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Chadwick states the proposition differently; "by nearly all statistical writers," he says, "the proportion of deaths to the population and the average ages of death are treated as equivalent," meaning however, (as appears by the context,) not the proportion of deaths to the population, but the proportion of the living to each death. However, Mr. Chadwick shows in an essay which forms an important part of the appendix attached to his Supplementary Report,' that this proposition is quite erroneous, and not founded on fact, and this from data obtained from the deaths in the two millions of the metropolitan population. Now what purely professional association, or even medical corporate body could have secured these extensive data? But Mr. Chadwick can go further; while he shows that the deaths and average ages have no relation,-in the Islington district, for example, the deaths are 1 in 55, and the average duration of life only twenty-nine years, whereas it ought theoretically to be fifty-five years, proving in fact that the average is a varying quantity, he is enabled from the same source, to show some of the circumstances which accompany these variations, particularly those having respect to the state of the habitation, drainage, sewerage, &c., and the occupations and domestic condition of the people. We again ask what means are there within the profession for obtaining observations so numerous and generalizations so extensive as these? The cultivation of general hygiene, and that alone, has led, or can lead to them.

The more these matters are considered, the greater will be their acknowledged importance. Yet there is one argument more in their favour, which we cannot overlook. On a previous occasion we remarked that the study of modern medicine is the study of human nature, and being such there are no questions concerning humanity which it may not assist to solve. These are imperishable truths, and since the medical profession thus necessarily knows human nature better than others, that better knowledge ought to be usefully applied as well to the science of legislation and government, as to the prolongation of individual life, and the removal of individual disease.

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We have made these remarks because it is but a twelvemonth since we reviewed that branch of general hygiene which refers to the disposal of the dead Those who have read Mr. Chadwick's general Report on the Sanitary condition of the labouring Population of Great Britain,' would expect a supplement of this kind. Like that Report it is more comprehensive and complete than any work on the subject with which we are acquainted. No available source of information has been overlooked, and we are happy to find that our own review of Riecke's publication has contributed its quota of information.

The Report commences with a discussion of the effects of putrid emanations on the public health. The negative evidence as to their innocuousness, and the facts distinctly showing their fatal effects are both scrutinized, the difficulty of effectually doing so being at the same time exhibited. The conclusion,-one which we believe none will deny,-is, that all interments in churches or in towns are injurious to the public welfare. In a second section, the harm done to the health and morals of the people by the delay of interment is exhibited. This delay is comparatively modern, since we ourselves know, from authentic documents, that at the end of the last century the corpse was rarely kept three days, in fact, was usually

interred on the third day. And this delay is the more injurious, because in a large proportion of families in the metropolis (to use Mr. Chadwick's own language) one room is the bed-room, kitchen, wash-house, sittingroom, dining-room, and frequently the workroom and shop. Statistical inquiries made in the borough of Marylebone show that not more than one family in one hundred has a third room; and the same proportion was observed in the inner ward of St. George's, Hanover square. Of 1465 families residing there, 929 had only one room, and 408 not more than two; but we know, in common with many others, that there are many single rooms in the metropolis occupied by two or three families. Of course a corpse is necessarily retained in the single room when a death occurs, no matter by what disease. Mr. Chadwick gives some melancholy examples of the spread of contagious fevers from this cause. This delay of interment amongst the poor is in some degree to be attributed to their poverty, and the excessive cost of funerals. Under the latter head Mr. Chadwick gives some details exhibiting the waste and distress occasioned to the poor by the funeral societies of undertakers and publicans. At Walsall alone it is calculated that ninety societies of this kind spend £1240 per annum in eating and drinking only. A darker stain on the morals of the people is, however, shown by proved instances of labouring people entering their children in several burial societies, and then murdering them outright, or starving, or illtreating them to death to obtain the sums allowed for interment! One man got £34 3s. in this way, on the death of one child, from ten burial clubs.

