and spreading, has, with few exceptions, found general acceptance, and been urged with great pertinacity and zeal. For several years, the Navy reports were deeply tinctured with extreme views upon this point, insisting strongly as they did that the fever was "a disease of persons, not of places," and that, whenever a case occurred in a ship of war, she should immediately run to a cold climate as the only known means of safety. So marked has been the bias in this direction of late, that the author, a talented officer of the service, of the article "Yellow Fever" in Reynolds''System of Medicine,' and other recent writers, regard contagiousness as an essential and distinguishing attribute of the disease. The weight of military medical testimony has, on the whole, been decidedly in the other direction, as may be gathered from the evidence in the official reports on the successive epidemics in Bermuda since 1853, in the report of Dr. Lawson (in this journal for October, 1859) on the Jamaica epidemic of 1856, and again in that of the military commission on the epidemic of 1866-67. While admitting that the fever is liable to manifest contagious properties under unfavorable hygienic conditions, they refuse to admit that it is never developed independently of communicatiou with persons already infected, or that the spreading of the disease is mainly due to such communication, and may be most efficiently prevented or arrested by strict quarantine against this source of contamination. The history of the last Jamaica epidemic, in respect to the question at issue, is especially interesting, as we have simultaneously (for the first time, we believe) two separate reports, both very able, from the principal medical officers of the navy and of the army in the island at the time respecting it. Dr. Donnet has exercised, as it seems to us, a judicious caution in the declaration of his opinion when he simply states that "the evidence which the history of this epidemic offers has much in it that is conclusive towards proving that contagion played some part in its development." This moderate view cannot, we think, be fairly gainsaid by any impartial examiner of the whole record; to go

1 Dr. Macdonald's definition is that it is an "infectious continued fever." Dr. Aitken defines it to be "a specific malignant fever of a continuous type, occurring as a rule only once during life, and propagated by contagion." He makes two distinct forms of the disease, viz. :-a 'specific yellow fever,' or the above, and a 'malarious yellow fever,' which is thus defined: "febrile phenomena due to malaria, in which the exacerbations and remissions are so connected that the fever resembles a continued fever, and is characterised by intense headache and yellowness of skin, but in which the urine is not suppressed, and continues free from blood or albu. men." The definition of yellow fever by the College of Physicians is altogether to be preferred:-" A malignant epidemic fever, usually continued but sometimes assuming a paroxysmal type, characterised by yellowness of the skin, and accompanied in the severest cases by hæmorrhages from the stomach (black vomit), nose, and mouth."

further, either affirmatively or negatively, would be, as it seems to us, unscientific and practically unwise. The general conclusion to which the Military Commission, of which Deputy-Inspector O'Flaherty was the medical member, came after a careful examination of the voluminous evidence they had collected, is thus given in the Army Medical Report' for 1867:

"The Commission having carefully considered all the facts connected with the origin and spread of yellow fever in Jamaica in 1866 and 1867, and their relation to each other as cause and effect, consider that general and climatic causes were combined in the production of the disease in the island; the former as shown by the prevalence of the disease in the countries marked on the map, and with which Jamaica has not unfrequent communication; the latter by the occurrence of cases such as those at Port Morant and Morant Bay, which had no external origin by any previous connection with ships or persons at infected places, together with those cases that there is little doubt of occurred at sea, prior to their arrival in the island, in ships which during their transit had not visited any infected place."

We have failed to discover the details of the evidence on which the closing statement in this passage rests. The omission is much to be regretted, as the fact, if such it was, would have all but decided the moot question as to the origination of the pestilence, and would have been of the highest epidemiological interest. This incident, along with others which will occur to the attentive reader of the two reports, indicates how very desirable it would be that in future the two public services should be always associated together in conducting such inquiries. We cannot but believe that had this been the case in the examination of the Jamaica epidemic of 1866-67, some notable gaps in the evidence would most probably have been filled up, and some apparently discrepant statements might have been avoided, if not reconciled. Such association would serve, moreover, to bring the medical officers of the two services most usefully together in the carrying out of those scientific investigations respecting the geographical distribution of epidemic diseases, now so much desiderated. The co-operation, too, of the resident medical practitioners should likewise be invariably sought for; it is they only who can afford reliable information respecting the public health and other antecedent phenomena of an epidemic visitation; and it is on this very point that the history of the recent Jamaica pestilence is most defective. In consequence of this event, it cannot be discovered with any precision what was the health state of either the outports, where the earliest cases occurred in July, or of Kingston itself prior to the first fatal case there in

The report of the Commissioners states that "a vessel from England, which

October, in one of the crew of a collier, who seems to have been taken ill within a day or two after arrival. We are not told whether any other person on board suffered before or subsequently, nor yet how long the vessel had been on the voyage from St. Thomas, where many supposed she contracted the fever. It is obvious that exact information on points like these is indispensable for a thorough history of the epidemic. That the town and harbour of Kingston speedily became a seat and centre of infection, appears to be indisputable; and as the fact was perfectly well known to the naval authorities, it seems strange that leave on shore to ramble about for two or three days should be granted to the crews of men-of-war under such circumstances of obvious risk. Most, if not all, of the attacks among the men of the "Cadmus" were certainly contracted in this way. After sending the cases to the hospital she went to sea, and remained free from any further traces of the deadly sickness. The same thing seems to have occurred in another ship of the squadron, the "Doris;" several of her men were attacked shortly after leave on shore at Kingston, and were sent to the naval hospital; the rest of the crew did not suffer. Such facts show the importance of obtaining detailed information respecting the health of the shore from the resident medical practitioners, on all occasions of epidemic sickness among our naval and military forces. No history can ever be complete otherwise, and unquestionably there is no pestilence in respect of which the most ample and exact information is so much needed as yellow fever. Uncertainty and difference of opinion still prevail about all that relates alike to its genesis, its nature and pathology, and its treatment, preventive and curative. regard of the last-named topic, that of the therapeutic treatment of the disease, no better instruction, we believe, can be given to the inexperienced than to avoid the use of all heroic remedies, and to guard diligently against doing mischief by overactive medication of any sort, thereby lessening the chances, small as they too often are, of recovery by the restorative energies of the system, under an abounding supply of pure refreshing air around the sick at all times, both night and day.

