REVIEW IX.

The Influence of Tropical Climates on European Constitutions, including Practical Observations on the Nature and Treatment of the Diseases of Europeans on their return from Tropical Climates. By JAMES RANALD MARTIN, F.R.S. A New Edition.-London, 1856.

MANY years have now elapsed since the late Dr. James Johnson produced his well-known work on the diseases of tropical climates. After six editions had been exhausted, the demand for it still continued, and Mr. Martin has taken upon himself the responsibility of again bringing it before the public. The present edition, however, is not a mere reprint of the last. Mr. Martin has re-cast and re-written the entire work, retaining a certain portion of Dr. Johnson's observations, but the greater part of it is exclusively his own composition. The present treatise may therefore be considered to a certain extent as a new and original work, and will justify a fuller analysis than we should otherwise feel called upon to afford.

That Mr. Martin has at least had full opportunities of acquiring a practical knowledge of the subject of which he treats we must probably allow, when we learn that he served in various parts of India-in peace and war-amongst natives and Europeans-in hospital and private practice for two-and-twenty years; that he has turned these opportunities to full account, all those who are acquainted with the sanitary benefits for which the capital of British India is indebted to Mr. Martin's suggestions and exertions, will at once admit. The profession will, doubtless, therefore expect a book full of sound and valuable information, and we think they will not be disappointed.

The first part of the work commences with the consideration of the physiological influences of the climate of the East Indies on European constitutions. The physical climate of Bengal is sketched out, and some interesting information afforded with respect to the geological nature of the soil, which is noticed to be ferruginous in many parts which are notorious for the fatal character of their fevers. The modifying influences of the labours of man are then dwelt on, but our author does not give a very favourable report on the state of agriculture round the metropolis of India; for he states, that with the exception of being able to produce a supply of vegetables for the markets in the cold season, matters are much the same as in the days of Job Charnock, the founder of Calcutta.

An interesting account of the hot and cold seasons, and of their effects on the newly-arrived as well as on the more seasoned European, follows, and we then proceed to the statistics of sickness and mortality in Calcutta.

The subject of statistics is one unfortunately that has been almost entirely neglected by the medical authorities of the Bengal Presidency. It is with great regret that we learn that, owing to this deficiency, no report can be given—

Of the hospitals of Calcutta, and of the general hospital in particular;-an institution that has existed for more than seventy years, and in which tens of thousands of European soldiers have been treated under three or four different

medical systems; yet no one fact, out of the numerous and important observations made during that long time, is known to any one of us. Its surgeons, and those of the other public institutions, many of them able and experienced officers,— have, through the neglect of the controlling medical authorities, been rendered, in respect to us and to science, no more than a set of dumb actors in the circle of a routine duty."

Mr. Martin we know has repeatedly remonstrated against this official neglect, but we also know how hard it is to set the official mind right, to stimulate it into wholesome and vigorous action. Owing to the absence of statistical record, it is not easy to give a satisfactory answer to the question as to whether of late years the climate is improved, or the mortality of Europeans diminished. Our author, however, is of opinion that the climate of the actual site of Calcutta is, to a certain extent, more healthy, and that the general mortality amongst Europeans, especially of the better classes, is diminished; but that the chief cause of this will be found in the improved habits of the higher ranks; for, with the troops. in garrison, notwithstanding the superior discipline and interior economy of modern times, it would not appear that mortality is much, if at all, lessened; and the same may be said of the nearest military station of former times-Berhampore.

The chapter On the Prevention of Disease contains much that is especially worthy of perusal. Notwithstanding our boasted civilization, we are only beginning to appreciate, as a nation, the higher and nobler offices of the medical profession, in their preventive or prophylactic capacity. In Bengal indeed a systematic plan for requiring from all competent medical officers reports on medical topography, and sanitary statistics of those parts with which they may be best acquainted, has been adopted on the recommendation of Mr. Martin, and his proposals for the sanitary improvement of Calcutta have been carried out under legislative enact

ments.

In the application of the principles of hygiene to military purposes, the disadvantages of the medical officer are almost endless. In the British armies, whether at home or on foreign service, the rule appears to be to leave even sanitary measures to what are called the proper authorities; the advice of the surgeon is scarcely ever asked, and if volunteered is pretty certain to be disregarded. Mr. Martin mentions, for instance, that once, while serving in one of the most pestilential countries known in India, he made a topographic examination of the localities, and reported. the result to his commanding officer, suggesting at the same time what he regarded as the most suitable arrangement for encamping the men against the coming rainy season, when it was well known that a great increase of deadly fever would result. The answer was briefly-"I'll be dd if I do." The field officer who treated a grave matter of duty in so contemptuous a manner himself paid the penalty of his neglect, for before the year was over he had lost his life.

