KEYIEWS. 
409 
Indies. That is to say, first there is diarrhoea, which is painless but copious ; 
then pain, vomiting, cramps of the extremities, sinking of temperature, blue- 
ness of skin, collapse and death. It is to be noticed that these Reports 
include those both of the civil and military services, and that the latter is 
infinitely the most lucid, full and scientific. There is also in this volume a 
valuable notice of previous epidemics, from the time of Hippocrates (b.c. 
460-370) down to the year 1873. We note also an important series of maps 
and plans, by which the reader is greatly assisted in arriving at his con- 
clusions. But perhaps the most valuable part of this American Report is the 
portion devoted to bibliography. This has been carefully edited by Mr. J. 
S. Billings, and extending as it does over more than 300 pages, includes, 
in alphabetical order, everything that has been written on the subject since 
it began to have any literature connected with it. This one feature will 
make it a treatise that must be referred to by all writers and readers on the 
.subject of cholera. Indeed this Report is a most thoroughly creditable one. 
Of Dr. Macnamara’s work — which is in some respects quite a different one, 
having to do rather with the origin both as to locality and nature of the 
•disease — we have not the less highly to speak in praise. It is a work which 
the author has addressed to the educated lay reader as well as to the physi- 
cian, but we fear the number of persons outside the medical world who are 
interested in cholera is extremely small. However, the book is of import- 
ance to all who consider the question, How is this plague to be arrested P 
And we are glad to see that Mr. Macnamara holds distinctly to the theory 
that cholera is only communicable through the swallowing of some portion 
of the discharge which has come from a patient suffering with the disease. 
Thus he believes — as we and nearly all rational physicians do — that the 
•disease is not by any means infectious, and that it is not contagious in 
the ordinary sense of the word. He believes, then, that it is conveyed 
from town to town, and from country to country — in point of fact, from 
Bombay to New York — by the medium of water. Of course ships may 
not have their water infected — though there are undoubted cases cited 
from the Crimean war, in which the water was the means of convoy — 
but then the disease has not had time during the voyage to die out, and 
thus cases are brought to the different intervening ports — let us say, 
between Bombay and London. And the author deals exhaustively with 
the many theories that have been, from time to time, put forward. To 
-account for the propagation of the malady thus, he deals very fully with 
the influence of winds in spreading the disease j and he shows, in the most 
•conclusive way, that the atmosphere has no agency whatever in the 
distribution of cholera. In a similar manner he treats the subject of 
food and meteorological influences, as heat, fog, &c., and he shows that 
they have no influence over either the origin or the spread of this fearful 
affection. 
We think that Mr. Macnamara has, on the whole, gone too fully into 
the several courses that cholera has taken from time to time, for we 
are of opinion that a very brief abstract would have been amply suffi- 
cient. We note also that he has said almost nothing as to the primary 
source of the fungus — for fungus it undoubtedly is which originates the 
malady — and we think that Dr. Lewis has already done some good work 
