Brian Altonen, MPH, MS

NOTICE!!

A Survey has been developed to document and compare GIS utilization in the workplace.  This survey assesses GIS availability and utilization in both academic and non-academic work settings.  The purpose is to document the need for GIS experience as an occupational skill.   GIS is currently being underutilized by most companies.  Spatial Technician and Analyst activities and a few managerial activities requiring GIS are reviewed. 

 This survey, which takes about 20-25 mins to complete (’tis a bit long),  can be accessed at

 Survey Link

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Introduction

John Hennen’s “Memoirs on Medical Topography” is perhaps the most important classic in this field if disease ecology and medical geography.  Hennen wrote extensively about the geography of diseases by focusing on every aspect of natural and human history that a given region could possess.   The theory for disease during the time of Hennen’s most productive years focused on evey aspect of nature and man trying to better understand how many of the different illnesses arise and why some of them only arise under certain climatic and topographic conditions. 

John Hennen’s other writings to review include the following.  The Advanced search terms for Google Books used to find some important references were: Medical Topography Map, Hennen, for 1760-1835 time period.

Sketches of the Medical Topography of the Mediterranean; comprising an Account of Gibraltar, the Ionian Islands, and Malta: to which is prefixed, a Sketch of a Plan for Memoirs on Medical Topography. By John Hennen, M.D. F.R.S.E. Inspector of Military Hospitals, &c. Edited by his Son, J. Hennen, M.D. Mem. Royal Med. Society, Edin. &c. 1830.

Rapport  du Comité consultatif: Report of the Advisory committee By International Financial Conference, League of Nations.

An interesting related writing on the history of medical topography also appears in Google Books, it is Art. III.—A Concise View of the Progress of Military Medical Literature in this Country; being a Chronological Arrangement of Authors, with Critical Remarks on their Works. By James Irving, M. D. (Concluded from Vol. lxiv. p. 389.). Edinb. Med. Surg. Jl. vol. 65, pages 34-49.

EDINBURGH MEDICAL AND SURGICAL JOURNAL.

1, APRIL 1821.

PART I.  ORIGINAL COMMUNICATIONS.

 [Note to reader:  Author’s footnotes normally appearing at the bottom of the page are in light gray text.]

I.  Sketch of a Plan for “Memoirs on Medical Topography.”

We now proceed to redeem the promise made in the 65th  number of this Journal, and offer to the consideration of our readers a plan upon which it appears to us that the medi­cal topography of a town, a district, or a country, may be ad­vantageously drawn up. That in preparing this outline, we have either exhausted the subjects of inquiry, or even that we have indicated them all, we are very far from supposing; but we trust it will be found that few points have been entirely omitted which are essential to the medical topographer; and we are convinced that, taking the present hints as the basis of his inquiries, he may render important services to science in ge­neral, while he materially assists himself in attaining a know­ledge of external circumstances which exert considerable in­fluence upon the health of those among whom he may exercise his profession. *

*We take this opportunity of noticing an omission in the article on the “Medical Topography of Canada,’ which has called forth the present sketch; we allude to a paper by Mr Royston, in the Medical and Physical Journal VOl. XXI. which should have held a prominent place in our enumeration of British authors.

VOL. XVII. xo. 67.                               L

We shall divide our objects of inquiry into four general heads, and these, again, we shall subdivide into specific sub­jects. Under the first head we shall include the Physical Geography of the place to be described, comprising notices on its botany, mineralogy, and natural history. The second head will refer to the Inhabitants, including an account of their food, habitations, customs, &c. Under the third head will be classed such subjects of inquiry as are connected with Diseases whether endemic, epidemic, or sporadic; which appear under the form of epizooties among the lower animals; or which affect the pro­ducts of vegetation. To the fourth head will be referred mis­cellaneous objects of inquiry, or such as could not be so well arranged under any of the preceding. Many of the subjects are so closely connected that they fall under more than one bead, and they will be treated most in detail in that division of the subject under which they seem most naturally to range themselves.

I.    The Name……the Latitude, Longitude, and Boundaries.-These heads require little or no comment. If the places to be described is extensive, it will be necessary to note whe ther the situation is insular, or a part of a continent. If it is only a small district or town, it will be necessary to state what distance it may be from the sea, and what elevation above it; what distance it may be from the metropolis, and the modes of communicating with it.

The Seas—the Rivers—the Lakes—the Wells—the Morasses–the Bogs, and the Canals.—These are points upon which the topographer should bestow considerable attention, as they so materially affect the dryness or moisture of a country. rrhe nature of the deposits, animal, vegetable, or mineral, which are left by the waters, should be accurately ascertained; as on them, especially in warm countries, the most important conse quences depend. The height to which the tide may rise in a river, as well as the rapidity or sluggishness of the stream, will materially affect these depositions, while the physical features of its banks, and the tortuosity of its meanders, will possess consi derable influence by concealing or exposing them to the soil and the winds; hence also the depth of the waters, the soil through which they flow, or in which they stagnate; the height of the banks, the materials of which they are composed, the shelter which they afford, the nature of that shelter, whether of sedge, underwood, full grown timber, or rock, should all be pointed out, and the accidental or periodical accumulations of filth or alluvial materials which pollute or enrich the stream, should be described. The inhabitants of the. waters, as well as their vegetable products, become incidentally an object of inves­tigation as they may conduce to the nourishment or the de­struction of man; and, as many of them fix their” habitat” in waters peculiar for their rapidity, their clearness, or their slime, their presence may often distinctly mark the existence of such peculiarities The surface for evaporation presented by the canals, the rivers, and other masses of water; the aid which they may contribute to the drainage of a country; the facilities which they may afford to agriculture and commerce; and the btncss of their waters for culinary purposes, are all objects of investigation. The state of the subterraneous moisture should be inquired into; and this is frequently demonstrated in low marshy countries, as Zealand, by the state of the wells, which are fed by the subterraneous water with which they are on a level. Indeed, the comparative healthiness of the villages in the Netherlands is easily ascertainable by the inspection of their wells, the waters in which sink in proportion to the droughts of summer, and afford a proof of the constant exhalation of con­cealed moisture. * The nature and effects of those exhalations which arise from low muddy beaches should be specially inquired into, and no opportunity should be lost of ascertaining a point which seems not yet to be perfectly agreed on, viz, how far the admixture of fresh water may accelerate or retard the corruption of the animal and vegetable materials deposited upon them. t

The Mountains—Their height, extent, and general direc­tion; the snows with which they may be covered periodically or throughout the year; the rivers or streams which may arise in them; the forest timber, plants, and minerals with which they may abound; the passes through them, and the influence they may exert over the currents of the winds; the interjacent vallies, and the state of their temperature, compared with that of the surrounding elevations, should all be noted.

