THE CLIMATE AND HYGIENIC STATE OF MALAGA.

20

Bristowe, who had been appointed by the Royal Commission absolute identity of rinderpest and variola, but he thought the

investigate the phenomena of the disease. The eruptivee resemblances in every particular so striking as to call for being thus established, the next and most important experiments on an extensive scale. If vaccination prevented point was to determine its nature. The present case was an or modified an attack of rinderpest, then we not only would important link in the chain of evidence. Mr. Rayner, of Ux- know what was the essential nature of rinderpest, but we bridge, who first saw the case, Prof. Spooner, Dr. Murchison, would have certain means of preventing what appeared to be and Mr. Ceely, who, with himself (Dr. Quain), saw it in dif- an incurable disease.

to

character

ferent stages, had all been struck with the very close resemblance which the eruption in this case bore to that of vaccmation. It only differed in the duration and (so to speak) the exaggerated character of the vesicle-facts which may in some measure be accounted for by the character of the infection. The case itself had given a decided impulse to the investigation, and had led to the very valuable communication on the probable Identity of Small-pox with Cattle Plague published by Dr. Murchison in THE LANCET. Dr. SANDEBSON exhibited a specimen showing the changes which are observed in the mucous membranes of the lips, gums, and cheeks in cases of rinderpest. He stated that, in seven cases of this disease in which he had watched the eruption from the very commencement, the alteration in question occurred before any constitutional symptom indicating disturbance of health was manifested, with the exception of elevation of temperature. The earliest change observed consists in the formation on the gums of minute granulations or nodules scarcely redder than the surrounding surface. Gradually these nodules enlarge into patches, becoming at the same time softened in their centres, and assuming a greyish-yellow colour. Having arrived at this stage, they either separate spontaneously, leaving a red and bleeding surface, or remain attached. In the latter case they assume an appearance, especially if they become confluent, which reminds one of diphtheritic concretions, with which, however, they have no real analogy. On microscopic examination, the nodules are found to consist at first entirely of epithelium. But the

THE VENEREAL DISEASES COMMITTEE. THE statement that this Committee intend to recommend that the abrogated order for inspecting soldiers periodically for venereal disease should be put in force, is inaccurate. Evidence has been given as to the good effects of this system in the Guards &c., and that evidence will of course appear; but the Committee have not made any recommendation of the nature described, although no doubt can exist of its value in the prevention of the spread of the disease. It is important that this should be understood by the army medical officers especially, amongst whom the order, when existing, was, unfortunately, very unpopular; the more necessary because a medical officer of high official standing in the army is a member of the Committee.

Correspondence. "Audi alteram partem."

