the funis from abnormal positions of the child, or from morbid states of it, such as hydrocephalus; but this appears to be purely hypothetical.

The second class of cases consists of separation of the placenta during birth. Hecker records three instances of this occurrence, in which an examination of the foetus was made. In one of them, though the embryo wanted six weeks of its full development, the extravasations within the thorax were well marked. The appearances found in the fœtus in cases of placenta prævia deserve further investigation.

We have only met with two cases of death of the mother, during advanced pregnancy or labour, in which the state of the futus appears to have been noticed. They are contained in Hecker's paper. In one of them, rupture of the uterus, which was rapidly fatal, occurred from the obstruction caused by a hydrocephalic condition of the fœtus. The child was removed by the Cæsarean section. The most evident signs of death by suffocation were observed on post-mortem examination. The other is a case related by Virchow, of a pregnant woman who died of cholera in 1848. In this case, also, the child was at once extracted through the abdominal walls, but was dead. Extravasations existed on the pericardium and the pleura pulmonalis, as well as in the coats of the intestines.

It only remains to consider what are the bearings of these views upon the points which arise in medico-legal practice. This is the principal object of Böhr's paper; and therefore we shall follow him especially in our remarks.

The first question is, whether the hydrostatic and other tests, in which the presence or absence of air in the lungs is used as a criterion of live birth, are in any way diminished in value by these observations. To this question an answer in the negative may with confidence be given, for in almost all forensic cases, the circumstances to which the entrance of air is ascribed in the instances given by Böhr, have, from the nature of the case, been absent.

The occurrence of the vagitus uterinus has always received its due amount of attention from writers on forensic medicine; and the theory which we have been unfolding rather lessens its importance by referring to definite causes a phenomenon which was previously unexplained. We have seen that, in all the cases of children which were dead at the time of birth, and in which even a small quantity of air was found in the lungs, its presence could always be accounted for on the ground that artificial inflation had been practised after birth, or that delivery had been effected by artificial means, or at least that, during the examinations made by the accoucheur, air had been enabled to get access to the foetal air-passages. Now, the conditions under which birth has occurred in cases of suspected infanticide are almost always such, that these causes can be left out of consideration with perfect certainty. It is true, that it was not proved that the entrance of air into the lungs really arose in the way which we have supposed; and it must be admitted that cases have been related which seem to set at defiance the principles deduced from all other observa

tion and experience. Such an instance is that recorded by Hecker,' in which the lungs of a child, born dead without operative interference, were found completely inflated with air. This case has caused Casper to modify somewhat the views which he held upon this subject. The only explanation of it which can be given is, that some one may possibly have practised artificial inflation on this infant while it lay in the dissecting-room; though Hecker appears himself to have rejected this supposition. These difficulties have, however, long been known to exist in the application of the hydrostatic test; and it may be safely asserted that the modern views do not in any way increase them.

It is, perhaps, possible that in some cases liquor amnii and meconium might be mistaken for fæces and urine when found in the foetal air-passages, if there were reason to suspect that the child had been drowned in a privy or chamber-vessel. But these substances would easily be distinguished on careful examination by anyone who was alive to the fact, that meconium frequently enters the trachea and bronchi during birth. Moreover, the amount of air in the lungs would form a safe guide in most of these cases.

2

But the great value of these observations, looked at from a medicolegal point of view, lies in their affording evidence by which a large proportion of still-born children may be known to have died during 'birth, or at least to have been born with the cause of their death actively working upon them. Most of the cases of suspected infanticide, in which the child really died during birth from natural causes, would be at once cleared up by a careful post-mortem examination, in which attention was drawn to the appearances which we have been describing. There are, however, certain limitations to their value which must not be overlooked. The absence of petechial extravasations of blood on the thoracic viscera is no proof that death did not occur during birth; for though Liman says that they are always present under these circumstances, this is shown by Böhr not to be the case. Again, the presence of the signs of respiration having taken place before birth does not absolutely prove that death occurred at the same time. We have seen that small quantities of air are often found to co-exist with evidence of foetal asphyxia, and apparently result in many cases from the infant having made its last respiratory efforts after its expulsion from the mother, and then having died. Moreover, the sub-pleural ecchymoses are probably very persistent, and might be found in infants, in whom they had been generated, and who had afterwards recovered, and survived birth some hours. These cases are, however, very rare. Krahmer is probably right in considering the entrance of liquor amnii into the chest as far less injurious to the fœtus than these pulmonary congestions and hæmorrhages; and therefore recovery after they have occurred is probably not very common. Children undoubtedly often survive who have sucked liquor amnii into the air-tubes during birth, the fluid being expelled in the first few respirations which they make after 1 Virchow's Archiv, 1859, Band xvi. Heft 5 and 6, p. 535. 2 Casper's Vierteljahrsschrift, Jan. 1861, Heft 1.