The Climate.—A complete system of meteorology is not on­ly unnecessary for the purposes of medical topography, but is of such difficult execution that the life of man seems inadequate to effect it; it is absolutely necessary, however, that some of the leading facts connected with the physical characters and

[Footnotes] [1]  Pringle, Diseases of the Army, Chap. 1. Part I.  Vide Lancisi De Nox.. palud. effluv. Lib. I. P. I. Cap. 5.  [2] In general for every 200 feet of elevation one degree of decreased tem­perature may be expected. The effects of the funnel-shaped chasms in the Ghauts of India, in tempering the heats of that country, are most remarkable.

medical effects of the climate should be given. The steadiness or mutability of a climate is a physical property which seems more to influence the health of man than either its heat or its cold, abstractedly considered; and a knowledge of this can only be acquired by long and correct personal observation, or by averages drawn from the observations of several preceding years. Dr Chisholm has given us a very good idea of the ch. mate of Bristol and Clifton by an average table of the number of wet and dry days for a period of fourteen years together, with an account of the prevalent winds upon the same principle. Dr Clarke also has given us some good views of the temperature of Nottingham. * In whatever mode the topographer may choose to proceed, he should give accurate accounts of the high est, lowest, and medium states of the thermometer, barometer, and hygrometer, for two or three years at least, together with an account of the prevalent winds, and the occasional fogs, meteors, hurricanes, &c. It must be observed, however, that nothing can be more jejune and uninteresting than a protracted enumeration of the daily variations of the atmospheric temperature, weight, and moisture, or of the different shiftings of the winds, if the person who describes such occurrences does not deduce from them some practical information, by marking the effects which they produce upon the health of man and upon the face of nature. Hence it is that many of those volumes which have cost their authors the minute labour of years to compose, lie so often unconsulted amid the lumber of the li­brary; but if to the changes of the state of the atmosphere is added an account of the manifest influence which they have exerted on the health of those who were previously well, or on the diseases of the sick and convalescent,—then an otherwise trivial piece of information is converted into an interesting and an instructive fact. In like manner, if any particular state of the weather has a marked effect upon vegetation, it may conse­cutively produce a very powerful influence upon the health of the inhabitants of the district where it has prevailed. Upon the whole, while the medical topographer should by no means neglect minute and regular observations upon the changes of the weather, he should consider them not as a primary object of research, but should view them as merely subservient to the great purpose of explaining the origin and progress of disease; and it is by comparing the cause and the effect together, and repeating the comparisons faithfully and frequently, that region­

 * Ed. Med. and Surg. Journ. Vols. V. VI. and XIII.

 the weather can ever be made available to useful pur­poses; or, as it has been happily expressed by a contemporary journalist can illumine that darkness of conjecture, reconcile  that contrariety of assertion, and reduce to a rational system that facility of belief which has so long existed upon atmosphe­rical influences.” These comparisons should be fully stated in detail, for few readers will stop in the course of their perusal to refer to an appended weather table, and wade through the slow, dull, and dubious process of comparing degrees of the thermome­ter and the anemoscope, with the variations of health. These records lose their utility and their interest by separation, and it is in vain to deny, that the most faithful recital of facts will often fail to make any impression, if they entail on the reader extraordinary and monotonous labour.

There are such a multiplicity of forms for registers of the weather, that the topographer can be at little loss in selecting a model, or in procuring from the observatories of large towns correct and satisfactory details; but it would be extremely de­sirable that the degrees of the thermometer in the sun, to which the labouring classes are so much exposed, should be occasion­ally stated; and it should also be kept in view, that, if the ob­servations are made uniformly at the same hour of the day throughout the year, the atmosphere will have felt the influ­ences of that planet for a much longer period at some seasons than at others, previous to registering the height of the mercury. In detailing the state of the winds, it will be of essen­tial importance to describe what tracts of land or water they blow over, and how far these may influence the deposition or absorption of heat and moisture, may alter the direction and force of their currents, or may affect the exhalations which they import or carry off; extensive tracts of forest will greatly modify ihe effects of the wind, and even a comparatively small num­her of trees will act as a check on healthful ventilation, or will Intercept the baneful miasmata of marshes. The ordinary ef­fects of the atmosphere on inanimate substances should be no­ticed; in some districts all polished metal speedily rusts, and the existence of saline particles in the air is inferred in others, by the remarkable fading of those dyed stuffs which require acids to fix or heighten their colours.* Some peculiar states of the atmosphere have been observed to precede certain epidemic affections; thus, Dr Rush states, that substances painted with white lead, and exposed to the air, have suddenly assumed a dark

 Chalmers’s Diseases of South Carolina, Vol. I. p. 11.

colour, and that a smokiness or mist in the atmosphere has ge­nerally preceded a sickly autumn in some of the American states.* Although we are ignorant of the causes, we know that the long prevalence of certain winds frequently predispose the living bo- dy to disease; the effects of various winds are also remarkably displayed in the phenomena observable on trees and buildings. In the American forests, the bark on the north side of a tree uniformly thickens, and the northern side of a brick building is said to be much more difficult to pull down thau that of any other aspect. In our own country, buildings of certain species of stone ooze forth moisture, or effloresce in those points where they are exposed to particular currents of wind. In all times, certain winds have been observed to produce de­leterious effects on wounds and ulcers; these effects have pro­ceeded from the south winds in some countries, from the east in others; at Gibraltar, such was the deleterious effect of the latter wind upon the wounded after the battle of Algiers, that the Leander left that station without waiting for her supplies,— a privation which was amply compensated, by the improved state of the invalids, so soon as they were removed. In our own country, certain seasons are more productive of buboes than others, and under certain states of the atmosphere, not yet clearly understood, both these and all other venereal sores take on simultaneously a malignant character. The effects which the climate produces, or is supposed to produce, in the alleviation of certain diseases, as phthisis, syphilis, hooping­ cough, &c. should be distinctly and fully described, while, at the same time, those complaints in which it proves manifestly injurious, or where it retards convalescence, should likewise be mentioned. These points will also come to be more fully considered under the head of Diseases.

