grims, on their return from Mecca. Again, during the last twelve years, quarantine has been established in Constantinople itself; several cases of plague have been imported and confined in the lazaretto; the disease has spread in the lazaretto, but not beyond the walls; and the city has remained free from a disease, which, before quarantine was practised, was so prevalent, that no one doubted that it was of local origin. Those who know Constantinople, know that, if filth, and crowding, and defective sewerage could produce plague, there it would certainly be in abundance. In Egypt itself, where, in certain districts, plague is endemic, and preserved by the system of burial, its communication to other districts is often prevented by quarantine regulations (Brit. and For. Med. Rev., vol. XXIV, pp. 248-50). In the Report of the Committee of the French Academy, quoted with such approbation in the present Report, when its statements suit the purpose in view, are published the following conclusions from authentic notices of twenty-five ships, which, since 1720, have arrived in France and Italy with the plague on board, and from facts observed at Venice, Leghorn, and Genoa: "That the plague is not only transmitted on board ship among persons leaving the same shores, breathing the same air, having the same exercise, the same habits, the same food, but that the plague patient, deposited in a European lazaretto, becomes the cause which developes in others the affection from which he is suffering" (Report of French Acad., p. 163); and that-"It is incontestable that the plague is transmissible beyond epidemic foci, both in ships at sea and in the lazarettos of Europe." (Op. cit., p. 165.) These conclusions are also fully proved by official returns, recording facts of importation at Malta, published in our own parliamentary correspondence on the quarantine laws. In the same French Report will be also found accounts by M. Ségur Dupeyron and M. Aubert Roche of every case of plague which has occurred in the lazarettos of Europe since 1720; and of sixty-five cases of maritime importation of plague, it having broken out in fifty of them during the voyage. All this, as well as the conclusions above quoted, are omitted here, and that alone is selected for publication which supports the favorite views of Mr. Chadwick. The third of the three sentences quoted in the preceding page, is one resembling many others in the Report, suggesting the idea that quarantine and sanitary measures are opposed and irreconcileable systems. We are told at page 84, "the only means of preventing the origin and spread of epidemic disease, is the adoption of sanitary measures;" and at page 5, "that the true safeguards against pestilential diseases are not quarantine regulations, but sanitary measures;" as if quarantine was not itself a sanitary measure, which we assert it to be, and one of the first importIt fully recognises the importance of other sanitary measures, but with the additional precaution of separating the sick from the healthy, not in crowding the sick together, but in separating them from each other, and from those to whom they might communicate disease. But the reporters state that, ance. "The principal ground on which we have objected to the continuance of quarantine, is that the fundamental principle on which it is based is fallacious, and that the only means of preventing the origin and spread of epidemic disease, is the adoption of sanitary measures. Substitution of sanitary measures for quarantine restrictions would, in our opinion, render the importation of any disease from one country into another in the highest degree improbable, and we therefore accompany the proposal to abolish quarantine with the recommendation to substitute for it a plan of sanitary regulation." (p. 84.) And at page 3 is also recommended the "substitution of preventive measures, founded on principles fundamentally different from those of quarantine." Yet those who have been the most ardent advocates for the reform, not the abolition, of quarantine, have also been the most earnest in their endeavours to render the regulations of quarantine unnecessary, by pointing out how the diseases which render their continuance advisable may be annihilated. They point out not only how to prevent the spread of contagious disease by limiting communication between the sick and healthy, but also how the origin of the disease may be traced and destroyed.* They do not, however, follow the irrational example of Mr. Chadwick and Dr. S. Smith, and argue that, as, in the course of time, a perfect system of sanitary regulation perfectly carried out, may probably destroy certain diseases, therefore, while these regulations are being tried and completed, we are to throw aside all other means of guarding against the spread of such diseases. It would be just as absurd to argue that, because vaccination is a preventive to smallpox, and because if perfectly and universally practised smallpox would probably become unknown in the course of time, no means are to be taken to prevent the spread of smallpox by inoculation, while measures are being adopted to complete the universal practice of vaccination. We have seen numerous specimens in the foregoing pages of the kind of practical inferences the Board deduce even from their own assumptions. Let us now briefly compare their inferences from known and admitted facts, with the inferences common sense would draw from the same facts. Because there are evident inconsistencies in present quarantine regulations, and numerous abuses in their practical application, the Board recommend the abolition of quarantine altogether. What says common sense? Simply, remove the inconsistencies, reform