state of spasm, what is so likely as opium to relieve them? And could the advocates of the opium treatment, if they are converts to Dr. Johnson's spasmodic theory, have a better proof of its correctness? But, unfortunately for them, Dr. Johnson ignores both opium and the warm bath, &c. Further on, Dr. Crisp states that what he regards as the hyperæmia seen in some organs is "due rather to the loss of the vis a tergo, the failing powers of the heart, and to the thickened state of the blood," &c. He also dwells upon the important effects of the non-passage of bile (in general, in cholera) into the intestines. It is not our province to follow this author into his appendix. on the cattle plague, or his letter on homœopathy, and the present state of the medical and veterinary professions, &c. Dr. Shrimpton asserts that cholera is not contagious; advises that the poor be treated in their own homes, except the worst cases, which must be sent to hospitals. He disbelieves in disinfectants, but highly approves of cleanliness. Dr. Peters insists on a long-continued and most rigid quarantine, on cleanliness, and on disinfection, as the means for preventing the spread of cholera. Though giving some of the opinions of many celebrated authors, as well as of others of less note, the work of Dr. Peters is not correct in some respects. Thus, at page 156 we find the following:-" One of the most striking features of cholera is, that all the discharges are acid-none have ever been found to be alkaline; the stools as well as the vomits;" &c. The reader will find this statement does not agree with the researches of M. Bordier given in another part of the article: it also varies from those of Pettenkofer and others. It is hardly necessary to remark that the views of Dr. Peters on quarantine are impracticable in the present age of locomotion. Dr. Haughton alludes to the idea of some, that the cholera in 1832, 1849, and 1866 has relation to meteoric phenomena, recurring at intervals of seventeen years.1 "Although," says Dr. Haughton," the influence of such periodical astronomical causes in aiding the conversion of endemic disease into epidemic disease cannot be denied, simply because it can neither be proved nor disproved, yet it is inconsistent with the rules of inductive science to admit a cause for a phenomenon which is only a possible cause, so long as a probable cause exists whose influence is real. We are, therefore, entitled to reject such causes so long as we are prepared to assign more probable causes for the phenomenon, which in case of cholera is always possible; and, even at the best, the astro 1 Dr. Howe, the author of this idea, ignores the epidemic of 1854: it would interfere with his theory.-Reviewer. 79-XL. 3 nomical causes of cholera would reduce themselves to meteorological causes of wide-spread influence; for it is only by influencing the constitution of large regions of the atmosphere that meteoric showers or other astronomical influences could make themselves felt." The facts of the first appearance of cholera in Dublin in 1866 are then stated; its victims within the year numbering 1193. Dr. Haughton traces out the spread of the disease to the case of Magee, a woman" who imported the disease from Liverpool, July 26;" and we have no doubt that the succeeding papers of this clear and scientific observer will form, with what has already appeared, a valuable addition to our knowledge of the workings of this dire disease. In Paris, in 1865, warm baths were not approved, on trial, in cholera cases. Dr. A. Clarke, physician to the London Hospital, regarded them as beneficial. Injection into the veins was approved of by some in extreme cases of collapse; others did not approve of the measure. M. Jules Besnier1 attributes the asphyxia of cholera to pulmonary congestion, and the deposit of a reddish, viscous matter, forming a kind of jelly, on the surface of the bronchial mucous membrane. In this tenacious matter the miscroscope revealed a considerable number of cells, some narrow and elongated, others larger and irregular, and both kinds provided with vibratile cilia at one extremity. 2 The braise de boulanger, a sort of charcoal remaining from wooden fagots used in heating ovens in France, was used as filterbeds for water. Sulphate of iron was used to disinfect les fosses d'aisance, sewers, &c. Ammonia, contrary to the ideas of Pettenkofer and others, was recommended as a gaseous disinfectant. Carbolic acid should be placed at every aperture by which air escapes from a cholera ward. Sir Henry Cooper regards arrest of the diarrhoea stage of cholera by astringents as of the first importance : "It is the duty of those in authority in cholera epidemic seasons to search out and arrest all cases of diarrhoea by the organisation of a sanitary police for the detection of the disease, and its treatment in its earliest stages." The Calabar bean was proposed as a remedy in cholera, but was speedily abandoned, as causing enteric hæmorrhage and adding to the danger of the cases. Dr. Morehead objects to the dogma that "in India it should be a rule to treat every cholera patient in a tent," arguing that heat and cold, dryness and moisture, as well as good nursing and 1 Archives Générales de Médecine,' Sept. 1866. 2. Gazette des Hôpitaux,' Sept. 22, 1866, and Med. Times and Gazette,' Sept. 29th, 1866. ventilation, must be taken into account, especially in a country so extensive, and so varied and variable in its climate, surface, &c., as India is. There are some other points in Dr. Morehead's pamphlet worthy of attention. Although by no means new treatment, some practitioners attributed benefit to the use of warm enemata in cholera. Dr. D. Menzies used ice in small portions in cholera in India with good effect. [In some cases at home also it appeared useful.] Dr. M'Cloy, of Liverpool, recommends Dr. Johnson's castoroil treatment, and condemns the ice to the spine treatment as miserably unsuccessful." So fatal were the results following the trials for a while made by some junior practitioners in Dublin with castor-oil, that the physicians of some of the hospitals open for the reception of cholera cases declared that they would not continue to admit cases so treated. Mr. Sanson's little work contains some useful rules on disinfection, and the agents to be used. He refers the train of cholera symptoms to the influence of "a real, actual poison," irritating the great sympathetic nerve. He would seek to combat its effects by sulphite of soda or carbolic acid, given internally in properly diluted doses. Too much stress is laid by this writer on anatomical states of the vascular system of which we have by no means sufficient proof, and the agents above named are too slow in their action for the disease under consideration. Many of the author's