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NEW TREATMENT OF CHOLERA.
‘
least objectionable custom of the two, if existing prejudices could be overcome. That the products arising from the decomposition of dead bodies, by escaping into the atmosphere, or by poisoning springs and drains, are often powerfully active amongst the various causes which affect the health of the living, is indisputable, although to what extent it may be difficult to prove, while so many other causes of disorder and death exist. If the population of the world is increasing at the rate some suppose, mankind will ultimately be driven to this mode of disposing of their dead, as an act of self-preservation. The plan here proposed for reducing a body to ashes, (if practicable,) appears as decent, speedy, and effectual a method as could well be conceived.
Foreign Department. ON THE PORTION OF THE URETHRA MOST FREQUENTLY AFFECTED WITH STRICTURE.
WE alluded
time since (THE LANCET, June 20th, 1857, statistics touching stricture of the urethra, published by M. See in the Gazette Hebdo?7zadaire, of Paris, of the 9th of January, 1857. In this latter journal (of the 24th of July, 1857), we find a letter addressed to the Editor by Mr. Henry Thompson, from which it appears that his investigations, mentioned in his Jackaonian Prize Essay, and which refer to no less than 270 preparations, have given him results differing from those mentioned by M. Sée. Mr. Thompson’s figures are as follow :-In the first portion of the urethra (the junction of the spongy with the membranous portion), 67 per cent.; in the second (the middle spongy portion-viz., from the anterior extremity of the membranous portion to within two inches and a half from the meatus), 16 per cent.; in the third (the last two inches and a half of the canal, terminating at the meatus), 17 per cent. Mr. Thompson insists upon the fact that no example of stricture of the prostatic portion of the urethra exists in the museums of London, Edinburgh, or Paris, and that the data upon which his researches rest are far more numerous than those on which the labours of the French surgeon are founded. p.
634)
to
accepted, and formed a portion of the supposed well-ascertained of the day. But it would appear that Pro. fessor Bernard’s views are doomed to be by turns vigorously assailed. A short time ago, the secretion of sugar by the liver was very skilfully put in question by several investigators; and we now find that M. Colin, professor of practical anatomy at the Veterinary School at Alfort, near Paris, has experi. mentally proved that animals whose pancreatic fluid is diverted by ligature and tube, and allowed to run to waste, absorb fatty matters into the chyle, which former can be proved to be present by the action of ether. The experiments have been repeated under the eye of M. Berard, member of the Academy of Medicine, and pronounced conclusive. In these experiments no less than thirty-six dogs, three horses, five bulls, and four cows were sacrificed. The pancreatic fluid
physiological facts
being made to run to waste by means of a glass tube communi. cating with an elastic one hanging out of the abdomen. The thoracic duct was opened at the lower part of the neck, and the
chyle thus collected. The latter was found to be composed of a fatty emulsion, the adipose substance being readily separable by means of ether. It will hardly be credited that an ox yielded no less than fifty quarts of chyle in twelve hours.
some
NEW TREATMENT OF CHOLERA.
some
BRONZED
SKIN.
THE affection of the supra-renal capsules, connected with this peculiar colour of the skin, is now called in France Addison’s disease; and numerous articles and cases have been published on the subject in the French medical journals. Nor has the complaint remained unnoticed by the Academy of Medicine, where M. Trousseau, the eminent physician of the Hotel Dieu, was Dr. Addison’s warmest advocate. The Germans have yet been less active, and we would just call attention to a case observed in Germany by M. Mettenheimer before the publication of Dr. Addison’s book, which offers a good illustra. tion of bronzed skin. The patient, aged forty-seven, had for several years suffered from debility, anorexia, and constipation; the skin was greyish brown, and he had such constant pain in the lumbar region that walking was impossible. He died comatose, and his skin looked as if he had long been taking nitrate of silver. Autopsy. -Pleural adhesions, pulmonary indurations (tubercular, cancerous?) Heart small, ossified coronary artery, terminal branches obliterated, incipient fatty degeneration, auricles traversed with fibrinous bands, atheromatous deposits on the aortic valves. Nutmeg liver, a few biliary calculi, spleen enlarged and of pulpy consistence. Both kidneys hypertrophied, and in the first stage of granular degeneration; between the apex of the right kidney and the liver lies a cancerous tumour of the size of a child’s fist; a similar tumour in the same region No trace of supra-renal capsules. Nothing on the left side. abnormal in the intestinal canal. DOUBTS RESPECTING THE FUNCTIONS OF THE PANCREAS.
