ART. VIII.-1. Handbuch der historisch-geographischen Pathologie. Von Dr. August Hirsch; 2te vollständig neue Bearbeitung. 3 Bände. Stuttgart, 1881-86. 2. Handbook of Geographical and Historical Pathology. By Dr. August Hirsch. Translated by Charles Creighton, M.D. 3 vols. London, 1883-86. (New Sydenham Society.) A WELL-KNOWN Edinburgh physician of the last generation, one of a philosophical school distinguished by the largeness of their ideas and the lucidity of their style, used to say that he thought it more than probable that, in fifty or a hundred years, the business of a physician will not be regarded in England as either a learned or a liberal profession.' Learned and liberal are, of course, words that take new meanings according as the subject-matter of knowledge changes. Confining the application to strictly professional accomplishments, these qualities may be justly claimed for the physicians and surgeons of the present generation who are well versed in physiological and pathological research. When we compare, however, the recent medical literature of England with that of other countries, we shall have to confess that Dr. Gregory's prophecy has to a certain extent come true. As a mere matter of contemporary observation, it is impossible not to be struck with the paucity of modern English books on the historical development and continuity of medical doctrine and practice, on the great national outbreaks of sickness, and on the distribution of diseases in other countries than our own. In the English medical book-market of recent years we find no great history of medicine, no great history of epidemics, no great geography of disease, no great climatology. Since Freind's History of Physic from the time of Galen' (which he began during a political imprisonment in the Tower, and never finished), it is difficult to name any English work of the kind, except Dr. Meryon's History of Medicine,' vol. i., 1861, an agreeable enough essay on a few epochs of medicine, but hardly to be taken seriously as a work of historical research. After Meryon, we have the useful historical sketch at the beginning of Forbes's Cyclopædia of Medicine,' compiled in part by Bostock, and in part by Alison. Epidemiological history is represented by Bascome's thin octavo on the History of Epidemic Pestilences from the Earliest Ages,' 1851, which is in the form of annals, and suggests the learned ease ('pottering' is the vulgar term) of a retired practitioner, rather than the 'Ernst der ins Ganze geht' that distinguishes the best works of the foreign press. Vol. 164,-No. 327. It It may be nothing against the title of English medicine to be accounted learned and liberal, that it is profoundly indifferent about a new edition of 'Galen.' Such indifference may be no more than that brutalité de sens commun' which has been discovered to be a national characteristic. We should be taking up a weak position if we stood upon the neglect of a Greek classic; but the neglect of historical development and continuity is a very different matter. Is there in England no rational curiosity about the history of medicine, nor any interest in the shiftings of medical doctrine and practice? However this may be, we have no English modern history of medicine, nor even a translation of a foreign work. Or if the bookmarket be not an absolutely safe index of our state, we may consider what we do, compared with other countries, in those monographs on various restricted topics which enthusiastic, uncommercial scholars are induced to publish. Even our own historical pestilence, the English Sweating Sickness,' has received its modern elucidation at the hands of Gruner and Hecker and Häser. We have, indeed, a translation, fifty years old, of Hecker's essay on the Black Death; but our more recent share in the study of that tremendous episode in the history of the human race has been borne for us by Mr. Thorold Rogers, in his History of Agricultural Prices in England;' and by the Rev. Dr. Jessop, in his recent articles on the 'Black Death in East Anglia,' published in the Nineteenth Century.' Apart from some excellent monographs by the Anglo-Indian branch of the profession, and Theophilus Thompson's Annals of Influenza,' the most notable piece of English work of that kind, which is always honourably noticed by foreign scholars, is Sir J. Y. Simpson's 'Antiquarian Notes on Leprosy in the British Islands,' published more than forty years ago in a series of papers in the Edinburgh Medical and Surgical Journal.' If these things are thought to be remote in practical interest, as they are certainly remote in time, there are peculiarly British opportunities for utilitarian and historic study. It can hardly be a matter of reproach to the medical profession of England, that they have allowed Germany to anticipate them in the production of the book that gives occasion to our remarks. A German professor has not only written the treatise on • Geographical and Historical Pathology;' it has fallen to a German professor to give form and method to that science. Previous to Dr. Hirsch's first edition (1860-64), no such comparative science existed. Materials, indeed, there were, in hundreds of books and thousands of memoirs and papers at hand, but no master workman was at hand. In the preface to the first volume of of his re-written work (1881), Professor Hirsch says: 'The task that I had imposed upon myself was not merely to collect and reduce to order an almost unmanageable heap of materials, and to test critically their authenticity and fitness; but more particularly it involved the founding according to a design, and the building up according to a system, of a discipline that had been the subject of but little labour before, and had still to make good its right to a place among the Medical Sciences.' There does not appear to be any good reason for abating one jot of the author's pretensions. Of his immense bibliographical knowledge there is no question; his private library at Berlin, containing some thirty thousand volumes, is known among medical bibliophiles for its very complete sets of archives, journals, transactions, and annual reports, in every language, and dating from the earliest days of concerted medical research. Many English readers will learn for the first time from this work, how busy their countrymen of former generations had been, both at home and abroad, in recording their observations, and how considerable a proportion of their books and essays was translated into German. It will give some idea of Dr. Hirsch's bibliographical resources, when we say, that his chapter on Malarial Fevers is followed by an alphabetical list of some eight or nine hundred writers, his chapter on Yellow Fever by a list of