being born; so that there remains no evidence of the premature inspiratory efforts having been made. It is therefore only in rare instances that a child which really lived after birth would be believed to be still-born on these grounds.

We have now, we believe, laid before our readers the chief points which have been ascertained by modern investigation with reference to the subject of the respiratory function of the placenta, and of the effects of its interruption. There are, no doubt, questions still undecided, and difficulties yet to be cleared up; but these have but little weight when opposed to the evidence from observation and experiment, which we have been unfolding; and there are, as we think, few doctrines in physiology against which there have not been urged graver objections than those which are employed against this.

REVIEW IV.

On the Causes of Sickness in the English Wars, and on the Means of Prevention. By E. A. PARKES, M.D., F.R.S., Professor of Military Hygiène in the Army Medical School. (From the Journal of the Royal United Service Institution,' vol. vi. p. 16.)

To our eye these few pages of history appear to rank amongst the most important that have ever been written. Instructive to those engaged in the practice and study of medicine, especially in its application to the health of armies, they are in an equal degree calculated to make the soldier reflect on those divisions of the military art which are most slurred over by writers, and which by mere tacticians are witlessly despised. Nay more, we shall say we would willingly see them pass into the hands of every man that can read and write, so important are they in their general aspect to the nation, so necessary is the diffusion of the lessons which they teach to effect change in the evils they are intended to reform.

The subject of the pamphlet before us is the health of armies considered historically, and in application to our military service. Short and condensed, it makes evident from recent examples how necessary is vigilance, how essential is resource, and how inevitable is disaster when each contents himself with merely doing his appointed share of work, not "looking on the things of others as well as on his own," or interesting himself in the final result.

In the briefest of all possible essays we see marshalled before us the few diseases whose frightful repetition and strong identity seem fated, as long as our nation lasts, to destroy our armies, to embitter onr conquests, impoverish the blood of the nation, and neutralize the employment of our wealth.

Not only the devastating and disabling maladies which have left their mark upon our annals are here brought forward for instruction, with details full of interest and enumeration sufficiently complete, but the causes are severally indicated which, by a direct action, invariably produce the results of disease; so true is it that, understanding the

conditions, you can with much certainty infer the disease, so also, knowing the disease, you can easily lay your hand upon the cause.

"The rations issued at Carthagena in 1741," says our author, 66 are not mentioned in history; but the scorbutic dysentery soon succeeding scurvy, shows us as certainly as if the diet lists were before us, that hard salt beef and biscuit formed the miserable allowance, scarce deserving the name of food, which was issued to these men."

Nor may we suppose that modern times have excluded the most recognised and most glaring of these causes from operation. In the two first Caffre wars (p. 4) a large proportion of the men became scorbutic. Foregoing the advantages of civilization, it may be said that we brought ourselves to the level of savage life, and fought with blunted weapons and limbs that were maimed. A yet more modern instance lies before us.

"In the first year of the Crimean war the diet was so insufficient, that any one accustomed to the subject would have been able at once, on being informed of the amount, to foresee the inevitable result; yet it was deemed sufficient to support the strength of men in the most trying and exhausting of wars."

From the avowal of M'Cleod, in his history of the surgery of that war, "scurvy influenced and complicated every wound. . . . it wrested more men from us than the conical ball." Again, he says, "It is useless now to inquire why that store of lime-juice which is proved to have lain at Balaklava during two months was not issued to the longing troops." We rejoice at his exoneration of our profession, but cannot acquiesce in so important a matter being wholly laid at the door of a subordinate department-the commissariat. It was but the story of Carthagena over again. The coast of the Black Sea offered abundance of green food and fruit, with wood for fuel, convenient to the use of those who would fetch it; "but perhaps," as Smollett has said, "the general was too much of a gentleman to ask a favour of this kind from his fellow-chief, who, on the other hand, would not derogate so much from his dignity as to offer such assistance unasked."