the abuses of an institution salutary in its tendency, in order that we may obtain the greatest possible public good with the least possible individual inconvenience and loss. Because some quarantine stations are in bleak, unhealthy localities, the Board say, destroy them all. Common sense says, No, simply remove them to healthy, airy situations. Because unnecessary laws impede commerce, and cause loss to merchants, the Board would expose merchants and their neighbours to the danger of plague to save their pockets. Common sense says, so alter the laws that no unnecessary loss may be the result, while every guarantee is afforded for public security. Because smallpox and scarlatina are more destructive than plague, the Board would run a risk of giving us plague also. Common sense says, keep away smallpox and scarlatina as well as plague. Because consuls and resident authorities in foreign ports are said to state that it is difficult or impossible to obtain information as to the prevalence of disease in really affected parts, for their guidance in issuing or withholding clean bills of health, we, in the name of common sense, do not say that bills of health are useless, but that consuls who make such statements most decidedly are so, and that they ought to be replaced by men See Brit. and For. Med. Rev., loc. cit. who are sufficiently active and intelligent to obtain reports from the medical men in their districts, which would give authority and correctness to the bills of health. Because quarantine regulations are extensively evaded, we do not say abolish them, but take care that the evasions should not be permitted. Because passengers misrepresent the nature and cause of their sickness to escape quarantine, we do not say, admit them indiscriminately to intercourse with the healthy, but take care that proper medical supervision renders misrepresentation impossible. Because there is not proper provision for attendance on sick persons in quarantine, we do not say, send the sick wandering along the sea-shore, but provide them with proper attendance. Because some quarantine stations are out of the reach of medical officers, we do not say, destroy the station, but appoint a resident medical officer, or remove it. Because the system at Stangate Creek is not perfect, we do not say all systems are bad, but, simply, reform the system at Stangate Creek. Because some persons think that the evils of quarantine are greater than the advantages, we do not say, banish both, but simply, banish the evils and retain the advantages. To some extent, the practical recommendations of the Board are good, and cannot be considered as carrying out the proposition for the abolition of quarantine. At page 123 they say "Instead of detaining all vessels whatsoever arriving from ports which may happen to be the seats of epidemic disease, we propose to detain only the persons who may be in an actual state of ill health, or labouring under epidemic disease. Instead of keeping the parties infected together on board their own vessel, or in a building of the description of those used as lazarettos, we propose that they shall, as far as practicable, be immediately separated, and removed to places where the air is pure, and where suitable accommodation may be provided for them. Instead of arresting vessels which arrive at a port distant from a quarantine station, and keeping passengers together who may be in a state of disease until they are sent to a distant quarantine station, we propose that medical attention shall be given at once on the spot, and for their own proper relief in the first instance, and not as sacrifices to the false notion of security to persons on shore.' But with some good this paragraph contains grave practical mistakes. We say certainly, as all quarantine officers of the present day would say, separate infected parties, remove them to places where the air is pure, and where suitable accommodation may be provided, but take care, also, that they are not allowed to communicate their disease to a healthy community. If it be said that it is impossible in practice to reconcile the results of conflicting opinions, to satisfy all reasonable men whose views on the subject of contagion differ, to afford security to the public even from imaginary danger, with but little inconvenience to individuals, slight impediments to commerce, and a concentration of attention of health officers upon real seats of danger, we reply, that nothing is more simple, and that all this might be effected by enforcing the following four rules: 1. To furnish all ships with clean bills of health when no plague is present at the port of departure, and with foul bills in the opposite state. 2. To receive all ships with clean bills of health in free pratique. 3. To impose eight clear days after arrival, and ventilation of cargo to all ships with a foul bill. 4. In case of any suspected disease on board, the quarantine to be regulated in duration by the local authorities. If these rules became law, it would only be from Alexandria that vessels would arrive subject to quarantine on account of plague, except in very rare instances (which would yearly become more rare) from some parts of Turkey and the Levant. Even from Alexandria whole years would sometimes pass without a vessel being furnished with a foul bill of health; and surely eight days' quarantine for vessels in these few exceptional cases could scarcely be considered as productive of great individual inconvenience, or serious commercial loss. At the same time scientific investigation has shown that nothing more is requisite to ensure public security. It would probably not be twice in a century that a ship would be placed in quarantine, on