THE ALLEGED CAUSE OF CHOLERA.

THE ALLEGED CAUSE OF CHOLERA.

THE ALLEGED CAUSE OF CHOLERA. 519 week, and included 42 which were referred a morbid influence, under which exosmosis is everything, principal zymot...

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THE ALLEGED CAUSE OF CHOLERA.

519

week, and included 42 which were referred a morbid influence, under which exosmosis is everything, principal zymotic diseases, against 65 and 42 in the endosmosis nil. There is in most cases an enormous transutwo preceding weeks; of these, 24 resulted from diarrhoeal dation of alkaline serous fluid into the intestines during one diseases, 11 from scarlet fever, 4 from "fever," 2 from diph- stage (rice-water) of the disease; but that does not justify theria, 1 from whooping-cough, and not one either from us in stating as a logical inference that the steall intestine is small-pox or measles. These 42 deaths were equal to an the seat of the disease, any more than we should be justified annual rate of 6 2 per 1000, the rate from the same diseases in saying that the doors of a theatre in case of a panic not exceeding 3 1 in London and 25 in Edinburgh. The from an alarm of fire were the seat of the disaster in the fatal cases of diarrhoea., which had been 48 and 29 in the theatre. Next (a) it must be shown without any shadow of doubt two previous weeks, further declined last week to 24. The in the preceding

to the

deaths referred to scarlet fever, which had declined from 13 to 7 in the three preceding weeks, rose again to 11 last week. The 4 fatal cases of fever exceeded the number in any recent week. The fatality of whooping-cough showed a marked decline from that recorded in the three previous weeks. Three inquest cases and 1 death from violence were registered in the city during last week, and 47 deaths occurred in public institutions. The deaths of infants showed a considerable decline from recent weekly numbers, while those of

The causes of 38, or more than 19 per cent., of the deaths registered during the week were not certified.

that these comma-like bacilli are absent in every other disease, and in healthy individuals under ordinary circumstances ; and for this purpose the number of observations recorded by Koch to establish it are, to my mind, insufficient. (b) Further, it must be shown that the bacillus is a specific object, and not a mere differentiation from some common microbe, owing to the nature of the menstruum in which these latter float, and on which they are presumably

nourished.

in regard to shape, bacteria kind is not changed into another, experiments are required to prove what would be the effect of subjecting the micro-parasites ordinarily present in the body to contact with a mucous membrane and an alkaline fluid like that found in cholera intestines. Why does a pancreatic digestive mixture soon swarm with bacteria when the natural juice or an infusion of the gland isused. (Foster’s"Physiology,"pp. 253-298). It is difficult to "Audi alteram partem."’ understand how the intestines can be the sole breeding-ground or infecting depôt, so to say, of these bacilli, which are to proTHE ALLEGED CAUSE OF CHOLERA. duceallthemorbid phenomena witnessed in cholera. Koch has To the Editor of TaE LANCET. not detected these comma bacilli in the blood, liver, spleen, or SIR,-There is no subject on which the same amount ofkidneys. Again, take the effects of desiccation, and how labour and observation has been bestowed with so little are we to explain the survival of this bacillus in the plains of India? If the gastric juice of a healthy stomach has real or apparent advance as that which forms the heading sufficient acidity to destroy the bacillus, it should follow of this communication. It has fallen to my lot to have seenthat the stomach is the safest place to put it. Koch has much of cholera, and it was my good fortune to have knownapparently to evoke the aid of some trifling indigestion or intimately the late Dr. James Bryden, than whom a moregastric derangement on the part of those attacked; but is truthful or philosophical-minded man did not exist. Strongnot this an assumption, and, at least as far as some cases are concerned, opposed to experience? Does he hold, as he lights are unnecessary, true ones being at command, saysseems to do, that the cholera cause can only reach the sysSelden ; and it seems strange, where every fresh theory ortem through the gastro-intestinal tract ? On what evidence ? hypothesis appears destined to add but another to the many I How does cholera, as a matter of fact, comport itself in scientific pitfalls for the footsteps of the unwary, that the India ? This cholera bacillus must be capable of covering works of a man who sedulously endeavoured to compile such the two extremes of (a) sporadic cases, where one man is attacked and dies in a place, no other cases occurring, and a truthful record of facts that it might have been written, so (b) an epidemic extending over half the globe. A return of to say, by cholera itself, and merely chronicled by him, should the cholera cases in Bengal for this year, or for any year, have received so little attention at the present time. would show that isolated cases at numerous stations, widely It is as easy as it is common to drop down with the tide separated from one another, are common phenomena ; of the latest popular view-the current doctrine of the day ; and further, these so-called sporadic cases at certain seasons but it unfortunately often happens that the facts are all going are often the precursors of epidemics later on. How are we to account, on the one hand, for the apparently sponthe opposite way. taneous origin of this cholera bacillus at one time and place, As I propose briefly commenting on the latest view of a and for its limited sphere of action ; and, on the other, for most accomplished and competent histologist, I desire to its enormous and rapid development when the disease is as an epidemic? guard against being thought to possess any sympathy with spreading The regularity of the course of epidemic cholera in Bengal the Philistinism of the day, which roughly ridicules what -its relation to time and space-could be easily illustrated. it cannot understand or appreciate. I quite appreciate and is it, in the first year of its advance to the north-west, Why sympathise with the labours of such men as Koch and his so often limited by the line of 80° E. long. ? It has been confrères, but it must be remembered that it is truth, not lately discovered that at this longitude the two monsoon from the Bay of Bengal and Arabian Gulf meet, and victory, that has to be sought. It is humiliating to have to currents must there give rise to an ascential current. It would be confess that we are still ignorant of the cause of cholera, to illustrate this and other circumstances connected easy (our the latest alleged discovery of it is not, I fear, destined with the past history of epidemic cholera in Bengal by some to prove a " true light." striking tables embodying the results of repeated observaKoch has, he says, found a bacillus of comma-like form tion ; and they cannot surely be mere coincidences. in all cases of cholera, and in that disease alone. These Again, how are we to explain the almost simultaneous bodies are met with in the small intestines, which are the outbreak of cholera at so many and distant stations ? How are seat of the disease ; they swarm in the inodorous watery we to explain the contrast exhibited by Peshawar as comalkaline fluid which characterises a certain stage of pared with other places in regard to epidemic cholera? In that disease, being substitutionary apparently of those Peshawar a cholera epidemic will continue till December ; in micro-organisms ordinarily found. These bacilli are easily other places, say the Punjab, it is over as an epidemic by the destroyed by desiccation, by acids, even by so weak a one end of September. A great deal has been said from time as that of the gastric juice, and so on. The outcome of his to time about the influence of water as the vehicle of a specific, observations is that these micro-organisms are the cause, and as contra-distinguished from a common, cause of impurity. not an effect or concomitant, of cholera. All attempts to In the celebrated Broad-street pump case the outbreak was impart the disease to the lower animals by inoculation have, almost identical in its course and duration with a typical outbreak in a regiment on the march in India; and the however, failed. Surely, several steps in the argument are assumed. For in- fact of the fatal cases ceasing at once after closure of the stance, is it the fact that the small intestine is the seat of the well is against that having been the cause. disease? In cholera the body is, as it were, dominated by The course of an epidemic of cholera in Bengal, instead

