quarantine, being a sham, a delusion, and a make-believe, in place of one which would be efficacious if properly carried out."

And another medical man there writes:

"The opponents of quarantine laughed at the puny efforts of the authorities to keep cholera out of the city in 1866, and yellow fever in 1867, and it did seem ridiculous to impose a rigid quarantine upon all vessels coming from northern ports, when cholera was raging in the north and west, while the river and railroads were left free to pour as much of the disease into our midst as they could transport.'

It is certainly high time that this difficult question of State medicine should be more thoroughly investigated, both by the government of the United States and by our own, than it has yet been.

Before closing, we would strongly recommend to the American Army Medical Department that all future similar reports be accompanied with a chart indicating the districts affected by the epidemic sickness, and the localities which were the chief seats of its ravages, together with the exact dates of its earliest appearance in each. Their value, too, will be greatly enhanced if authentic information respecting the health of the civil populations as well as of the troops in the affected districts be given.

Progress of Sanitation in India. This sketch gives an extremely interesting account of the progress of sanitary work done in India during the ten years ending 1869, with accompanying remarks. The variety of subjects briefly noticed will be understood from the following imperfect enumeration:-Sanitary commissions; vital statistics of the army; construction of barracks and hospitals; official investigations into the causes and prevention of cholera ; conclusions of the Constantinople Conference; hill sanitaria; epidemic fever in different districts; effects of irrigation and other public works on health and disease; vaccination; water supply; quarantine; dry-earth conservancy; quality of animal food; emigration. For a couple of short extracts is all the space we can afford. In reference to the conclusions of the Constantinople Conference, our author remarks:

"If, on the assertion of the majority of the members of the said body, we admit that Asiatic cholera is never developed spontaneously, has never been observed as an endemic disease in Europe, but that it has always entered from without; if we admit these dogmas as correct, we not only ignore facts connected with the etiology of the disease, but also adopt a very dangerous theory. If the public are taught to believe that cholera is always introduced from without, internal sanitary arrangements will soon be regarded as less

Review of the Progress of Sanitation in India. By Dr. W. J. MOORE, Surgeon, Rajpootana Political Agency. Parts I and II, 8vo, pp. 65 and 47. 1870.

necessary. Instead of trusting to home sanitation, an impracticable system of quarantine will be the reed on which public health will lean. The Commission properly insisted on increased attention to sanitation in India, and especially in Bengal, where they consider cholera may be attacked as the only focus of origin. But for the protection of other countries they had nothing better to advise than a large and impossible system of quarantine. As regards

India being the only birthplace of cholera, and as regards the spread of the disease being prevented by the large quarantine system suggested, we firmly believe that the Commission are entirely mistaken. Facts and experience are both against their conclusions."

On the subject of the causes of epidemic fever [which is often of a mixed type, typho-malarial, being a compound of typhoid or pythogenic and of marsh fevers], we are told that

"Although epidemics of fever have occurred in localities like Rajpootana, Guzerat, North Canara, where such works as railway embankments, irrigation canals, and raised metalled roads are unknown, still it is none the less a fact that fever has been more persistent and destructive in all those localities to which we are accustomed to point as presenting triumphs of European administration. However humiliating this reflection may be, the fact is undoubted ; and to ignore it is to perpetuate the evil. If we ignore it, the natives certainly do not. They ask if the boasted improvements of the English have not resulted in physical, if not moral, deterioration of the people in those localities where the most magnificent works exist. They assert that the raised metalled roads, the railway embankments for hundreds of miles through a flat country, have interfered with the natural drainage; that the canals have saturated the subsoil and produced an atmosphere damp, malarious, and unhealthy. They complain that we have assigned too much importance to jungle, to rank vegetation, and want of conservancy in their towns and villages; and, lastly, they declare that the few sanitary regulations enforced have not been followed by any certain favorable result. But in truth the cause of the fever is neither altogether due to the neglect of sanitation, nor to the operation of our public works, but to both, and in certain localities to other influences over which we have even less control."

Mauritius Fever Inquiry.1-These reports-for there are two, one by the majority of the medical members of the committee, and the other by Dr. Barraut, the acting general sanitary inspector-of one of the most disastrous fever epidemics on record in any of our colonies, are confessedly incomplete, in consequence of the absence at the time, from ill health, of the chief medical officer of the island, and of the short time allowed for their preparation. The leading facts in the history of the visitation seem to be that, for several

Report of the Fever Inquiry Commission (Mauritius), 1866 and 1867. Folio pp. 78, Mauritius, 1868.

years previously, the public health had been decidedly deteriorating. A large portion of the lower classes was more destitute, and there was more wretchedness and squalor in their condition than formerly. Besides abounding sanitary evils in Port Louis, the chief town, which had lately become worse than usual, many of the rural districts had become more swampy and malarious, owing mainly to the effects of the "deboisement" or denudation of the adjacent hills. In the spring of 1865 there occurred a very destructive inundation, and this was followed by seasons of extreme dryness and heat, characterised, too, by other meteorological peculiarities, as great stillness of the atmosphere, the total absence for months of the trade winds, and the scarcity of thunder storms.

As to the nature of the epidemic it is declared in the first report to have been

"a mixture of the various fevers described separately by authors under the names of intermittent, remittent, continued or pseudocontinued, pernicious and bilious, or bilious remittent. In the epidemic, of which this report is the history, will be seen the faithful reproduction of the numerous epidemics of pernicious fever which have ravaged Europe, the description of which has been handed down to us by numerous authors from Morton and Torti to Alibert."