PROFESSOR CLAUDE BERNARD, the successor of Magendie at the College of France, holds that the pancreatic secretion
assists nutrition in facilitating the absorption of fatty matter the lacteals. This view, supported by the actual experiments of such an eminent physiolocist. had been !!enerallv
by
200
To the Editor
of THE LANCET. SiR,—An able paper by Mr. Boate, on the subject of cholera, which appeared in your impression of August 8th, presents certain points open, I believe, to objection; and, if you will
afford
me
space, I will endeavour to demonstrate them
as
briefly as possible. Mr. Boate saysthat cholera originates in a suspension of the powers of the par vagum, owing to the effect which a deficiency in the elasticity of the earth and atmosphere produces on the cerebro-spinal ganglia. That such a deficiency really universally exists when the disease is present, he has yet to show; that, if existing, it is sufficient to produce cholera, he has yet to prove; and he has also to make his theory consistent with the known peculiarities of the cause of this malady, its method of travelling slowly, but surely, in definite directions, aid the phenomena which attend its aggression. But with regard to his assertions concerning the paralysis of the pneumogastrics, I submit that he is in error. Section of these nerves will not produce symptoms of cholera. Vomiting may take place, but this is by no means an invariable symptom, and, when it does occur, is owing to the irritation produced by the operation, and passes off, so that after a time the animal will take food, and even digest it, as is shown in Dr. Reid’s experiments. I have divided the pneumogastrics myself, and neither vomiting nor purging followed, nor at first was there any apparent discomfort beyond what might have been expected from an operation of any kind. The pneumogastrics, as regards their relation to the alimentary canal, are motor nerves of the oesophagus and stomach, and, if they have any connexion with the mucous membrane also, at all events their paralysis does not primarily interfere with digestion. It is their irritation, not their paralysis, that occasions the vomiting and other symptoms which they assist in producing, both in cholera and in various other diseases. Such irritation may be due to centric or eccentric disturbance of the cerebro-spinal functions, and in either case the pectoral symptoms referred to bv Mr. Boate might be present. The exciting causes mentioned will induce irritation of the vagi, without the existence of any predisposing electrical condition in the earth or atmosphere. Vomiting and purging follow the inhalation of any noxious exhalation, the introduction of an improper ingestum, or anything which offends the organic system, just as they do a blow on the head or any other direct injury to the brain and spine. With regard to the comparison which Mr. Boate draws be. tween his own success in the treatment of diarrhoea, and that of the London hospitals, I do not think he takes into account the different class of patients with whom he has to deal. Soldiers under strict military discipline, duly cautioned, and almost obliged, to report themselves as soon as the first symptoms make their appearance, are scarcely to be brought in opposition to the worn-out, and in many instances half-fed, mechanics of the metropolis, who, with their wives and children, often seek assistance only when the time for help has passed and the powers of life are failing. I am. Sir. vour obedit-nt servant. EDWARD COOPER WILLIS.
least objectionable custom of the two, if existing prejudices could be overcome. That the products arising from the decomposition of dead bodies, by escaping into the atmosphere, or by poisoning springs and drains, are often powerfully active amongst the various causes which affect the health of the living, is indisputable, although to what extent it may be difficult to prove, while so many other causes of disorder and death exist. If the population of the world is increasing at the rate some suppose, mankind will ultimately be driven to this mode of disposing of their dead, as an act of self-preservation. The plan here proposed for reducing a body to ashes, (if practicable,) appears as decent, speedy, and effectual a method as could well be conceived.
Foreign Department. ON THE PORTION OF THE URETHRA MOST FREQUENTLY AFFECTED WITH STRICTURE.
WE alluded
time since (THE LANCET, June 20th, 1857, statistics touching stricture of the urethra, published by M. See in the Gazette Hebdo?7zadaire, of Paris, of the 9th of January, 1857. In this latter journal (of the 24th of July, 1857), we find a letter addressed to the Editor by Mr. Henry Thompson, from which it appears that his investigations, mentioned in his Jackaonian Prize Essay, and which refer to no less than 270 preparations, have given him results differing from those mentioned by M. Sée. Mr. Thompson’s figures are as follow :-In the first portion of the urethra (the junction of the spongy with the membranous portion), 67 per cent.; in the second (the middle spongy portion-viz., from the anterior extremity of the membranous portion to within two inches and a half from the meatus), 16 per cent.; in the third (the last two inches and a half of the canal, terminating at the meatus), 17 per cent. Mr. Thompson insists upon the fact that no example of stricture of the prostatic portion of the urethra exists in the museums of London, Edinburgh, or Paris, and that the data upon which his researches rest are far more numerous than those on which the labours of the French surgeon are founded. p.
634)
to
accepted, and formed a portion of the supposed well-ascertained of the day. But it would appear that Pro. fessor Bernard’s views are doomed to be by turns vigorously assailed. A short time ago, the secretion of sugar by the liver was very skilfully put in question by several investigators; and we now find that M. Colin, professor of practical anatomy at the Veterinary School at Alfort, near Paris, has experi. mentally proved that animals whose pancreatic fluid is diverted by ligature and tube, and allowed to run to waste, absorb fatty matters into the chyle, which former can be proved to be present by the action of ether. The experiments have been repeated under the eye of M. Berard, member of the Academy of Medicine, and pronounced conclusive. In these experiments no less than thirty-six dogs, three horses, five bulls, and four cows were sacrificed. The pancreatic fluid
physiological facts
being made to run to waste by means of a glass tube communi. cating with an elastic one hanging out of the abdomen. The thoracic duct was opened at the lower part of the neck, and the
chyle thus collected. The latter was found to be composed of a fatty emulsion, the adipose substance being readily separable by means of ether. It will hardly be credited that an ox yielded no less than fifty quarts of chyle in twelve hours.
some
NEW TREATMENT OF CHOLERA.
some
BRONZED
SKIN.