The Soil.—It will be of great importance to describe the ge­neral nature of the soil, and its elevation above the adjacent seas or other waters, and to particularize those properties by which it may favour the retention or the transmission of water, either at the surface or at a distance from it. With this in view, it will be necessary to state the proportions of pasture, arable and wood land, and whether the soil is alluvial, rocky, gravelly, clayey, sandy, &c. while the stratification or intermixture of all these materials, as far as they have been ascertained, should be mentioned. The periods of the year at which noxious ex

~ Rush’s Works, Philadelphia, 2d Edition. Vol. IV. p. 174.

+  Quarrier, in Med. Chir. Trans. Vol. VIII. p. 7.

halations arise from the soil in greatest abundance, will become an important subject of inquiry; at the same time, it will be necessary to investigate the extent to which evaporation may bave proceeded when these exhalations become most deleteri­ous. That they most abound when the waters are nearly or quite expended, has been observed by able physicians, and they have also endeavoured to account for it, by supposing, that the sun’s rays then penetrating the miry soil, exalt vapour which had been long pent up, and may be supposed to have contract­ed vicious qualities, or become concentrated from having re­mained undisturbed by the wind. Whatever may be the cause, it is certain, that, in many countries the malaria does not arise until all the surface water has totally disappeared, and leaves the whole face of the country, including the very courses of the winter streams, an arid desert.*

The Vegetable, Animal, and Mineral Products of a country have a powerful influence over the health of the inhabitants, and should be examined under the various points of view in which they may contribute to their food, their clothing, their warmth, and their domestic comforts; or as they may promote or retard these in a secondary way, by influencing population and manufactures, favouring the influx of new inhabitants, in­troducing new modes of living, or becoming subservient to the operations of commerce. In countries which abound in cer­tain vegetable products, the effects of moisture and putrefac­tion are often found seriously to affect the health; of this the cul­ture of rice and various other plants are striking examples. The rearing of certain animals, as the silk worm of Lombardy, and the Merino flocks of Spain, considerably affect the face of the country, and give a new character to the natives. The perio­dical visits of certain birds, fishes, and even insects, prove most seasonable articles of supply in some instances, or are de­structive to comfort and life in others. The presence of ex­tensive mines is marked with peculiar features by the hand of nature. Among the more prominent instances of this may be mentioned the gold and silver districts of Peru, the quicksilver mines of Almaden, and those of lead and tin in our own coun­try, where external poverty and desolation reign; while the presence of coal, wherever it is wrought, is the sure forerunner of a crowded and manufacturing population. The early ap­pearance of many plants, and the slowness or rapidity of their

* See Chalmers’s Diseases of South Carolina, Vol. I. p 6. Fergusson, Med. Chir. Trans. Vol VIII. p. 132.

vegetation, tile torpidity, arrival and departure of many qua­drupeds, birds, and insects, will often mark more strongly than the indications of the glass, the nature of a climate; and the judicious naturalist will avail himself of the circumstances in his topographical description. Strong indications of the health­fulness of a country may be drawn from its plants and animals, and the approach of unhealthy seasons has often been marked by the changes produced on them. In America the common house fly has disappeared, while musquitoes have been multiplied, and several new insects have been observed previous to some of their malign ant epidemics; and, at similar periods, certain trees have emitted unusual smells, the leaves of others have fal­len prematurely, and the fruits have been of inferior size and quality; while, in some places, an unusual growth of vegetable productions (fungi) has preceded the most destructive scourges of mankind.

To give a complete medical topography, all the products of the district, whether poisonous, edible, medicinal, or employed in the arts, should at least be enumerated, and should be particularly investigated as far as they may immediately affect the health of man. Among the various products, those which are appli­cable to medical purposes should be specially described, and this, whether they enter the established pharmacopoeia, or are employed as succedanea by the regular. practitioners, or as spe­cifics by the inhabitants or by empirics. Tile most approved modes of preserving and preparing them should be fully detail­ed, together with their doses and sensible effects. In this enu­meration, the mineral waters will claim peculiar attention; the complete analysis of these should be given, or at least such ex­periments should be made upon them as may serve to point out the most prominent articles with which they are impregnated, at the same time should be mentioncd the articles with which they are adulterated, improved, or imitated at the spring, or at more distant places. The temperature of thermal waters will of course be mentioned, together with the effect which their external application produces, or is supposed to produce, upon tnose who have recourse to their aid. Saline springs not used for medicinal purposes, or mines of rock salt, alum, &c. whe­ther wrought or unwrought, will be well deserving of notice.

The State of Agriculture.—This has a manifest and power­ful influence on the health of the inhabitants of a country, and should therefore he fully considered, and not only are the im­mediate effects of cultivation of importance to be known, but it will be also necessary to inquire into the effects of such after­processes as are ascertained or suspected to be unhealthful, especially where the putrefaction of the substances treated is a necessary part of them, as the preparation of flax, &c.

The State of the Roads and Communications.—The facilities of communication are of such essential importance to the come fort and health of the inhabitants of a country as to deserve being distinctly noticed.

A map of the places described will greatly enhance the value of a topographical description; nothing more will be necessary except a simple outline of the boundaries, of the direction of the mountains and rivers, and of the situation and extent of the forests, lakes, morasses, bogs, &c. A sketch of the stratifica­tion of the soil would also be a valuable addition to the view of its surface.