After demonstrating the excessive cost of funerals, which in England and Wales is estimated at nearly five millions sterling, per annum, and showing that in the metropolis at least more than half of the expenditure is sheer waste, Mr. Chadwick discusses the remedies for these various evils, and at length proposes his own plan, which consists in the appointment of officers of public health. The functions of these persons would be ordinary and extraordinary. The ordinary would be the verification of the fact and cause of death by personal inspection and inquiry, and its due civic registration; the extraordinary would be the direction of such sanitary and juridical measures as the cause of death and the circumstances under which it took place might render necessary. The officer of health must combat contagion and infection by cleansing away impurities, or by the removal or embalment of the corpse. He is to detect murder and denounce it to the coroner, and assist, of course, in getting up evidence. Further: assuming the necessity of national cemeteries, he would also "have charge of the material arrangements, and take the place of the churchwardens and overseer in respect to all places of burial, and be responsible for the control of the servants of the establishment, and moreover be enabled to regulate and contract for supplies at reduced prices of materials and service of the nature of those now supplied by the undertaker." (p. 160.) The officer of health under this arrangement would also be a conductor of funerals, and indeed would be authorized to offer his services as such to surviving relatives. The salary is proposed to be fixed at 19s. per diem, (staff-surgeon's pay,) with an allowance for a one horse vehicle.

Mr. Chadwick works very hard himself, and plainly expects every other employée to equal him in his Herculean labours. But let our readers

XXXIV.-XVII.

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join us in a little contemplation of the qualifications aud duties required. First, it is absolutely necessary to the successful performance of his duties, that the proposed officer have a good general as well as a good medical education, and therewith a special knowledge of general hygiene and forensic medicine. He must also be of gentlemanly manners and pleasing address. Having to meet passions and prejudices, avarice and selfishness in all guises, and in all classes-he must be well acquainted alike with human nature and with business details. In short, he must be imperturbably good tempered, a man of tact, a man of business: humble, for he will have to act as an undertaker; eminently scientific and nobleminded, for he will have to apply medical science to social and political economy. Then as to the labours of the office: In the metropolis and larger towns, even the ordinary duties will be arduous and incessant. Fifteen corpses will be handled by him daily, Sundays not excepted, and fifteen will be daily conducted by him to the grave. Add to these the extraordinary duties: The removal of causes of disease—the investigation of suspected murders-the autopsies and analyses-and (a very important item) the return of statistical data, (Mr. Chadwick will, we are sure, provide that this duty shall not be neglected,) and we really think that our catalogue of qualifications and duties will put the staff-surgeon and his nineteen shillings per diem quite out of court. Indeed there are no points of comparison between the two services, except that they are both public and both medical.

Our catalogue however, is incomplete. There are factories, prisons, workhouses, lunatic-asylums, schools, manufactories, workshops, and other quasi public establishments to inspect; the attendance on sick prisoners, and sick poor to supervise; factory-children to look after, and adulterations and impurities in food and drink, as water, wines, butchersmeat, bread, tea, &c., to detect. These, it is true, are not mentioned by Mr. Chadwick, but they are undoubtedly an important part of the publichealth officer's duties.

Mention is made of a "clerk" to the officer of health, and of a cemetery" establishment." From these and similar expressions we suspect a supplementary plan is in Mr. Chadwick's bureau. It is evident there must be a gradation of offices, and a greater complexity of difficult details than appear. The plan will be more difficult to apply to the small agricultural towns than to the metropolis and the manufacturing and commercial towns. Still more difficult will its application be to the rural manufacturing districts, such, for example, as the large parish of Rochdale, containing an area of 58,620 acres, and 84,718 inhabiIt appears to us that the attendance on the poor, and the duties of supernumerary officer of health might, in districts like those alluded to, be combined in one individual. Of course the guardians of the poor should have no control over him. Indeed, the medical attendance on the poor is the true practical school in which the officer of health should study his duties, and should be the first grade in this new medical service. It would be his "title" to medical orders.

tants.

In an Appendix, Mr. Chadwick has supplied some interesting documents, and especially a series of most valuable statistical returns, exposing the erroneous principles in vital statistics to which we have alluded. This essay gives the coup de grace also to the Malthusian theory, and we can

not but congratulate Mr. Chadwick on these two important results elicited by him from the materials at his command. There is a rule of our own for correcting the errors in the averages arising from the understatement of ages which we commend to his notice, namely to the sum of the ages of all dying under one year, add the sum of the ages of as many dying under one month; and to the sum of the ages of all dying aged above one year, add the sum (corrected) of the ages of as many dying under one year. A nearly exact average is the result.

