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 desrve 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 exlusively professional Board have been divided in practicethe 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 P ortal, 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 cure. 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.

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

momentous importance to treatment, and yet more to prophylaxis; but we entertain a conviction that our acquaintance with the physiology of the blood and the nutritive actions,-with what may be considered the corresponding particulars in the healthy states and actions, to those we are in search of under the pathological condition,-has attained of late years so much of precision and certainty, as to warrant an expectation that a more exact pathology of all diseases of nutrition should be rendered possible; although we cannot but feel a misgiving, that the "ultimate facts" capable of being reached will still leave a residuum veiled in darkness which no analysis will be subtle enough to penetrate.

It was then with no small avidity that we proceeded to the examination of three works, making their appearance simultaneously, the title-pages of which led us to hope for some valuable accession to our knowledge on these points. This examination, however, it must be confessed, has, with exception of Dr. Madden's little volume, resulted in more of disappointment than satisfaction. We have, indeed, seldom risen from the perusal of three works devoted in great part to the same topics, with more diverse feelings as to the merits of each, or with a more varying degree of satisfaction in coming to their several terminations. We must own that we closed Dr. Addison's book, heartily glad to have got to the end; and with a far less satisfactory impression of its contents than our attentive study of them might have been expected to have. Bearing the impress, like all its author's works, of no little originality of thought and observation, though sometimes having more of the semblance than the substance of this, from the mere draping of old ideas in new speech,— there is so much of confusedness both in expression and arrangement, that the perusal of this book is throughout a painful exercise of patience. The result, too, at least so far as regards those practical bearings of pathological research, with reference to which we so eagerly desire further enlightenment is, whether true or not, eminently unsatisfactory. For what can be more so than to learn that,—

"It follows from all the circumstances of the case, embryonic development, growth, and nutrition, as unravelled by microscopical observations, that if we would rid ourselves of the evils of inflammation and scrofula, we must be prepared also to resign the benefits of cure and healing. For it appears that the primary stages of growth originally and the first steps necessary for the healing of a wound, the repair of fractures, and the cure of a burn, are identical with those morphological operations which originate and maintain a scrofulous disease." (p. 316.)

It is to the unfolding and establishment, and illustration of the idea expressed in this last sentence, that the great if not sole aim of Dr. Addison, in the present work, seems to us to have been directed. From the "Introduction," which is devoted to an explanation of the now wellknown facts respecting the cell-development of vegetables, and the laws which govern the metamorphosis, regular, irregular, and retrograde of plants, through a succession of chapters, severally headed "Practical Physiology," "Practical Pathology," "Practical Psychology," (!)" Semeiology," "Etiology," "Therapeutics and cure," to the end of the work; this appears to be the great object sought; and the one governing idea, variously expressed, meets us again and again. How far this point is made out, and whether, if established, we gain any thing from it, we shall presently more particularly inquire.

Meanwhile we cannot but contrast with Dr. Addison's the modest, unpretending volume of Dr. Madden, directed, like it, to the development and elucidation of one leading idea respecting the substantive nature of phthisis, but characterised by great precision of thought and language, by a lucid order, and a wide view and philosophical consideration of analogies. This idea is, that tubercular disease has its origin in a morbid poison: and it is sought to be shown how, by this hypothesis, we can give a more natural and satisfactory explanation of the morbid phenomena, than is possible upon any other supposition, while there flow out of it at once an explication of the ascertained beneficial results of remedies, and a guide for the rational treatment of consumption. We do not hesitate to express our conviction, that in giving this definite expression to what no doubt many have practically recognised in the doctrine of diathesis, Dr. Madden has enunciated a proposition, containing much probability of truth, and one which, if established, will prove an important advance in our notions respecting tubercular disease. But whether our readers should so far accord with us, or not, we think they will agree with us as to the beneficial terdency of this Essay to promote inquiry in a definite direction; while it certainly furnishes an example of a well directed attempt,-firstly, by analysing the characters, both structural and chemical, of the morbid product, the condition of the blood, the general state of the nutritive function, and the most characteristic symptoms of phthisis; and secondly, by endeavouring to interpret these several facts by the light of analogies supplied by other diseases, to unravel the conditions which lead to the deposition of tubercle, and to decipher those which are fundan.ental and primary.

The work which stands third in our list owes its existence to a competion in 1847 for a prize founded by Portal, of which the subject was that forming the title of this memoir; and it was published as having been honoured by the Royal Academy of Medicine, in whose hands the adjudication was left, not with the prize, but with the distinction of an "honorable mention." It differs widely in scope and character from either of the other two with which we have associated it; its object being confined to that expressed in the title, and the discussion being mainly rested on the facts supplied by a large number of cases, amounting to 76, of which the particulars are formally detailed with all the amplitude usual with our Gallican brethren, and which thus constitute the staple of the entire book. Had the cases been compressed to an extent commensurate with the bearing of their several characteristic points on the main subject, the result would have been a pamphlet, instead of a volume of some four hundred pages. But the author's endeavour would seem to have been rather to spin out than to condense and abridge; this tendency to prolixity being, however, by no means confined to him, but a common characteristic of the writings of his countrymen. Another sin, not of commission, but of omission, common to the medical writers of France, and illustrated in the work before us, is the remarkable absence of that allusion to the productions of English authors, which anyone well acquainted with the medical literature of both countries would consider inevitable. It will be a sufficient justification of this remark to observe that, in a work specially devoted to a consideration of the relations of scrofula and tubercle, no mention of, or allusion to, the works of Mr. Phillips or Dr. Glover is to be