in their profession, and who would have most of science, most of incident to impart. There is all the difference in the world between books that are written to obtain practice, and books that are written out of the fulness of practice. ... In medical autobiography we have such charming narratives as those written by Sir Benjamin Brodie and Sir Henry Holland. There is no doubt that even fictitious narratives, such as "Early Struggles," in the "Diary of a Late Physician," really give us facts substantially as true as any which we find in regular memoirs. I myself know physicians of singular learning and ability, who for half a dozen years have not taken half a dozen guineas a year. Other men, by the happy use of dress and address, though inferior, leave them far behind. One instance is on record which might well be worked up into some narrative like Mr. Warren's. An able man waited and waited hopelessly till ruin stared him in the face. One night, when brooding on his miseries, he heard a bell ringing violently at his surgery door. Opening it, he found that a man had been thrown out of his cab and nearly killed, and they wanted to bring him into the surgery. The medical man found that there were concussion of the brain and dislocation of the shoulder-joint. His card-case showed that he was a man of birth and a well-known politician. He stopped some time at the surgeon's house, who was thus enabled to lay the foundation of a large and lucrative connection.

Dr. Denman, the father of the great Lord Chief Justice, and the grandfather of our new judge, who has so worthily been promoted to the bench, which he will adorn, prefixed an autobiographical narrative to his "Introduction to the Practice of Midwifery." He was educated at the Free School at Bakewell, and, going up to London to study at St. George's Hospital, he boarded and lodged with a hair-dresser at half a guinea a week. In six months his money was gone, and he thought, as a desperate chance, he might get a surgeon's appointment on a king's ship. To his great astonishment, he passed, but he had to pawn his watch before he could join his ship. Once he tried to set up a practice, but he was obliged to betake himself to the royal navy again. However, he tried again. "I had taken a small house in Oxendon Street; but I furnished only one parlor, thinking to complete it gradually as I was able, and I hired a maid-servant, who cheated me very much. When I went into this house, excepting my furniture, I had but twenty-four shillings in the world, but I was out of debt." He got on gradually, made a very happy marriage, bought houses, bought land, kept his coach, and, what, as a Bakewell man, pleased him immensely, he was called in to attend the Duchess of Devonshire. "I was made happy," he writes, "by the birth of a son, which was an unexpected blessing, as I had given up all hopes of having any more children." This son was the celebrated Lord Chief Justice. In time, Dr. Denman became the head of his profession.

Many similar instances might be supplied. Even John Hunter had to make his way amid the greatest difficulties, having to satisfy his brother William of his genius before he could satisfy the outside world. Sir James Simpson is another instance of a man who might have taken nitor in adversum as his motto. He was one of the poorest of poor students who flock to a Scottish university. There is a pretty little village called Inverkip on the Firth of Clyde, near which is Sir Michael Shaw Stewart's great place. He applied for the office of village surgeon, but, not having any local influence, the appointment was refused him. Sir James used to say that he felt a deeper amount of chagrin and disappointment from this circumstance than from any other event in his life. Going before a famous pathologist for examination, the examiner was so pleased with him that he asked him to become his assistant. When Simpson became a candidate for the chair of Midwifery at Edinburgh, the great local interests were again enlisted against him. It was alleged that his election would be prejudicial to the interests of hotel-keepers and city tradesmen, for it was not likely that many strangers would be induced to visit Edinburgh for the purpose of getting professional advice. It was not for the first time that the highest intellectual interests had been imperilled at Edinburgh by such petty considerations. As a matter of fact, no physician ever attracted such a number of visitors; the invalids came in shoals. Simpson once, told his pupils that many of his best papers were written by the bedsides of his patients. His great principle, when he met with any apparently hopeless case, was to interrogate what Nature did in the rare instances in which she effected cures. Simpson's great discoveries may be here enumerated; they form the most thrilling page of modern medical history. His first great achievement was that he procured chloroform undiluted, and discovered the effects of the vapor. This great discovery alone would suffice to associate his name with that of Harvey. That night of the 25th of November, 1847, is much to be remembered, when this great discovery was made. He then demonstrated the possibility of banishing pain and subjecting it to human control. There are now a great many manufactories of chloroform in Edinburgh alone—one that makes several million doses a year. His great surgical invention is acupressure—stopping blood from cut arteries by the use of metallic needles. His third great achievement was his contributions to that great work in which Dr. William Budd has preëminently labored. This is to endeavor to stamp out contagious diseases as completely as the poleaxe could exterminate the rinderpest. His last great work was in the direction of hospital reform. How was it, he asked, that, in the hospital, the mortality in cases of amputation was one in 30, and elsewhere one in 180? Hospitalism has its special evils, that are fatal in these palaces of human suffering. Sir James Simpson's final suggestion goes to the root of the matter—that all stair-cases, etc., should be outside the building, and that no one ward should ever have even the slightest chink of communication with another.