From such causes mainly, in the most glorious of enterprises, indeed, but in an early part of the Crimean war, perished that small, compact, and model army, of whose composition we may aver that, as regards manhood and perfection of form, the eye rests on nothing like them in the present day.

"Troops well cared for," according to our author, "must be healthy;" but the inveteracy with which these habits of mere neglect recur, lead us to fancy we hold in the sheets now before us some chapter torn from a treatise on human nature, intended to display its recklessness and heedlessness alike. Out of many examples, we shall pause a moment over the recent one of that Burmese war which occurred rather less than forty years ago:

"In both cases," says our author, speaking of the Burmese expedition in 1824, and of the China war in 1840, "the cause of the immense mortality which ensued, or by far the most potent cause, was the food which was issued to the men. In both cases it was thought that men could be maintained, not only in health but in fighting condition, upon diet so bad that no slaveholder in any part of the world, or in any age of the world, would have given it to his slaves. 66-XXXIII.

.5

Wretched cattle, hastily purchased and driven to Calcutta, were there hastily salted; and on this wretched meat, and almost as wretched biscuit, the troops were kept, when within a few days' sail there was a land of wheat and of rice and of fresh vegetables without end.

"To the immense mortality in the Burmese war (1824) I need scarcely refer. In three or four months some of the regiments lost half their strength; in eleven months, 1-311 men died out of 2.716. The 13th Foot lost by disease 341 out of 608 men, or 56 per cent. So general was the scurvy that the surgeons were in the habit of examining the gums of the men before a skirmish to prevent any of the men having symptoms of the disease from advancing, as wounds received in that condition of body are most intractable. Malignant malarious fever and scorbutic dysentery were the great agents of destruction."

When one reads such things, it matters little to ask whether the disaster of Carthagena was in this or yonder century, in the past or yet to come. Details as we are now considering them seldom or never reach the general reader in such a form as to interest the nation; it is enough if in the history of a distant war, recounted in all likelihood by some officer of the service, a hint here and there occurs of fever and cholera.' Dysentery is invariably attributed to over-indulgence in fruit; short supplies and deficient commissariat conveyance are slightly mentioned; the fighting is all in all. The period, however, is not so far distant but that it survives in the traditions of the service; can it be true that some of the beef served out to the troops in Burmah had been in store since the Java campaign in 1811? There could then be but one opinion as to its nutritious qualities. What is most certain is, that it was nauseated and kicked about by the men. We remember hearing from the lips of one officer of his regiment being in such a state that a double dram had to be served out before it could be marched less than a mile from Rangoon to the commissariat store.

"Twenty-six years later, in the expedition to China, the same tragedy was repeated without variation. The history of the Cameronians may be taken as a type of the fate of the whole force, although the amount of sickness was greater than that which prevailed in some other regiments. The Cameronians landed at Chusan, a splendid body of men 900 strong, on the 5th July, 1840. In the first week in August 500 were in hospital; towards the end of August less than 100 mustered on parade. Later in the season the débris of the regi ment, under 200 men, were sent to Manilla to recruit, and of them but a fraction ever saw their colours again. The bloodiest battle would have been mockery to this. Doubtless they were to a certain extent in a malarious country, but the malaria was not sufficiently intense to cause so great a loss. Again the simple cause is to be found in the diet."

1 Snodgras' Burmese War.

2 The head of the commissariat is, we believe, liable in money for the goods in store. 3 During the last few months, facts have been prominently brought forward, which display in a striking degree the prophylactic influence of a sound dietary against the poison of malaria. We allude, in the first instance, to the getting in of the harvest in the Roman Campagna under better conditions of diet and shelter, without the usual occurrence of fever, as communicated during the past year to the Royal College of Physicians of London; and, in the next instance, to the circumstance of the total disappearance of ague from Scotland under improved condition of its inhabitants, as remarked upon by Dr. Christison in his address at the last meeting of the Social Science Association. See also a recent work, Hind's Labrador, regarding the influence of diet in the production of night-blindness.