11.—The Population.—The aggregation of large masses of human beings produces effects so important upon their health as to become a special object of inquiry to the topographer; he should, therefore, endeavour to obtain the most correct state­ments within his power. If, in a country parish or district, he should compare the numbers of inhabitants with the space over which they are spread; and if in a town or city, he should ascertain the bounds within which they are pent up, and how far the evils of confinement are aggravated or relieved by vari­ous external circumstances, of which the following are the most important.

The Dwellings.—In describing the dwellings the medical to­pographer should notice the exposure, the soil on which they are founded, their elevation above it, the materials of which they are built, the mode in which they are finished, especially as concerns their dryness, their warmth, and their ventilation, and the facilities afforded to the inhabitants for preventing or removing accumulations of filth. Under this view will come to be examined the nature and extent of the cess-pools and sewers proceeding from the houses to the common receptacles of filth, and, above all, the conveniences for the reception of human ordure. It is a fact well worthy of attention, that the inhabitants of those buildings which are run up in a slight manner at the back of a row, and exposed to the efiluvia of privies, have been found most susceptible of the contagion of typhus fever. The average number of inhabitants in each dwelling, the cubical contents of their rooms, and the number and direc­tion of the means of ventilation, should be ascertained with a view to show how far they may enjoy the advantages of a free

 Ferriar, Medical Histories and Reflections.

circulation of pure air. Much sophistry and much special pleading have been employed to invalidate the opinions of those who hold that the effiuvia arising from the human body in close and crowded situations are productive of contagious diseases; but the facts collected upon this point appear to be incontrovertible.

The mode in which the streets are laid out, their width or compactness, their pavement, their drainage,* their exposure to the sun and to the wind, are considerations of much import­ance. The difference of a few paces may make a very consider­ able difference in the health of the inhabitants; thus at Rome some streets, nay certain points, sides, and even houses, of some streets are more damp, chilly, and exposed to the malaria, than others. In many of our own towns certain streets or districts have been always remarkable for fever, and they have been as remarkably exempted from its attacks when the air has been al­lowed freely to percolate them by the removal of old walls or compact masses of houses, which prevented ventilation and the access of the solar influence. In our own city nothing but the violent gusts of wind, which occasionally perfiate our densely built wynds and closes, could check the generation and progress of disease.

The Bedding, Clothing, and Furniture.—With the super­fluities of the rich the medical topographer has little to do; but on the necessary supplies of these articles in possession of the poorer and more numerous part of the population, much of their comfort and health depends. A sufficiency of bedding and clothing to obviate cold and moisture is indispensable to health; and, during the prevalence of contagious diseases of the typhoid class, is of the utmost importance as a preventive. A very striking illustration of this will be found in the medical report of Dr Ainslie, Mr Smith, and Dr Christie, on the epide­mic fever which lately ravaged an extensive district in India. Wherever the inhabitants were elevated above the surface by settles or bed-frames, and defended by rugs, there the disease was decidedly less frequent and less fatal in its consequences.

*Compact gutters, by preventing the sinking of the water into the earth, are reckoned by Dr Rush one cause of the unhealthiness of Philadelphia.

See Clarke’s Medical Notes. The wards of the Santo Spirito Hospital to the south and south-east are more insalubrious than others, and the lower apartments of some hospitals are affected with the malaria, while those imme­diately above escape its influence. A very slight obstacle, as a gauze curtain, is said to prevent the entrance of the malaria at Padua. In the West Indies, soldiers residing in the lower part of the barracks were found to be more lia­ble to yellow fever than those in the upper, in the proportion of 2 to 1. See Fergusson in Med. Chir. Trans. Vol. VIII. p. 587.

10

Every article of furniture which can aid in the promotion of cleanliness, in the preservation and cooking of food, and in other purposes subservient to domestic economy and personal comfort, must essentially contribute to the preservation of health. The materials of the beds and furniture, the frequency of their renewal, and the modes adopted to preserve and purify them, are all worthy of attention.

The Fuel.—The nature of the fuel, and the facility of pro­curing it, is of the utmost consequence to all ranks of society, but especially to the poorer. It is scarcely possible to conceive how thousands of the pauper inhabitants of Ireland could protract their existence, did not the bogs amid which they pine, fur­nish them with the means of cooking their food, and obviating the effects of the chilling damps with which they are surround-

The Diet.—The quantity, the quality, and the regularity of our meals have such an obvious influence upon health, that the medical topographer should be minute in his inquiries upon these subjects. He should enumerate the species and the price of the different articles, the modes in which they are prepared or preserved, the adulterations which they undergo, and the condiments which are employed along with them. The nature of the beverages used should be investigated, and their effects when taken in moderation, or pushed to excess, should be de­scribed. The nature of the water used as an article of diet, or employed for culinary purposes, should be ascertained; and those impregnations which act directly on the kidneys, the bowels, or the skin, should be investigated, while the secondary effects which their hardness or softness may produce by their adaptation to the purposes of cookery and cleanliness should be pointed out. The abundance or scarcity of this vital article should be particularly specified. The sources from whence it flows, the materials through which it is conveyed, and in which it is preserved, the accidental pollutions which may fall into it in its course, and the facility with which it disembogues itself after having served the various purposes of life, will be import­ant subjects of consideration. The effects of the water on strangers should be mentioned; in a great number of situations no new comers can taste the water with impunity, and the same effects are produced on their cattle. The ordinary mode in which nature appears to remove these noxious effects is by the bowels; but it will be an interesting object- of inquiry to ascer­tam what other outlets she may employ for that purpose. The use of snow water for drink in Alpine regions has long been supposed to give rise to goitrous tumours. This mode of ex­plaining these unseemly appearances has been questioned some upon the principle that the disease is frequent in Sumatra, where snow or ice are never seen, and unknown in Chili and, Thibet, though the rivers of these countries are chiefly supplied from melted snow; but a sufficient proof that goitre proceeds in some cases from snow or ice water is, that navigators, who were not exposed to any other of the circumstances which affect the inhabitants of the Alpine regions, yet, after having been forced to drink ice or snow water, have become affected with, the (See Cook’s Voyages.) It will be a most interesting and legitimate object of inquiry to ascertain how far cuta­neous affections depend upon the peculiar sources from which:

the water in ordinary use has been procured. The good or bad effects produced, or supposed to be produced, in some dis tricts by certain articles of food long continued, should be in­quired into; the use of oil is stated in some countries to predis. pose to hernia; beer and cyder are supposed to be productive oC calculous disorders, while salted meat is, on no slight grounds, presumed to prevent them. * In some countries the most in­nocent articles of food are deemed injurious, and in Greece, eggs, butter, and milk, have been stigmatized as three poisons. t