In

That the large and repeated doses of quinine recommended

anchored at Port Morant, had the captain and several of the crew ill from fever, which proved to be yellow fever. The cases were reported to the Governor, who ordered the vessel to proceed to sea." It is to be hoped that this arbitrary dismissal was not adopted without due precautions having been previously taken for the welfare of the remaining crew. The practice of at once ordering off' sickly vessels, especially merchantmen, in the hope of preserving a country from a threatened epidemic, is surely discreditable to a nation like ours, and serves to sanction the monstrous proceedings of the Spanish and Portuguese quarantine authorities.

by Blair and others are, on the whole, powerless for good, and have often done much harm, seems to be now generally admitted. Dr. Donnet altogether abstained from this line of treatment, or from the use of any other active remedies, and confined his endeavours to mitigating the most distressing symptoms as well as he could. Considering the important part which the disordered urinary secretion seems to play in the progress and fatality of the disease, it may be reasonably inferred that sedulous attention should be given to promoting free diuresis from the earliest stage, and to relieving by all appro-. priate means the congested condition of the kidneys. When the irritability of the stomach forbids the use of copious diluents by the mouth, the frequent administration of large simple enemata will probably be found to be advantageous. Inspector-General Lawson, in his admirable papers in this Journal for April and October, 1862, alludes to other beneficial effects from their use, by acting upon the bowels

"Nothing is of more importance than to re-establish the secreting function of the colon and to obtain feculent evacuations, not mere bilious discharges-for a patient may have these and die-but proper dark brown feculent stools."

Whether the addition of oil of turpentine-recommended so highly by the late Dr. Archibald Smith from his experience of its effects in the "hæmogastric " fevers of Peru-to the enemata might be safely and usefully made, is well worthy of attention. In respect of this, as of every other therapeutic suggestion, it is to be remembered, as Dr. Lawson remarks, that "all practice in yellow fever must at present be more or less empiric, and we can expect to substitute more rational plans only as our knowledge of the diseased actions and their results becomes extended." Such is the practical conclusion arrived at by this excellent observer, after a long and varied experience of the disease both in Africa and in the West Indies. That experience has led him to opinions respecting its nature and properties which coincide much more with those of several of the most practised observers in the last century than with the more positive and confident declarations of recent authors. Hunter, Jackson, and Moseley held that yellow fever was a mixed fever, of a variable type between remittent and continued fevers; and this is the view which he has likewise adopted, as will be seen by the following passage from one of his papers, after the anatomical and chemical pathology of the disease had been minutely described:

"Fevers in tropical climates are by no means so simple or welldefined in their forms on all occasions as many suppose; on the

contrary, they are often very complicated. I have known cases commence as remittent, and continue as such to from the sixth to the tenth day, having an intermission on the morning of these days, yet the same afternoon fever recurred, which soon took on the character of yellow fever, and proved fatal on the fourth or fifth day of that form, with black vomit and other unmistakeable symptoms of this disease. I have seen in other cases which commenced as intermittent, diarrhoea ensue, and after three or more tertian periods, the fever became continued, and assumed the character of typhoid fever, and ultimately presente! the affection of the kidneys and urine seen in yellow fever, and then terminated in death. On examining the bodies, the intermixture of the morbid appearances peculiar to yellow and typhoid fevers were detected in variable proportions, as already detailed. The cause of the typhoid complication in these cases was a privy immediately in the rear of the building from which they came, but to windward of it at night; this had a deep cesspit, which had been emptied, and thus exposed the additional surface of the sides as well as the bottom to give off emanations. On clearing the building of the inmates, the typhoid complication disappeared. These facts show that yellow fever is not a complaint separate and distinct from all others, but that it becomes mixed up with them in various ways, according to circumstances."

In concluding our notice of these Annual Reports, we have only to add that not only should they be regularly studied by every medical officer in the two public services, but also that they will well repay the perusal of physicians in civil life, enlarging their views in respect of many diseases, and leading them to modify or correct opinions founded on observations in limited fields of inquiry.

VIII.-Life of Dr. Knox.1

WE are indebted to Dr. Lonsdale for a volume that is very pleasant to read, but not very easy to condense. We shall, however, endeavour to extract, from the 410 pages of which it consists, the most salient points of the life of the distinguished teacher of whom it treats-a life which serves rather "to point a moral" than to "adorn a tale."

Robert, the fifth son of Robert and Mary Knox, was born in Edinburgh in 1791, and after a good home-education, was sent at an early age to the High School, from which he emerged as Dux to 1810. In the autumn of that year he joined the medical classes of the university, and having studied anatomy under

1 A Sketch of the Life and Writings of Robert Knox, the Anatomist. By his Pupil and Colleague, HENRY LONSDALE. London, 1870.