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A PARAGRAPH AND A PROPOSITION.
481 in others, none..tie regarded the term cholera as a misnomer. He did not recommend chloroform as a specific, but to relieve the painful symptoms. It was often given from time to time by the experienced nurses of the establishment alluded to; and always afforded relief. The urine, in these cases, had been scanty, but not quite suppressed. Dr. L. STEwART concurred that, like opium, chloroform would be advantageous in relieving symptoms, but it did not address itself to the cause of the disease. With respect to the cases of cholera at Peckham, he was by no means inclined to undervalue the influence of impure air, but this could not be the chief cause of cholera, though it was an auxiliary, for cholera occurred in districts where the air was pure and good, and there was plenty of ventilation. As to the cause it was a morbific poison. Mr. GARRETT described the cases which had occurred in Peckham Asylum. Some of them were of the most malignant kind, and the patients must have died in the stage of collapse had not assistance been at hand. The attack came on very suddenly, and all the worst symptoms of the disease immediately developed themselves. Brandy and capsicum were first administered, the patient being in bed. Chloroform was then resorted to: this agent he considered to be beneficial by producing reaction. By forced respirations the pulse rose, and by the time the patient became fully under the influence of the chloroform, the body was warm. He believed that without the chloroform there would have been no reaction, for opium would not have developed its effects under two hours. The cases were undoubtedly those of spasmodic cholera. The opening of the drains only acted by developing the disease, and did not produce it per se; for the drains were opened on the Monday, and the first case of cholera developed itself on Thursday. The urine was scanty, but not suppressed.
vomiting;
Medical Socíetíes. MEDICAL SOCIETY OF LONDON.
MONDAY, OCTOBER 23, 1848.—MR. HANCOCK, PRESIDENT. CHOLERA AT PECKHAM—USE OF CHLCROFORM.
Dr. CLUTTERBUCK had seen, since last week, several cases of cholera at the Lunatic Asylum at Peckham, which contains 500 patients; of these, about thirty had been attacked, and five had died. Many of the cases had been of the most severe kind, with all the symptoms of malignant cholera. At the beginning of the attack, twosevere cases were treated with acetate of lead and opium, and both were fatal. He had found a simple plan of treatment the best. Calomel and opium could not be administered with safety, and large doses of laudanum did great mischief. The administration of chloroform had been productive of the greatest benefit. The spasms and pain were almost immediately relieved, and the patients became composed, and enjoyed a kind of sleep. These results took place after the use of the chloroform for about a quarter of an hour. The effects, so far, had been immediately and uniformly good. He considered it much to be preferred to opium, for the relief of the painful spasms attendant upon cholera. In answer to questions, Dr. Clutterbuck said the Asiatic cholera, in his opinion, differed from the common cholera of this country only in degree. In the fatal cases at Peckham, all the worst features of what was called the Asiatic cholera presented themselves. The pulse was imperceptible ; the skin cold and blue; the features sunken; the depression complete ; and the evacuations watery. The cases were quickly fatal. There was no ground for questioning the identity of the disease. He insisted upon the necessity and value of treating the disease by simple remedies. Moderate doses of brandy, and the application of external heat, werethe chief A PARAGRAPH AND A PROPOSITION. indications in the early stages. He believed that there was To the Editor of THE LANCET. no specific for the disease. was with almost inexpressible amusement that I Mr. DENDY differed from Dr. Clutterbuck as to the identity SIR,—It of Asiatic and English cholera. He had thought, years ago, read the letter at page 408 of THE LANCET of October 7th, that Dr. Clutterbuck had acknowledged a difference between signed " a Surgeon :’ The good man is evidently overwhelmed with grief at the these diseases. It had been his intention to try chloroform in the first cases of cholera which lie might see; but he consi- malpractice of his brethren. Shopkeeping for a surgeon ! dered it would only act as a substitute for opium by relieving Gracious heavens ! who ever heard of such a monstrosity ? spasm. This was, however, an important point in the treat- Thus he addresses them: " Ye surgeons between Bishopsgate ment, and he was