1847.] Hermaphroditical Formations. 455 scrotum, the prominent suture or raphe indicating their line of junction. The existence, in both sexes, of the peculiar glands called Corpora Wolffiana and the destination of their excretory ducts, are also points of importance; nor should the prostate and Cowper's glands, developed apparently in the female as well as the male, be overlooked. Taking these facts as a guide, it becomes apparent that by far the larger number of the so-called cases of hermaphroditical malformations can at once be referred to certain modifications either of the male or female organs; and doubtless all of them would be thus interpreted, if they were thoroughly investigated. The author is evidently inclined to this opinion, speaking in most doubtful terms of the existence of true hermaphroditism. The most ordinary forms of false hermaphroditism are, in the female, the disproportionate size of the clitoris, so that it may be mistaken for the penis; especially if, which sometimes happens, there is an opening or an inferior channel connected with the clitoris, somewhat resembling the male urethra. "If, at the same time, as is frequently the case, there is constriction of the vagina, considerable development of the hymen, tumefaction of the labia pudendi, approximation of the total habitus to the male sex by deep voice, traces of beard, and slightly developed mamma; such individuals may be easily mistaken for men." -P. 521. The most common form of "false hermaphroditism in the male sex, arises from the urethra being fissured beneath and atrophied (hypospadias), while, at the same time, also, the scrotum and even the perineum are cleft, so that the fissure resembles the female vulva; the resemblance being increased by the circumstance, that, like the latter, it is lined with a soft, red, mucous membrane. 66 Generally, also, in such cases, the testicles have not descended (cryptorchismus), which adds to the deception, so that such individuals have been frequently taken for girls until the period of puberty, when they have suddenly changed into men."-P. 522. There are some other malformations in the male which have led to a similar error; as where fissure and eversion of the urinary bladder have been mistaken for a vagina; especially if, at the same time, the penis is atrophied and cleft upon its upper side-(epispadius.) In rarer cases, the approximation of the male genitals to the female habitus, is produced by the penis being attached to the scrotum by adhesions; it is thus drawn downwards, and appears to have vanished; the deception is further favoured when the testicles do not descend. In dismissing this subject, it will not be superfluous to call attention to the fact, that a large number of these so-called cases of hermaphroditism have been examined only during life, and therefore most inefficiently; that the accounts of them have for the most part been drawn up by persons unacquainted with developmental anatomy; and that, even when the parts have been inspected post-mortem, instead of having been submitted to a rigid scrutiny, the most superficial investigation has satisfied the enquirer, so that such an obvious proceeding, for example, as the application of the microscope to determine whether a doubtful organ was a testis or an ovarium, has not been adopted. We must here conclude our remarks of Dr. Vogel's Treatise, and although, as already stated, we think there is less of originality than might justly have been expected from a writer who stands so high as a pathologist, and fewer of those philosophic generalizations, which the character of the work would seem to demand, we can strongly recommend the volume now translated to the favourable notice of our readers. In the course of this article, we have not alluded to the English editor, Dr. Day, because, as that gentleman states, the additions he has made are unimportant. We cannot, however, conclude without bearing our testimony to the very efficient manner in which Dr. Day has executed his task; the whole volume indeed, owing to the omission of all German expressions, reads like an original work. The numerous plates, selected principally from the author's "Icones Histologiæ Pathologica," form a very important addition to the text, illustrations being an almost indispensable accompaniment of descriptions relating to minute anatomy. I. DICTIONARY OF PRACTICAL MEDICINE. By James Copland, M.D., F.R.S., &c. &c. Parts X. & XI. Article, PESTILENCE. London, Longman & Co. 1846-7. II. A TREATISE on the Plague; MORE ESPECIALLY ON THE POLICE MANAGEMENT OF THAT DISEASE, ILLUSTRATED BY THE PLan of OPERATIONS SUCCESSFULLY CARRIED INTO EFFECT IN THE LATE PLAGUE OF CORFU. WITH HINTS ON QUARANTINE. By A. White, M.D., Deputy Inspector-General of Hospitals, &c. Octavo, pp. 342. London, Churchill, 1846. THERE is no subject in the whole range of Medical Science of such wide and momentous interest, alike to the physician and to the public at large, as the history of Pestilential Diseases-including their probable mode of origin; the various circumstances of climate, season, locality, &c., which seem either to promote or to check their development; the causes of the changes or phases which they occasionally exhibit; the laws of their propagation and diffusion; their influence upon population; the effect of quarantine and other restrictive measures upon their progress; the operation of medicinal and hygienic treatment upon individual cases, and also upon the general mortality in a community; as well as various other questions of minor note that must suggest themselves in so comprehensive an enquiry. By the term "Pestilence," has generally been understood any malignant and rapidly fatal Epidemic, or extensively diffused distemper. It has been used, therefore, not so much to designate any particular disease or set of diseases, as to denote the general feature or character of their prevailing within a short period over a large extent of space, and of their proving, at the same time, highly destructive. Dr. Copland however employs the word in a more limited, and in a somewhat peculiar, sense. "Under the head pestilence," says he, "I comprise certain maladies which have appeared as wide-spreading and devastating epidemics, but which have surpassed all other epidemics in their rapid extension, in their fatality, and in the duration of their prevalence." He goes on to remark that these "certain maladies," although usually prevailing epidemically, may occur 1847.] Distinction between Infection and Contagion. 