1

grave disease. Thus, in some parts of the West Indies, we learn, cholera, yellow fever, and smallpox prevail together; in Naples smallpox rages; while in Jersey, as in other localities still nearer home, as we have in another part of this paper stated, cholera has broken out. Several of the Jersey cases appear, as was also the case in other places last year, to have originated at the "wake" of two of the first persons dead of the disease, no less than ten of the persons who attended the wake having died of the disease.

Though the disease is stated as being prevalent close to St. Brieux in Brittany, no importation of the disease has been traced in the Jersey outbreak.3

Dr. Chapman asserts that ice to the spine is the remedy in cholera and diarrhoea, reasoning upon the theory that these diseases depend on the vascular condition of the spinal cord, and the power of ice to control that condition. We would ask for his evidence of this condition of the spinal cord. He overlooks the changes recognised in the blood in such cases as he asserts are under the control of ice to the spine. That cold to the spine has an influence in hyperemia of the spinal cord, is not a new statement.

Dr. Chapman will have seen, long ere this, that the comparatively successful results of cases classed as cholera in Russia depended not upon the cooler climate, as suggested by him, but upon the principle pursued there of classing as cholera, cases of choleraic diarrhoea.

Having lauded the efficacy of his treatment in almost all "the ills to which flesh is heir," he says, "I am aware that the large claims put forward in this section on account of the remedial method in question are likely to be met generally with scepticism, and not seldom with ridicule," &c.

We cannot regard him as the author of what he styles "a newly discovered general law."

Dr. Cockle is far from denying the contagiousness of cholera under certain conditions, doubting only whether it be through the medium of recent excreta.

He regards cholera as the result of some special agent profoundly modifying the function of the extensive gastro-intestinal tract, rapidly radiating back a paralysing influence on the great nervous ganglia connected with the spino-sympathetic centres, and suddenly abstracting from the circulation, under such depression, a large amount of blood constituents, &c.

3 Since this was put in type, it has been thought that importation was engaged in the production of the disease in the island.

SUMMARY.-The importance of the many questions arising out of the recurrence of the cholera has led, as may be seen by the heading of this article, to a great amount of thought and of writing, as well as to an European Conference, and has thrown into action numerous governmental and scientific bodies.

As in previous epidemics, our knowledge at present points to the removal of those conditions which have been seen to favour the production and spread of the disease, as well as to the arrest of the earlier phases of the malady, which recent experience, as well as that of former times, teaches us are the most hopeful for treatment.

The undaunted courage of the profession, as well as its zeal and perseverance in the face of danger and difficulties, have added considerably to our knowledge of the disease and of its sequelæ.

In the latter we frequently find evidence of the engagement of the nervous centres; but whether such disorder is attributable to the disease in itself, or to the serious changes in and loss of so much of the constituents of the blood, is not clearly known.

There is much in the symptoms, both concurrent and succeeding (eruptions of the skin, &c.), to lead to the supposition that cholera is allied in its nature to the results of irritation of the stomach and nervous system by poisonous ingesta; at the same time, it appears to possess a considerable relationship to some diseases of malarious origin, as well as to those classed as exanthemata.

In the opinion of the International Sanitary Conference, and many other observers, water-closets should never be within houses, nor should the latter be in communication with

sewers.

The Conference recommends the "dry system" in lieu of that of water-closets.

Almost all regard intercommunication of mankind as the means of spreading the disease.

The predisposing causes of the disorder are of two kinds— individual and local.

At the present moment, no people living in what is termed at state of high civilisation can reckon upon immunity from cholera. It is the duty of every country to use its utmost endeavour to lessen, and if possible, and as soon as possible, to remove the sources whence the disease springs or spreads.

The occurrence, in some parts of the United Kingdom, of a form of disease most generally fatal in a few hours, attended with shock to the system, collapse, with frequently evidence, both symptomatic and post-mortem, of disease of the brain and

spinal cord, with more or less, in some cases, of tetanic symptoms, attended often with feelings of extreme cold and with vomiting, and in some cases with purging, and by the occurrence of numerous patches of dark-coloured blood effused either just under the cuticle or through the whole thickness of the integuments, is not a little remarkable.

In some of those cases, sphacelus of portions of integuments and other soft parts occur.

It is for the most part in the young, or in persons in the prime of life, that this form of disease has appeared, in this point as well as in some others bearing some analogy to cholera. The symptoms often commence at night or in the early morning, and with great suddenness.

Apparently clinging to some localities-in some instances, at least, very low in hygienic conditions-the disease has not afforded much, if any, evidence of contagiousness.

Several cases of a like nature occurred in the early part of last year.

In some instances a distinct urticaria occurred, mixed with vesicles of tolerably large size, intense itching causing some of the sufferers actually to tear themselves.

