having been placed in strict quarantine immediately on their arrival at Gibraltar, the contagionists, in order to explain the origin of the epidemic by importation, are driven to the extremity of assuming a breach of quarantine. We would ask, if assumptions so perfectly gratuitous, be expected to be received as bonâ fide proofs of an affirmation, what fable, however preposterous, could be rejected on the score of want of evidence?

In the next epidemic in 1813, Sir Joseph Gilpin was at the head of the medical department in Gibraltar. In a letter to Dr. Chisholm, published in the Edinburgh Medical and Surgical Journal, in speaking of the contagious nature of yellow fever, and of its importation in 1793 from Africa in Grenada, he states, “of the infected state of the Hankey, I never did, nor ever shall, entertain the least doubt." This is certainly sufficiently declaratory of the tendency of his antecedent opinions. He says, that the first cases of the epidemic of 1813, occurred in two strangers, who imported it into Gibraltar on the 11th of August, in a vessel called the Fortune, from Cadiz, where he states, (very erroneously, as will be shown,) the epidemic in question prevailed at the period of their departure. Now, Lieute nant General Campbell, the Lieutenant Governor of Gibraltar, writes to Sir James Duff, the British Consul at Cadiz, on the 13th of September, 1813, stating, that some cases of fever had lately occurred in the garrison, "but that there was not one of a contagious nature, as they were peculiar to the season only." Here we have the highest authority that no contagious disease prevailed in Gibraltar for more than a month after the arrival of the strangers from Cadiz ; and the non-existence of the epidemic at Cadiz, not merely at the time of their departure from thence, but for a considerable time afterwards, is proved by the testimony of Sir James Fellowes, who in speaking of Cadiz, states, at page 256, "in fact, until the end of August, the people collectively were, according to all the reports at the time, in a healthy state, and at page 261, he remarks, that it was only on the 14th of September that he observed any case in the British hospitals that excited his suspicions." These statements prove, (as in the instance of 1804,) that no disease prevailed at Cadiz, at the time of the departure of the Fortune from that port; she could not therefore, have imported a nonentity. Further, it has been seen, that more than a month elapsed after the arrival of the Fortune at Gibraltar, before the epidemic was observed in that garrison; on which point Dr. Bancroft observes,

"As Dr. Pym confidently asserts that the contagion of the Bulam produces disease in four days, at least in Gibraltar, its existence must have been made manifest by the occurrence of very many attacks within that interval; while, if it had been known to have produced even one, Sir Joseph Gilpin must have been highly culpable, had he not informed the Lieutenant Governor thereof," p. 375-376.

It is not a little curious, that "the garrison of Gibraltar was in strict quarantine for several months before the malady made its appearance, and a Board of Health was sitting almost daily on account of the plague which had broken out at Malta,"

This circumstance, added to the assumed breach of quarantine in

1810, inevitably involves the dilemma, of either acknowledging the futility of quarantine regulations for the prevention of the Bulam ; or otherwise, that the disease was not in either case imported. The advocates for quarantines are at liberty to choose their difficultythe impossibility of supporting both positions is palpable.

The origin of the epidemic of 1814, the last which has occurred in Gibraltar, has not been attempted to be referred to importation, except by one individual, who advances no facts in support of his opinion. By the replies to the questions proposed by Deputy Inspector Fraser to the medical officers of the garrison, seventeen in number, we learn, that twelve declared it to be their belief, that the disease originated in domestic or local causes, unconnected with importation. Three were neutral; one declined offering an opinion; and one only derived it from importation. The original documents adduced in proof of the domestic origin of the epidemic of that year, are too numerous for us even to glance at. We, therefore, take our leave of the subject of yellow fever at Gibraltar, by repeating our perfect concurrence with the author, after a deliberate consideration of the question, that the fever which has prevailed there epidemically several times within the present century, originated from local or domestic causes, and was destitute of any contagious property.

