Imatges de pÓgina
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Though locally irregular in its attacks, the progress of cholera is not as a whole erratic. Slowly and fitfully, but steadily, the baleful influence rolls along till its appointed pilgrimage has been run. But, warned by the visitation of cholera in 1832, that it was not only possible, but highly probable, that it would return, were we better prepared to encounter it in 1848 than on the occasion of its former appearance? We knew, that as a general rule, foul air, filth, and the overcrowding of hovels, at least aggravate, if they do not induce, some diseases, and that cholera was most frequently found where these existed.

What then was done ? Nothing, till cholera had a second time broken out as an epidemic in the country. Then did the various civic powers that be, take measures for “putting it down." An Augean labour commenced, and for the time, the evil was increased by the removal and disturbance of fetid matter. No preparations had been made for the cure or treatment of the poorer class of patients, and in some cases a disgraceful economy as to the supply of remedies and the payment of medical men, after the disease had broken out, called forth the interference of the legislature.

A second time, under Providence, cholera seems to be receding from our shores, but we ought now to know that its periodical recurrence is in the highest degree probable.

Of the true nature of this mysterious malady, experience has still left us in doubt; its cause is still shrouded in darkness, and what mode of treatment may be most beneficial is still a matter of uncertainty.

The three publications, the names of which are prefixed to this notice, are similar in one respect, and almost in one respect only. They are each, for the most part, reprints, the respective authors adding the results of their experience down to the present date. Their titlepages are characteristic, and we were not disappointed in the anticipations which they severally induced us to form.

We confess we doubted that the ancient veil of cholera was about to be raised, though its “causes and cure” were boldly announced by Mr. Dickson. We found that the task Mr. Lizars had imposed upon himself was not without difficulty, when he undertook to rob cholera of all its mystery, and to prove that it was “as free of contagion as a cut finger or an amputated limb.” From a “ Report on the Epidemic Cholera drawn up under the superintendence of the Medical Board of Madras," we expected many facts, and calm reasoning upon them, and we are glad to say we have not been disappointed.

Few persons are now unacquainted with the general appearance and history of cholera, as regards individual cases. The patient has probably felt himself slightly indisposed and mentally depressed for a short period, then, suddenly, and generally during the night, he feels a chillness and experiences giddiness and nausea, he is seized with vomiting, purging and spasms. A cold sweat is suffused over his clammy skin. His pulse, at first rapid and weak, ceases to be felt. His breathing becomes painful and laborious. Burning within, he feels a cruel and quenchless thirst, whilst, externally, an icy coldness pervades his limbs. His skin assumes a ghastly blue appearance, and his whole body, but particularly the face, shrivels and shrinks, producing a singularly cadaverous expression. Deafness is felt, the voice fails, and the eyes sink in their sockets and become dim. Latterly, the more violent symptoms disappear, and give place to stupor, and after this fierce and terrible struggle, death generally claims its victim in quietness. Mercifully this dreadful malady is neither frequent in its attacks nor continuous in its ravages, “ for except those days should be shortened there should no flesh be saved.” " What then is cho. lera ?" is asked by both Mr. Scot and Mr. Dickson at the outset of their works. The former does not profess authoritatively to answer the interrogatory; the latter declares his conviction that it is a disease produced by atmospheric, but still more by telluric, influence, acting upon the brain and nerves. Being satisfied of this, he ridicules the idea of using calomel, or any other medicine, which does not immediately act upon the organs supposed to be the seat of the disease. He then proceeds to show that arsenic is the most fitting agent for the purpose required. Upon questions purely medical, we do not presume to advance an opinion, but when arsenic is recommended as almost a specific for cholera, we cannot but remember that when given in quantity its effects are very similar to the more prominent features of the disease for which it is proposed as a cure. The same nausea, diarrhoea, thirst, and vomiting. He strongly repudiates bleeding in cases of cholera, and, indeed, in all diseases. He seems to labour under a perfect área-Goore, and to be an exact converse to Dr. Sangrad.

Mr. Dickson declars that cholera asphyxia may be produced by ar. tificial means,“ by loss of blood, poisons, passions, and local injury.” (p. 53.) “In one case the prostration which followed a broken leg actually became cholera asphyxia !” (p. 42.)

