524

may be observed in connexion with the sensations andmovements of sickness." Laughter and anger are also wellknown to be infectious. Many of these analogies, althoughof much interest, and affording considerable food for

reflection, seem to us to be somewhat overstrained, andscarcely to fulfil those conditions which Dr. Liveing demandsfor the constitution of nerve-storms. The object of thetheory seems to be to make the nervous system primarilyresponsible for the seizure, and all the phenomena of theseizure dependent upon the primary centric derangement.Dr. Liveing is bold when he speaks of nervous force as anentity, and we question the advisability of attempting toexalt the nervous system into an organisation which is

capable of being considered apart from, and without refer-ence to, all other parts of the economy. With regard tothe anatomical seat of megrim, Dr. Liveing infers, from aconsideration of the phenomena of the paroxysm, that it islimited for the most part to the sensory tract and the

ganglia of the sensory nerves, from the optic thalamusabove to the nucleus of the vagus below.

Dr. Liveing’s treatment of the disease is rational. 11 Our

aim," says he, "must be twofold : first, to lessen the ten-dency to explosive action in the nervous centres; and,secondly, to avoid or remove the exciting causes of theseizures." This he tries to accomplish by means of hygienicmeasures and drugs ; but there is little that is new in thispart of the volume, and Dr. Liveing admits that the treat-ment of the disease is unsatisfactory, and the effect of thera-peutic measures is often capricious.At the end of the volume will be found a table of sixty-

seven cases of megrim, giving the chief symptoms andother points of importance in connexion with each case.

There is also an excellent chromo-lithograph of the spectralimages observed by a certain proportion of migrainouspatients, which has been copied from Dr. Hubert Airy’spaper on that subject.

It is unfortunate that Dr. Latham’s two lectures havebeen published coincidently or nearly so with Dr. Edward

Liveing’s work on Megrim, since the latter must of neces-sity throw into the shade any other treatise on the subject.Dr. Latham’s views on megrim are pretty generally known.He refers the phenomena to the excitement and subsequentparalysis of the cervical sympathetic. The prodromata,such as the irregularities of vision, &c., are caused by thecontraction of the cerebral vessels accompanying the ex-citement of the sympathetic, and the headache to the over-distension of the cerebral vessels, which is the natural con-sequence of the paralysis of the cervical sympathetic.

On the Convolutions of the Human Brain. By Dr. ALEXANDEREcEEB, of Freiburg. Translated by JOHN GALTON, ofthe West Riding Asylum. pp. 70. London: Smith,Elder, and Co. 1873.

T-uis is a little brochure that well repays the trouble ofthe translator, and should be in the possession of everypractitioner. The nomenclature of the convolutions and

sulci of the brain has been far too much neglected, and istaught as it should be taught in but very few of our dissect-ing-rooms. Every reader of reports of post-mortem exami-nations must have felt how difficult it is to understand theexact position of lesions described as being on the 11 upperand outer" or "posterior and inferior" part of the brain.This difficulty should now no longer exist. The labours of

Gratiolet, Tiedemann, Serres, Meynert, Huxley, Turner, andthe author of the work before us, have led to the applica-tion of names that are now very generally admitted, andshould be adopted in every description of these parts. Thevalue of such differentiation is strikingly exhibited in therecord of the experiments of Dr. Ferrier just published in

the Reports of the West Riding Lunatic Asylum, and inthe clinical researches of Dr. Hughlings Jackson, whichwithout such helps would be much more difficult to follow.Dr. Ecker gives a series of drawings of the upper, outer,lower, and median surfaces of each hemisphere, in whichthe sulci and convolutions are boldly mapped out. Thetext contains a description of each of these, with theirsynonyms, which are fortunately not very numerous. Wherean alteration has been made from the nomenclature ofGratiolet and Huxley, the change in general appears to bejudicious. We cordially recommend the book to our readers.

REPORTOF

The Lancet Sanitary CommissionON THE

OUTBREAK OF TYPHOID FEVER

AT WOLVERHAMPTON.