The Employments.—The nature of the employment or trades. of the inhabitants, the periods occupied in them, whether in close, crowded, and damp apartments, or in the open air; the metallic or other vapours, or the currents of air or water to which the workmen are exposed, arid cther similar circum­stances, should all be most minutely particularized. To these particulars should be added the nature of the diseases produced among the artificers, the means they adopt to prevent their oc­currence, and the remedies peculiarly useful in their removal.

The Amusements and Customs.—As these mark the general habits, and often in particular instances lead to disease, they are well worthy of enumeration. The topographer should notice whe­ther they are active or sedentary, whether exercised within doors or in the open air, whether they tend to the excitement of the

In tropical climates, calculus is scarcely known. On the Continent, and in Britain generally, it occurs in the public hospitals in about 1 case in 300 or 400 patients. In the cyder counties of England it is much more frequent than in many others, but in the Norfolk district, it is as frequent as in 38, a pro­portion exceeding any thing’ which has. been noticed in any other district of Europe. In the British army, calculosis complaints are exceedingly rare, but we do not know whether ‘any comparative estimate has been made of their frequency; in the navy, however, they are so strikingly low: as 1 in 17,200, See Hutchison in Medico-Chirurgical Transactions, Vol. IX. p. 459.

*See Clarke’s Travels, 8vo. Vol. III. p. 255.              –

depressing passions or not. Even the most trivial local amuse­ way produce the most powerful effects on the passions and the health; a fact which will not be denied- by those who recollect the effects of music in exciting the Scotch Highlander, or in producing nostalgia, and even death, in the Swiss moun taineer.

The Morals—the Education—and Mode of Rearing Children.—The influence of religious instruction on the modes of living of individuals cannot escape the most unconcerned ob­server and hence the general state of the morals of the’ district which he describes, should be an object of the medical topogra­pher’s investigation. In pursuing this he should not lose sight of the number of inhabitants which the exhortations nnd the example of fanatics have so constantly consigned to the mad-house and the foundling-hospital; while he will perhaps find that equal num­bers have been reclaimed from the ginshop,—another fruitful source of supply to one at least, if not to both, of these establish­ments. Under this head the effects of early marriages upon health seem most naturally to range themselves.

The Police of a city or district has a considerable influence upon the health of its inhabitants at all times, but in periods of public calamity from contagious disease it becomes absolutely essential to it. The subject of medical police in general is one of such extent, and comprising such a multiplicity of objects of inquiry, as to form a distinct science of itselt We shall there­fore content ourselves with enumerating a few only of the prin­cipal points which appear to us to bear more directly on the subject of medical topography, and which should he minutely inquired into by all who cultivate that study. The first of these is the establishment of common sewers, without which no town can ever be either a pleasant or a healthful residence; the erec­tion of necessaries; the pavement, cleaning, and lighting of the streets; the regulation of the slaughter-houses and markets; the removing to convenient distances burial-grounds and all manu­factories productive of noxious exhalations ;* the establishing a control over the admission and lodging of vagrants; the regu­lating the purchase and exposure of old clothes and furniture;

* The consequences of burying in churches are now well known, perhaps the best mode ever adopted is that in use at the branch of the Hospitat of In­curables of Naples, near Torre del Greco. The burial ground is divided into 365 large and deep vaults, one of which is opened every day of the year, and, after the bodies are deposited, is accurately shut. The process of putrefaction is completely finished before it is again opened. See Eustace’s Italy, Vol. II. 8vo. p. 346.

the controlling the venders of spirituous liquors; the diminu­tion, as much as possible, of the number of prostitutes, and the holding out to them, and the lower orders of society in general, encouragement to have recourse to hospitals on the first appear­ance of disease among them.

The State of the Poor.—Under this head should be enume­rated their employments, the rate of wages, the price and na­ture of the food which they are able to procure for themselves, or which is supplied then, either as an equivalent for their labour or in the form of charitable donations; the rent of their cottages or rooms, the public institutions for their instruction and their support, and the friendly or other associations for their relief, &c. &c.

111.—As The ultimate aim of medical topography is to ascertainevery circumstance that has an influence upon health, the nature, extent, and varieties of the diseases of the district which he undertakes to describe, are subjects of primary importance to the topographer. Under the present, as well as the other heads of inquiry, much must be left to the judgment, and much must depend upon the opportunities for observation, but the fol­lowing objects appear to us indispensably necessary to be inves­tigated.

The Endemic Diseases.–In the details on this head, the fol lowing points of inquiry should be particularly attended to. -The age, sex, and constitution of those most commonly attack ed; the nature of the diet, employments, or situation which renders them most liable to be affected; the popular opinions on the disease; the domestic prophylactics; the mode of cure followed by the regular practitioners in private life, and the re­sult of hospital treatment deduced from the tables of admissions, discharges, and deaths.

The Epidemic and Sporadic Diseases.—The same subjects of inquiry should be attended to in these as in the preceding class, and the utmost caution should be observed in examining into the proofs of the contagious or non-contagious nature of the diseases of whatever species.

Hereditary or Family Diseases claim the attention of the to­pographer, and not only should their existence be ascertained, but any modes which may have been adopted to prevent or to cure them should be fully detailed.