some six or seven hundred, and that his account of the remarkable epidemics of diphtheria in Spain in the sixteenth and seventeenth centuries is annotated with references to obscure contemporary Spanish books, most of which have a place on his own shelves. In the It is the unusual combination of extensive bibliographical range and methodical accuracy, with intellectual grasp and philosophical insight, that has enabled Dr. Hirsch to become the founder of a new department of medical science. During the twenty years between his first and second editions, many hands have been at work on the building, but the originality of the design rests with himself. We shall have opportunities, in the sequel, of showing what sort of problems the science of geographical and historical pathology deals with. meantime, we shall venture on a few criticisms of the book. One of the first things that will occur to a student of the work is, that this or the other disease is taken in the wrong place. For example, the chapter on Malarial Diseases comes in the first volume, among the Acute Infections, while the chapters on Dysentery and on Tropical Abscess comes in the third volume, among Diseases of Organs. Again, among the chronic infections, exception may be taken to the position of leprosy, which has 0 2 has affinities rather to the class of slow constitutional disorders represented by pellagra. Goitre comes awkwardly among the chronic infections. For it, as well as for one or two others, there seems to be needed a new class of 'natural' endemic diseases, or diseases of locality due to the conditions of virgin nature. Cretinism in the offspring is too lightly assumed to be produced by the same cause as goitre in the parents. So far, indeed, as its geographical distribution is concerned, it is connected with goitre; but when its pathology is analysed, it is found to be a congenital disorder, or a tendency of development born with the child, and having in goitrous localities the same relation to an over-taxed function of child-bearing that rickets has to the same maternal strain elsewhere. From this point of view, it deserves a chapter to itself, a chapter that would have the farther interest of pointing out the goitrous localities where there is no cretinism, such as are nearly the whole extensive goitrous region of the New World. When the ground is next gone over, it is probable that the divisional boundaries will be altered. Thus the inadequate idea of the present generation, that the various species of disease have been reproduced ab æterno by means of infective particles with absolute or fixed properties, will be supplanted by the evolutional doctrine, which will assign an increasing number of these species to the several physiological disorders out of which they had remotely sprung. Dr. Hirsch's placing of diphtheria, whooping-cough, and several other epidemic maladies in his third volume ('Diseases of Organs'), is therefore a step in the right direction; and in the arrangement of his subject as a whole, he has placed himself beyond the reach of serious cavil, not only by reminding us that cross-divisions are inevitable, but also by the workmanlike way in which he finds a place for all the data of each disease. To a future generation of philosophical writers on disease, these volumes will be the indispensable mémoires pour servir.' To contemporary readers they are not merely an ample presentation of the facts, and a serviceable clue to bibliographical sources, but they have an undercurrent of good sense and fairness of mind, which is, at any rate, a convenient substitute for the more penetrating judgment that comes of large principles firmly grasped and boldly applied. The English translation by Dr. Creighton, of which the last volume has recently appeared, is appropriately brought out in the series of the New Sydenham Society. One can hardly imagine a book more in the spirit of Sydenham's own aims and achievements. It is his favourite theme, the Natural History History of Disease, enriched a hundredfold with new facts and ideas. In presence of this modern wealth of knowledge, gathered from every period of history, and from every latitude and race, Sydenham's own pioneering 'Observationes Medica' appear as the mere gropings of one confined within a narrow space. Even his broadest generalization of an 'epidemic constitution' of the air, varying from year to year and from season to season, receives but little recognition from modern epidemiologists; although Häser, throughout his third volume, is clearly reluctant to abandon it. But Sydenham's method has been fully vindicated. His comparison of diseases, marked by a special type, with the species of living things, each with its natural-history characters and habitat, continues to be our most fruitful analogy. Also in his preference for the study of the 'conjunct and proximate causes,' instead of the remote causes, he will eventually be found to have shown practical wisdom; although the tendency is now to dwell upon causes that are neither conjunct nor proximate. The conjunct and proximate cause was the complete natural history and external circumstances of the disease-species itself. Like the natural species of animals and plants, each of the great historic pestilences or other forms of national sickness has had a certain conformity of type in all the thousands and tens of thousands of individual cases-a conformity which is made the more striking by the occurrence, within certain limits, of variations from the type. Each type, again, has had its native habitat; it has been in some peculiar way associated with its environment-with the climate, or with the telluric characters of the region, or with racial, social, and domestic habits, as if it had its place in a local flora or fauna of disease. Besides this analogy of geographical distribution, there is the other and even more remarkable analogy of succession in time. Old types have disappeared absolutely from certain regions, or are missed in certain newer strata of civilization; while new types have come in their place. There are diseases, such as the plague, that have been gradually driven from an almost universal prevalence among civilized men into remote corners and mountain fastnesses; other diseases, like the cholera, have in their turn emerged from the narrow limits of their habitat to overrun both hemispheres. If it be premature to say, that any old-world pestilence is as extinct as the mammoth, there are certainly some that have vanished as completely as the hyæna from Europe, and there are still others that are now as rare as the lynx or the elk. Asiatic cholera is curiously like the brown rat; less than a hundred years ago it began its migrations from the |