- Email: [email protected]
THE CHOLERA IN THE UNITED KINGDOM IN 1854.
431 sulphuric acids, from which he was in the act of pouring, deceased inhaled, for a few minutes, the fumes evolved by the spilt acid. He also received some severe cuts about the hands, and became very faint and sick. From evidence given at the inquest, it appeared, that when first seen by his medical attendant, nearly three 7tozi-,,-s after the accident, "he sat up and appeared in moderately good health," and remarked that" he had sent for him more particularly about his hands. He coughed now and then rather violently, but said he had been as bad before." At the next visit, three hours afterwards, matters had assumed a more serious aspect. "He breathed with difficulty, and coughed a good deal. The pulse was rather hard and laboured. He complained of tightness at the lower part of the throat. At tinzes, he said he could scarcely breathe, but that he was worse when the cough came on." In five hours more, being eleven from the time of the accident, and before the arrival of his attenclant, who had been again sent for, he died. Examination of the body revealed congestion of the trachea and bronchial tubes. "There was a considerable effusion of blood into the bronchial tubes. The heart was flaccid, and contained little blood; the interior of the heartand aorta, was slightly inflamed. The blood gavea,slightly acid reaction with testpaper. The liver and all other parts of the body presented a healthy appearance." The condition of the larynx is not stated, yet it is 2wobccble that it played a principal part in the
tragedy.
What could be done in such a, case? If litmus paper, reddened by an acid gas, be brought over a jar containing carbonate of ammonia, the colour will be speedily restored, and I find that air sufficiently impregnatecl with the alkali to effect this’ object can be easily respired. Aqueous vapour, charged with ammonia, answers still better, and may be readily by dropping a lump of the carbonate into a vessel containing hot water. In a similar case to the above, I would suggest, then, the inhalation, as eccoly as possible, of the alkaline vapour, directing the patient to make deep inspirations at intervals. This would perhaps put a stop to any further mischief. Swabbing the larynx with a weak alkaline solution is another expedient, which might be adopted, but would be less efficacious than the inhalation. Should the practitioner not be called to the case until the breathing has become embarrassed, trial should still be made of the alkaline vapour. If this, and other means, should fail to afford relief, if the dyspno2a should become so urgent as to threaten asphyxia, and if the obstruction should appear to be situated in the larynx, the question would be as to the performance of tracheotomy. Supposing the co-existence of only a moderate degree of bronchitis, this operation if not delayed too long, would afford a fair chance of rescuing the sufferer from a terrible death. AN OLD SUBSCRIBER. April 4, 1854.
previously
prepared,
THE CHOLERA IN
THE UNITED KINGDOM IN 1854. IN
reasoning
upon the
and often conflicting appahistory of cholera, it is beyond
numerous
rent facts connected with the
things necessary that such facts be taken for no more than they are worth, and that a careful discrimination be made between what they prove in veritate and in srecie only. The all
case we
alluded to -last
week, of
the
nurse
in La
C7tcti-iti,
to the disease, similar to that manifested by the also evinced by soldiers fatigued by long marches, and its observed in convicts under long sentences of imprisonment, in whom the nervous powers, even more than the nutritive e functions, are depressed,"—(College Reports, p. 179.) we are only shown that ’whatever is the cause of the disease, it may be escaped or resisted by one class of persons, while those of another class in the same building suffer." " Thus, in Milibank Prison, during the entire epidemic of 1848-49, 48 convicts died, the average number in the prison during the period being 1107; while only two deaths occurred among the officers and the members of their families resident in the prison, the number of whom amounted to 195. The prisoners therefore suffered in a proportion four-fold greater than the officers and their families."—(op. cit. 179.) Again, with respect to the assumed proof thus afforded of non-infectiousness, it may be remarked that many other conditions are requisite in the person beside proximity to the focus of zymotic poisoning, in order that (universally admitted) zymotic diseases shall be propagated in the way in question. Further, whilst the first glance at the matter might incline to the belief of non-infectiousness, the second would not, if wemay accept the following statement of Dr. Baly :-" ln Millbank Prison, as in the lunatic asylums, the number of deaths among the officers and attendants is too. small to afford satisfactory datafor estimating the risk incurred in attendance on cholera patients. But the evidence these institutions afford, scanty and inconclusive as it is, must not be The attendants engaged on the sick certainly overlooked. suffered in a larger proportion than those not so employed. The exact number of persons brought into contact with the patients struck with cholera in the lunatic asylums is not known; but there can be no doubt that the two or three deaths formed a much larger proportion amongst the attendants thus employed than the three or four deaths among those officers and attendants who had little or no intercourse with the patients labouring under the disease."—(p. 180.) The great difficulty surrounding the questions we have now and before touched upon has been well pointed out by Professor Alison, of Edinburgh, (Medico-Chirurgical Review, xxv. p. 5,) when he dwells upon the impossibility of commanding all the ’ conditions of any experiment or contrived observation, so as to leave out one after another of these conditions in each repetition of the observation, and havean instantia crucis as to the influence of any one of them (e. g., contact with the already sick, depressing hygienic conditions, moral and physical, &c.) on the result. The Cork Reporter contains the following record, dated from Kanturk, Thursday evening : " We are happy to be able to state that, since our last report, under date this day week, no case of cholera has appeared in the town, and but two, of a very mitigated character, in the Quarry auxiliary workhouse, the particulars of which, as detailed by Dr. Barry to the guardians, will be found in the report of their proceedings." The Belfast W7tig of Saturday says:—" We regret to say that on Thursday evening there were thirty-eight cases treated, of which thirteen terminated favourably; and, although no official returns have been since made,- we are given to understand that up to last night the number of persons affected, and the type of the disease itself, afforded no room for congratulation, but the reverse." Mr. Laity, one of the officers of her Majesty’s steamer Advice, has died of choleraat KilruSh.
