THE NATURE AND CAUSES OF CHOLERA.

760 last. The fatal cases of diarrhoea., which had been 8 in - each of the preceding two weeks, declined to 6 last week. The 137 deaths in Dublin last week included 31 of infants under one year of age, and 34 of persons aged upwards of ,sixty years ; the deaths both of infants and of elderly exceeded those recorded in the preceding week.
THE SERVICES. MOVEMENTS OF THE MEDICAL STAFF. SURGEON- CAPTAIN PINCHING, lately attached to the "Egyptian Army, has been transferred to the Egyptian Sanitary Department. Brigade - Surgeon - Lieutenant - Colonel

Fraser has relieved Brigade-Surgeon-Lieutenant-Colonel Clapp as Senior Medical Officer in the Mauritius, and Surgeon’Captains Fallon, Colledge, and Butterworth have arrived there on a tour of service. Surgeon-Lieutenant-Colonel O’Reilly has embarked for India in the V2-,etoria. Surgeon’Major James has arrived in England from Malta on leave of ’absence, and Surgeon-Lieutenant Taylor has been transferred to Shorncliffe. ARMY MEDICAL STAFF. Brigade- Surgeon- Lieutenant- Colonel James Macartney, M.D.. is placed on temporary half-pay on account of illhealth.-1st Life Guards : Surgeon-Captain Seton Guthrie Hamilton retires from the Service, receiving a gratuity. Surgeon-Major Horatio R. 0. Cross, from Scots Guards, to be Surgeon- Captain, vice S. G. Hamilton, his rank of ’Surgeon-Major being cancelled. THE INDIAN MEDICAL SERVICES. The services of Surgeon-Major K. R. Kirtikar, Civil Sur.geon, Thana, are placed at the disposal of the Bombay Municipality with a view to his appointment to act as Executive Health Officer of the Municipality, vice Sur,.geon-Lieutenant-Colonel T. S. Weir appointed to act as Municipal Commissioner for the City of Bombay. Sur-

C. B. Hunter, I.M.S. (Bengal), whose services have been placed temporarily at the disposal of the Chief Commissioner, Central Provinces, is appointed to be a Civil Surgeon and is ported to the Seoni district. Surgeon-Captain W. L. Price, M.B., Civil Surgeon, Chhindwara, is placed temporarily in Medical Charge of the Seoni district in addition to his own duties. SurgeonCaptain C. E. G. Stalkartt, M.D., who is at present on general duty in the Bombay district, has been transferred The Queen’s approval to the followto the Sind district. ing promotion in the Madras Medical Establishment is gazetted :-To be Brigade-Surgeon-Lieutenant-Colonel : Sur-

geon-Major

Edward Fawcett (dated April 4th, 1894). The Queen has also approved of the transfer from the Half-pay List to the Retired List of Surgeon-Captain William Wilfrid Webb, Bengal Medical Establishment (dated Aug. 22nd, 1894).

geon-Lieutenant-Colonel

NAVAL MEDICAL SERVICE. The E. G.

following appointments

notified :-Staff-Surgeon Surgeons : H. J. Hadden, M.B., to Bermuda Hospital ; A. G. W. Bowen, M.B., to the Pccrtridye; G. T. Bishop, to the -Linn--t; R. D. Jameson, to the Galatea; Robert S. Barnard, to the Victory, additional, to be lent to the Minotaur, temporarily;and James Mowatt, to the Edinburgh. Swan,

are

to the Briton.

VOLUNTEER CORPS.

Rifle:: lst (Cumberland) Volunteer Battalion, the Border Regiment: Surgeon-Lieutenant W. Symington, M.B., to be Surgeon-Captain.-3rd Volunteer Battalion, the Essex Regiment : Surgeon-Lieutenant C. absence without leave.

W. Bass is

superseded

for

VOLUNTEER OFFICERS’ DECORATION. This decoration has been conferred upon the following officers : Westerrn District: Royal Engineers: 1st Gloucestershire : Surgeon-Lieutenant-Colonel Samuel Smith and Surgeon-Lieutenant-Colonel Douglas J. Dutton.-Thames District:Artillery:2ad Kent : Surgeon. Major Frank Smith, M.D.-Home District : -Rifle : lst Volunteer Battalion, the Royal Fusiliers (City of London Regiment) : Brigade-SurScottish geon-Lieutenant-Colonel Samuel Parsons Smith. -District:Artillery:: lst Midlothian : Surgeon-LieutenantColonel Peter Alexander Young, M.D. -