This last reform of Sir James Simpson's is especially important. It is not too much to say that all the great triumphs of surgery, such as those in lithotrity and ovariotomy, have been practically neutralized by foul hospital air, to which is due one-half of the deaths in our great metropolitan hospitals. In surgical wards there is a condensation of foul air, and, in addition, the specific poisonous effluvia given off by foul air. Mr. Spencer Wells is famous for that wonderful operation by which the lingering agony of years is prevented by the knife being used under anæsthetics. He generally uses the new anæsthetic methylene, which, in many cases, is preferable to chloroform. He found that there was a large mortality in hospitals, which was reduced to one-eighth in private practice. St. George's Hospital has now a small institution for ovariotomy at Wimbledon, an example which may be extensively followed. It is to be hoped that in the magnificent sea-side institutions that are so much increasing among us there will be a conspicuous adherence to the principle of the cottage hospital. The National Hospital at Ventnor is constructed on the cottage principle, and we have before had occasion in these pages to testify to its wonderful efficiency.

A case, which, some time ago, was tried in the Court of Queen's Bench, illustrates, in a striking manner, some of the dangers that belong to the annual national migration to the sea-side, and also suggests some very large and important considerations affecting the national health. Without going fully into the details of a peculiarly painful case, it will be sufficient to mention the salient facts. Sea-air having been ordered for a child by a medical man after an attack of scarlatina, a lady took her nurse, governess, and children, to the coast, and hired apartments without telling the lodging-house keeper of the nature of the illness in her family. After a time this most infectious of all infectious diseases broke out afresh, apparently from the neglect of the proper disinfecting processes, and the poor lady lost two of her children, and the unhappy landlady of the lodging-house also lost two little ones. The anguish of parental grief cannot be measured by a pecuniary standard, but actual medical and funeral expenses, and the injury done to the course of business, are susceptible of being assessed, and the jury gave the lodging-house keeper substantial damages. It is impossible not to feel commiseration for the sea-side visitors who experienced this blow in addition to their own calamities, but the verdict was not unwarranted by the facts, nor, to use regretfully a harsh word, undeserved. Those who are acquainted with the history of special classes among the poor are aware how much deadly illness there has been at times in the families of laundresses and pawnbrokers, who have had under their charge the raiment of fever-patients, to which no purifying process had been applied. (Still greater mischief has been done by milk which has been adulterated with water taken from some impure source.) We know, also, of cases where lodgings or furnished houses have been let, in the holiday season of the year, after the occurrence of contagious illness, and yet no disinfectants have been used, and no honest warning has been given. It must increasingly be felt how necessary are some caution and judgment in making holiday arrangements. It is comparatively easy for a lodging-house keeper to recover damages from a well-to-do family in a case where fever has been propagated through a want of care and candor; but, if the converse case had occurred—and it happens in at least an equal degree—it is hardly likely that substantial damages could be obtained from the landlord, even if bereaved fathers, in their grief, should be inclined to seek them. Scarlet fever slays in this country annually some twenty thousand people, and disables, more or less, for a longer or shorter time, a hundred thousand more. Yet, humanly speaking, the larger amount of this mortality might be averted by the processes of disinfection, separation, and, we may add, a religious adherence to truth.