Besides the different forms of true malarial fever in the epidemic, Dr. Barraut insists much on the coexistence of a continued fever, allied to true typhus, and known in Mauritius by the absurd appellation of "Bombay fever," and which, according to him, had existed in the island for many years prior to 1865, "insidiously and slowly pursuing its way."

The idea entertained by some persons at first that the Mauritius epidemic had been imported from abroad is declared by all the reporters to be entirely groundless.

With respect to the treatment of the disease, we are told that "those who were well lodged, well fed, and properly attended to struggled successfully enough against the effects of the malaria, whilst the others fell by thousands, as much from want of food and the polluted atmosphere of their overcrowded huts, as from want of medicine and medical attendance, as had already been the case in our previous epidemics of cholera."

Indian Cholera Statistics.'-Dr.Townshend arrives at the following conclusions from the documentary evidence in the body of his report :

1. That for the production of cholera two conditions are 11. Report on the Cholera Epidemic of 1868 in the Central Provinces. By Dr. S. C. TOWNSHEND, Sanitary Commissioner, Nagpore. Fol., pp. 85, 1869. 2. Statistics of Cholera. By EDWARD BALFOUR, Deputy Inspector of Hos. pitals, Madras Army, &c. Second edition, 8vo, pp. 98, Madras, 1870,

necessary, the presence of a special contagion, and a susceptibility to its influence on the part of the person to whom the contagion is applied.

2. That with respect to the origin of the epidemic of 1868, the evidence is in favour of the contagion having been brought from elsewhere rather than that it was generated in the localities where the disease first broke out.

3. That the subsequent diffusion of the contagion was effected solely by means of human intercourse.

4. That a high temperature and extreme dryness are no obstacles to the diffusion of the contagion.

5. That with respect to the general population of the country the imbibition of water containing animal organic impurities is the most common means by which personal susceptibility to the effects of the contagion is induced.

With reference to the second of these propositions, Dr. Townshend admits that," with regard to the origin of the first outbreak, there is no evidence of the importation of the disease from elsewhere," and also that "from the first outbreak in the Gunneshguni valley, cholera did not, as far as can be ascertained, spread to any other locality." Nevertheless, he subsequently declares that

"The fact of the first manifestations of the disease having occurred in bodies of men located close by a road daily thronged with passengers from a part of the country in which the disease had previously appeared, afforded strong support to the supposition that the infecting matter may have been imported rather than generated locally; and the account given of the subsequent spread of the disease, and of its appearance in the different towns and villages scattered over the epidemic area, appears to me to favour the opinion that the choleraic influence is diffused by means of human intercourse, and by that means alone."

While he maintains that "a water supply containing organic impurities is the chief, if not the sole, condition under which cholera manifests itself," and that "cholera will not prevail epidemically among a population when the water supply is abundant and fairly protected from pollution," he does not seem to accept the hypothesis that the "materies morbi" is apt to find its way directly into water from the alvine excreta of the sick, and that the drinking of this cholera-tainted water is the channel by which the disease is chiefly propagated. The accurate details he has given respecting the diffusion of the epidemic in Rajpootana render his report highly valuable as a topographical narrative.

The first edition of Dr. Balfour's 'Statistics' was published in 1849, and was favorably received. This, its second issue, contains a large amount of instructive details, which should be diligently studied by Indian medical officers, who will find many of the topics

treated of highly suggestive. These details serve to show the magnitude and complexity of the numerous problems respecting the disease that are still unsolved, and the fluctuation and uncertainty of our knowledge in regard of them. Dr. George Johnson seems to have been anticipated in his method of treatment more than eighty years ago:

"Mr. Duffin, head surgeon at Vellore, writing of the rapidly fatal epidemic there in 1787, speaks doubtfully as to the value of opiates, and recommends castor oil as the only effectual remedy, with wine, brandy and water, and 'scarce ever lost a case.' In a subsequent letter he attributes the outbreak at Arcot to filth and the peculiar weather, and recommends removal."

The neighbourhood and banks of rivers are shown to be particularly dangerous in the Madras presidency.

"In 152 marches of native soldiers in which cholera broke out, 106 outbreaks occurred within fifteen miles of rivers (the average distance was 31th miles); and of these 106, 47 occurred on the banks. * * * The delay on the banks of rivers, and the labours in crossing them, render soldiers more liable to be attacked with cholera; near rivers the contaminating agent seems to be more abundant. The water from them may be polluted, or the cholera agent may seek the low moist beds of rivers and the valleys in which they run, or, if it be a thing with life, moisture may be needed for its development."

The marked decrease of attacks and deaths from the disease in the Madras army during the last twenty years or so, compared with what it was previously, gives rise to the following remarks:

"To what cause are we to attribute the decreasing numbers of attacks alike amongst the European and the native soldiers?

"There have, in the time under review, been improvements in the pay, diet, dress, and dwellings of both arms of the service, and the conservancy in and near the barracks and lines has been more closely attended to; but the most marked change in the Madras presidency has been the less frequent marches of regiments, and the increased facilities and comforts which steam vessels, railroads, and horse and bullock transit carriage have afforded them when moving. Its prevalence is still great amongst the civil population in every part of the Madras presidency, and in some collectorates the mortality from it amounts, in some years, to one third or one half of all the deaths."