In this short notice we have by no means done justice to the valuable contents of the Supplementary Report.' We have discussed Mr. Chadwick's plan rather than criticised his facts, for, knowing that success is the highest praise, we are rather anxious that he should be successful in the application of "the new science of prevention" contemplated, than to give him our critical commendation. The latter is in fact unnecessary, for the volume itself speaks sufficiently for the industry, zeal, and talents of its author.

ART. IX.

Lehrbuch des Nervenkrankheiten des Menschen. Von M. H. Romberg, Doctor der Medicin, &c. Erster Band.-Berlin, 1840-43. 8vo, pp. 610.

A Manual of the Nervous Diseases of Man. By M. H. ROMBERG, Doctor of Medicine, Professor and Director of the Royal Polyclinical Institute of the University of Berlin, &c. Vol. I. Part I, 1840; Part II, 1843.

PROFESSOR ROMBERG is of opinion that the diseases of the nervous system should now be considered scientifically. He has been led to this conclusion from a consideration of the numerous researches instituted of late years by physiologists, and of the important results which have followed; and he has been induced to act on that opinion from the conviction that no work has yet been published in which the neuroses were so discussed. We need scarcely say that important as modern neurological discoveries confessedly are, the physiology of the nervous system is as yet undeveloped, and can only be but very imperfectly applied to pathology. There is more to be filled up than the gaps acknowledged by our author. Whole fields of research remain altogether unexplored,

and we find that the further we advance the more we have to discover. This is not written with intent to disparage Professor Romberg's labours; on the contrary, we think that he has manfully grappled with a difficult subject, and we gratefully accept his work, to use his own phrase, as the first step in the right direction.

His classification of nervous diseases is founded on the four great functional divisions of the nervous system, namely, the sensitive, motor, mental, and nutrient. Upon these, four classes of diseases are formed, namely: 1. The Sensitive neuroses. 2. The Motor neuroses. 3. The Phreno-neuroses. 4. The Tropho-neuroses.

The first part of this, the first volume, is devoted to the Sensitive neuroses; the second to the Motor neuroses. The following are Professor Romberg's subdivisions of his first class the Sensitive neuroses. The

class divides naturally, according as the normal sensibility is increased or diminished, into Hyperesthesia and Anesthesiæ.

ORDER I.-HYPERESTHESIE OF THE NERVES.

A. The Cerebrospinal Nerves.

GENUS 1. Cutaneous hyperesthesia.

a. Neuralgia.

b. Pruritus.

c. Ardor.

d. Algor.

b. Vertigo.

GENUS 2. Muscular hyperesthesiæ.

a. Neuralgia muscularis.

GENUS 3. Pueumo-gastric hyperesthesia.

a. Neuralgia-Globus, Pyrosis, Gastrodynia neuralgica. b. Bulimia.

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c. Polydipsia,

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The imperfections of this arrangement are obvious. In forming the second order, Professor Romberg abandons, with little ceremony, his own scientific principles, and adopts the old empirical method of arrangement. Neuralgia cerebralis is no neuralgia at all-in fact, no definite disease— but simply cephalæa, or violent headach, a symptom common to many and very different diseases, as we shall find as we proceed. Nor can we understand how vertigo is to be considered as hyperesthesia of the mus

cular nerves.

ORDER I. HYPEResthesia of the NERVES. The pathology of the sensitive neuroses must be founded on the physiological laws of sensation. There are three principal laws of this kind. The first is the law of isolated continuity of a nervous fibril and of isolated conduction of sensation from its peripheral to its central termination. This applies, without exception, to all the peripheral nerves. The second law is the law of irradiation of sensation in the central organ; and the third is the law of excentric phenomena, by which the sensations consequent upon change in a sensitive nerve in any part of its course are referred by the individual to its peripheral extremity. This law divides the hyperesthesia into the two divisions of peripheral and central, according as they are allocated in any part of the fibril in its course from the periphery to the centre, in the central axis itself. This law is of very considerable importance in the study of the pathological anatomy of the sensitive neuroses, and in explaining the symptoms of diseases of the nervous system generally. In dissecting a case of crural neuralgia, for example, it would not be suffi cient to confine the attention to the seat of pain. The whole course of the nerve must be traced up to its insertion in the spinal cord, and (if it

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