DR. MOREHEAD'S CLINICAL RESEARCHES ON DISEASE IN INDIA. * THE author

of this work has served a quarter of a century in India, in very various places and positions, ending at last in the Principalship of the Grant Medical College, and several high offices connected with hospitals, &c. at Bombay. On returning to England for his health, an additional year of absence was granted him in order that he might draw up a work on the Dis- eases of India "calculated not only for the students educated in . Indian Medical Colleges, and for Indian graduates but also for medical commissioned officers of the Honourable graduates, ser-

vice on first arrival in India, and till such time as they have ac- quired that experience which years of services alone can supply." The work before us is the result of Dr. Morehead's holiday ; and it forms an extensive and complete view of the diseases an India, whether general disorders influenced by the climate, or com- plaints more peculiar to the country. It is the result not only of the author's extensive practice and observation, but of the gene- ral experience of the hospitals with which he has been connected, and of the writings of some other Indian practitioners. The primary object of the work seems to have been that of a text-book, in which a strictly practical view should be taken of the causes nature, and treatment of diseases ; so that the Indian student should have a guide to practice ready to his hand, and the European practitioner just arrived in India might have a work before him that should at once and safely modify the opin- ions formed under a totally different system of climate and mode of living to those in which he is suddenly placed. Truths esta- blished by experience are the first consideration, not novel the- : ories, or hypotheses, or discoveries, unless directly tending to : practical treatment. New views are indeed continually met with ; but they do not refer to the abstract principles of medicine as it were but to the safest modes of proceeding. Dr. Morehead, for instance, in his introduction, combats the opinion that Europeans are more liable to bilious affections than the natives, if they adopt the native mode of living, especially in regard to food. -

"The European soldier or sailor [and the same observation may probably be applied to most Europeans civil or military] lately arrived in India does , not readily appreciate or adapt himself to the alterations in habits of life necessary to the maintenance of health under these circumstances of a warmer climate. The excesses, therefore, which in the cold climate might ' be unattended with disorder, are, under the increased predisposition conse- quent on the influence of elevated temperature, followed by derangement. .,

"Bilious diarrhcea or cholera is in these circumstances very apt to occur; and the theory usually conceived of this event is in all probability correct, viz, that defective elimination of hydrocarbon by the lungs, under di- minished heat-generation, is liable to throw on the liver the burden of the elimination of these elements, when they are present in excess in the sys- tem. But it by no means follows from this that, when there is the ,just re- lation between food-supply and excretion which is implied in the habits of every prudent resident in a warm climate; there obtains more of action of the liver vicarious of the lung in the one climate than in the other."

Similar originality of views or opposition to received opinions will be found scattered among the observations on particular diseases, . but they still have the character of being immediately applicable to the treatment of patients. They are distinguished by keen observation, judicious reasoning, and, it strikes us 'by safety. The day of active practice seems to have passed in India as else- where.

The diseases in the book are divided into classes, the different subdivisions being included under the generic head. The sub- jects that occupy the largest space, and are the most fully consi- dered, are the numerous affections of the liver, and fevers—inter- mittent, remittent, eruptive, and continued, with a short notice of the plague of the Levant, the yellow fever, and the fevers of colder climates. Cholera and dysentery are of course handled at length ; Bright's disease, and chest disorders, both of which seem more common among the natives than among Europeans, are also somewhat elaborately considered, as well as tetanus, which is not an uncommon complaint in India. There are a variety of other diseases more or less fully discussed. The plan is the same throughout, varying only with the number of facts and the extent of the exposition. The prevalence and causes of the particular disease are first exhibited, then the symptoms, and next the treatment. Selected cases illustrate the observations of the text, and hospital statistics show the monthly proportions of admissions, deaths, &e. As the object is to assist practice, the book is printed so that the cases may be passed by those who wish to master the principles contained in the text. At the same time, a catalogue raisonne in the form of an index presents a continuous view of the cases, with a reference to the

• Clinical Researches on Disease in India. By Charles Morehead, M.D., Prin- cipal of Grant Medical College, Professor of the Principles and Practice of Medi- cine and of Clinical Medicine, 4.c. In two volumes. Published by Longman and Co.

page where they will be found, for those who may wish to study the particular facts of disease by themselves.