The existence or frequency of Feigned Diseases should not be -overlooked, and the details on this point should be ample, em­bracing the history of individuals, the particular diseases and symptoms which they have imitated, the real diseases which they have brought on, and the modes adopted for their disco­very. The history of the fasting woman of Tutbury, and the steps which led to her detection, will long be remembered in the medical annals of this country. The diseases of the manufacto­ries, the prisons, the poor-houses, and the, boarding-schools, Should not be forgotten, nor should those from imitation, which so often arise in the latter establishments, be overlooked. These diseases of imitation also often prevail in other situations, for instance the convulsive disease in Wales, Shetland, and else­where, and the disease known by the name of the “ Louping Ague,” in Angusshire. *

Tables of Marriages, Births, Diseases and Mortality, if drawn from extensive and authentic collections of reports, become pe­culiarly valuable, and the greater ntimber of points of compari­son with preceding years which they furnish, the more is their value enhanced.

Epizootics.—The diseases of cattle and other animals should be inquired into, particularly when they have been very exten­sive and fatal. The most severe epidemics, the plague, for in­stance, which have afflicted man, have been preceded by similar nffections of the lower orders of animated beings. The influen­za, which raged in this country, and extended almost over the world in the latter end of the eighteenth century, was pre­ceded in some places by a mortality among cats, and ia others, birds were found to be peculiarly affected. The dis­eases of the cattle, which serve for agricultural purposes, or directly for the food of man, should be an object of parti­cular inquiry. The health of this class of animals is peculiarly linked with that of the human species who tend and feed them, and who, in return, owe to them so much of their comfort and their support. In the epidemic which lately ra­vaged some of the Indian provinces, upwards of 44,000 head of cattle died in one district in the course of seven months, partly from want of food, and partly from disease. It is asserted that dy­sentery is produced among sheep closely pent up, and that the dis­ease thus generated becomes contagious among these invaluable animals. The nature of the rot, to which they are subjected, is an inquiry of much importance, the more so, that in its early stages it is found that they take on fat, and are therefore in that mor­bid state often applied to the purposes of food. There can be no doubt that the flesh of animals who have died of disease, or who are killed when overheated by excessive labour, is highly injurious to health; and even the flesh of those who have died

*See a full account of these in our 3d Vol. p. 434.

a natural death has occasioned sickness, and has in some cases proved fatal.

The Diseases of Plants employed as articles of food should be inquired into, as they are by them deprived of a considerable portion of their nutritive qualities, and even rendered deleteri­ous: thus to the ergot or blight in rye, a most extensive and fa- tal endemial gangrene has been traced in France, and there is reason to suppose that a similar disease has been produced from blighted wheat in England.

Popular Medicine.—Under the head Endemic Diseases, we touched upon a branch of this subject, but it is worthy of being still farther enlarged upon. In many districts periodical bathings, bleedings, purgings, vomitings, diet drinks, &c. are resorted to, under the supposition that sickness in general is prevented by such practices, while there are other practices adopted for the prevention and cure of particular complaints. Rum and milk, egg and brandy, and similar disguised drains, are in high estima- tion in incipient cases of phthisis in some districts, and contri­bute to swell the number of annual victims to that scourge of our islands. The popular remedies used for the diseases of cat tle and other animals should also be noticed.

Hospitals.—An account of the establishments of this descrip­tion, whether for the reception of particular diseases, as fever, mania, syphilis, &c. for lying-in women, foundlings, blind, deaf and dumb, or for more general purposes, should be a very principal object of the medical topographer’s inquiries. He should inform us of the site, size, and plan of the hospital, the number and accommodation of the wards, with the methods of ventilating, warming, and cleansing them;. the plans for separating and classifying the patients, their numbers, and the mea­sures pursued for obviating or checking contagious diseases among them; the materials and arranaement of their beds, bed­ding and other articles of furniture; the means of collecting and conveying the sick to the hospital, with a statement of the obstacles or facilities of access to the building itself, as well as to its various apartments. We should have an account of the plan, extent, and arrangement of the kitchens, baths, and wash houses, and of their supply of cold and hot water, and steam, together with a detail of all contrivances for the abridgment of labour; the diminution of the consumption of fuel; and the increase of the nutritive quality of the food, or its fair,

 *The diseases produced by the use of various animals, while out of season, as it is called, should be considered under the article” Diet.”

regular, and comfortable distribution. Knowing, as we do, how much the individual comforts of the sick, and the general good order of an hospital, depend on the water-closets or  latrines,” we should attach great importance to the description of their site, size, and actual state, the extent of their supply of water, air, and light, and the measures adopted for removing the soil, or preventing the diffusion of unpleasant and un­healthy effluvia. To all this information on the immediate  accommodations for the sick, we should wish to be added an  account of the storehouses and offices of every description; the airing ground for the convalescents; the places of recep tion for the dead, with the modes of disposing of the bodies, &c. &c. We should have also a statement of the rank, num­ber, salaries, and duties of the various officers of the establish­ment, whether medical, surgical, or purveying, with an enumeration of the servants of different classes, their wages, the propor­tion which they bear to the sick, and the respective duties which they perform. In short, we should wish for informa­tion on every point subservient or preparatory to the grand objects of administering food, medicine, and surgical assistance. We should then be prepared for a view of the mode of carrying on the medical, surgical, pharmaceutical, and purveying duties, which would naturally lead us to the history of new or peculiar practices or operations; accounts of new remedies; details of the diet, ordinary and extraordinary, administration of wine, and other cordials, &c. The sources of revenue, from which these wants are supplied should be specially enumerated, and, from all these premises, we should have no difficulty in entering into a view of the expences of the establishment. The nature of the records and annals kept at the hospital should be stated to us, and, from these, interesting information on comparative mortality, prevalence of disease, and peculiar epidemics, originating either from within or without, might be afforded; as well as satisfactory notices on every other point, medical, statistical, or financial. * The same principles of examination should be applied to prisons, lazarettos, workhouses, &c.

If there are any veterinary hospital establishments, they should be described; and any peculiar practices or operations by the regular profession or quacks should be mentioned.

Spontaneous Cures.—Diseases in general have not a natural tendency to terminate in death, and some, if not interfered

We have already given this outline of inquiry into the state of hospitals in our review of Dr Carter’s work, Vol. XVI. p. 76, but we think it more con­venient and more adapted to the purposes of the present paper to reprint than to refer to it.