Although it may be true that,

elderly persons were more numerous.

are

Correspondence.

=

very constant and

one

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THE METAPHYSICS OF COMTE.

of being with is against the course of the natural drainage ofall. It is plain to anyone reading Mr. Harrison’s letter i The Times of this week that Pusitivists do not seethe country. Of course it is no new thing that cholera hugs in 1 the banks of a stream ; but it has never happened that anthemselves quite as others see them. One cannot be surepidemic of cholera commenced in the Himalayas or Upper prised. The "giftie" of seeing ourselves as others see us Provinces and spread gradually down the Ganges, Jumna, would belong rather to Relativists than Positivists. But or Indus; its advance has been exactly opposite. Mr. FitzPatrick has been acquainted with the distinguished Professor Koch, misled no doubt by incorrect information,group of Comte’s followers, and he must be aware that the has attributed the improvement in the health of the garrison " latest phases " of Comte became mystical and obscure, and at Fort William, Calcutta, to the introduction of a pure left the safe ground of five-sense science, and undertook to deal water-supply ; but the fact is that an Order in Council exists objectively with the subjective aspect of life, and that refusing to sanction the necessary expenditure for its intro- in this departure he was not followed by all his followers, duction, in consequence of the remarkably good health which small as the distinguished group has always been. Was the Fort William garrison had then been enjoying for several not Littré rather than Comte the Paul of the Positive years past. The town water was subsequently introduced ; system ? And is not Mr. Frederick Harrison now a kind but there was no such causal connexion between the two of melodramatic Athanasius, declaring the polity things as has been alleged. There are, moreover, some with its human subjective synthetic side to be óµ facts within my knowledge connected with the prevalence with the awful primitive abstractions of Positive Science. of cholera on board some of the Assam steamers, and the One, indeed, can easily foresee fundamental divisions town and district of Dacca, which would indicate how amongst the Comtists. But such divisions will never cautious we should be before considering that cholera infec- reach great dimensions through the numbers involved. To tion through a specifically contaminated water is a demon- be d, Positivist your brain must preponderate over your heart-a result obtainable either through much brain or strated fact. This communication has already extended to a wearisome little heart; and either of these alternatives will disqualify length, therefore I will finish what I have to say next week you for a wide religious success amongst the multitudes who if you will kindly grant me the necessary space. compose humanity. Mr. Frederick Harrison has evidently much brain. The little Comtists whose qualification for the I am, Sir, yours obediently, Positive philosophy consists in little heart are in even a more J. A. MARSTON, Deputy-Surgeon General, A.M.D. September, 1884. hopeless case than Mr. Harrison as to the prospect of attracting the attention of their divinity. I am, Sir, yours truly, "THE METAPHYSICS OF COMTE." W. MOXON. Finsb.ury-circus, E.C., Sept. 15th, 1884. To the Editor of THE LANCET. SIR,-The tone of Mr. FitzPatrick’s letter makes me fear CONGENITAL SACRAL TUMOUR: A CORRECthat I did wrong in using the not very elegant term TION FOR THE "SYSTEM OF SURGERY." "rubbishy" to qualify metaphysics. But the context would To the Editor of THE LANCET. show that the worthlessness of rubbish was ascribed by me SIR,-My attention has been called by Mr. Charles to metaphysics in general, and not only to the mystical Hawkins to an unaccountable error in an article of mine in latest phases of Comte, which are at least as like metathe " System of Surgery." May I ask you to allow physics as one fog is like another. me space to make the necessary correction? The pasI certainly did not mean to speak slightingly of Comtists, is in vol. iii., p. 781, of the new (third) edition,. and am very sorry if I seemed to do so. No mere passer-by sage in the article on Surgical Diseases of Childhood. Speak. would cast a reflection ever so remote and momentary upon of " congenital sacral tumour," and of the danger of the distinguished group of men known as Comtists, or ing on such tumours, I say, "This remark is illusPositivists. Even a wayfaring man must be moved by the operations trated a by preparation in St. George’s Hospital Museum aspect of a somewhat forlorn group worshipping Humanity in the cold shade of public neglect. Nay, it is even quite consisting of a number of irregular pieces of bone from a contouching to witness their almost simple disregard of that genital tumour removed by Sir B. Brodie from the sacral reciprocity which more numerous and ordinary worshippers region. The operation proved fatal." I cannot explain how such a misrepresentation could have crept into my commonly have an eye to. The Comtists made science into what they call philosophy, work, since I had previously, in my book on " Surgical and philosophy into what they call religion, and having done Diseases of Children " (second edition, p. 20) quoted from so they worship. They worship humanity, the source ot their Mr. Hawkins’s paper in the Path. Soc. Trans., vol. iii., undivine religion and science. Very few people join in the p. 447, the following account of the real history of worship ; and it is curious to me that the Comtists do not the case in Sir B. Brodie’s words :-"Contrary to my see why this is. They do not appear in the least to appre- advice, a surgeon made an incision into the tumour, ciate the greatest and first of truths which is at the foun- which not only served no useful purpose, but left him dation Of all religion-the truth, namely, that there must in a worse state than he was before. Different cysts be a reciprocity between worshipper and worshipped. The suppurated, discharging pus and adhesive fluid. Some. reciprocity is, indeed, necessarily a close one. Even Pagans times a collection of fluid and pus pressed on the rectum, have seen this greatest of truths. Cicero clearly perceived ’, occasioning a difficulty of expulsion of faeces, and then it. He remarks that the deity of elephants would have a discharging its contents into the bowel. After this he was proboscis. But the correspondence of worshipper and always in a state of greater or less suffering. He lost flesh, worshipped may be ground too sacred to admit of playful had occasional attacks of fever, and at last he sank and died." treatment. Nevertheless, I may remark how the intensely Thus my statement is erroneous in three particulars. 1. Sir personal Jew worshipped a correspondingly personal God. B. Brodie far from having removed the tumour always Intense individuality required uncompromising mono- advised the patient strongly to permit no interference with it. theism. The Jew has never been able to accept Christ’s 2. The tumour was never really removed; the "other sursimple summary of the Commandments. The intensely geon"only made an incision into it, when it was inflamed personified God who reciprocated to the intense ego of in consequence of the patient having fallen on it. 3. The the Jew was even supposed by the Jew to grow jealous pieces of bone in the preparation were removed, not during But Humanity will never grow jealousI life, but by Mr. Hawkins in post-mortem examination. about him. I have thought it desirable to correct the error, which about the Comtists, however their clever high priest, Mr. Frederick Harrison, may flirt with the Unknowable quite indeed ought never to have got into the text, or ought to have openly before the very eyes of Humanity in the Nineteenth’ been corrected in the second edition of the System. The main Century and The Times. The weakness of the Comtists’ conclusion, however, which I attempt to enforce in the article philosophy-religion, which is neither religion nor philo- is unaffected by my blunder-viz., that such tumours should sophy, but which at any rate worships Humanity, is that only be operated on when the surgeon believes that he can there will never be any reciprocity of worshipper andl extirpate the whole tumour, and even then not without an worshipped. I must leave it to Mr. Harrison and to) adequate motive, since the operation is always a very forMr. Spencer to settle for Mr. FitzPatrick whether Comtismt midable one. I am, Sir, yours truly, m includes the whole Spencerian system, metaphysics andi T. HOLMES. Great Cumberland-place, Sept. llth, 1884.

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