1913. PUBLIC HEALTH. 17 already complaining of the large amount of "THE EVOLUlqON OF EPIDEMICS "* work and the large number of committees BvJ. T. C. NASH, M.D. (Edin.), D.P.H. (Camb.). (President of the Etstern Branch of the Society of which they are expected to attend. Medical Officers of Health.) The advocates for placing all sanitary Being a brief epitome or pr6cis of Chadwick Trust matters under the county councils would Lectures I., II. and III., on the Evolution of Epidemics. have us believe that the members of these councils have a much higher sense of duty than T HE evolution of disease implies and involves the members of rural district councils, but this the evolution of ideas of disease as well as certainly cannot apply to all county councils, of causes--the resultants being the labelled as, notwithstanding the permission given in the phenomena. Hence the importance of careful Local Government Act of i888 to appoint observation of phenomena objective and sub- medical officers of health, a cert~dn proportion jective, and of subsequent philosophic reasoning of county councils did not avail themselves of eoncerningsuch phenomena before pronouncing this privilege, and, indeed, only grudgingly a judgment. The history of disease should be appointed such officers when compelled to by traced back to broaden the outlook and the Housing and Town Planning Act of 19o 9. engender liberality of sentiment. Neither Chadwick nor Pasteur were medical DEFORmTIES.--\Vhen not due to tuberculosis men, but both played great pioneer parts in serious deformities are generally the result of preventive medicine, both making and recording infantile paralysis. The newer methods of modern observations and then applying philosophical surgery, such as muscle grafting, nerve grafting, induction. and tendon transplantation have extended the field of treatment of paralysis and deformities, My first lecture embraced a brief historical and in experienced hands often yield brilliant survey of some of the more remarkable results. Unfortunately, only a small percentage epidemics of the Middle Ages, obtained chiefly of crippled children at present can obtain admis- from the writings of Hecker and Creighton. sion into orthopaedic hospitals. The after cure There is almost total lack of contemporary of these cases is beset with numerous difficulties, walking or other apparatus is frequently needed. expert information--the medical men of the It is as a rule costly to obtain, and under the day being apparently galenically hide-bound wear and tear of school life is apt to get out of and lacking in independent philosophy. But order, and as growth proceeds not infrequently from ecclesiastical, municipal and other records becomes useless. It is clear that crippled children require more supervision and after-care than can we gather the striking fact that the Middle be bestowed under the present conditions. They Ages were years of great human misery and of are in many instances anaemic, weakly, ill-fed, cataclysmic natural phenomena, such as earth- and badly clothed, an easy prey to the first serious quake and flood. The lower classes were illness which may attack them. On leaving school, cast on the world without a trade, shut extremely indigent and their dwellings were in out from the ranks of unskilled labour by their a frightful condition of concentrated filth, as physical inability ~o compete with the able- recorded by Erasmus. The mud floors were bodied, left to themselves they go to swell the strewn with rushes, which, when impregnated ranks of the unemployed and destitute. On the with all manner of putrefying filth, were simply other hand, with proper treatment of the defect, and efficient after-care, they may become highly covered over with fresh rushes--covering over, skilled workmen and valuable members of society. bztt not removing, the ghastly mass of decombosing --Joseph Cates, M.D., D.P.H., Annual Re~bort, filth already there. In Britain, after " The Great Medical O~cer of Health, Lancaster. Plague of Cadwallader's time " in the middle of the 7th century (the exact nature of which APPOINTMENTS. is uncertain), the pestilences for the next seven JOIIN DEAN BUCItANS-N, M.B., B.Ch., B.A.O.R.U.[., centuries appear to be, according to Creighton, 1), P.II., Viet., has been appointed nledical officer of health ~,l" Lancaster. mainly the results of famine; but various \VJLLIAM ARNO'rT DICKSON, M.D., Ch.B., St. And., F.R.C.S., Edin., D.P.H., has been appointed tuberculosis periodical, sudden and fatal outbreaks, affecting el'fleer for Glouccstershire. monastic communities, were probably fresh ANDRE~V I,ESLIE D¥1-:ES, ~[.D. Edin., D.P.H. Lend., outbreaks of genuine plague. The feudal has been appointed assistant medical officer of health of the County Borough of Oldham. system was responsible for much misery. It RORY I~IcLAREN,M.I)., I).P.H., has been appoiatt~d a~is- is stated that in the reign of\Villiam Rufus the lant county medical officer of he'dth for Dorset. TIIOM.