ceptibility
insane, is
CENTRAL CRIMINAL COURT, SATURDAY, APRIL 8. (Before Baron Martin.) UTTERING FORGED DIPLOMAS.
strongly shows the necessity of strict attention being paid to LEWIS Bossy surrendered to take his trial for a misthis point, as will also the illustrations we shall further offer. demeanour. From the data derived from the official returns received by the Mr. Bodkin and Mr. Poland were counsel for the prosecution; Commissioners in Lunacy, and placed in the hands of the com- Mr. Clarkson and Mr Hawkins appeared on behalf of the mittee of the College of Physicians, it appears (page 178 of defendant. Mr. Bodkin said that the offence imputed to the defendant Report) that in the West York Lunatic Asylum, 98 out of 633 this indictment, was having uttered, as true, a false diploma patients died, and only 1 nurse out of 51 attendants and other by of the Royal College of Edinburgh, entitling him to assume the resident officers; and in the Bethnal-green House Asylum, 54 title of " Doctor of Medicine. He understood that the defenpatients died out of 567, and 2 attendants out of 71. Now, it dant was really a licentiate of the Apothecaries’ Company, and might be argued that this comparative immunity of the attend- he was entitled to that title, but he had no authority to practise ants on the sick of cholera who were dying in the above pro. as a physician, which he professed to do under the false certificate or diploma which was now the subject of inquiry. portions proves ’’ the absence of contagion or other infectious He thought it right to state that the defendant had assumed on the one and on the other leads to the belief to act power" hand, as medical referee to several life insurance companies; that the insane are particularly susceptible of the morbific in- and, in consequence of certain circumstances, which on the fluence of the disorder. But when it is considered that a sus- present occasion he should not be justified in making a further "
tragedy.
What could be done in such a, case? If litmus paper, reddened by an acid gas, be brought over a jar containing carbonate of ammonia, the colour will be speedily restored, and I find that air sufficiently impregnatecl with the alkali to effect this’ object can be easily respired. Aqueous vapour, charged with ammonia, answers still better, and may be readily by dropping a lump of the carbonate into a vessel containing hot water. In a similar case to the above, I would suggest, then, the inhalation, as eccoly as possible, of the alkaline vapour, directing the patient to make deep inspirations at intervals. This would perhaps put a stop to any further mischief. Swabbing the larynx with a weak alkaline solution is another expedient, which might be adopted, but would be less efficacious than the inhalation. Should the practitioner not be called to the case until the breathing has become embarrassed, trial should still be made of the alkaline vapour. If this, and other means, should fail to afford relief, if the dyspno2a should become so urgent as to threaten asphyxia, and if the obstruction should appear to be situated in the larynx, the question would be as to the performance of tracheotomy. Supposing the co-existence of only a moderate degree of bronchitis, this operation if not delayed too long, would afford a fair chance of rescuing the sufferer from a terrible death. AN OLD SUBSCRIBER. April 4, 1854.