patches or concretions, although consisting superficially of THE CLIMATE AND HYGIENIC STATE OF epithelium, exhibit in their deeper layers nuclear corpuscles MALAGA. only. Still later the whole presents the appearance of granular To the Editor of THE LANCET. detritus, in which numerous nuclei are visible. The alteration of the papillae is the same in nature, although different in apSIR,—My attention has recently been directed to a letter pearance. They always exhibit red patches, either at their from Dr. Shortliff, of Malaga, which appeared in your journal or their on near careful are bases, which, examination, apices found to be produced by the separation of the epithelium and of Nov. llth. In this letter Dr. Shortliff complains rather exposure of the subjacent vascular layer. Dr. Sanderson re- bitterly of my stating, in my recent work on Winter in the marked that these lesions were not only interesting as illus- South of Europe," that Malaga is not a healthy city, and that trating the real nature of the cutaneous affection, with which it is decimated by cholera, fever, and dysentery. they have a close anatomical resemblance, but above all in relation to diagnosis. He had met with them in the mildest as Considering that Dr. Shortliff, as he tells us himself, has well as the most severe cases of rinderpest, and as distinctly resided and practised more than thirty years in Malaga, I am in the sheep as in the bovine animal. not much surprisecl that such a statement respecting the city Prof. GAMGEE expressed his agreement in Dr. Sanderson’s in which he has passed his life should startle him. I believe, views. He called attention to the fact that the cutaneous erupthat he will find it difficult to demonstrate the saluhowever, tion is by no means constant in the cattle plague, though the lesions of the intestines are so; and he also dwelt on the ana- brity of Malaga. In his early days the hygiene of cities was tomical differences between the eruption in this disease and but little studied, or thought of even, by the most eminent that in small-pox, and on the fact that the progress of the medical men, and the principal diseases which ravage them eruption is no test of the progress of the disease in cattle were not traced, as they now are, to defective hygienic conplague, as it is in small-pox. He also cautioned the Society as ditions. Nor is a prolonged residence in a large southern to drawing conclusions from dissecting wounds in the lower animals, illustrating this caution by his own experience and city, where hygiene is as yet all but unknown and uncared that of others from inoculation in delivering a cow. The ap- for, calculated to remedy this deficiency of early education. pearances presented by the gentleman exhibited to the Society Thus, although convinced that Dr. Shortliff is sincere and he believed to be by no means uncommon. believes Malaga to be salubrious, I do not by any means Dr. MURCHISON agreed with Dr. Sanderson that the eruption of rinderpest differed from that of human variola in some accept his assertion as proof that it is so, especially as it is in particulars, and more especially in the fact that there was no direct opposition to positive evidence to the contrary. vesicular stage. The differences, however, he thought, could Indeed, Dr. Shortliff confesses that Malaga is not a healthy be accounted for by differences in the skin of cattle and men. city, without seeming to be aware that he does so, when he It was not merely in the cutaneous eruptions that the two naively states, as a proof of its salubrity, that there have only diseases resembled one another. Their general symptoms and been five epidemics of cholera since 1832, when it first appeared anatomical lesions closely corresponded. Even the remarkable in Europe. I would ask how many more than five there havee ecehymoses and gangrenous patches found in the fourth sto- been in the densest and most unhealthy centres of European machs of cattle that had died of the plague had also been population ? It is a well-known fact that cholera has constantly found in the stomachs of human beings who had died of un- chosen the most populated and most unhealthy cities in which modified small-pox. It was well known that in many parts of to exercise its ravages, and the fact of five epidemics of cholera the world, and particularly in India, a malignant form of having occurred in any locality during the thirty-three years small-pox prevailed among cattle. The question came to be, that have elapsed since it first appeared in Europe must be fatal to a reputation for exceptional salubrity. was this actual small-pox or a different disease, "rinderpest ?" As to this claim for exceptional salubrity advanced by Dr. That it was small-pox had been shown by the fact that children inoculated with the poison had either died of small-pox or Shortliff, let us listen to the most recent writer on the climate contracted ordinary vaccinia. If rinderpest were not variola, of Malaga, Dr. More Madden, in his pamphlet entitled"The then there was no such thing as malignant small-pox in cattle Climate of Malaga in the Treatment of Chronic Pulmonary in Europe, although this form of the disease was so common in Disease. Dublin, 1865." At page 18 Dr. Madden says very India. Dr. Murchison was not yet prepared to maintain the graphically and explicitly :.

"