account of having yellow fever on board, in an English port. We have now finished what has been a very unpleasant task. We should have infinitely preferred awarding to the whole Report the unqualified praise which is due, and which we have rendered, to one portion of it. But we have a public duty to perform, which permits no influence of private feelings, or respect for official position, to interfere with its fulfilment. We could not pass over glaring and serious errors, leading to grave practical dangers, without pointing them out before it was too late,— without warning the legislature from adopting suggestions made without sufficient reflection, and evidently with an imperfect knowledge of the subject of the Report. We do not wish to enter at present into an examination of the constitution of the Board of Health; but the Report we have just criticised clearly proves that it must be remodelled before it can obtain or deserve the confidence of the profession or the public. Instead of one medical man and three laymen, we should say reverse the order, and let us have a lay president, with a medical committee of three or more. This is the constitution which has proved on trial to be the best for the Board of Admiralty. When this Board consisted solely of persons not educated for the navy, ignorance of naval affairs and political jobbing were its notorious characteristics. When it consisted exclusively of naval officers, the exaggerated importance given by these gentlemen to purely professional questions led to wasteful expenditure of public money and unfair promotion of personal friends. To remedy these evils, a lay president and secretary were appointed; and with these sat a committee of six or more naval officers. In this way the necessary evils attendant both upon an exclusively lay and exclusively professional Board have been divided in practice-the ignorance of the one, the waste of the other, being alike corrected. A similar constitution should be framed for the Board of Health. Is it not truly absurd, on the approach of a great pestilence, to find medical discussions upon the relations between diarrhoea and the first stage of cholera-upon the treatment of the collapsed stage, as distinguished from that of the premonitory diarrhoea-sent forth to the public by a non-medical secretary, by command of two noble lords, a barrister, and but one physician? Surely this cannot be allowed; and we do trust that before another Medical Report is issued by the Board, its medical members will be increased in number, and will take care that nothing so discreditable as the present production shall again appear. ART. XIII. 1. On Healthy and Diseased Structure, and the True Principles of Treatment for the Cure of Disease, especially Consumption and Scrofula; founded on Microscopical Analysis. By WILLIAM ADDISON, M.D., F.R.S., Licentiate of the Royal College of Physicians.-London, 1849. 8vo, pp. 320. With Four Plates. 2. Thoughts on Pulmonary Consumption; with an Appendix on the Climate of Torquay. By WILLIAM HERRIES MADDEN, M.D., Physician to the Torbay Infirmary and Dispensary, &c.-London, 1849. Post 8vo, pp. 220. 3. De l'Analogie et des Différences entre les Tubercules et les Scrofules; Mémoire qui au Concours, fondé par Portal, a mérité de l'Académie de Médecine une mention honorable. Par A. LEGRAND, Docteur en Médecine de la Faculté de Paris, &c. &c.-Paris, 1849. 8vo, pp. 402. 4. The Undercliff of the Isle of Wight; its Climate, History, and Natural Productions. By GEORGE A. MARTIN, M.D.-London, 1849. Post 8vo, pp. 366. AMONGST all the various forms of disease to which the human organism is subject, there are none whose wide spread diffusion, insidiousness of origin and attack, and terrible effects upon health, happiness, and life, bespeak, from the cultivators of medical science, a more sedulous and patient investigation than those comprehended under the designations of scrofula and tubercle. It were impossible, indeed, but that a disease,—of which, to adopt the views most commonly entertained (in this country at least) with respect to the relations of these affections, one or the other form has left some sad memorial of its presence in almost every home, deforming and weakening where it may have failed to destroy, and whose fatal results have been estimated to produce from one fifth to one third of the total mortality,―should prompt the most earnest endeavours to seek out its true essential nature, to discover the first events in that series of disordered actions out of which our general notion of the disease is constructed, to trace out the conditions under which these actions arise, and to determine the true order of succession, the efficient connexion between these several facts; and all this, with an ultimate reference rather to prevention, which we take to be the highest end of medicine, than to And accordingly it is to a recognition of the strong claims of these affections upon the attention of the physician, that we owe some of the most able and important researches which the literature of medicine records. cure. All that has hitherto been done, however, still leaves the ground open for further attempts at reaching a true and complete theory of scrofula and tubercle, which shall determine their relations upon a certain basis, and which, explaining the exact nature of those primary departures from normal function, whence all the subsequent changes characteristic of these forms of disease proceed, shall show-to use Dr. Madden's words-" by what links the separate facts are connected, and demonstrate why the results are what our investigations prove them to be." And not only do we feel that such a theory is greatly to be desired for the sake of its |