~S HF~NIeY lh.:~ToX, M.D., 13.Ch., B.A.0. Dub., incubus of excessive tribute apparently led to 1). P.II., has been appointed tubcrculosis officerfor ChcM]h'e. famine through no less remarkable a cause than Wigan Education Authority have unanimously decided h, appoint MRS. ALICE S'raLKER, M.B., Ch.B., D.P.H., to a refusal to cultivate the land. Such times of the position of assistant school medical officer and assistant * President's Address at Annual Meeting of the Eastern Counties tuberculosis officer. Branch of the Society of Medical Officers of Health. 18 PUBLIC HEALTH. OCTOBER, misery and lawlessness, with barbarous in- of visitations of disease which in the course of vasions by Scots and Celts, civil wars, baronial ages have appeared in divers forms, renders cruelties and predations, all contributed to the clearer our insight into the nature of disease. dire famine of 1143, when people ate the flesh We are, therefore, naturally in a better position of dogs and even the raw garbage of herbs and to trace evolutionary factors than our prede- roots. Better times followed in the reign of cessors, though our successors again will have Henry II. A five years'famine in II93-97was the advantage of us. accompanied by a pestilential fever; and In the evolution of medical science two dis- famine and pestilence prevailed again in 12o3 tinct tendencies diametrically opposite are in and after the hard frosts of 12o5. In 1256-59 evidence :-- famine was accompanied by remarkable scarce- (1) A tendency to differentiate as distinct ness of money, owing to the exactions of King affections diseases which had been in- and Pope, so that even men of good position cluded under one common designation ; felt the pinch of hunger. The last of the great (2) A tendency to determine a persistency famines was in 1315. A new chapter in the of type running through a long series history of English epidemics was opened by of disorders of various designations. the advent of the Black Death in 1348. Variation in the birth-rate and death-rate is England was, however, singularly free from the only the most obvious and numerically precise epidemics of "ergotism" which raged in of a whole series of variations in vital phe- France in the I4th century, probably due to nomena, such, for instance, as the apparition rye-bread being but little eaten in England as and vanishing of leprosy in mediaeval Europe. compared with France. Comparisons may be drawn between leprosy Let us for a moment refer to the astonishing and pellagra--another disease with profound psycho-pathies or neurotic epidemics of the disorder of the nerves--and as regards the Middle Ages, more particularly the dancing causation of both these diseases there are two manias, which illustrate how, in crowds, camps of opinion, according as to whether it is "ideas, sentiments, emotions, and beliefs pos- held that the cause of each is something sess a contagious power as intense as that of noxious in the dietary or not. microbes" (Le Bon, " The Crowd," p. 128). It is conceivable that a common saprophyte " The convulsions in the most extraordinary may, under different evolutionary conditions, manner infuriated the human frame, and excited such as semi-putrid fish on the one hand or the astonishment of contemporaries for more semi-putrid vegetable on the other, under than two centuries" (Hecker). Something of varying conditions of season and light, become the sort may still be seen in connection with a lepra bacillus in the one case or a pellagra devilworship or other heathen rites. Wretched- micro-organism in the other. It is, however, ness and want, combined with superstition and equally likely that the somewhat similar unusual excitement, had apparently much to nervous symptoms in leprosy and pellagra may do with these extraordinary disorders, which be the results of interaction between susceptible gradually became mitigated under military tissues and two quite distinct organisms. conditions. Apart from superstition, however, Recent research suggests that both leprosy men's minds were everywhere morbidly sensi- and pellagra are insect - borne diseases. tive through frightful calamities and pestilences Ravbitschek's and Charlton Bastian's observa- of a magnitude rarely known in these days. tions illustrate the enormous evolutionary Even decided sceptics were so vulnerable to importance of light and heat in the production these influences that they were subdued by a of primordial life. poison, the effects of which they had ridiculed, When studying the history of plague in and which was in itself inert. Hysterias were England I remarked that the I5th century common, and women (especially in Italy) led theory that bubo-plague was due to a cadaveric idle, lonely and miserable lives, and so were poison fitted in with both Pettenkofe's ground peculiarly susceptible to ecstatic attacks water fluctuation influences and the most excited by the delights of music, which fur- recent rat theories, as regards the causation of nished a magical means of exorcising their plague.