457 also in a sporadic form. The attribute of epidemicity might thus seem to be not necessary to the existence of a pestilence; but Dr. C. guards himself against this objection, by stating that it is to "the irruptions of these maladies, to their rapid extension, and to their great fatality, the generic term pestilence may be justly applied." Why Dr. C. should have deviated from the ordinary view of the question, and also have limited the term to three diseases, viz., Epidemic Cholera, Yellow Fever, and the Plague, or, as he calls them, the Choleric Pestilence, the Hæmagastric Pestilence, and the Septic or Glandular Pestilence, is not very apparent; unless, indeed, he considers that this triad is possessed of certain characteristic features in common, peculiar to themselves, and distinguishing them from all other maladies to which the appellation of " pestilential" has usually been applied. Whether he has acted wisely in so doing, we shall not now wait to enquire. That this arrangement has had its effect in leading Dr. Copland to adopt some very peculiar views, as to the origin and diffusion of the diseases in question, will appear when we come to examine the details which he has adduced upon these very important subjects. He loses no time, we may remark, in announcing, at the very threshold of the enquiry, his strong and decided opinion, not only that the three pestilences named are essentially infectious, but also that this property of infectiousness has always operated as the most influential cause in their dissemination. The reader is thus at once prepared for what awaits him in the perusal of the sequel: we need scarcely say that our author displays his accustomed industry and erudition in endeavouring to substantiate the views which he has adopted. It is to a patient and candid examination of the proofs and arguments which he adduces, that we now invite the attention of our professional brethren. As it is most necessary, in scientific discussions, that the exact signification of the technical terms or phrases employed should be clearly understood by all parties, we have to observe, that whenever the words infectious, infection, &c., are used, we wish to denote that property of certain diseases being communicable from one individual to another, in consequence of certain effluvia or morbific miasms emanating from the body of the sick, and acting, through the medium of the respired air, upon that of a person in health. Scarlatina, Measles, and Hooping-cough, are universally admitted to be infectious diseases, in this acceptation of the word. The epithet contagious, on the other hand, ought assuredly to be restricted. to such diseases as are communicable only by contact, and not by any vitiation of the atmosphere with morbific effluvia, in the manner we have just alluded to. We would suggest the term contagio-infectious, to denote those that are capable of being communicated in both ways. To this latter class belong Small-Pox, Hospital Gangrene, and perhaps also Glanders and Puerperal Fever. The importance of attending to these distinctions will be perceived in the course of our enquiries, more especially when we come to notice (once more) the last of the three Pestilences on Dr. Copland's list. But, before concluding these prefatory remarks, we must not fail to allude to a circumstance of the very highest interest in the general history of Infection, and one which requires to be most assiduously kept in mind whenever an attempt is made to determine whether this property belongs to certain diseases or not. The point to which we refer is thus very accurately set forth by Dr. Copland in the following passages, from the article "Infection," in his elaborate work : "It may be stated as an axiom, that the foul air generated by the crowding of many persons, or animals, even in health, but more especially in disease, into a confined space, as in the wards of hospitals, &c., or by few persons only in the same apartment, if their diseases be attended by copious discharges, will infect those who breathe it in a state of predisposition, with low fever, dysentery, &c.; and that the persons thus infected will communicate the malady to others similarly predisposed." Again, we thus read in another passage: "Diseases may take place sporadically, or from local causes; and, owing to various circumstances acting either in close succession or coetaneously, the circu lating and secreted fluids, and even the soft solids, may be so changed during its course as to emit an effluvium contaminating the surrounding air, and thereby infecting many of those who breathe this air in a sufficiently contaminated state; and thus it will be propagated to several, and from these to others-especially under favourable circumstances of temperature, humidity, electrical conditions, and stillness of the air, and of predisposition on the part of those who come within the focus of infection, Thus diseases may become infectious and epidemic, aided by the constitution of the air and other circumstances; and, after a time, cease and entirely disappear with the circumstances which combined to propagate it.” This very lucid description of what is usually meant by the expression "contingent" or "conditional infection," deserves especial notice, as bearing, in no indirect manner, on the history of Epidemic Diseases in general.