glad to hear of the success of the remedy. and Hackney, I call upon ye, in the name and for the honour He considered it a great mistake to suppose that cholera was of our profession, to close.;your shops for ever. Maintain with your professional honour," &c. always preceded by diarrhoea; in the worst cases there was honest dignity Now, Mr. Editor, a vast deal has been said and written about sometimes no disturbance of the bowels. The disease would " the dignity of the profession,"and it is no doubt very imcome on suddenly without any premonitory symptoms, and the patients would succumb. He regarded cholera, in its portant to uphold it ; but does our friend think that the " suressential nature, as dependent on an alteration ’in the crasis geons between Bishopsgate and Hackney," even if they did of the blood; and if we could not get blood, the patient would give up their shopkeeping, would thereby increase this said sink. He had, in some cases, scraped away the solid particles dignity. Believe me, the honour of medicine as a science is of the blood which had assumed the consistence of pitch. If not to be added to by means so easy as that proposed. The man who, having well employed those valuable years of you could get rid of all the watery constituents of the blood, you would produce a state similar to cholera. As to treatment, early life, during which he was attendant upon the doors and why should not large doses of calomel, said to be so effective gates of medical knowledge, and who, having entered the hall in India, be equally beneficial here? He was quite sure that of science, and, feeling that he is a learner still, patiently and what was called "simple treatment," would have no effect in laboriously marks and investigates the cause and progress of the blue stage of cholera. With respect to the hot-air bath, disease and the effects of treatment, who, also, making himself he was quite sure that in the last visitation many patients acquainted with all that is done by his brethren in the science at home and abroad, stores up each important fact, and uses were boiled and baked to death. Dr. CLUTTERBUCK said that no proof existed of the cholera the whole to illustrate and explain the pages of Nature’s book being dependent on a condition of the blood. Previous to the as they are unfolded before him—this is the man who adds to appearance of the disease at Peckham, the drains and cess-’the real dignity of the profession. And such a person, though he should labour eighteen hours pools had been cleaned out. All were more or less affected by the smells arising from this proceeding, and cholera made! out of the twenty-four, and after all obtain little more than sufficient to supply the necessaries of life, is indeed a dignified its appearance in thirty persons. Mr. HEADLAND agreed with the remarks of Mr. Dendy re- man. Science thanks him ; suffering humanity looks to him a friend; and though he may at last go to his grave unsp’ecting diarrhoea as a premonitory symptom of cholera in its as more malignant form. Was there suppression of urine in Dr. heeded by the multitude, the grateful remembrance of many Clutterbuck’s cases ? He hoped that chloroform might prove. a poor sufferer will long hang around his last resting-place-a a valuable agent in this disease, not only as relieving one ofgarland such as many a nobler mansion than his cannot boast the more painful symptoms, but exerting a sort of antiseptic; of. Do not think, Sir, that in writing thus, I attempt to excuse influence on the blood. If the cases mentioned really de-. pended on the effect of the sulphuretted hydrogen evolved the shopkeeping system. Far otherwise. I dont like" iles for from the drains, we could understand why chloroform should rheumatiz." But I would wish verv much that those who do good in the cases detailed. This, however, he did not re- talk about the dignity should consider in what that dignity gard as a common cause of cholera, because it existed inde- really consists, and not fancy that it may be obtained merely by pendent of this cause. If chloroform did good in cholera shutting up shop, any more than by filling out their waistcoats generally, then indeed we had made one important discovery. with beefsteaks and porter, or by puffing themselves red in the Dr. CLUTTERBUCK did not think diarrhoea as essentially a face with their own vanity and self-conceit. I am, Sir, yours truly, forerunner of cholera. In some cases it had hardly existed AN OLD SUBSCRIBER AND CONSTANT READER. at all; in some it was severe; in some, again, there wasi .
.
.
.
.
vomiting;
Medical Socíetíes. MEDICAL SOCIETY OF LONDON.
MONDAY, OCTOBER 23, 1848.—MR. HANCOCK, PRESIDENT. CHOLERA AT PECKHAM—USE OF CHLCROFORM.