As M. Thiers remarks, in ordinary histories we see only armies completely formed and ready to enter into action; the effort it has cost to bring the soldier to his post, to feed, to train, and finally to cure him if sick or wounded, are lost sight of. The nation sympathizes deeply with the results of a battle, the slaughter of a few hundreds by the sword or bullet excites the keenest feelings of regret or of anger; but the tenfold

loss occasioned by mismanagement, by unnecessary exposure to the burning sun or to the heavy dew, by the unhealthy bivouac, or the malarious encampment, passes unnoticed, or is looked on as the necessary consequence of warfare. England, often engaged in great wars, is perhaps of all nations the most slow to learn the real nature of war and of its requirements, and when peace returns, all the experiences of former wars are forgotten in the eager pursuits of commerce.

We may quote here with propriety the remarks with which the author concludes his observations on this interesting subject:

"Finally-it cannot be too often repeated, that on the perfection of the socalled civil establishments-the medical and the commissariat departmentsmust depend not only the efficiency, but the very existence of our fleets and armics.

"The recent calamitous losses in the Crimea have demonstrated another fact,— viz., that so long as the departments above-named are dependent and subordinate, and under the management and control of officers holding but an inferior rank, consideration, and power, so long will they remain insufficient to their great purposes; but let them once be ruled and directed by responsible officers of a rank and station adequate to command an instant attention to their respective wants-let such officers be largely and immediately responsible-and then, but not till then, will the two most important establishments of our fleets and armies rise so as to be equal to all requirements, whether during peace or in war."

The chapter which follows-the longest in the work-enters minutely into the nature, causes, and treatment of remittent fever, the subject which the author considers the most important which can engage the attention or excite the interest of the practitioner in tropical regions. He states that on the thorough and complete knowledge of this affection must depend nine-tenths of the usefulness of every medical officer who is called upon to combat the diseases of hot climates, and that he who can treat remittent fever successfully is not likely to be deficient in the skill to manage any other tropical malady. This chapter will no doubt engage the serious attention of our professional brethren in the East, and will amply reward them for the time devoted to its perusal.

"The

The chapter On Fever is followed by an article on the next most important disease of tropical climates and of armies in general, in every region, especially when engaged in active service,-acute dysentery. As William Fergusson states, this is essentially an army disease. soldier," he says, "when in the field, may escape fever, but never dysentery, if he lie on the ground." Out of a force of 25,000 men serving in Bengal Proper, between 1823 and 1836, there occurred about 8500 cases of dysentery and diarrhoea. The losses of the French army in Egypt were greater by dysentery than by the plague. During two years and a half only of the time occupied in the Peninsular war, the British army, according to Sir James M'Grigor, lost 4717 men by dysentery, and the last winter campaign in the Crimea has made us only too conversant with the fatal effects of this scourge of armies.

Mr. Martin treats succinctly of this interesting subject in all its known complications, and in its most destructive forms when complicated with scorbutus, as witnessed by himself personally on the expedition to Rangoon during the first Burmese war. He describes it, as well as the forms in which it subsequently appeared in China, and as it has been

seen on the shores of the Black Sea during the war just concluded. The remarks on the predisposing causes, on the best means of preventing this formidable disease, and on the treatment of it when it has actually supervened, well deserve the attention of those surgeons to whom the care of our soldiers and sailors is entrusted.

The next subject which comes under review is the diseases of the liver -diseases which, either as original or as secondary affections, constitute in reality a vast proportion of the sufferings induced by a protracted residence in tropical climates, especially amongst those in active military service. The official returns, indeed, under the special heads of hepatitis, acute or chronic, record but a very inadequate proportion; for when the hepatic affection occurs as a complication or sequela of fevers, dysenteries, or other allied disorders, the cases are classed with the primary disease, the condition of the liver remaining unnoted.