The seventh and last chapter contains an inquiry into the causes of the epidemics of Cadiz, and other places in Spain in 1810, and in some subsequent years; but, as the disease was avowedly the same with that of former periods, it will not be incumbent on us to notice all the particular subjects, which, in order to leave nothing relating to these epidemics without investigation, Dr. Bancroft has deemed it his duty to examine. With respect to the fever of Carthagena in 1810, which caused the deaths of 3000 persons in six or eight weeks, he observes,

"We are told by Dr. Burnett, (p. 274.) that Dr. Riseuno, Physician to the Spanish Royal Hospital there, positively asserts, that the fever was brought from Cadiz and Gibraltar, in 1810;' while Dr. Pym as positively asserted it to have been carried from Carthagena to Gibraltar. This last assertion has already been proved to be erroneous, (see page 359, &c.) and the former must be so, because the ardent yellow fever, or Bulam, did not appear at Gibraltar, (except in the transports,) until near the middle of October, a month after the disease had been prevalent in Carthagena; and this observation is also applicable to Cadiz, which continued healthy till the middle of September, 'before which time many deaths had occurred at Carthagena; and these contradictory assertions serve only to manifest the readiness with which the contagionists, who believe that an epidemic yellow fever must always proceed from imported contagion, hazard tales to account for it," p. 415.

The history of an epidemic yellow fever, which prevailed in the 64th regiment at Stony Hill in Jamaica, has been brought forward by Dr. Pym, as a proof of the contagious origin of that disease. This opinion rests on the circumstance, that a detachment of the 54th regiment, which was sent from Stony Hill to Fort Augusta, and there quartered with a negro regiment and some European troops, became sickly;

and that after their return to Stony Hill, fever passed through the whole regiment. It is not said from whence the contagion was derived; certainly not from the Negroes at Fort Augusta, who know nothing of yellow fever; nor yet from the European troops in those quarters; nor is it stated, that the other regiments in the same quarters with the detachment of the 54th, were not affected by the fever. "If therefore no contagion existed in Fort Augusta, none could have been carried to Stony Hill."

This statement had already been controverted by Mr. Doughty in his valuable publication on Yellow Fever.

"That the 54th Regiment was attacked with the aggravated form of yellow fever, as described in these letters, (published by Dr. Pym) readily admit; and, that the other corps in the same quarters did not suffer, as stated by Mr. Rocket, I also most firmly believe Now, as Mr. Redmond and Mr. Pym agree that the fever which prevailed in the 54th regiment was highly contagious, and Mr. Rocket asserts the other corps remained unaffected with it, I ask from what source did the 54th imbibe its contagion? The fever developed itself at the season when the endemic cause prevailed, and which might that year be more powerful, and exert its influence to a wider extent, than it had done the preceding years. The soldiers of the 54th were susceptible of its influence, whilst those of the other corps were not in the same degree; because one of those latter regiments had been in the island, to my knowledge, not less than three, and the other six years, and a great part of the time in quarters, annually visited with yellow fever." Observations on Yellow Fever, p.

54.

There remains the history of another epidemic yellow fever, recorded by Dr. Pym as owing its origin to contagion, which we are somewhat surprised to find that Dr. Bancroft has omitted to notice ; more especially as his local knowledge of the scene of the transaction, (with which we also have some acquaintance,) would, we apprehend, have rendered the task of its refutation void of difficulty. We allude to the fever of the 70th regiment in Fort Edward, Martinique, in 1794; and refer to Dr. Fergusson's excellent topographical remarks on Fort Royal; (Med. Chir. Trans. Vol. viii. p. 119 to 122,) and also to Mr. Mortimer's introductory letter to his valuable report on Yellow Fever, published in the Medico-Chirurgical Journal, in proof, that the sickness of that regiment, attributed by Dr. Pym to contagion, (Obs. on the Bulam Fever, p. 10-14,) depended wholly upon local and indigenous causes.

We conclude this subject with the author's exhortation respecting the preconceived opinions of contagion, which strangers usually carry with them into tropical climates; but which, in by far the majority of instances, ultimately yield to a more intimate acquaintance with the habitudes of the disease in question.

66

"I earnestly request my readers attentively to reflect upon the facts stated in this chapter; and especially upon the readiness with which numerous medical men, respectable by their characters, their conduct, and their professional ranks, have come forward to make confessions which are generally felt as in some degree humiliating,

by acknowledging that they had, when they first arrived in the regions of yellow fever, entertained opinions, deeply fixed in their minds by the ordinary course of medical education, which however, after more extensive observation and better means of information, they had found reason to abandon as erroneous, and been forced to adopt conclusions directly the reverse, in regard to the alleged contagious nature of the yellow fever. This is stated to have been done by Dr. M Lean, Dr Fergusson, and all their colleagues on the hospital staff at St. Domingo; it was done also by myself. and almost all on the hospital staff in the Windward Islands, (see the letter of Mr. Young, Inspector General, on this subject, at page 335 of my Essay ;) it was done by Dr. Dickson, and as he declares, generally by others in the circle of his acquaintance; and, beside many others, it will soon appear to have been done by Dr. Erly at Sierra Leone, on the very coast where Dr. Pym and Dr. Chisholm pretend to derive their Bulam fever. In all these cases, the change of opinion has been made spontaneously and disinterestedly, by the silent and gradual, but certain operation of truth; and without any desire to gain credit by a supposed preservation of many lives from a danger which had no existence, and without any of those views to promotion and reward, which may have produced some of the exertions and erroneous statements lately made, in regard to the fever under consideration," p. 189-191.