suggestions as to diet, good nursing, &c., are well worth remembering. Professor Frankland, in a communication to the RegistrarGeneral, states the result of his investigations into the nature of cholera evacuations. Water may become seriously contaminated with choleraic matter without the presence of the latter being indicated by chemical analysis; and, secondly, water so contaminated is not completely deprived of this impurity either by filtration or passage through animal charcoal. It still remains to be proved to what particular constituent of choleraic dejections the propagation of the disease is due; but it is obvious that if the propagating matter be a germ or an organism, it must be in suspension, and not in solution. Sir Dominic Corrigan, without altogether denying the existence of contagion in cholera, argues that the comparative infrequency of the spread of the disease in 1848 and 1849 in Ulster and Leinster, and the fact that every town in Connaught and forty-two out of forty-seven towns in Munster suffered from the disease, is against the contagion theory, as the latter districts are remote from the chief traffic routes. On considering, however, that the vast majority of those who travel to and from the cities and districts in England for harvest-labour, &c., and whose habits of life render them most likely to suffer from the disease, dwell in Connaught and in Munster, it appears to us rather to favour than otherwise the contagion theory of the disease. The sound advice given by this author in regard to the vast importance of improving, as far as possible, the general health of every one during the prevalence of cholera, cannot be too forcibly impressed upon the whole community. Dr. Shapter, of Exeter, has been long known to the profession and the public as a writer on cholera, especially in connection with Exeter. He looks hopefully on early treatment of the diarrhoea which usually precedes the disease, and points out the great value of sanitary measures. He regards the consecutive fever as more an accident than as a necessary part of the disease, for often "the worst cases of collapse are recovered from rapidly and without any such fever." "Collapse from other causes, as long exposure to severe cold, is often succeeded by a form of fever precisely similar in all its main features." His experience is in favour of opium early in the disease, and of mercury either with or without opium in the advancing stages of the disorder. In advanced collapse and in consecutive fever, he regards opium as obviously and immediately injurious. If nausea and vomiting, however, continue persistently, he thinks a dose or two of opium useful. Dr. Cockle's little work is a valuable résumé of the leading theories of the disease, evincing accurate acquaintance with the literature of the subject. "That cases may do well without our aid, we sometimes see, for cholera has its plus and minus forms. But, face to face with the disease in its more serious shape, eye-witnesses of the telling influence of the oft-frightful drain, does it impress us as nature's act to cure, or carry with it one character of safety? Do patients tell us, at each escape of fluid, they feel relieved or have their strength increased? for such are the results that should attend eliminative or critical discharge. If they do, their looks belie them strangely. In such a state, no matter how we regard the disease, fever or flux, irritation or poison-no matter how we treat it,-calomel to restore the bile, salines to moderate the congestion, or opium and astringents to repress,-again and again we seize the symptomatic indication, and try our best, each in his way, to stop that vomiting and purging, alike the symptoms and the danger of epidemic 1 cholera. Is this mere routine, or the settled conviction of reasoned experience? If we are wrong, we have at least for our consolation the example of our betters; take that of the late Dr. Graves, a physician of more than ordinary fame, or look abroad and search opinion there; and in the face of such teaching, it must indeed require overwhelming evidence in favour of an opposite procedure; for the experience of able men, when theories clash, must be the fitting and the only guide. One closing argument in favour of the arrestive plan may be drawn from the state of the epithelial lining of the gastro-intestinal tract: the larger the drain, the greater the destruction, and the more tedious and intractable its repair." The debate on cholera in the Harveian Medical Society of London has been published. It contains the opinions of the several speakers on the occasion, which, however, it would be very difficult to introduce in the form of a review. Several of the members advocated excellent measures of a sanitary nature. The introduction by Dr. Drysdale, the secretary, contains a good outline sketch of the chief features of the disease. Professors Pettenkofer, Griesinger, and Wunderlich, and Dr. Macpherson, "are perfectly agreed that cholera is propagated by means of subterraneous waters." Dr. Klob, according to intelligence from Vienna, "has, with the use of a microscope of from 800 to 1000 magnifying power, discovered in the rice-water evacuations millions of microscopic fungi, which in appearance differ little from the ordinary European forms; and that they form the basis of the frightful malady, and that cholera is easily propagated by their means, can scarcely any longer be doubted." As if to impress upon the profession of medicine the great importance of pressing upon "the powers that be" the vast interests at stake in the promotion of state or preventive medicine, accounts are almost daily received, showing the great necessity for such steps as will lessen the growing tendency to Unless some singular error prevails, the arrestive treatment yields by far the best results. According to Boudin, ‘Traité de Géograph. et Statist. Médicales,' p. 366 (1857), the mean mortality is thus stated : Evacuant treatment 71.7 in 100 54 36 20 To understand the exact arrangement of his tables, the original work must be referred to. Ainsi, en général, plus les évacuations sont copieuses et prolongées, et plus le choléra est fatal."-Majendie, p. 133. "C'est surtout à diminuer les évacuations qui doivent tendre les indications symptomatiques. Rien ne mène plus rapidement à la ruine des forces, rien ne hâte davantage le progrès des plus redoutables symptômes, que la fréquence des vomissements et des selles. Non-seulement alors toute médication, toute réparation, sont impossibles, mais il en résulte encore un épuisement général et une perte absolue de toute résistance vitale, par les déperditions et par la lassitude que causent les besoins sane cesse renaissans de ses déjections continuelles."- Rapport de l'Acad. Roy. de Paris,' 1831, p. 77. |