Dr. CLUTTERBUCK had seen, since last week, several cases of cholera at the Lunatic Asylum at Peckham, which contains 500 patients; of these, about thirty had been attacked, and five had died. Many of the cases had been of the most severe kind, with all the symptoms of malignant cholera. At the beginning of the attack, twosevere cases were treated with acetate of lead and opium, and both were fatal. He had found a simple plan of treatment the best. Calomel and opium could not be administered with safety, and large doses of laudanum did great mischief. The administration of chloroform had been productive of the greatest benefit. The spasms and pain were almost immediately relieved, and the patients became composed, and enjoyed a kind of sleep. These results took place after the use of the chloroform for about a quarter of an hour. The effects, so far, had been immediately and uniformly good. He considered it much to be preferred to opium, for the relief of the painful spasms attendant upon cholera. In answer to questions, Dr. Clutterbuck said the Asiatic cholera, in his opinion, differed from the common cholera of this country only in degree. In the fatal cases at Peckham, all the worst features of what was called the Asiatic cholera presented themselves. The pulse was imperceptible ; the skin cold and blue; the features sunken; the depression complete ; and the evacuations watery. The cases were quickly fatal. There was no ground for questioning the identity of the disease. He insisted upon the necessity and value of treating the disease by simple remedies. Moderate doses of brandy, and the application of external heat, werethe chief A PARAGRAPH AND A PROPOSITION. indications in the early stages. He believed that there was To the Editor of THE LANCET. no specific for the disease. was with almost inexpressible amusement that I Mr. DENDY differed from Dr. Clutterbuck as to the identity SIR,—It of Asiatic and English cholera. He had thought, years ago, read the letter at page 408 of THE LANCET of October 7th, that Dr. Clutterbuck had acknowledged a difference between signed " a Surgeon :’ The good man is evidently overwhelmed with grief at the these diseases. It had been his intention to try chloroform in the first cases of cholera which lie might see; but he consi- malpractice of his brethren. Shopkeeping for a surgeon ! dered it would only act as a substitute for opium by relieving Gracious heavens ! who ever heard of such a monstrosity ? spasm. This was, however, an important point in the treat- Thus he addresses them: " Ye surgeons between Bishopsgate ment, and he was glad to hear of the success of the remedy. and Hackney, I call upon ye, in the name and for the honour He considered it a great mistake to suppose that cholera was of our profession, to close.;your shops for ever. Maintain with your professional honour," &c. always preceded by diarrhoea; in the worst cases there was honest dignity Now, Mr. Editor, a vast deal has been said and written about sometimes no disturbance of the bowels. The disease would " the dignity of the profession,"and it is no doubt very imcome on suddenly without any premonitory symptoms, and the patients would succumb. He regarded cholera, in its portant to uphold it ; but does our friend think that the " suressential nature, as dependent on an alteration ’in the crasis geons between Bishopsgate and Hackney," even if they did of the blood; and if we could not get blood, the patient would give up their shopkeeping, would thereby increase this said sink. He had, in some cases, scraped away the solid particles dignity. Believe me, the honour of medicine as a science is of the blood which had assumed the consistence of pitch. If not to be added to by means so easy as that proposed. The man who, having well employed those valuable years of you could get rid of all the watery constituents of the blood, you would produce a state similar to cholera. As to treatment, early life, during which he was attendant upon the doors and why should not large doses of calomel, said to be so effective gates of medical knowledge, and who, having entered the hall in India, be equally beneficial here? He was quite sure that of science, and, feeling that he is a learner still, patiently and what was called "simple treatment," would have no effect in laboriously marks and investigates the cause and progress of the blue stage of cholera. With respect to the hot-air bath, disease and the effects of treatment, who, also, making himself he was quite sure that in the last visitation many patients acquainted with all that is done by his brethren in the science at home and abroad, stores up each important fact, and uses were boiled and baked to death. Dr. CLUTTERBUCK said that no proof existed of the cholera the whole to illustrate and explain the pages of Nature’s book being dependent on a condition of the blood. Previous to the as they are unfolded before him—this is the man who adds to appearance of the disease at Peckham, the drains and cess-’the real dignity of the profession. And such a person, though he should labour eighteen hours pools had been cleaned out. All were more or less affected by the smells arising from this proceeding, and cholera made! out of the twenty-four, and after all obtain little more than sufficient to supply the necessaries of life, is indeed a dignified its appearance in thirty persons. Mr. HEADLAND agreed with the remarks of Mr. Dendy re- man. Science thanks him ; suffering humanity looks to him a friend; and though he may at last go to his grave unsp’ecting diarrhoea as a premonitory symptom of cholera in its as more malignant form. Was there suppression of urine in Dr. heeded by the multitude, the grateful remembrance of many Clutterbuck’s cases ? He hoped that chloroform might prove. a poor sufferer will long hang around his last resting-place-a a valuable agent in this disease, not only as relieving one ofgarland such as many a nobler mansion than his cannot boast the more painful symptoms, but exerting a sort of antiseptic; of. Do not think, Sir, that in writing thus, I attempt to excuse influence on the blood. If the cases mentioned really de-. pended on the effect of the sulphuretted hydrogen evolved the shopkeeping system. Far otherwise. I dont like" iles for from the drains, we could understand why chloroform should rheumatiz." But I would wish verv much that those who do good in the cases detailed. This, however, he did not re- talk about the dignity should consider in what that dignity gard as a common cause of cholera, because it existed inde- really consists, and not fancy that it may be obtained merely by pendent of this cause. If chloroform did good in cholera shutting up shop, any more than by filling out their waistcoats generally, then indeed we had made one important discovery. with beefsteaks and porter, or by puffing themselves red in the Dr. CLUTTERBUCK did not think diarrhoea as essentially a face with their own vanity and self-conceit. I am, Sir, yours truly, forerunner of cholera. In some cases it had hardly existed AN OLD SUBSCRIBER AND CONSTANT READER. at all; in some it was severe; in some, again, there wasi .
.
.
.
.