Cholera, he says, is not contagious. This opinion he supports by argument, and we shall here quote the principal instance which he adduces as proof. Captain Scott, Commander of H. M. Ship, President, thus writes :

“Upon the arrival of the President at Halifax, in August, 1834, some cases that occurred on shore awakened a suspicion that that plague, the Asiatic Cholera, was about to visit us. Nor were we kept long in suspense. The troops in the barracks were the first attacked, and a great many men died. On their retiring, however, from the town, to encamp some fifteen miles off, the disease ceased among them, no fresh case, so far as I remember, occurred. My ship lying close to the shore, I gave orders that in case the disease should show itself on board, the men seized should be at once sent to a temporary hospital, which I had in anticipation provided in the victualling yard. The first seaman assailed was a main-top; and so sudden and severe was the seizure, he was obliged to be instantly lowered doun. He was then put into the boat and taken with all expedition on shore to the hospital, where he died in less than five hours from the time he was attacked. The disease from that day became prevalent in the shipthe number of seizures increasing gradually to eighteen and twelve men daily. I then, at the suggestion of my Admiral, Sir George Cockburn, ordered the moorings to be slipped, and the ship to be run up into Bedford

where we anchored off Mary Island, a distance of three miles from

the former anchorage. Just as we had made sail, a man was attacked on the quarter-deck, and sent on shore. This was the last case that occurred on board. From the time of our moving, not another case took place. It appeared as if the cause of the disease occupied the very spot we had quitted, and a very contracted one it would appear to have been, for of three other ships of war anchored around and close to us, not one solitary case occurred among their crews.' (P. 63.)

We think that the advocate for contagion might extract some evidence in support of his views from this narrative. Cholera appeared at Halifax, and the crew of a ship "close to the shore," and probably in communication with it, was attacked by the disease. After getting quit of the last patient, the ship sailed away, and the malady ceased. Perhaps the vessel had got clear of the epidemic cloud under the influence of which, infection more readily took place, or perhaps the disease had run its course. We know that the more sudden and severe its attack, the more hasty is its departure, and in this instance its progress was rapid, and the cases severe, The fact that “not one solitary instance occurred” among the crews of the other ships, would seem to indicate that the crew of the President was infected by the first man seized.

Turning now to Mr. Lizars' publication, we shall in the first place refer to his observations on infection, that important subject being now under our consideration. He sets out by stating that the majority of the medical profession is in favour of non-contagion. He tells us that:

“None of the medical officers, attendants, or nurses, attached to the Fisherrow Hospital, were attacked with the disease, which, perlaps, existed there in a more malignant form than in any other locality since its irruption in Great Britain ; while on the admission of a typhus fever patient, one surgeon, one male, and three female attendants were attacked with this fever.” (P. 60.)

Regarding this instance, we may observe, that medical attendants have, unfortunately, not always enjoyed such an immunity, and no one will contend that typhus is 'not infectious to a much greater degree than Cholera. Mr. Lizars then informs us that “the resurrectionists of Edinburgh, then about twelve in number, escaped the disease, with the exception of one man.” (P. 61.) This fatal case seems also fatal to the instance, as an argument. Homer talks of “ strong

fellows who steal kine.” We presume the worthies who stole bodies were “ strong fellows” too ; yet a twelfth of their number fell a victim to the disease. Regarding this and the more important examples of Cholera bodies being dissected with impunity, we do not profess to be in a position to decide whether a dead subject is as likely to cause infection as a living patient.

We are informed by Dr. Lizars that “the pernicious doctrine of contagion" destroys the finer feelings of our nature, and produces diarrhoea! He writes:

" The kindly affection of the father for his family is blunted or destroyed ; the still stronger link of nature between the mother and her offspring is broken, and she looks upon her innocent children as sources of danger ;the hitherto affectionate children, in their deceptive agonies of self-preserration, abandon their parents to perish in the hand of the stranger, and to desert them in the last necessities of mortality. No tear of sympathy or compassion falls to soothe the agony of departure from all we hold dear ; no kindly hand is raised to close the eye of death. In this selfish and cowardly contest for life, the ennobling attributes of benevolence and education are disregarded, and civilized man becomes a savage.” (P. 64.)

This is a libel upon humanity, and the reasoning upon it is consequently false. Neither the civilized man, nor the savage deserts his offspring in acknowledged danger. The lower animals would shame him if he did. It is self-devotion that most ennobles human nature, and nothing tends more to strengthen the ties of love and affection than the disregard and sacrifice of self. Do husbands and wives, mothers and children, brothers and sisters, I trust I may add-do friends fly from each other in a case of typhus fever?