VOL. xvii. NO. 67.                            M

with, proceed spontaneously to a favourable termination. The medical topographer should investigate these cases, and shoul endeavour to discover how far external circumstances, which do not come under the head of medical means, may have aided th efforts of nature. This inquiry will also lead him to the inve tigation of the effects of the climate and situation which he decscribes, on diseases imported into it. The disease for which, change of climate has hitherto been principally recommended’ in this country has been Phthisis; but there can be little, if any doubt, that many lives have been sacrificed in this way, Physicians, judging from latitude, have supposed that many situations should be favourable to phthisical patients, which, [‘OD] trial, have proved remarkably the reverse. Many parts of the’ south of Europe come under this character, from the nature of their climate alone, and many others which are more fortunate’ in this respect, are eminently defective in all the domestic and medical comforts which are of the last importance to the reco­very of the invalid. The effects of climate in accelerating the cure of syphilis, of cutaneous affections, of diseases produced from the excessive employment of mercury, and of other chro­nic affections, should also be an object of inquiry.

The State of the Practice of Physic and Surgery, as well as that of Empiricism, should be noticed; the privileges or the control exerted over the members of the profession, with their divisions, numbers, &c. should be stated; as also their various institutions, libraries, societies, &c.; their peculiar doctrines and practices should be noted generally, and any thing of special interest should be particularized; the progress of Vaccination should be minutely inquired into. Upon the cir- cumstances above stated, either singly or combined will greatly depend the last and most important object of the investiga­tions of the medical topographer, with which we shall close this class of-our suggestions. ‘

Longevity.—Not only the remarkable instances of longevity should be given, but a general view of the mortality among all ages and sexes, extended to as long a period of years as the in­quirer can refer to, marking those which have been particularly affected by epidemic or contagious visitations. If the inquiries’ of the topographer extend over a large surface of country which comprises several districts, tables of mortality for each district should be given, otherwise a very incorrect idea may be impress ed on the mind of the reader; thus, from Dr Price’s calculations, there is great-’ reason to suppose that. in hilly districts, ‘half the numbers born, live to the age of forty-seven, and that one in twenty reach so far as eighty years of age; while, in marshy districts, one only in fifty-two attain that period of life, and only one half the numbers born, survive to the age of twenty five. There is also, as is well known, a considerable variation between the ages of persons who reside in towns and in country parishes, insomuch, that, in some instances, the difference is more than double, some cities being calculated to give a morta­Jity of one in nineteen, and some healthy country villages being reported so low as one in forty, fifty, or even sixty, although it must be confessed that there is great reason to suppose that these estimates have been overrated, from inattention to con­comitant circumstances. It is certain, however, that those em­ployed in the Insurance of Lives estimate the longevity of a country village at fifteen, while that of the metropolis is only rated at ten and a half. *

IV.—’Under the fourth head should be classed those miscel­laneous topics of inquiry which more remotely bear upon the medical topography of a town, district, or country, and which could not be so conveniently arranged under any of the other heads. Peculiar circumstances will of course contribute to the enlargement of these, but the following appear the most import­ant.

A catalogue of the works already written on the subject of thc places described, whether referring to their topography, na­tural history, or diseases.—Notices on the subjects of the col­leges, or schools for medical education, of their museums, and libraries, and of the rare and curious articles contained in them, whether preparations, books, or manuscripts.—Notices on sin­gularities in the formation of the brute, and more especially of the human species, as dwarfs, giants, cretins, &c., and on such persons as have been remarkable for their physical powers and 1)ropensities, as strength, voracity, &c. &c.—Notices of eminent medical authors and practitioners who have flourished or live in the places described.—Notices on important and curious objects of botany, mineralogy, natural history, &c. As the excellent directions of Professor Jameson, addressed to the contributors to our College Museum, may not be in the possession of many of our readers, and as they will enable any common observer to preserve various important contributions towards the natural history of the place where he resides, or which he may acci­dentally visit, we shall conclude this paper with an abridged statement of them.

“Quadrupeds and Birds.—Quadrupeds and Birds to be preserved by

* Hints for an Insurance Company for Kent and Sussex, 1804, p. 7.

taking off their skins, which maybe easily done, by making an inci­sion in a straight line, from the vent to the throat, and removing the skin by means of a blunt knife. The skull and bones of the legs and feet are to be left. The brain, eyes, and tongue, ought also to be extracted. The skin, in order that it may be preserved from decay, should be also rubbed on the inside with some one of the following compositions: 1st, Tanners’ bark well dried and pounded, one part ; burnt alum, one part; and in a hot climate one part of sulphur; to be. well mixed together.—2d, Tanners’ bark well dried and pounded one part; tobacco, perfectly dried, one part; burnt alum, one part: add to every ounce of these ingredients one ounce of camphor, and half an ounce of sulphur. (N.B. No sublimate or arsenic ought to be put on the skins, as both substances destroy their texture.) These compositions to be kept for use in well corked bottles or jars.

“ Skins, when thus prepared, and partly dried, must be packed carefully in boxes, the lids of which ought to be pasted up, and the paste used in fixing the paper, a little corrosive sublimate must be put, which prevents insects from eating through the paper.

“ Reptiles and Fishes.—Reptiles and Fishes are best preserved in spirit of wine, rum, or whisky, some of which must be injected into the stomach, through the mouth, and into the other intestines through the anus. Before putting them into bottles, jars, or barrels, they ought to be washed clean of slimy matter. If long kept in spirits before they are sent, the spirits should be changed two or three times. The jars or bottles ought to be closed by means of sheet-lead and bladders. The larger reptiles, as crocodiles, and the larger fishes, may be preserved in the same manner as quadrupeds and birds.

“ Animal Concretions.—Concretions of various kinds are occa- sionally found in the brain, lungs, heart, liver, kidneys, gall-bladder, intestines, and urinary bladder. The stomachs of many animals afford concretions of different kinds, particularly those known under the name of bezoar stones; and travellers inform us, that stones are met with in—the eggs of the ostrich. All of these bodies are interest­ing and valuable to the natural historian.