previously
prepared,
THE CHOLERA IN
THE UNITED KINGDOM IN 1854. IN
reasoning
upon the
and often conflicting appahistory of cholera, it is beyond
numerous
rent facts connected with the
things necessary that such facts be taken for no more than they are worth, and that a careful discrimination be made between what they prove in veritate and in srecie only. The all
case we
alluded to -last
week, of
the
nurse
in La
C7tcti-iti,
to the disease, similar to that manifested by the also evinced by soldiers fatigued by long marches, and its observed in convicts under long sentences of imprisonment, in whom the nervous powers, even more than the nutritive e functions, are depressed,"—(College Reports, p. 179.) we are only shown that ’whatever is the cause of the disease, it may be escaped or resisted by one class of persons, while those of another class in the same building suffer." " Thus, in Milibank Prison, during the entire epidemic of 1848-49, 48 convicts died, the average number in the prison during the period being 1107; while only two deaths occurred among the officers and the members of their families resident in the prison, the number of whom amounted to 195. The prisoners therefore suffered in a proportion four-fold greater than the officers and their families."—(op. cit. 179.) Again, with respect to the assumed proof thus afforded of non-infectiousness, it may be remarked that many other conditions are requisite in the person beside proximity to the focus of zymotic poisoning, in order that (universally admitted) zymotic diseases shall be propagated in the way in question. Further, whilst the first glance at the matter might incline to the belief of non-infectiousness, the second would not, if wemay accept the following statement of Dr. Baly :-" ln Millbank Prison, as in the lunatic asylums, the number of deaths among the officers and attendants is too. small to afford satisfactory datafor estimating the risk incurred in attendance on cholera patients. But the evidence these institutions afford, scanty and inconclusive as it is, must not be The attendants engaged on the sick certainly overlooked. suffered in a larger proportion than those not so employed. The exact number of persons brought into contact with the patients struck with cholera in the lunatic asylums is not known; but there can be no doubt that the two or three deaths formed a much larger proportion amongst the attendants thus employed than the three or four deaths among those officers and attendants who had little or no intercourse with the patients labouring under the disease."—(p. 180.) The great difficulty surrounding the questions we have now and before touched upon has been well pointed out by Professor Alison, of Edinburgh, (Medico-Chirurgical Review, xxv. p. 5,) when he dwells upon the impossibility of commanding all the ’ conditions of any experiment or contrived observation, so as to leave out one after another of these conditions in each repetition of the observation, and havean instantia crucis as to the influence of any one of them (e. g., contact with the already sick, depressing hygienic conditions, moral and physical, &c.) on the result. The Cork Reporter contains the following record, dated from Kanturk, Thursday evening : " We are happy to be able to state that, since our last report, under date this day week, no case of cholera has appeared in the town, and but two, of a very mitigated character, in the Quarry auxiliary workhouse, the particulars of which, as detailed by Dr. Barry to the guardians, will be found in the report of their proceedings." The Belfast W7tig of Saturday says:—" We regret to say that on Thursday evening there were thirty-eight cases treated, of which thirteen terminated favourably; and, although no official returns have been since made,- we are given to understand that up to last night the number of persons affected, and the type of the disease itself, afforded no room for congratulation, but the reverse." Mr. Laity, one of the officers of her Majesty’s steamer Advice, has died of choleraat KilruSh.
ceptibility
insane, is
CENTRAL CRIMINAL COURT, SATURDAY, APRIL 8. (Before Baron Martin.) UTTERING FORGED DIPLOMAS.
strongly shows the necessity of strict attention being paid to LEWIS Bossy surrendered to take his trial for a misthis point, as will also the illustrations we shall further offer. demeanour. From the data derived from the official returns received by the Mr. Bodkin and Mr. Poland were counsel for the prosecution; Commissioners in Lunacy, and placed in the hands of the com- Mr. Clarkson and Mr Hawkins appeared on behalf of the mittee of the College of Physicians, it appears (page 178 of defendant. Mr. Bodkin said that the offence imputed to the defendant Report) that in the West York Lunatic Asylum, 98 out of 633 this indictment, was having uttered, as true, a false diploma patients died, and only 1 nurse out of 51 attendants and other by of the Royal College of Edinburgh, entitling him to assume the resident officers; and in the Bethnal-green House Asylum, 54 title of " Doctor of Medicine. He understood that the defenpatients died out of 567, and 2 attendants out of 71. Now, it dant was really a licentiate of the Apothecaries’ Company, and might be argued that this comparative immunity of the attend- he was entitled to that title, but he had no authority to practise ants on the sick of cholera who were dying in the above pro. as a physician, which he professed to do under the false certificate or diploma which was now the subject of inquiry. portions proves ’’ the absence of contagion or other infectious He thought it right to state that the defendant had assumed on the one and on the other leads to the belief to act power" hand, as medical referee to several life insurance companies; that the insane are particularly susceptible of the morbific in- and, in consequence of certain circumstances, which on the fluence of the disorder. But when it is considered that a sus- present occasion he should not be justified in making a further "