DEATHS IN THE SERVICES. Hamilton Mitchell, who died on the 26th of August last at Derry, after a short illness, became assistant surgeon in 1854, surgeon in 1867, and was placed on half-pay in 1880. He served in the Crimea from November, 1854, to February, 1855, receiving the medal with clasp for Sebastopol, and Turkish medal.-Surgeon George McShane, R.N., of the Linnet, son of Inspector-General McShane, R.N., recently died at Chefoo, China, aged thirtyone years. FIRST AID IN INDIA. The Ambulance Squad of the Poona Volunteers, under the command of Surgeon-Major C. J. Addison, A.M.S., was inspected on Thursday, Aug. 30tb, by his Excellency LieuThe Red Cross operations were tenant-General Nairne. conducted under circumstances approaching as near as possible those likely to occur in actual waifare, and the whole of the proceedings were can led out with great

Brigade-Surgeon

success.

In consequence of the reduction

of the British garrison in medical officer will be retained for duty in the island, the medical staff being distributed between Egypt, Malta, and Home. Surgeon-Major Kenny is the officer who will remain.

Cyprus only

one

Correspondence. "Audi alteram

gartem:’

THE NATURE AND CAUSES OF CHOLERA. To the Editors of THE LANCET. SIRS,-Adverting to your article on Cholera in THE LANCET of the 22nd inst., which I read with great interest, I desire, with your permission, and guided by the light of what I heard and understood from the discussion of this subject at Budapest, to make a few remarks thereon. The discussion on cholera at the recent Congress took place on the 5th inst.

761

I

of the first three Sections, under the of Professor Koranyi and of myself. Some of the highest authorities in bacteriology explained on that occasion the result of their studies before a crowded and attentive I desire at the outset to guard against being audience. supposed to possess any special knowledge of bacteriology. To such knowledge I lay no claim. I merely wish to place on record what I heard at Budapest in connexion with a subject which necessarily engaged much of my thought and time during my long service in India. Professor Grüber of Vienna gave his audience to understand that "the bacteria as such are innocuous (ungiftig)-they become toxic only under certain circumstances ; that there is no known specific poison of cholera; and that Koch’s theories

at

a

joint meeting

presidency

for diagnosis worthless." Professor Hugge of Prague expressed similar views. Metchnikoff stated that man may swallow considerable quantities of cholera vibrios "sans prendre le cholera." He declares that the presence of cholera bacilli in the stools of healthy persons is not at all an uncommon occurrence, and quotes the experiments of Dr. Wall, who, when at Budapest during a former epidemic, had on four different occasions swallowed large quantities of cholera Metchnikoff goes further, and vibrios without injury. are

observes that his assistants, Blachetein and Sanarelli, discovered the cholera vibrio in the River Ssine near the Pont Neuf in Paris, and also at S5. Cloud and Versailles, although it is well known that Versailles had never been visited by a cholera epidemic notwithstanding that it stands in need of much in respect to saniIts water-supply comes from the river Seine tation. after passing by Paris and its suburbs, where cholera

MEDICAL ETHICS. To the Editors of THE LANCET. I was under the impression that the medical SiRS, editor of the daily or weekly paper was a thing of the past, and that it was not in accordance with professional usage for a registered medical practitioner to answer correspondents as. to their ailments through the public press. Twenty years, ago some weeklies seemed to have a medical editor for thepurpose, but I think the medical Press and professional opinion caused it to cease, and I was under the impression. that this form of advertising was relegated to obscurity. Inthe provinces this is so. Fancy my astonishment, howeveron perusing a London evening daily paper to find that one. Arthur A. Beale, M.B., had taken to this form of practice, and this under the very noses of the "light and leading" of the profession in the metropolis. I enclose you the cutting, from the Echo so that you may see that it is an established. practice. Trusting that timely admonition from you may put. a stop to a further breach of professional rules, I am, Sirs, yours faithfully, WM. BERRY, F.R.C.S.I. Wigan, Sept. 22nd, 1894. -