The professional and practical nature of the work, as well as its extent, of course preclude that species of popularity which may arise from the account of an expected or prevailing pestilence or a disease common to the country of the reader, or some treatise on the management of life. There are, however, passages of general interest, indicative of native manners, or constitution. Here are some facts as to the proportion and relative effects of delirium tremens.

"During the six years from 1848 to 1853, 41 cases were admitted into the Jamsetjee Jeejeebhoy Hospital : of these' two proved fatal, one being an Eu- ropean whose case has just been detailed. The classes chiefly affected were Hmdoos and native Christians. Though the lower classes of the Parsee commu- nity drink spirits to great excess, and though I have often seen them tremu- lous, and euibiting other indications of intemperance, I have never seen one in the second stage of delirium tremens: the cause of this fact I am un- able to explain."

Idiopathic tetanus is a much more common disease in India than in Europe ; though Dr. Morehead seems to think that the idiopathic and traumatic forms are alike,—that is to say, that there exists a constitutional predisposition which may be excited by a wound or natural causes, of which last, cold is the cause generally assigned by patients themselves. Tetanus from strych- nia he has only seen once, when a medical apprentice swallowed. an over-dose by mistake, and recovered. His description of the

• symptoms from natural disease are opposed to those advanced for the defence in the Rugeley case, from the length of time which it generally takes to run its course.

Tetanus has been divided into acute and chronic. By the first is under- stood severity of form, and a fatal result generally within nine days. By the second, less severity of symptoms, a protracted course, and often a successful termination."

There seem in India to be preliminary symptoms, not existent or not reported at Rugeley.

"Mr. Peet has called attention to a peculiarity in the expression of the countenance which he correctly. thinks a the earliest indication of tetanus. He says—' But, even before.pain hi complained of, there is often something very peculiar in the expression of the face : it is not easy, perhaps, to de- scribe exactly in what this change consists,—it has seemed to me to depend upon an apparent increase in breadth, the angles of the mouth being in some degree drawn outwards, the lips compressed, and the eyelids slightly corrugated. This expression is very different from that present at a later period, in which the skin is wrinkled, the furrows of the face highly de- veloped, the angles of the mouth depressed, and the whole appearance that

which has been so well designated by the term Barstow:sus.' The length of time over which the change in the expression of face first noticed may extend I am unable to state : I have witnessed and pointed it out ten hours before any other symptom of tetanus was present.' The greater or less permanent rigidity is followed, sooner or later, and sometimes very speedily, by spasmodic contractions, which vary in force, frequency, duration, extent, and preference for particular muscles. In these variations consists the difference in severity in different cases. The extent and force of the permanent rigidity are always in_proportion to the force, frequency, duration, and extent of the spasms. The spasms may recur at intervals, ranging from two or three minutes to half an hour or more, and may endure for a second or two to half a minute or a minute. The prefer- ence given to one set of muscles over another occasions the varieties which have been previously alluded to.

"The spasms may recur without any appreciable excito-motor impression, but they are generally very readily excited by trifling causes, as the sound of the voice, the motion of the observer's hand, the slightest touch, &c. "I concur with Mr. Pectin believing that it is not always possible to say from the symptoms at the commencement whether the course of the disease mill be rapid and fatal or prolonged and recovered from. I have seen cases that gave every promise of being mild become suddenly and unexpectedly aggravated, and others which threatened to be severe beeothe unexpectedly moderated.

"The statement usually made, that the fatal result from tetanus occurs for the most part within nine days from the commencement of the attack, is on the whole correct. Yet exceptional cases are by no means uncommon. I have seen several in which death took place as late as the twentieth day, under recurrence of an aggravation of the symptoms' or in consequence of increasing asthenia. And I entertain the opinion that more frequent re- coveries, and a more protracted course in fatal cases, would result fromIreat- ment, if depressing remedies and full narcotism were abandoned, and mo- derate anodynes, with tonics, stimulants, and support, substituted in their place."