It is not pleasant to think of the successive steps in the history of the sad case to which we have alluded, yet they illustrate the dangers of the travelling public, and might explain the apparently mysterious origin of many a similar attack. The mischief arose with a convalescent patient going to the sea-side. We easily picture him going to the terminus in a London cab, travelling in a public railway-carriage, then travelling in another public conveyance, and finally deposited in a public lodging-house. Early convalescence is often a most dangerous period in the disorder, when minute particles from the skin-invisible, impalpable—take wings, and become elements of danger, multiplying seeds of disease and death. It is safer to travel in a carriage with parcels of nitro-glycerine than with such a patient. If our national sanitary arrangements were in a satisfactory state, such a case would be certified from the London to the local physician, and, both on road and rail, special carriages would be provided, or the ordinary carriages be at once disinfected. Or if, as is usual in this country, such things must be left in private hands, there is a proper treatment which would entirely, or almost entirely, annihilate the danger of contagion. Many of our readers will recollect the piteous case set forth some time back by Dr. Bradley, the present head of University College, when he was head master of Marlborough College. He wanted to know, in the columns of the Times, and various afflicted parents made the same inquiry, when it would be safe for a boy recovering from scarlet fever to return to his home. Scarlatina is almost the one terrible rock ahead which public and private schools have to fear. Many of us know very sad stories of the premature deaths of the young, and the losses and even ruin of school-masters through this terrible visitation. It is not every school which has the vitality of Marlborough College to withstand such trials. In answer to these appeals, the whole theory and practice of disinfection were clearly set forth by competent medical authority. Such obvious methods were suggested as the isolating the patient, the anointing him from head to foot with camphorated olive-oil, the destruction or most thorough cleansing of all things infected, the use of entirely untainted clothes; and then we are assured that patients might be restored to society after a very limited quarantine. The natural apprehension would be that these simple means might not prove sufficient; but the real fact is, that it is extremely difficult to make people resort even to such simple means as these. Not one hundredth part is found of the energy in preventing disease that is employed in attempting to work its cure. What is wanted is a wider teaching of the elementary principles of such matters, and a greater degree of courage and conscience in applying them.

The fact is, that the prevention of diseases should be more regarded than it is, as a true end and scope of medical science. It is to the credit of medical men that they are more and more devoting their best energies in this direction. The skill of medical diagnosis has been carried to the utmost, but not with the result of any corresponding subjugation of disease. Indeed, it is a humiliating fact that, in those chest-cases where medical science has made the most marvellous discoveries, the actual amount of disease is probably greater than ever it was. The doctors are even quarrelling among themselves, whether certain illnesses are contagious or non-contagious. There is no doubt that scarlatina is contagious; but, at the time of the illness of the Prince of Wales, it was sharply debated whether typhoid fever was infectious or not. Even the fact of such a discussion is hardly creditable, for it might have been thought that scientific men, by a scientific induction of facts, could have set such a question at rest by this time. But we feel quite certain, especially in days when people travel and sojourn away from home, that no case of illness should be found to exist which any opinion entitled to respect should consider infectious, but it should be surrounded with safeguards, and so be saved from becoming the source of those terrible domestic tragedies with which we are all so unhappily familiar.

We have now brought our readers to a point to which we have been working up in the course of this paper, a point of extreme practical importance and urgency, on which the opinions of the public and their suffrages should be collected. We wish to draw more particular attention to a subject which we have just lightly touched on, one which we believe cannot be too much ventilated and discussed among general readers, and on which they are qualified to form an opinion, and to take action upon it. The theory involved is extremely simple and interesting, albeit strictly scientific; but the practical importance of it is enormous. Somewhere in the dim perspective many of us can discern the promise of a golden age, when all curable accidents will be cured, and all preventible diseases will be prevented. There can be no doubt but a simple contagious disease is susceptible of being stamped out. We stamped out the cattle-plague, and, if the plagues of men touched the same obvious and immediate pecuniary interests as the plagues of cattle, we might stamp out similar calamities among human beings. To a certain extent the history of the small-pox shows how much can be done this way. In the remarks we are about to make we most especially acknowledge our obligations to Dr. William Budd's writings and teachings on the subject, who has developed his views, full of import to the happiness and well-being of humanity, with immense ability and experience, and much literary skill. The theory is, that any contagious disease can be eradicated; or, at all events, limited within a very slender area; and that various diseases are in reality contagious, such as typhoid fever and consumption, where the ordinary medical and general mind does not admit the fact of the contagiousness. If we resort to the primitive processes of counting noses, or listening for the largest amount of shouting, we shall decide against the theory; but at present legitimate argument and logical deduction appear to be in its favor.