WANTED SCIENTIFIC ASSISTANTS. To the Editors of THE LANCET. seems SIRS,-It strange that in these days of progress

a,

valuable branch of medical practice should remain unex-ploited, and that we should still be without the special scientific assistant. I do not mean that he should be attached was frequently ragmg ; tne water nowecl into tile town to one practitioner, but to many, general and special, irh through a long aqueduct, and was often so"offensive and certain districts. Such a man would be, for a suitable fee, disgusting " that persons using it have been unceasing in open to engagement by medical men who desired his services.. their complaints. Nevertheless, Versailles remained free He would be a competent physiologist, chemist, bacceriofrom cholera epidemics. Why, then, did the cholera vibrio logist, &c., and would, when required, visit any particular: discovered in the Seine by Sanarelli produce no cholera at case, draw up a full report on it, analyse and microscope speciVersailles ? The answer, according to Metchnikcff, is this: mens of tissues and secretions, and tabulate facts which neither that of late many micro-organisms entirely resembling Koch’s practitioner nor consultant have time to estimate. He would, bacillus have been described, and the diagnosis of the true in short, reckon up the case from time to time and preserve an cholera bacillus, therefore, has become extremely difficult. The enormous mass of material which is now lost, to the disaster rules also which Koch laid down in 1884—nay, even those of of patients and the misfortune of science. It would not be1893-are no longer applicable to our knowledge of to-day. difficult to prevent the abuse of such a scheme, but it would "That is the reason," continues Metchnikoff, "that in the be to overestimate the value of such assistance toimpossible best bacteriological laboratories, including that of Koch him- the who is too busy to get a real insight, busy practitioner self, micro-organisms had to be declared as choleragenetic into his cases, and. who thus loses the keen interest in them which were not so considered before, and vice versti." which he would otherwise have. Certainly, the standards ofMetchnikoff likewise states that he tried what may be practice would be enormously’ raised ; we should realise called crucial experiments upon his own person, and amused the responsibility of ignoring modern methods which, " his audience by mentioning "toutes les cochonneries which he are medicine, the work of the busiest revolutionising had swallowed. He did not enter into further details beyond us would become in the best sense educational, amongst remarking that on some occasions he suffered from a passing and brilliant men who are now turned out of our schools, diarrhoea, but no other harm came to him. Metchnikoff without practices to go to and with no sphere for the exerdistinguishes inhibitive and adjuvant vibrios ; to the latter cise of their elaborate training, would be given congenial category belong the sarcina, bacillus coliformis, and the torula, work which would be, at reasonable fees, sufficiently remuand these are said to favour the production of the toxic nerative. To have our patients reckoned up for us at crises element of cholera ; but he adds that there is still something of diseases would afford a series of valuable lessons and very special and "mystérieux" in the matter, requiring further must result in advantage all round. I confess the idea fascistudy. nates me. When I was absorbed in general practice, I Nobody appeared to take up the discussion on the other frequently felt the want of such assistance, and to do the side. work myself was out of the question, except at great sacri-May I quote one more remark from Metchnikoff? " At fice of time and the complete sacrifice of leisure, which came, one time it was supposed that the cholera vibrio was an too rarely. But without this work one’s practice was value-exotic plant, hardly adapted to live in our climes. Numerous less as regards its educational benefit to oneself, and the facts have proved that this hypothesis was untenable. interesting cases had a teiok of coming when one was far too The cholera vibrio adapts itself to the conditions of life under busy to do anything but give them any but the most. circumstances very different from those of the Gangetic casual attention, if it might be called attention at all. delta, 1and in our latitudes it can exist for a long Like myself, most men have these cases, and they are a. time." source of infinite regret to them and not unfrequently of It is to be regretted that the English and Indian Govern- discredit. I throw out the suggestions of this letter, crude ments were not officially represented at the Congress of Buda- as they are, with the hope that they may commend thempest, for the scientific discussion on cholera was of supreme selves to you and your readers, and that an occasion may interest to them. As to the real nature and cause of cholera arise for amplifying them. the most earnest investigators tell us that we have not yet I am, Sirs, yours obediently, attained the goal. There is still something very "special G. A. HAWKINS-AMBLER, F.R.C.S.Eng. and mysterious" about the subject, requiring much further Liverpool, Sept. 24th, 1894. study and investigation. I am. Sirs. vours trulv. THEODORE DUKA, "UNUSUAL CASE OF SCARLET FEVER." Late President of the Tropical Section To the Editors of THE LANCET. at the Hygienic and Demographic Nevern-square, S.W., Sept. 25th, 1894. Congress of Budapest. SIRs,-In reference to the above case, which is said by Dr. Clement Dukes to be a characteristic one of epidemic 1 Annales de l’Institut roseola, I should like to mention that my diagnosis was based Pasteur, Août, 1894, p. 586.