“ Skeletons.—Collectors ought not to neglect to preserve the skeletons of the different species of animals. Of man, the skull is the most interesting part, as it varies in the different races of the human species, and is also frequently singularly altered by the practices of savage tribes. The best way of cleaning bones is to expose them to the air, and allow the insects to eat off the flesh. This being done, they ought to be washed with sea-water, and afterwards freely ex- posed to the sun. The best skulls are obtained by putting the whole head in rum or whisky, or a strong solution of alum; and both male and female head ought if possible to be preserved. – –

“ Molluscous Animals,— Vermes and Zoophytes.—Molluscous animals, such as cuttle-fish, the inhabitants of shells, &c. vermes or -worms, and zoophytes, or animals of the coral and other allied kinds, ought all to be preserved in spirits; and in the two former classes, viz, the mollusca and vermes, the spirit of wine should be injected into the intestines, by means of a syringe, to prevent the putrefaction of the internal parts, and the consequent destruction of the organs of digestion, respiration, and of the nervous system. Many Zoophytes or corals, or rather their houses, may be preserved dry; but frag­ments of every species ought to be put into spirits, that the real struc­ture of the animal may be discovered.

“ Shells.—Shells, or the coverings of molluscous animals, are anxiously sought after by the naturalist, not only on account of their great beauty, but also from their intimate connection with the various fossil species met with in rocks of different kinds. The best live shells are collected by means of a trawling-net, such as is used by fishermen, if the depths arc not too great; they are also brought up by the cable in weighing anchor, the log-line, and in sounding.

“ After a storm, good shells may be picked up on sea beaches or shores, as the violent agitation of the ocean in a tempest separates them from their native beds, and often casts them on the shore. Shells that have been much tossed about by the waves are of less value than fresh ones ; but these, when other specimens are not to be got, ought to be carefully collected. Many interesting shells arc found in rivers and lakes; and numerous species occur on the surface of the land.

“ Fresh shells, or those in which the animal is still alive, ought to be thrown into hot water, the temperature of which may be gradual­ly brought to the boiling point, by the repeated additions of hotter

portions, by which means the animal will be killed. The shells are allowed to cool for two or three minutes, and then the animal is picked out.

“ Insects.—Beetles of every kind are speedily deprived of life by putting into boiling water, which does not injure those having black, brown, or any dark colour; but those which are covered with fine down, or have brilliant colours and lustre, should not be exposed to moisture, but are easily killed, if put into a phial, and placed in a vessel of boiling water for some time. When the insects are quite motionless, such as have been in the water should be exposed to the air and sun for a day or two, until perfectly dry. In this state, they are to be placed in boxes with cotton-wool, along with camphor. Beetles may also be preserved in spirit of wine.

“ Butterflies, moths, and many other tribes of insects, with delicate and tender wings, may be easily killed, by pressing the thorax or breast betwixt the finger and thumb; and it is preferable to have the  wings closed, because they thus occupy less space, their colour and lustre are better preserved, and they can be expanded afterwards by the steam of hot water. Care should be taken that the antennae or feelers and legs are not injured. A pin should be stuck through them, by means of which they are fastened to the bottom of a box lined with cork, or to one of deal, or other soft wood. Camphor ought to be put into the box.

“The arachnides or spiders are best preserved in spirits. -In collecting insects, we use either the forceps or a net. The forceps are about ten or twelve inches in length, provided with fans of a circular or other form, and are covered with fine gauze. They are held and moved as a pair of scissors. The net is very easily made. It is of gauze, or any very fine open muslin, made upon a piece of cane of four feet long, split down the middle about the half of the length: the split part is tied together, so as to form a hoop, upon which the gauze is sewed in the form of a bag; the lower part serves as a handle, and with this, all flying insects may be very easily caught. When the insect is once within the rim of the net, by turning it on either side, its escape is completely prevented by the pressure of the gauze or muslin against the edge of the hoop.

“ Crabs.—Crabs, lobsters, &c. may be suffocated in spirits of _ wine or turpentine, and then (Iried in an oven.

“ Crustaceous Animals.—Sea stars, after washing in fresh water, may be extended on boards by means of pins, and when dry, laid between folds of paper, and l)acked in a box with a little camphor.

“ In Echini or Sea Eggs, the soft internal parts are to be extracted – -by the anus: they are then to be stuffed with cotton, and carefully packed with tow or cotton. Particular attention should be paid to -the preserving of the spines.

“ Seeds.—ln collecting seeds, it is desirable that they should be well ripened, and dried in the sun. Large quantities should never be put together, but only a few, and these well selected. They retain their vegetative powers much better if tied up in linen or cotton cloth, than in other substances ; and if then packed up in small boxes, and placed in an airy part of the ship, there is every proba- -bility of their arriving in a sound state. The same remark applies -to bulbous roots. Bulbs should never be put in the same box with seeds. The boxes with seeds, and with bulbs, ought never to be put -into the ship’s hold.

“ Dried Plants.—The greater part of plants dry easily between leaves of books, or other paper. If there be plenty of paper, they often dry best without shifting; but if the specimens are crowded, they must he taken out frequently, and the paper dried before they are replaced. ‘those plants which are very tenacious of life ought to be killed by the application of a hot iron, such as is used for linen, after which they are easily dried. The collections to be carefully packed in boxes with camphor, and closed in the same manner  as directed for quadrupeds and birds.

Minerals.

-l. Every mineral, from the most common clay or sand to the gem, ought to be collected. –

– “ 2. Specimens of rocks, such as the granite, porphyry, limestone, &c. should, if possible, be broken from fixed rocks, and not from loose masses, which are generally decayed. In selecting the speci­mens, one set ought to represent the different varieties of appearance presented by the rock in the fresh stateanother the rock in its dif ferent states of decomposition.

3.  When the specimens of simple minerals, or rocks, contain crystals, they ought to be wrapped in gauze-paper, then in cotton and afterwards in several folds of strong wrapping-paper. –