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INQUIRY ON CHOLERA.
622 Five weeks after the aeci. under the care of Mr. Nunn, the swelling had in some measure abated, but the foot could scarcely touch the ground without producing intense pain. The arch of the foot was very much flattened, and the styloid process of scaphoid bone could be detected more easily than in the sound foot, in spite of the swelling and thickening of the tissues. During six weeks, complete rest, iodine paint, pressure by strapping, with camphorated mercurial ointment, hot fomentations, placing the foot on a higher level than the rest of the body, had each a trial given them, without producing at all an encouraging amount of improvement; the exquisite tenderness of the sole of the foot remained unrelieved. After the failure of these remedial measures, Mr. Nunn subjected the foot to a course of rubbing, or rather kneading, with the balls of the thumbs. This treatment,
body upon the foot, followed. dent, the time when the case first
the
came
contemporaneously in
more than one site in the whether it appeared to spread from Were there any peculiar circumstances obone point only. servable in its local character, or in the course or direction of its advance, which may throw any light upon the important question, whether the disease be of a contagious* nature or otherwise? "4. Have you invariably been able to trace the disease to of the atmosphere, or have you seen it attack local persons living in a pure air, apart from grave-vards and other sources of putrefaction, in well-drained and well-ventilated dwellings ? In cases of the latter description, if any have been observed, has there been any intercourse with the sick which may tend to-establish the doctrine of contagion, or the
commenced
same
town
or
district,
or
impurity
reverse ?
" 5. Did the cholera appear in your neighbourhood with or accompanied with severe suffering, produced, without the general and contemporaneous appearance of the Has after a few weeks, most satisfactory results. The effusion dis- milder forms of disease—diarrhœa, bilious cholera, &e. ? appeared, the morbid sensibility almost ceased, and the part dysentery or typhus been prevalent or otherwise ? " 6. Were its ravages indiscriminate as to personal vigour, was ultimately restored to its proper office. Mr. Nunn said, that he considered the great tenderness to have arisen from age, sex, station, occupation, &c.; or might the attacks be the effused lymph having impeded the nerves in a solid traced to some predisposing personal cause-as weak bowels, medium, and that thereby any pressure, however slight, was intemperance, debility, fear, errors in diet, uncleanly or sedenimmediately transmitted to them, instead of being warded off, tary habits, or impaired health from any cause ? "7. Were ’premonitory’ symptoms of general occurrence, as in a healthy condition of parts, by the highly elastic pad of fat- and muscle by which the nerves were protected. Mr. or did the disease frequently appear suddenly in the malignant Nunn’s explanation of the success of the treatment was, "that form, with violent cramps, vomiting and purging,rice-water’ and rapid collapse ? by means of the strong friction and kneading the more deeply- dejections, " 8. Did the symptoms differ from those generally observed seated vessels were stimulated to increased, and, at the same and frequently described ? Had the disease any peculiar type time, healthy action."
although
at first
any
Correspondence. " Audi alteram
partem."
INQUIRY ON CHOLERA. [DR. HASTINGS,President of the Provincial Medical and Surgical Association, presents his compliments to the Editor of THE LANCET, and begs to send a copy of the queries respecting cholera which have been issued by the Association to every member of that body, and Dr. Hastings would feel obliged by their insertion in an early number of THE LANCET.] Worcester, Nov. 26, 1849.
An inquiry into the history of the cholera in its recent visitation to the different counties of England and Wales, which, if duly responded to, cannot fail to excite interest, has been set on foot by the Provincial Medical and Surgical Association, and the following questions have been addressed to each member of that body. We have been requested by the President of the Association, Dr. Hastings, of Worcester, to publish them in THE LANCET, in the hope that those of our readers who have been engaged in cholera cases will kindly assist in the inquiry, by forwarding their replies to Mr. Hunt, of Bed-
ford-square. The following notice appeared in the Provincial 3,1-edical and Surgical Journal of September 19, 1849-viz. "In compliance with the resolution passed at the annual meeting held at Worcester, the annexed questions have been carefully framed, and it is earnestly requested by the council, that the members of the Provincial Medical and Surgical Association will assist in this laudable purpose, by forwarding as full and complete a series of answers as possible, to Mr. Hunt, 26, Bedford-square, London, who has kindly undertaken the "
CHAS.
