ROYAL MEDICAL AND CHIRURGICAL SOCIETY

1846 The Lancet  
219 gtving attachment to the four tongues of a belt that goes round the back and hips, and to a strap that passes under the buttock, to be attached to a button fixed in the belt behind. Any degree of pressure, tightness, or support, may be obtained, as the tongues or straps are regulated for any period, without the possibility of slackening or shifting position; and as this is accomplished by a means that does not admit undue pressure, no pain or inconvenience can arise from that cause, be it
more » ... that cause, be it necessary to wear the instrument as long as may be. By this means the invaginated skin may be maintained in exact contact with the parietes of the inguinal canal for any period, and, I conceive, without risk or annoyance. I think, moreover, that the action set up by passing the needles would be sufficient, after adhesion takes place, to hold the invagination in position without further interference. I do not think it impossible that this instrument, if worn for a lengthened period, would alone effect a cure, as it might induce that amount of action between the skin and the walls of the canal as to cause them to adhere. I much question the necessity of making the needles penetrate the parts so extensively and so deeply as M. Gerdy directs, in operating with sutures. Mere punctures, five or six in number, might, perhaps, be sufficient to produce the amount of action required, the parts being held in intimate contact by the means described. When adhesion has taken place, the instrument may be dispensed with, and the further directions of M. Gerdy carried out or not, as the case may seem to demand. The instrument I have described is Iam told, easily made, by no means costly, very simple, and very readily applied, and can be regulated at will by the wearer. I do not wish to attach any undue importance to this modification; but I do wish to attach credit and importance to an operation, characterized by so high an aim, and based on principles at once sound, simple, and scientific. Upper Montagu-street, Montagu-square, Jan., 1846. REVIEWS. On Famine and If'eve7·, as Ca2r,se and Efect in Ireland; with Observatious on IIospital Location, and the Dispensation in Out-rloor Relief of Food and Medicine. By D. J. CORRIGAN, M.D. Dublin: Fannin and Co. 1845. pp. 33. THE views here set forth of the relation existing between famine and fever in Ireland were first promulgated by Dr. Corrigan in THE LANCET many years ago. On the present occasion he has recorded the principal phenomena which have presented themselves in the chief epidemic fevers of the sister island in the century commencing with 1728, and ending with 1829. In this period, six of these fearful visitations are included. From the facts it is observable that a constant relation has existed in these epidemics between the supply of food and the existence of fever. In every instance the fever commenced after a single bad harvest, or a succession of them; continued to increase in violence as long as the scarcity of food remained, and as speedily and certainly passed away on the coming of an abundant harvest. In five out of the six epidemics it is distinctly evident that the disease either disappeared altogether, or commenced its decline in the first autumn which brought a plentiful harvest. There can be no mistaking these facts. "Want and fever, want and fever, precede and succeed as cause and effect on every occasion. The epidemic fever of Ireland, produced in the first instance by want, becomes contagious, extends among high and low, affecting all classes, so that rich and poor are alike interested in its prevention, from the lowest motives of self-interest alone, independently of the higher movings of philanthropy. Dr. Corrigan dwells upon the failure of the present potato crop, upon the want now commencing, and so almost certain to increase in severity during the present year; and points to the pestilence so sure to follow in its track, except it be relieved. Sir Robert Peel says, from the data in his possession, it is more than probable that four millions of people will be without food in May, unless energetic measures are adopted in the interim. Dr. Corrigan's facts and reasonings go to combat the opinion of Mr. Chadwick, that fever is caused pre-eminently by defective drainage, locality, atmospheric conditions, and so forth, and tend strongly to prove that want is the prime element in its production. That want being present, fever arises in certain localities, and under certain conditions, with greater frequency than others, he would allow. He also controverts, and we think successfully, a dogma intimately connected with the above, and supported by the Edinburgh Reviewnamely, that fever is more fatal when it exists in the contagious form among the rich and well fed, than among the poor. He asserts, that " the error lies in supposing, that the greater fatality in disease in a certain class necessarily involves a greater frequency of disease. There is not only no connexion whatever between the two, but they even bear an inverse ratio to one another. The poor are the more liable to fever, but recover easily and quickly from it, comparatively. The rich are the less liable, but, when attacked, fever with them seems higher and quicker, and the disease is more severe and more fatal. * * * If twenty rich persons and twenty poor be attacked with fever at the same time, that a greater number of rich than of poor will be carried off, I do not deny, but if an equal number of rich and poor be exposed to the same contagion, that the liability to catch the disease will be as great with the rich as the poor, I do deny." Considerable attention is given to the best mode of distributing relief in food among the poor by means of hospitals, societies, and the new poor-law apparatus. Dr. Corrigan concludes with the following positions, of the establishment of which we think there can be little doubt :-" lst. That famine (including deficient or unwholesome food) is the paramount cause of the epidemic fevers of Ireland. "2ndly. That epidemic fever, originate as it may, soon acquires a contagious power, a power of generating and propagating itself, and thus involving all, rich and poor, in the country, in one common danger; and " 3rdly. As a corollary from these two, that employment and wholesome food will be the best prevention, aided, should the necessity arise, by hospitals to extinguish contagion :' The following passage is also worthy of great attention:-"I cannot conclude without noting a warning circumstance that has had some influence with me, in bringing out these observations at the present time. It has been remarked by all the observers of the epidemic fevers of Ireland, by Rogers, O'Connell, Rutty, Barker, and Cheyne, that small-pox has invariably prevailed, either immediately before, or with each visitation of it. The same connexion between small-pox and the bad fevers which ravaged England in the sixteenth and seventeenth centuries, has been observed by medical writers. Sydenham has gone so far as to say, that from their intimate connexion, he doubts that the plague and small-pox may not be of the same nature, only with different forms of development. It seems as if the human constitution, under whatever influences have acted injuriously on vegetable organization, or have predisposed to epidemic fever, had lost so much of its energy as to render it less able to resist infection. Smallpox has been of late very prevalent in Ireland. * * * This visitation should put us on our guard." This pamphlet is most germane to the present critical posture of affairs, when scarcity of no ordinary kind has commenced, and when the attention of government and the country is given to its relief and removal.
doi:10.1016/s0140-6736(02)89747-1 fatcat:qmiq2xnvpveqtfnjudya3r3nle