Mr. Disraeli's policy was lately denounced as a policy of sewage. What has been called by some a policy of sewage, has been more properly called by others a question of life and death. We do not mind Mr. Disraeli and his friends having a policy of sewage, but it is essential that the policy should be accurate and enlightened. The advocates of the contagion theory have no weakness for sewage, especially in an olfactory point of view. They say, also, that it places disease under the most favorable conditions for the consummation of its evil mission. But they assert, in opposition to former theories of the Board of Health—that has an unlimited command of print and pay—that sewage, in itself, does not breed fever and infection, unless it is charged with specific ingredients of contamination. Infectious diseases are only communicated by the virus of specific poison. Many of us, in the course of the holiday season of the year, accumulate a collection of instances on the subject. In the famous cities of the Continent, and in exquisite Swiss villages, we have the most noisome stinks and sights, yet we hear nothing of fever. In fact, it almost seems a rule that, where Heaven throws the greatest beauty and magnificence, man should exhibit the greatest abominations. Natural beauty goes, like King Cophetua's beggar-maid, in rags. Clovelly, in Devonshire, is the most romantic spot we know in the western land, and, till recently, it was the most undisguisedly dirty. But all through the west of England, and, indeed, we are afraid, all over the three kingdoms, we shall find lovely villages that, despite their loveliness, will give the utmost offence to sight and smell. Yet, for whole decades of years, no infectious illness is heard of in these villages; and then, suddenly, fever or small-pox breaks out, and, to say the least of it, simply decimates the humble inhabitants. The contagionists will assert that the evil state of things was comparatively harmless until charged with a specific virus. One fact bearing on the subject will be fresh in the recollection of all readers. Many years ago, the Thames began to stink horribly in the hot months. The law courts broke up, the Houses of Parliament were saturated with chloride of lime, the river steamers lost their traffic, and business-men went miles out of their way, in order to avoid crossing a city bridge. "India is in revolt, and the Thames stinks," were the two national humiliations bracketed by our severe friend "the intelligent foreigner." It so happened, also, that a Thames waterman died of the cholera; and that unfortunate waterman created the utmost consternation in the country. A frightful outbreak of cholera and fever was expected. But nothing of the kind happened. The health of the metropolis was remarkably good; the death-rate below the average, especially in the diseases supposed to result from poisonous emanations. There was certainly a failure in the supposed connection between epidemics and a bad sanitary state of things; and the suggestion arises that we were mercifully saved the introduction of some element that might have wrought all the misery we dreaded.

When the Prince of Wales was ill, we all of us, unhappily, quired some kind of notion on the subject of typhoid fever. Each morning paper became a kind of daily Lancet. It is not much to the credit of the medical profession that there has been a great deal of confusion between typhus and typhoid. The latter, from which our prince suffered, is totally distinct from typhus, and has its own distinctive marks, as much as small-pox itself. An eminent physician suggests that it should be called the pythogenetic fever, which is, however, begging the question at issue, which is the great medical problem of our time, whether this disease is the result of malaria or of contagion. Dr. Budd argues that as it is in typhoid fever, so it is in small-pox; as it is in small-pox, so it is in measles; as it is in measles, so it is in scarlatina; as it is in scarlatina, so it is in malignant cholera: amid all varying phenomena, one thing constant, a specific morbid cause, "a cause which is neither a permanent product of the soil, nor of the air, nor of particular seasons, but which is susceptible of transmission from place to place; which breeds as it goes, and then again dies out, or becomes dormant, without leaving any sign to mark its track." The slaughter of the Franco-Germanic War is repeated year by year in England by preventible diseases. This enormous mass of disease furnishes ample material for infection on every side. A most infinitesimal germ, invisible, impalpable, would suffice to infect a single human body, and that body might suffice to infect very many others. It may be said that the link of connection is not always sufficiently clear between the infector and the infectee. In a vast proportion of cases this is clear enough, and it is no argument where it is not. People have been taken ill of small-pox even in prison, under solitary confinement; yet how could we doubt of real though remote infection? Let each individual do his part in the holy crusade against ignorance and disease. Let it be asked, amid contemplated legislation, whether the state cannot give effectual hope. We may then hope to transmit to our children their heritage of earth and time less stained by scalding tears and passions of regret than it has been to us and to our fathers.—London Society.