Mr. Martin provides us, however, with a series of statistical tables, illustrating the actual amount of these disorders, of much novelty, interest, and value, for which we must refer the reader to the work itself. We may quote, however, the results of the author's experience with respect to the treatment and probable termination of abscess of the liver:

"When the abscess is small, we may favour the efforts of nature at absorption by care in diet and clothing, gestation in the open air, and change of air, the use of the nitro-muriatic acid, with bitter tonics, &c. When the abscess has happily discharged its contents into the stomach or bowels, or externally, a more nutritions diet will be proper, with the view to support the strength of the patient, and even a little wine may now be allowed. But nothing should be done which may excite the nervous or vascular functions; and mercury in every form is to be carefully avoided, and even the mildest aperients should only be exhibited under necessity.

"Of the instances of recovery within my personal knowledge, by far the greater numbers were amongst such as had discharged the pus by the bowels; and one married lady I remember to have recovered health rapidly, after vomiting the contents of an enormous abscess. I also saw four instances of recovery where the abscess had opened into the lung. Of those in whom the pus was discharged through the external integument, the majority have, within my knowledge, died. But by much the greater proportion of the instances of hepatic abscess end fatally, either before the bursting of the abscess, or within a few hours from its discharge into the peritoneal cavity. And this brings me to the consideration of the propriety of making an opening for the discharge of such abscesses through the external integument. I have often seen this operation performed in India, and I have myself performed it; but in no instance that I remember did the operation appear to me to result in eventual good."

It will be seen that Mr. Martin agrees with Dr. Budd as respects the impropriety, as a general rule, of any surgical interference in these

cases.

An article on endemic congestion of the spleen follows naturally upon that on hepatic lesions. The true nature of splenic cachexia is fully entered into, and the fatal nature of the splenic complication, both in malarious fevers and in epidemic dysenteries, carefully pointed out. In the treatment of the chronic enlargement of the spleen, we notice that the combination of tonics and aperients, which forms the general practice in Bengal, coincides very closely with the experience of the natives, who seem to have been long aware of the beneficial results in this complaint

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of purgatives, chalybeates, and acids; a very successful native formula, consisting of a mixture of aloes, vinegar, and garlic, with a small proportion of the bazar sulphate of iron, "Kuzees." In Europeans, where the liver is involved in disease along with the spleen, as is so frequently the case, Mr. Martin considers that there is no remedy which, in his experience, can at all be compared in power and efficacy to the persevering use of the nitro-muriatic acid bath, using the combined acids internally at the same time, with bitter infusions, and keeping the bowels freely open.

The chapters On Epidemic Cholera, and On Yellow Fever, in addition to some very interesting historical and topographical notices having reference to the origin and progress of those epidemics, contain a great amount of useful and practical information on the subjects of which they treat. These subjects have, however, been so freely discussed of late in this journal, that we refrain now from any further allusion to them.

Unfortunately, a work relating to the diseases affecting our soldiers and sailors, as well as the civil service, in warm, indeed in any climates, must necessarily include an account of delirium tremens. Some tables furnished by Colonel Tulloch, and given by the author, demonstrate both the frequency and the importance of this affection, the more important as it forms a very frequent complication with many of the acute diseases of hot countries. If we could trust to a report of the statistics of delirium tremens amongst the troops in Canada, during thirty years, by the Inspector-General Henry, we must fear that the habits of our soldiers, in Canada at least, are not improving, the disease becoming more frequent; at least, while in the first fifteen years the ratio of cases to strength was as 1 to 175, in the second fifteen years it was as 1 to 75. We must fear that the same increase extends to other stations, and is still continuing. An interesting table furnishes us at once with proof of the far greater frequency of this affection amongst the troops stationed in our tropical colonies or dependencies, and suggests also some curious and perhaps profitable inquiries as to the causes which give rise to the variations, both in numbers and in mortality, among the different Presidencies. In four years, for instance, in Bengal, the aggregate strength of the European troops being 36,286, the number of deaths was 14, or in the ratio of 1 death to 48 cases admitted. In Bombay, during the same period of time, the aggregate strength being only 18,073, the deaths were 15, or nearly as 1 in 7 of those admitted.

With respect to the prevention of this degrading malady, many practitioners have recommended doses of tartar-emetic or powdered ipecacuanha, to be given at the moment the craving for strong drinks comes on, or to be mixed with the intoxicating liquors, for the purpose of exciting a feeling of disgust. When the person who has made himself a slave to this evil habit of drinking, makes an effort to extricate himself from it, he at first feels himself most miserable, the stomach misses and craves for its usual stimulant, and some substitute must be found. In Canada, according to the experience of Henry, the best medicine under these circumstances consists of a wineglassful of a mixture of the infusion and tincture of gentian, with a little sulphate of magnesia, taken early in the morning, at mid-day, and again in the evening. This would seem