Cerebro-spinal apparently in its nature, the disease just mentioned possesses sufficient analogy to cholera to claim this short notice here; and its study in connection with that of the several stages of cholera, and of the consecutive fever of the latter, promises, we think, to throw light on each form of disease.

The tendency is at present to take enlarged views of disease, and its modifications by climate, race, &c. In this way we are led to consider cholera as well worthy, in every way, of the close attention of observers, being convinced, as we have already said in previous numbers of the 'Review,' of its importance, not only on its account of its being at least one of the most formidable plagues, but also of its tendency to throw light on the morbid action in other diseases.

1 See Hebra, 'Diseases of the Skin,' New Sydenham Society, 1866, vol. i, p. 395.

REVIEW II.

On Malformations of the Human Heart, &c. With Original Cases and Illustrations. By THOMAS B. PEACOCK, M.D., &c. Second Edition. pp. 204. 1866.

CARDIAC malformations have proved an attractive subject for medical writers and readers since physiology and pathology received that impetus by the discovery of the circulation they have never since lost. How little previously was known as to the normal or the abnormal structure of the heart is illustrated by the fact that cases of malformation were assumed to represent the healthy type of structure by some of the most celebrated of the opponents of Harvey. Readers of medical history will remember that Gassendi and Cæcilius Folius both quoted instances of permanently patent foramen ovale as evidence that the blood naturally passed from the right to the left side of the heart by a direct communication. Even Cæsalpinus, one of the trio who shared the honour of having, before the time of our great countryman, most nearly approached the true doctrine of the circulation, retained the Galenical notion, which we may surmise had its origin in the study of an imperfect organ, that the septum ventriculorum was permeable; although, in justice to the anatomy of the sixteenth century, it should be remembered that the solidity of the partition in the normal condition had been asserted by Berengarius and proved by Vesalius. Since the time of Harvey, however, cardiac malformations and malpositions have attracted peculiar attention. First observed and noted among the curiosities of nature, they have acquired a far higher interest and importance with the growth of physiological and embryological science. The light thrown on them by the revelation of the phases through which the foetal organ passes in the course of its development, and by a study of the permanent conditions of the heart in the Hæmatocryal Vertebrates, enhances the fascination which the observation of deviations from the ordinary course of the circulation must have for the student of physiology and animal mechanics. It might be expected, therefore, that a large mass of materials would exist for a more or less complete treatise on the subject; and, in fact, the medical journals of Europe and America abound with cases of malformation. In addition, there are many valuable essays on the subject by writers of the highest eminence in this country-as Farre, Williams, Todd, and Norman Chevers; and on the Continent, Meckel, Louis, Gintrac, Andral,

Tiedemann, Förster, Bouillaud, Breschet, and many other distinguished men, have contributed to its literature. Without in any measure detracting from the just repute of these, we believe that we are only stating the acknowledged truth when we assert that, for comprehensiveness and completeness, the work the title of which stands at the head of this article is without a rival. Good wine, however, needs no bush, and we believe that the highest recommendation we can offer of Dr. Peacock's valuable and full treatise is a short, and therefore necessarily imperfect, analysis and summary of its contents.

The first two chapters are devoted to the consideration of misplacements of the heart and cases of deficiency of pericardium. The former are divided into misplacements within the thorax, and those in which the heart is situated external to that cavity. Of internal misplacements there are two: Dexiocardia, where the heart is placed in a position on the right side of the chest corresponding with that which it normally occupies on the left; and Mesocardia, where a malformed heart remains in the median position in the thoracic cavity it held in early foetal life. Transposition is the more common of the two, and it is frequently accompanied by transposition of all the other viscera. But this is not invariably the case, neither are the arterial connections of the transposed heart always the same. In many cases the heart is well formed, and the vessels retain their natural relations; or, without any malformation of the heart itself, the arteries may be misplaced relatively to the ventricles; or, where the heart itself is malformed, other irregularities may coexist. The course of the aorta varies in cases of this kind. Sometimes it crosses over the right bronchus, and passes down to the right of the vertebral column; or it has been observed to cross over the right bronchus and behind the lower end of the trachea over the bodies of the vertebræ to its usual position. When the aorta lies to the right of the spinal column, the great vessels arising from the arch may or may not be transposed. Of misplacements external to the thoracic cavity, some very curious examples are given under the heads of Ectocardia pectoralis, Ectocardia abdominalis, and Ectocardia cervicalis; the most remarkable perhaps being the case of a soldier, given on the authority of M. Deschamps, of Laval, in whom after death the heart was found occupying the place of the right kidney, the vessels arising from it passing through an opening in the diaphragm into the thorax. Dr. Peacock has collected several undoubted examples of absence of pericardium, although, as he observes, some of the recorded cases have probably been instances of universal adhesion. In many of the genuine instances, a rudimentary pericardium in the form of a crescentic