MATURE 



413 



THURSDAY, SEPTEMBER i, 1892. 



EPIDEMICS, PLAGUES, AND FEVERS. 

 Epidemics, Plagues and Fevers : their Causes and 

 Prevention. By the Hon. Rollo Russell. (London : 

 Edward Stanford, 1892.) 



IN this handbook the author has aimed at collecting 

 together the main facts concerning preventable dis- 

 eases and presenting them in a convenient form for the 

 use of those interested in the promotion of public health. 

 The work is in the main a compilation of extracts from 

 the most varied sources, and references are given which 

 enable the original authorities to be consulted. It is 

 difficult to speak too highly of the care and industry with 

 which Mr. Russell has fulfilled this task, and of the com- 

 pleteness with which the work has been brought up to 

 date. 



In an introductory chapter on the nature of spreading 

 diseases in plants and animals the analogy is traced be- 

 tween such processes as dry-rot and yeast fermentation, 

 and the action of disease germs upon the animal 

 organism ; a short account is given also of various 

 epizootic diseases. 



Passing to the main subject of the book, the author 

 deals seriatitn with the different human diseases of micro- 

 parasitic origin. A long chapter is devoted to cholera. 

 Accepting provisionally Koch's comma-bacillus as its 

 cause, Mr. Russell exhibits in a mass of evidence the 

 conditions of filth and water pollution which enable 

 the disease to maintain itself in its native home, 

 India, and to spread thence in epidemic visitations 

 to other parts of the world. In many parts of India 

 much has been done by sanitary measures, such 

 as drainage and im.proved water supply, to reduce 

 the incidence of cholera : in a later part of the book 

 stress is justly laid on the responsibility which rests on 

 England in the matter of the sanitation of India. The 

 measures by which cholera may be arrested are set forth in 

 full, the most important being personal cleanliness, a pure 

 water supply, and the disinfection of dejecta and soiled 

 linen. No adequate account is given of the measures of 

 notification and supervision which in this country replace 

 strict quarantine. 



Another important section of the book is devoted to 

 consumption, which it is a pleasure to find included 

 amongst preventable diseases. Nothing is more lament- 

 able than the carelessness with which a phthisical patient 

 is allowed to spread infection broadcast by the sputum, 

 and though public opinion is not yet ripe for the question 

 of seclusion of cases of consumption, much might yet be 

 done by educating patients to disinfect the sputum and 

 use reasonable precautions against the infection of mem- 

 bers of their families. The diffusion of tubercle by means 

 of domestic animals and especially by milk is enforced by 

 Mr. Russell, and attention is drawn to the general sanitary 

 measures such as drainage and ventilation which have 

 already reduced its mortality in this country. 



In the chapter on diphtheria mention is made of the 

 recent researches of Klein and others showing the con- 

 nection of this disease with a certain disease in cows and 

 in cats. The author has drawn also on Dr. Thome 

 NO. 1 192, VOL. 46] 



Thome's recent Milroy lectures, but he has hardly laid 

 sufficient emphasis on the aggregation of children in 

 schools as the main cause of the late increase of urban, 

 as compared with rural diphtheria mortality, a point to 

 which Dr. Thome draws especial attention. 



The section on influenza is based on the most recent 

 observations, and even contains in a note some account 

 of Pfeiffer's and Canon's influenza bacillus. Exception 

 must be taken to the statement that this organism is pre- 

 sent in immense numbers in the blood. In the sputum 

 it is extremely abundant, but in the blood, as a rule, only 

 in the scantiest numbers. 



Scarlet fever and small-pox have each a comparatively 

 short chapter devoted to them. That on scarlet fever 

 contains mention of the so-called " Hendon disease " in 

 cows, to which the extensive outbreak in the north-west 

 of London in 1885 was traced, and a good practical 

 epitome of the precautions to be observed in the sick 

 room. In the section on small-pox vaccination statistics 

 are given, but we find no reference to the elaborate Local 

 Government Report by Dr. Barry on the late Sheffield 

 epidemic, which contains a mine of information on the 

 most serious outbreak of small-pox in England in recent 

 years, and should certainly have been noticed. The 

 spread of the disease by aerial diffusion from small-pox 

 hospitals is clearly illustrated. 



Typhoid fever receives long and thorough considera- 

 tion. Mr. Russell accepts the " typhoid bacillus " of 

 Eberth, Klebs, and Gaffky as the true virus of the disease 

 — a conclusion which is far from settled in the minds of 

 many, inasmuch as the true lesions of the disease have 

 not been reproduced by it. But this does not affect the 

 questions at issue. The ordinary method by which the 

 disease spreads, viz., excremental pollution of drinking 

 water, is abundantly illustrated by numerous examples, 

 and the contamination of milk is likewise mentioned. 

 The thorough disinfection of typhoid dejecta is clearly a 

 matter of the first importance, and a sound practical 

 method of accomplishing this is much to be desired ; at 

 present it must be admitted that no adequate means 

 has been devised. 



Amongst the numerous other diseases which Mr. 

 Russell has treated of, we are glad to notice that pneu- 

 monia finds a place ; it is undoubted that some forms at 

 least of inflammation of the lungs are infectious and pre- 

 ventable in the same manner as other specific fevers. The 

 claims of rheumatic fever, which has also been included, 

 to a similar position, are to say the least doubtful. 



In the concluding chapters of the book, Mr. Russell 

 deals with more general problems, such as susceptibility, 

 immunity, the distribution of microbes, the origins of 

 epidemics, and so forth. Gathering his evidence from 

 various sources, he deals with these matters in a very 

 impartial way. Thus in discussing immunity, while ac- 

 cepting provisionally the doctrine of phagocytosis, he by 

 no means regards it as the only means by which micro- 

 organisms are eliminated from the body. The germicidal 

 powers of the fluids of the body receive due consideration 

 as at least an equally important defensive agency. The 

 scheme of a National Health Service is discussed in an 

 appendix. 



Mr. Russell is to be congratulated on the service which 

 he has done to Public Health by the collection of this 



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