THE affection of the supra-renal capsules, connected with this peculiar colour of the skin, is now called in France Addison’s disease; and numerous articles and cases have been published on the subject in the French medical journals. Nor has the complaint remained unnoticed by the Academy of Medicine, where M. Trousseau, the eminent physician of the Hotel Dieu, was Dr. Addison’s warmest advocate. The Germans have yet been less active, and we would just call attention to a case observed in Germany by M. Mettenheimer before the publication of Dr. Addison’s book, which offers a good illustra. tion of bronzed skin. The patient, aged forty-seven, had for several years suffered from debility, anorexia, and constipation; the skin was greyish brown, and he had such constant pain in the lumbar region that walking was impossible. He died comatose, and his skin looked as if he had long been taking nitrate of silver. Autopsy. -Pleural adhesions, pulmonary indurations (tubercular, cancerous?) Heart small, ossified coronary artery, terminal branches obliterated, incipient fatty degeneration, auricles traversed with fibrinous bands, atheromatous deposits on the aortic valves. Nutmeg liver, a few biliary calculi, spleen enlarged and of pulpy consistence. Both kidneys hypertrophied, and in the first stage of granular degeneration; between the apex of the right kidney and the liver lies a cancerous tumour of the size of a child’s fist; a similar tumour in the same region No trace of supra-renal capsules. Nothing on the left side. abnormal in the intestinal canal. DOUBTS RESPECTING THE FUNCTIONS OF THE PANCREAS.
PROFESSOR CLAUDE BERNARD, the successor of Magendie at the College of France, holds that the pancreatic secretion
assists nutrition in facilitating the absorption of fatty matter the lacteals. This view, supported by the actual experiments of such an eminent physiolocist. had been !!enerallv
by
200
To the Editor
of THE LANCET. SiR,—An able paper by Mr. Boate, on the subject of cholera, which appeared in your impression of August 8th, presents certain points open, I believe, to objection; and, if you will
afford
me
space, I will endeavour to demonstrate them
as
briefly as possible. Mr. Boate saysthat cholera originates in a suspension of the powers of the par vagum, owing to the effect which a deficiency in the elasticity of the earth and atmosphere produces on the cerebro-spinal ganglia. That such a deficiency really universally exists when the disease is present, he has yet to show; that, if existing, it is sufficient to produce cholera, he has yet to prove; and he has also to make his theory consistent with the known peculiarities of the cause of this malady, its method of travelling slowly, but surely, in definite directions, aid the phenomena which attend its aggression. But with regard to his assertions concerning the paralysis of the pneumogastrics, I submit that he is in error. Section of these nerves will not produce symptoms of cholera. Vomiting may take place, but this is by no means an invariable symptom, and, when it does occur, is owing to the irritation produced by the operation, and passes off, so that after a time the animal will take food, and even digest it, as is shown in Dr. Reid’s experiments. I have divided the pneumogastrics myself, and neither vomiting nor purging followed, nor at first was there any apparent discomfort beyond what might have been expected from an operation of any kind. The pneumogastrics, as regards their relation to the alimentary canal, are motor nerves of the oesophagus and stomach, and, if they have any connexion with the mucous membrane also, at all events their paralysis does not primarily interfere with digestion. It is their irritation, not their paralysis, that occasions the vomiting and other symptoms which they assist in producing, both in cholera and in various other diseases. Such irritation may be due to centric or eccentric disturbance of the cerebro-spinal functions, and in either case the pectoral symptoms referred to bv Mr. Boate might be present. The exciting causes mentioned will induce irritation of the vagi, without the existence of any predisposing electrical condition in the earth or atmosphere. Vomiting and purging follow the inhalation of any noxious exhalation, the introduction of an improper ingestum, or anything which offends the organic system, just as they do a blow on the head or any other direct injury to the brain and spine. With regard to the comparison which Mr. Boate draws be. tween his own success in the treatment of diarrhoea, and that of the London hospitals, I do not think he takes into account the different class of patients with whom he has to deal. Soldiers under strict military discipline, duly cautioned, and almost obliged, to report themselves as soon as the first symptoms make their appearance, are scarcely to be brought in opposition to the worn-out, and in many instances half-fed, mechanics of the metropolis, who, with their wives and children, often seek assistance only when the time for help has passed and the powers of life are failing. I am. Sir. vour obedit-nt servant. EDWARD COOPER WILLIS.