To Dr. Lizars' work is prefixed a Letter from Professor Delpach, giving an account of a number of dissections of cholera bodies, in this country, conducted by himself, in conjunction with Dr. Coste of Montpelier, and Dr. Lowenhayen of Moscow. Dr. Lizars then gives a summary of twenty dissections conducted mostly by himself. These are the most valuable portions of his publication, and they will be received by the medical profession with the attention which is justly due to the researches of such eminent anatomists as Dr. Lizars, and the gentlemen whose experience he gives to the public along with his own.

All dissections show, that one effect of cholera is to de range the blood, and, in severe cases, to decompose it. Chemical analysis having shown “ that the serous portion of the blood was deficient in the albumen, and salts, which it holds in solution, and that these principles were detected in the evacuations,"-(p. 49,)-a most ingenious remedy is thus described by Dr. Lizars. It seems almost a “ forlorn hope" of relief, but it is, certainly, a beautiful result of combined science and skill :

“ When the patient is unable to drink the hot water, decomposition of the blood has either commenced, or is on the verge of undergoing that process, and in such a desperate state, nothing can save him, but injecting the veins with a saline solution.

One of the veins at the head of the arm is then to be opened, into which the mouth of an injecting pipe is to be inserted, the elbow being put into hot water, to exclude the air, and the pumping slowly proceeded with."-(P. 73.)

We cannot say much for the style which Dr. Lizars has adopted. If he writes for the medical profession only, technical terms should be used throughout, if for the public, why so much of the jargon of the schools? Why talk of “the cutaneus capillary exhalents," or call the air, “ the circumambient atmosphere ?"

Mr. Scot's work is totally opposite, in character, to the two publications we have just noticed. After a long and anxious study of the disease in India, after the most ample opportunities for observing it in different situations, and under various circumstances, and after the review of a vast number of carefully recorded cases, he shrinks from giving a positive opinion on the subject, he does not dogmatise upon its cause, and he boasts of no cure as a specific. Regarding the much vexed question of contagion, he (though with an evident leaning to a

belief in the doctrine) declares his inability to pronounce authoritatively upon it. Regarding individual cases, he informs us, that experience has shown, that any array of facts collected on one side, may be met with an equal number of instances, from which a directly opposite inference may be drawn, but he states that,

" Whatever may be the case in respect to its capability of communication from man to man individually, there is undoubted evidence, that bodies of men, travelling through a country in which cholera prevails, have the disease imparted to them-that they carry the disease along with them, and do at times impart it to the inhabitants of the country which they are traversing.”—(P. xi.)

Mr. Scot remarks that “ It is common to hear, that cholera is not an infectious disease, but only an epidemic. Now, it may be asked, what other epidemics are not infectious? We scarcely know of any. Influenza cannot be said--at least, it is not proved—to be an exception."—(P. xxix.)

After adducing strong proof, that masses of men, among whom the disease is raging, can certainly communicate it to others, he thus impartially sums up the arguments on both sides, as regards the commucation or non-communication of the disease by individuals :

The evidence which has been adduced in favour of the infectious or contagious quality of Cholera, as it respects the intercourse between individuals, may be thus stated. The relations who have attended on people ill of cholera, as well as the nurses appointed in military corps for that duty, and, in general, those whose employment has led them to be much with the sick, have been observed, in very many instances, to be attacked with cholera, during, or shortly after their attendance. For instance, a soldier's wife is taken ill and dies; her friend in attendance is also taken ill, but recovers ; while the husband of the former is seized tho same day, at noon, and dies in the evening. Many such examples might be produced. The sick in hospital, labouring under other diseases, have likewise been observed to be attacked with cholera, especially those who lay near the patients ill with that disease. Sometimes whole families have been swept off successively. Servants have often been observed to sicken after attending their masters. The instances, however, above recited are, by no means, uniform ; they are, indeed, opposed by directly opposite experiences; but it is contended, that a greater proportion of people, occupied as above described, have been attacked with cholera, than has been observed to be the case in an equal number of people who were not employed amongst the sick. It should be remembered also, that medical men and hospital dressers and servants, being inured to the contact of sick, are less liable, on that account, to receive infection. It is known, that thirteen medical officers of this establishment have died of the disease, and that between fifteen and twenty suffered attacks from it, but recovered ; in perhaps every instance the officers had been previously engaged with patients under cholera. The circumstances of some of these attacks are very remarkable. The medical officer, in repeated instances, has been the only European in the corps or station who has suffered.”—(P. 104.)

From the per contra side of the question we extract the following: " It has been already observed, that by far the greater number of medical men concur in the unqualified opinion, that cholera is not an infectious or contagious disorder. .

They contend, that if cholera had been

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