On the subject of typhus within the tropics, we think Dr. Bancroft has somewhat, and with advantage, modified his former opinions; for his admission, page 174, seems to sanction a greater latitude of inference, than could be deduced from his former volume, respecting its being carried as far as Barbadoes. We also are of opinion, that typhus may, and does exist occasionally within the tropics; and we have seen what we consider to be the unequivocal cases of that disease on the Atlantic Equator; but we coincide with the author, that the climate is extremely unfavourable to the existence and perpetuation of typhus contagion, and that it ultimately exhausts itself.

Upon the occasional occurrence of a hybrid disease, which Dr. Bancroft simply alludes to as having noticed in his Essay "without either approbation or disapprobation," we do not profess to offer any decided opinion. It is known, that Sir John Pringle, Sir Gilbert Blane, Dr. Lempriere, and others, have spoken of a mixed or hybrid fever; and we have understood, that Dr. Dickson is of opinion, that he has seen some instances which favour the existence of such character of disease; where the appearance and duration of the symptoms were so indeterminate between typhus and yellow fever, that it was difficult to say, to which order of fever they most belonged. But we believe, at the same time, that he considers such occurrences as extremely rare; that he has not detected any satisfactory evidence of their possessing an infectious quality; and that under the influence of climate, they soon disappear, and are succeeded by the legitimate endemic of the West Indies. Such questions can only, we conceive, be ultimately decided by those who may enjoy similarly extensive opportunities of witnessing the disease under all varieties of circumstances and character.

We conclude by expressing our sense of the ingenuity, acuteness, and research, which the author has exerted with equal facility and effect in the present elaborate production; and we are satisfied, that the voluminous mass of irrefragable evidence which he has been enabled to adduce, will impress conviction on every unprejudiced mind, of the perfect triumph he has achieved by the complete refutation of the opposite opinion, of the existence of the Bulam as a distinct contagious fever, attacking but once. In the preceding analysis, we have aimed at the inclusion of the most prominent parts of the discussion for its length we plead the importance of the inquiry, and the desire to diffuse a portion, at least, of the information with which the pages of this" Sequel" are enriched, as well as to contribute our mite to the advancement of what we consider to be the cause of truth, and to the correction of a popular error; for as the author justly observes in his conclusions, the supposition of the existence of contagion"accords with the prejudices and apprehensions of the greater part of mankind, who are prone to believe that all diseases are contagious when they become generally prevalent." To those whose lot and duty it has been to alleviate the sufferings inflicted by yellow fever, and who, therefore, with us, naturally feel a peculiar interest in the discussion, we need not say more to induce them to avail themselves of the information and experience accumulated in this volume.

Topographical Remarks, illustrating the causes and prevention of the Tropical Endemic or Yellow Fever, by Dr. DICKSON, F. R. S. Ed. F. L. S. Fellow of the Royal College of Physicians of Edinburgh, and late Physician to the Fleet, and Inspector of Hospitals in the West Indies.

Quod sol atque imbres dederant, quod terra creârat

Sponte sua.

LUCRET. Lib. v.

SEC. III. As the knowledge of a disease is of interest in proportion to its danger or frequency, and as the means of prevention depend upon a correct appreciation of its causes, the investigation of the laws which govern the Tropical Endemic is confessedly of the highest importance.-With this view I offered some topographical remarks on the Etiology, and Prevention of the Yellow Fever, in the 13th Vol. of the Edinburgh Medical and Surgical Journal; and, on the present occasion, I have endeavoured, by the addition of several observations and illustrations, still further to elucidate the subject.

Marsh Miasma has been very generally, and justly considered as a grand source of the fevers of warm climates; and it is a very frequent, though not the only source of the destructive form of the Tropical Endemic. While its operation has been too exclusively insisted upon by some authors, it has been admitted under great limitations only by others. The term, indeed, is not free from objection, since it has caused the latter to receive it in a sense far too strict and literal, and to question the existence of such exhalations, except in the vicinity of a complete swamp or marsh.