WE have felt it to be our duty to institute an independentinquiry into the circumstances of the recent outbreak oftyphoid fever in the town of Wolverhampton,-partly onaccount of the gravity of the case, and partly because ofthe contradictory statements which have been made in

regard to it. We regret to say that our inquiry has beenmuch hindered by the extraordinary course which the Sani-tary Committee of the Town Council has thought it right topursue. On visiting Mr. Love, the medical officer of healthfor the borough, he informed us that he had been directedby the committee to withhold all information bearing uponthe sanitary state of the town. We have therefore been

compelled to trust for knowledge to the results of our ownobservation, and to the facts placed at our disposal by theother medical men of the town. To the courtesy of theselatter gentlemen we are deeply indebted, and, thanks to-their assistance, we find ourselves in a position to place

; before our readers all the essential points in the case. Wegive the sanitary particulars first, as a natural introduction

, to the history of the epidemic.The town of Wolverhampton numbers nearly 70,000 in-

habitants. About a year ago it consisted of 210 streets and600 courts, containing altogether 12,000 houses, of which itis said that about 9000 derived their water-supply from apublic company. Of the quality or quantity of this waterwe cannot speak with certainty at the present time, but thecharacter of the well-water upon which the remaininghouses depend will be sufficiently indicated in the course ofour narrative. A system of sewerage has been adopted,

.

and all the principal streets are drained by sewers whichseem fairly well ventilated. A very large number of thehouses are, however, as yet unconnected with the sewers.The sewage is carried to a farm some three miles off, whereit is used in land irrigation.Of the houses which do not drain into the sewers some

, are provided with cesspools, but in the majority the sanitary. arrangements are of the simplest and most disgusting kind.One or two privies, often in a horrible state of dirt and di-

, lapidation, stand by the side of, and discharge into, a large" and deep 11 ashpit," often capable of containing many cart-. loads. These ashpits are the curse and disgrace of thel town. They receive all the refuse of the houses, and, as at matter of course, emit a stench which is beyond description.At irregular intervals they are emptied by the town scaven-

l gers, and the manner in which this operation is effected is,

525

in the most literal sense, 11 a caution." The accumulated of progress bears no kind of relation to the magnitude offilth of the pit is ladled out on to the pavement of the court the evil. A town which boasts the wealth and importancewith a kind of magnified soup ladle. Whatever is solid of Wolverhampton should feel as a disgrace every dayenough is then shovelled into carts, the rest flows in a black which delays the extirpation of such foul abuses. It is aand fetid stream to the nearest surface gully. Then comes sudden and complete change in these quarters that isa handful of disinfecting powder, and the beautiful process wanted, and not a mild tinkering. The sham reform which,is over. Very often the pit is only partially emptied, and finding a pestilent ashpit, sends a man with much paradethe residue, well stirred up, is left to salute the eyes and to whitewash it outside, should give place to a real one.noses of the unlucky inhabitants. We confess we did not The pits should be swept away, and the handles taken offwitness this great sanitary operation, and cannot altogether all the pumps, and proper substitutes for both providedregret it; but in more than one court we saw the black without delay. Until all this is done the Town Council hasgreasy smear on the pavement, and we had the description no right to waste time in talking of difficulties or countingfrom so many eye-witnesses that we cannot doubt its accu- the cost of the alterations.racy. When we add that each house in the court commands, We may now consider the circumstances which give im-as a rule, a full view of the public privies and their in- portance to the recent cases of typhoid fever in the town.separable ashpit, it will readily be believed that the effect The occurrence of a certain number need occasion no sur-of the whole vile arrangement is and cannot fail to be as prise when we remember the insanitary conditions whichinjurious to public morals as it is to public health. It would prevail, and, indeed, deaths from typhoid seem to havebe difficult to devise a system better calculated for the spread taken place in almost every month of the present year; butof zymotic diseases, and we cease to wonder at the ravages there are points connected with some of the recent caseswhich small-pox, scarlet fever, typhoid, and diphtheria com- which are of grave importance when viewed in the lightmit in the town. In too many courts the well and pump afforded by our recent London experience.still linger in fatal proximity to the pit. The borough Well-marked cases of the disease occurred during theanalyst reports that the water is "contaminated." Of course month of July in Brook-street, a wretched slum situatedit is contaminated. It is almost waste of time to analyse just behind the lower end of Darlington-street, which issuch water, for a single glance at the pit or cesspool which one of the principal thoroughfares of the town. A mainstands next the well, or a moment’s thought of the foul sewer, formerly a water-course known as the Black Brook,soakage which the porous soil must receive from every passes under Brook-street into Darlington-street, where ithouse, is sufficient to indicate the character of the water. forks into another sewer which runs down the latter street.In justification of the strong language which we have It appears to be admitted by everyone that the middens of