HASTINGS,
" President of the Council. "
QUESTIONS.
the
prevalence of the epidemic, has your own During neighbourhood, town, or district, been exempted from the visitation ? If Eo, can you mention any local circumstances which may account for the exemption ? Was the district " 1.
either of mildness or malignity ? " 9. Are you aware of exempting circumstances of any description, which have uniformly protected certain individuals from the disease, snch as trades, habits, diet, &c., not inclusive of local habitation ? " 10. Can you throw any light on the physical origin or remote cause of the recent or former visitation ? Are you able to say, from your own observation, that the general symptoms and history of both are similar ? Have you instituted any researches into the density, humidity, temperature, or electromagnetic phenomena of the atmosphere ? Have you observed the progress of the cholera to be arrested by storms, wind, or rain ? " 11. Have you made any post-mortem examinations of fatal cases of cholera, and with what result ? Do you know of any circumstances which justify the immediate interment of the dead ? Did you ever observe cholera patients show signs of organic life for hours or days after apparent death ? "12. Can you describe any method or principle of treatment which has proved successful in so large a number of cases of cholera, as to commend it to universal adoption ? If so, has not the method frequently failed in other hands, and can you explain the cause of failure ? "13. What mode of treating the epidemic diarrheea and premonitory symptoms generally have you found most successful ? "14. Can you suggest any means of preventing or arresting the spread of the disease, in the event of any future outbreak ? " 15. What is your opinion as to the propriety of removing the inhabitants, who have not taken the disease, from the infected dwellings to houses of refuge, in situations where the presumed causes of the disease are not in operation ?" ’
THE ROYAL COLLEGE OF SURGEONS AND THE PROPOSED NEW CHARTER. To the Editor of THE LANCET. SIR,—I am glad to find that the Council of the Royal College of Surgeons are about to amend their Charter of 1843. Many of that council must have been struck from time to time with the groaning injustice which it dealt out to the members of that college; and when we recollect that that
Charter was based upon retrospective legislation, it certainly healthy during the visitation of the cholera about the year must strike every thinking man as an act of oppression at once 1832, and did circumstances then exist which may be supposed unique and unrivalled. to have protected it ? Those who promised to protect and defend every member "2. If the cholera* has appeared in your district, how many of that college who might be disturbed in the exercise and fatal ? cases have you seen ;-how many of these have been enjoyment of the rights, privileges, exemptions, and immuni" 3. When did the disease break out, and how long did it ties acquired by him as a member, (and be it recollected, prevail ? Please to state generally, whether many persons every member had the same privileges &c. prior to that were simultaneously attacked or otherwise; and whether it charter,) were the first to break the bond of faith, to give the It is proposed, to avoid confusion of terms, to restrict the term ’ cholie to their own by-laws, to exalt the few, to degrade the lera’ to cases of vomiting, purging, cramps, and ’rice-water’ evacuations; " *
the term bilious-cholera’ to vomiting and and the term ’ diarrhœa’ to profuse alvine nntmg or cramps.
purging of bile, with cramps; discharges, without either vo-
"* *
A house
or
district may be
strictly contagious. Respondents
so as to spread a disease not therefore requested to confine the by personal approach or contact.
infected, are
latter term to evidence of communication
body upon the foot, followed. dent, the time when the case first
the
came
contemporaneously in
more than one site in the whether it appeared to spread from Were there any peculiar circumstances obone point only. servable in its local character, or in the course or direction of its advance, which may throw any light upon the important question, whether the disease be of a contagious* nature or otherwise? "4. Have you invariably been able to trace the disease to of the atmosphere, or have you seen it attack local persons living in a pure air, apart from grave-vards and other sources of putrefaction, in well-drained and well-ventilated dwellings ? In cases of the latter description, if any have been observed, has there been any intercourse with the sick which may tend to-establish the doctrine of contagion, or the
commenced
same
town
or
district,
or
impurity
reverse ?
" 5. Did the cholera appear in your neighbourhood with or accompanied with severe suffering, produced, without the general and contemporaneous appearance of the Has after a few weeks, most satisfactory results. The effusion dis- milder forms of disease—diarrhœa, bilious cholera, &e. ? appeared, the morbid sensibility almost ceased, and the part dysentery or typhus been prevalent or otherwise ? " 6. Were its ravages indiscriminate as to personal vigour, was ultimately restored to its proper office. Mr. Nunn said, that he considered the great tenderness to have arisen from age, sex, station, occupation, &c.; or might the attacks be the effused lymph having impeded the nerves in a solid traced to some predisposing personal cause-as weak bowels, medium, and that thereby any pressure, however slight, was intemperance, debility, fear, errors in diet, uncleanly or sedenimmediately transmitted to them, instead of being warded off, tary habits, or impaired health from any cause ? "7. Were ’premonitory’ symptoms of general occurrence, as in a healthy condition of parts, by the highly elastic pad of fat- and muscle by which the nerves were protected. Mr. or did the disease frequently appear suddenly in the malignant Nunn’s explanation of the success of the treatment was, "that form, with violent cramps, vomiting and purging,rice-water’ and rapid collapse ? by means of the strong friction and kneading the more deeply- dejections, " 8. Did the symptoms differ from those generally observed seated vessels were stimulated to increased, and, at the same and frequently described ? Had the disease any peculiar type time, healthy action."
although
at first
any
Correspondence. " Audi alteram
partem."