21 " The hygienic condition of Malaga is as defective as it can with the poison of rinderpest, and where the result was somewell be. In a great many of the houses there is no provision thing closely resembling a vaccine pock. I stated that the for sewerage of any kind ; and even in the more civilized part case had been pronounced to be vaccine pock by a surgeon in of the city, in the hotels on the Alamedu, the drainage is very the country. The name of the surgeon had escaped me, and The main sewers, which run under the principal I was unable to ascertain it at the time, as my paper was bad indeed. streets, are choked up by the decomposing accumulation of written in great haste, in consequence of a summons to go years, and being provided with immense square openings, some distance into the country. I have since learned, and I through which the dirt and rubbish is thrown into them, in have now much pleasure in stating, that it was Mr. Rayner, of the centre of the streets, the mephitic gases evolved below Uxbridge, who first saw the case in question, and recognized freely escape into the atmosphere of the narrow lanes of the ’, its great importance. Mr. Rayner sent the patient to London, city. The bed of the Guadalmedina is really the main sewer where he was first seen by Professor Spooner, of the Royal of Malaga ; and as for nearly ten months annually it is little Veterinary College, who formed the same opinion, and forI may add that the patient more than a wide dry bed of gravel, being dependent on the warded the patient to Dr. Quain. torrents in winter for its puriiication, the odour it exhales in is Mr. Hancock, one of the Government Veterinary Inspecwho has taken great trouble to make his case available for warm weather renders a residence near it as disagreeable as it i tors, the purposes of science. is unhealthy. "The connexion between epidemic disease and bad sewerage At the instance of Dr. Quain, Mr. Hancock exhibited his is, I think, very well illustrated in Malaga, which has at hand at the Pathological Society on Tuesday evening, and the all times been remarkable for the prevalence of zymotic members of the Society had the opportunity of comparing the disease. I have collected from the older Spanish writers notices appearances with those of the true vaccine pock as depicted by of no less than twenty-two epidemic pestilences, some of Mr. Ceely. The progress of the disease has confirmed my original and has convinced some authorities who first doubted which almost depopulated the city, between 1493 and 1804. The earlier of these seem to have been epidemics of genuine its close analogy to cow-pox. I have had many communications during the week from oriental plague, and the latter generally assumed the form of yellow fever. Of late years, since 1834, these pestilences have medical men in the country, offering to carry out the suggesnot appeared, but their place has been taken by Asiatic tions made in my paper, and requesting me to furnish the writers with vaccine lymph. The supply of the material, cholera, which has several times ravaged the town." It must be remembered that the above most inviting The applicaseems to be unequal to the demand. description of Malaga is written by the author of a recent tions which I have made have hitherto been unsuccessful. work on climate, who, after travelling all over Europe to find The National Vaccine Institution is, 1 believe, overwhelmed the best winter sanitarium for the consumptive, agrees with with similar applications, and has not the necessary funds to Dr. Shortliff in fixing on this most salubrious town as the enable it to meet the present emergency. Medical men will sought-for Eldorado. So that this chosen European habitat, be doing good service in this inquiry by obtaining fresh supin former and present times, of the plague, yellow fever, and plies of vaccine lymph ; and if no other opportunity of turning cholera, is to be selected to restore the health of our poor it to account present itself, I shall be glad to take charge of it countrymen and women, already debilitated by disease, con- for the benefit of my correspondents. In the meantime it would be very desirable to obtain austitutionally broken down, and a prey to an organic malady. Surely, as I have repeatedly stated, it is mere wanton trifling thentic particulars of cows that have recently suffered from with human life to send such sufferers, with a view to the ordinary cow-pox, so that there might be an opportunity of recovery of their health, to winter in large, filthy southern purchasing them, and ascertaining whether they be proof towns like Rome, Naples, and Malaga, foci of malaria and against the poison of rinderpest. T remain Sir your obedient servant of epidemic and zymotic diseases. Does not the simplest CHARLES MURCHISON, M.D. common sense tell us that invalids, with the seeds of death in Wimpole-street, Jan. 1866. them, should not be located for months in the centre of towns where even the healthy cannot live, and die annually at the To the Editor of THF LANCET. rate of thirty or more in the thousand ? Singularly enough, I believe I am the first, and as yet the only writer on climate, who SIR,—The opinion expressed in the last number of THE has recognised and forcibly insisted on the all-important and LANCET that cattle plague will probably turn out to be a self-evident fact that consumptive patients should reside, win- modification of that most preventable of fatal diseases, small’ter or summer, in England or abroad, where they can breathe pox, has been received with great satisfaction by the public, pure air night and day-that is, in the country, in healthy both medical and general. Most earnestly do I hope that your villages in the healthy outskirts of towns. Their breathing is more than a of air of few anticipations may be realized. Experiments are now in proinfinitely degrees pure importance temperature more or less, or a little more or less protection gress under the direction of the Experimental Committee of from this or that wind. A fact so consonant with modern the Royal Commission, which I trust will soon set the quesphysiology and pathology has only to be brought forward to tion at rest ; and it is reported that other investigations are be universally acknowledged, and the time is near when medical men will wonder how they could ever think of cooping up being made by independent observers. So long ago as last November a plan had been submitted to their patients in unhealthy southern towns for the sake of Better far that they should stay at home than the Committee by Mr. Ceely for the experimental determinamere warmth. purchase exemption from the cold of our climates by exposure tion of the question whether or not vaccinated animals are to hygienic conditions which produce, as a matter of course, in liable to cattle plague, and whether animals recovered from successive generations, plague, yellow fever, and cholera. In conclusion, I would assure Dr. Shortliff that I have read cattle plague are capable of being infected by small-pox, or and it was then determined that the nearly all that has been written on Malaga, that I have con- successfully vaccinated;should be performed as soon as posversed with and treated many who have long resided there, necessary experiments In out these sible. investigations carrying great difficulties and that I have the highest opinion of the mere climate of the region in which Malaga is situated. Indeed, were there have been met with in obtaining suitable animals and suitable the ressource of suburban villas in healthy localities, as at Nice, places for their reception during vaccination or inoculation, as as for their exposure to the infection of cattle plague. Cannes, and Mentone, perhaps I might now have been his well These difficulties, however, have now been overcome, so that and the of winter instead neighbour fellow-practitioner, being there is a good prospect of the definitive settlement of the M.D. of a village on the Riviera. question. I remain, Sir. vour obedient servant, With these preliminary observations I wish to call your HENRY BENNET, M.D. Mentone, Dec. 1865. attention to some statements contained in Dr. Murchison’s article as to the resemblances between small-pox and cattle plague, with which the results of my own observation do not THE POINTS OF RESEMBLANCE BETWEEN allow me to concur. I deem this to be important, not with RINDERPEST AND SMALL-POX. reference to the question whether or not cattle plague is identical with small-pox, but merely for the sake of scientific To the Editor of THE LANCET.

opinion,

however,

SIR,—In the communication

on the above subject which in did me the favour to you publish THE LANCET of last week, I mentioned the case of a person who had been inoculated

accuracy.

During the last month I have had opportunities of carefully observingthe appearances presented by the cutaneous eruption in all its forms, and have watched them with all the attention of