* Other passages, inculcating the same views, might be quoted from the Dictionary of Practical Medicine; but these now given will amply suffice. * In a recently-published pamphlet we expressed the same doctrine, in the following terms: "Whenever a number of human beings, even in a state of health, are cooped together in a narrow, ill-ventilated space, the air gradually becomes so contaminated by the effluvia given off from their bodies, that, in the course of a more or less limited space of time, Fever will almost inevitably make its appearance among them; and this fever, so generated, will often be found to exhibit infectious properties, if the sick are not removed to a more airy and wholesome locality. Something of this sort was observed in the case of most of the 23 survivors of that dreadful night when upwards of 140 human beings were shut up in the Black Hole at Calcutta. We have daily illustrations of the same fact in what takes place on board troop and slave ships, in jails, crowded penitentiaries, and so forth. "If such, then, be the case with persons in health, can we wonder that the effluvia from the bodies of the sick must be still more poisonous and contaminating? If any one has a doubt upon this score, let him walk from the open air into the ward of a hospital, when all the windows have been closed for a time; a sense of nausea and oppression, accompanied not unfrequently with actual shivering, are often immediately experienced. "Now, it is in the way we have just mentioned that various maladies, which are certainly not primarily or essentially infectious, are apt to become so in impure and badly-ventilated situations, more especially when many sick are crowded together. The infectiousness is not a necessary quality of the disease; it is an 1847.] Doctrine of Contingent Infection. 459 Now, if the doctrine of Contingent Infection be admitted-and where is the enlightened reader who will dispute its truth?-it is obvious that, to talk of medical men being of a necessity either "infectionists," or "noninfectionists," in reference to certain diseases-as if they must positively make up their minds either to admit or to reject in toto the communicability of these diseases under all circumstances-is not dealing quite fairly with the question. To call those who hold the doctrine just mentioned "non-infectionists," is clearly to mislead the unpractised reader, by leaving an erroneous impression upon his mind. Let us take an example. If the broad and general question, " Is Erysipelas or is Dysentery infectious?" were put to a physician, he might with perfect truth and propriety answer it in the affirmative; and yet all that he meant by such a response might be the simple declaration of his opinion that these diseases are occasionally or conditionally communicable from one person to another, although such an occurrence does not happen once in a thousand times, and only under very peculiar circumstances. It would be wrong, however, to assert, without any qualification, that the physician in question was either an infectionist or a non-infectionist. Now, as it is with Erysipelas and Dysentery, so it may be with malignant cholera. To adduce a few instances wherein there has seemed to be a transmission of the disease from one individual to another-and this, too, be it remembered, not in sporadic cases, but when an acknowledged epidemic is prevailing at the time-cannot satisfy any dispassionate enquirer that the disorder should be placed in the same category with Scarlatina or Measles. But the mere determination of the question, whether a disease like Pestilential Cholera is ever infectious, is far from being either the most difficult or most important point in our enquiries. We have to ascertain whether this property of infectiousness is primary, essential, and permanent, or only contingent, conditional, and occasional; whether the attacks of the pestilence can, with any show of probability, be attributed to personal infection from one individual to another; whether its dissemination from one district to another, and from one country or continent to another, can be fairly traced to this agency; and whether there be any rational grounds for hope that its progress may be arrested, or its invasion prevented, by any of those means of restraint or precautionary regulations, comprised under the general term of Quarantine. These are the really momentous problems in the enquiry to be discussed; and not the very minor one, whether the disease has, upon any occasion, manifested infectious properties. Medical men have too often allowed themselves to be altogether occupied with the history of insulated facts, and have neglected to view the question in its accessory or contingent attribute. Various forms of low or typhoid Fever, Erysipelas, Dysentery, Angina, &c., may be mentioned as affording not unfrequent examples of the phenomenon in question. The consideration of this subject teaches us two important lessons. In the first place it inculcates the imperious necessity of thorough cleanliness and free ventilation, wherever a multitude of sick persons are congregated together; and in the second, it exposes the absurdity of the disputes which have so often taken place about the infectiousness or non-infectiousness of several diseases."-Quarantine and the Plague, 8vo. pp. 71, Highley, 1846. |