been compelled to use in describing the lower quarters of Brook-street drain somehow into the sewer; indeed, ourWolverhampton, we quote a few pages, almost at random, informant stated that they were always dry. The Blackfrom our note-book. In looking over these rough memo- Brook, contaminated in this way, runs exactly under theranda, jotted down in the hundred or so of courts through yard and a portion of the house of a dairyman living inwhich our guide led us, we are struck by their monotony. Darlington-street. We visited this house, and going into11 Ashl)it," C< well," C< stink"; the words recur again and the cellar saw and touched the brickwork of the sewer. Atagain, and indeed there were few others to use beyond the the bottom of the stairs, close to the sewer, we saw theoccasional complaint of a widowed wife or childless mother. well which supplied the dairyman’s family. The water ofThis is how the thing reads :- this well has recently been analysed and found to be very" Court in Horse Fair.-Foul ashpits ; open gutter which bad, and there can be no doubt that it receives direct con-

carries off drainings. tamination from the sewer. The sanitary arrangements of" St. Peter’s-square.-Foul privies and ashpits, which the whole premises were of a disgusting kind.

exude into the court. Pump in the middle of the court. Early in August typhoid appeared in the dairyman’s"North-place, North-road.-New ; better than most. Ash- family. Four cases occurred in it, and the dairyman was

pit one yard from house. Pump four yards from ashpit. strongly urged by his medical attendant to stop the sale of11 Stafford- street.-First court entered : Honeycomb of milk. Unfortunately he did not take this good advice, and

cesspools and asbpits, one pit exactly under bedroom it appears certain that the result has been the introductionwindow.-Another court: Looks better; well built. Deep of the disease into some houses which would otherwise inand foul ashpit. People will not stay in next house. One all probability have escaped. Many of the cases occurredhouse below level of court. Privies leak directly into at a considerable distance from the centre of infection, andsitting-room. Well fourteen yards from ashpit. Two the medical officer of health, together with nearly all theprivies for the fourteen houses.-Another court: Rather other practitioners of the town, concur in the opinion, firstbetter. Another court: Ashpits horrible. Tap water. suggested by Mr. Manby in a letter to the Wolverhampton

11 Castle-place.-Irish population. Tap water. Filthy Chronicle, dated August 19th, that the milk was in theseprivies. General smell of ordure. cases the immediate cause of the disease. We inquired

" Back-lane.&mdash;Two taps for some fifty houses or so. Fight carefully into the particulars upon which this opinion wasfor water every morning. founded, and were unable to resist the conviction that it

11 A court in Lichfield-street.-Cesspool filled to level of was in the main correct. We do not think it necessary orcourt." desirable to trace the separate history of these cases. ItAnd so on, page after page. In many courts the pits were will be enough to quote Dr. Frazer’s experience as he gave

partly filled with slimy fluid. In one the stench was so over- it to us. Up to the 1st inst. he had met with eighteenpowering that we were compelled to shrink back. An un- recent cases of typhoid in his practice in various parts ofhealthy-looking woman told us it had made her sick that the town. Of these, fifteen occurred in persons who hadmorning. The well which supplied the whole court was used the suspected milk.four yards from this tank of filth. Cases of small-pox had Very little need be added to these conclusions. That thein some cases occurred, during the last epidemic, in every milk cannot be held liable for the origin, or for the wholehouse in a court. One particularly filthy privy had 11 bake- of the spread, of the epidemic is obvious; but, on the otherhouse " inscribed upon it, the words referring, we found, to hand, it appears pretty certain that it did a good deal of mis-a miserable shed which stood next. In one court one tap, chief which might and ought to have been prevented. Someand that a very small one, yielded the sole supply of water allowance may well be made for the dairyman, himself a suf-for nineteen houses ; and pages might easily be filled with ferer by the epidemic, though of course we must blame himsimilar records. But it would be useless to multiply ex- severely for not having stopped the issue of milk at any costamples, and we need only add that if any of our readers are to himself. But the deepest blame attaches undoubtedlyinclined to accuse us of exaggeration in regard to those we to the sanitary authorities of the town, who, after the re-have given, they have only to walk through the localities peated warnings conveyed to them by previous epidemicswe have named, or indeed through almost any of the courts and the reiterated complaints of the members of the medi-of the town, to be fully satisfied. cal profession, continued to tolerate a system so noxious as

After what we have said we are glad to be able to add that which we have sketched.that the medical men of the town, and many members of i=:

the Town Council also, are fully alive to the evils which IN Vienna there were from the 16th of July 3020surround them. Considerable progress in sanitary reform cases of cholera, of which 1230 proved fatal. The latesthas already been made, and more will follow. But the rate accounts show that the disease is sensibly abating.