INQUIRY ON CHOLERA. [DR. HASTINGS,President of the Provincial Medical and Surgical Association, presents his compliments to the Editor of THE LANCET, and begs to send a copy of the queries respecting cholera which have been issued by the Association to every member of that body, and Dr. Hastings would feel obliged by their insertion in an early number of THE LANCET.] Worcester, Nov. 26, 1849.
An inquiry into the history of the cholera in its recent visitation to the different counties of England and Wales, which, if duly responded to, cannot fail to excite interest, has been set on foot by the Provincial Medical and Surgical Association, and the following questions have been addressed to each member of that body. We have been requested by the President of the Association, Dr. Hastings, of Worcester, to publish them in THE LANCET, in the hope that those of our readers who have been engaged in cholera cases will kindly assist in the inquiry, by forwarding their replies to Mr. Hunt, of Bed-
ford-square. The following notice appeared in the Provincial 3,1-edical and Surgical Journal of September 19, 1849-viz. "In compliance with the resolution passed at the annual meeting held at Worcester, the annexed questions have been carefully framed, and it is earnestly requested by the council, that the members of the Provincial Medical and Surgical Association will assist in this laudable purpose, by forwarding as full and complete a series of answers as possible, to Mr. Hunt, 26, Bedford-square, London, who has kindly undertaken the "
CHAS.
HASTINGS,
" President of the Council. "
QUESTIONS.
the
prevalence of the epidemic, has your own During neighbourhood, town, or district, been exempted from the visitation ? If Eo, can you mention any local circumstances which may account for the exemption ? Was the district " 1.
either of mildness or malignity ? " 9. Are you aware of exempting circumstances of any description, which have uniformly protected certain individuals from the disease, snch as trades, habits, diet, &c., not inclusive of local habitation ? " 10. Can you throw any light on the physical origin or remote cause of the recent or former visitation ? Are you able to say, from your own observation, that the general symptoms and history of both are similar ? Have you instituted any researches into the density, humidity, temperature, or electromagnetic phenomena of the atmosphere ? Have you observed the progress of the cholera to be arrested by storms, wind, or rain ? " 11. Have you made any post-mortem examinations of fatal cases of cholera, and with what result ? Do you know of any circumstances which justify the immediate interment of the dead ? Did you ever observe cholera patients show signs of organic life for hours or days after apparent death ? "12. Can you describe any method or principle of treatment which has proved successful in so large a number of cases of cholera, as to commend it to universal adoption ? If so, has not the method frequently failed in other hands, and can you explain the cause of failure ? "13. What mode of treating the epidemic diarrheea and premonitory symptoms generally have you found most successful ? "14. Can you suggest any means of preventing or arresting the spread of the disease, in the event of any future outbreak ? " 15. What is your opinion as to the propriety of removing the inhabitants, who have not taken the disease, from the infected dwellings to houses of refuge, in situations where the presumed causes of the disease are not in operation ?" ’
THE ROYAL COLLEGE OF SURGEONS AND THE PROPOSED NEW CHARTER. To the Editor of THE LANCET. SIR,—I am glad to find that the Council of the Royal College of Surgeons are about to amend their Charter of 1843. Many of that council must have been struck from time to time with the groaning injustice which it dealt out to the members of that college; and when we recollect that that
Charter was based upon retrospective legislation, it certainly healthy during the visitation of the cholera about the year must strike every thinking man as an act of oppression at once 1832, and did circumstances then exist which may be supposed unique and unrivalled. to have protected it ? Those who promised to protect and defend every member "2. If the cholera* has appeared in your district, how many of that college who might be disturbed in the exercise and fatal ? cases have you seen ;-how many of these have been enjoyment of the rights, privileges, exemptions, and immuni" 3. When did the disease break out, and how long did it ties acquired by him as a member, (and be it recollected, prevail ? Please to state generally, whether many persons every member had the same privileges &c. prior to that were simultaneously attacked or otherwise; and whether it charter,) were the first to break the bond of faith, to give the It is proposed, to avoid confusion of terms, to restrict the term ’ cholie to their own by-laws, to exalt the few, to degrade the lera’ to cases of vomiting, purging, cramps, and ’rice-water’ evacuations; " *
the term bilious-cholera’ to vomiting and and the term ’ diarrhœa’ to profuse alvine nntmg or cramps.
purging of bile, with cramps; discharges, without either vo-
"* *
A house
or
district may be
strictly contagious. Respondents
so as to spread a disease not therefore requested to confine the by personal approach or contact.
infected, are
latter term to evidence of communication