THE PATHOLOGY AND TREATMENT OF CHOLERA.

27 the Government, and enables those who are in reality most responsible to escape. No enactment can be complete which does not bring the vendor’s stores under direct supervision, and which fails to inflict deterrent penalties, not only for adulteration, but also for proved negligence on the part of owners and masters of ships. The cost of genuine lime-juice, properly packed and warranted to last two years, is little, if at all, greater than a solution of citric acid of the same strength. It is true the factitious mixtures in vogue are much weaker, and, although chiefly composed of citric acid, are sometimes sharpened with vinegar or sulphuric acid. For the supply of an ordinary ship, a very few pounds will represent the difference in cost of the best and the worst lime-juice in the market. And it is for this paltry saving that "highly respectable" men-local magnates-leaders, it may be, of public movements-do not scruple to rob their servants of health and strength, and to bring scorn and reproach on their country. It is to be regretted that in such flagrant cases as have recently occurred the sufferers did not seek redress by an action for damages. When the culprits are so numerous as to keep one another in countenance and defy exposure, it is only by mulcting the pocket that a desirable impression can be made. We shall await with interest the discussion of this subject in the ensuing session, and can assure the Government that any comprehensive measure for the physical improvement of the "mariners of England"will be most heartily welcomed on

by our profession.

QUEKETT MICROSCOPICAL CLUB. AT the ordinary monthly meeting, held at University College on Friday, Dec. 28th, there were no less than 120 members present at this flourishing Society, which has been esta-

blished a little members.

more

than

a

year, and

now

numbers about 250

science. Mr. Cooke then noticed Mr. Lewis’s the effect of the passage of the electric spark through media, which was read before the Quekett Club ; the microspectroscope, which had not realised its anticipations, its use by Dr. Herapath in the detection of human blood being, howIn the Comptes Rendus, M. Rouget has ever, important. set himself to work to controvert Dr. Beale’s views on nerveends, affirming that they do not end in a fine network of delicate fibres, but in a peculiar terminal plate or disc. In the same periodical, M. Balbiani has discussed the hermaphrodite state of aphides ; and Dr. Fripp the light-emitting apparatus of the glow-worm, in the Popular Science Review for July. Mr. Beck, in the Microscopical Journal, confirmed the fact that acari have at first six legs, and ultimately eight; that agamic reproduction extends at least through a succession of three generations. Mr. Robertson communicated to the Microscopical Society of Oxford a singular form of acarus adherent to the connective tissue of the skin and the large veins near the heart of the pigeon. Professor Schjodte, in the Annals of Natural History for March, showed that the commonly-accepted notion that the pediculus vestirnenti has mandibles and can bite is erroneous. Several papers on trichina have escaped the attention of English readers. Those of Assmus, published at Leipsic; Anton Frie, at Prague ; H. Heschl, p. 27, at Gratz ; Leuckart, p. 121, Heidelberg; Model, p. 28, Nordlingen ; Niemeyer, p. 18, at Magdeburg; Rodet, p. 57, Paris ; Scoutetten, p. 108, Paris ; Stinde, p. 13, Hamburg; Virchow, p. 87, Berlin; Rupprpcht, a synopsis of trichina literature, p. 87, Vienna. Etichenmeister has issued at Dresden a work entitled "Mikroscopische Fleischschau" (the Microscopical Inspector of Meat). Amongst papers on helminths are Mecznikow’s ; on Ascaris nigrovenosa ; Macalister on Ascaris dactyluris, in the Microscopical Journal for January and April. In botany, Mr. Herbert Spencer’s papers on the circulation and formation of wood in plants, in the last part of the Linnaean Transactions De Bary’s section of the ’-German Hardbook of Physiological Botany," recently issued; Dr. Braxton Hicks’s paper on Volvox globator, the tendency of which is to show that in winter the volvox passes into an amceboid state-in other words, becomes an animal,-are worthy of note. Mr. Cooke also gave ample reference to observations on anatomy, insects, crustacea,

microscopical

paper

on

;

rotifers, echinoderma.ta, hydrozoa, protozoa, desmids, and

lichens. Mr. How exhibited about forty excellent micro-photographs, and the meeting terminated with the usual conversazione. There is one feature in this club worth mentioning. A is placed on the table, so that anyone may put "question-box" of interest to medical observers. The author first of all retherein written questions on any microscopical matter, and marked upon the activity of late displayed by the Royal Microthese are submitted to a subsequent meeting after having scopical Society, in some degree a consequence of the esta- passed through the hands of the council ; thus interesting blishment of the Quekett Club, which has so successfully short discussions are often excited, and the experience inaugurated excursions and demonstrated the possibility of members brought out and utilised. holding conversazioni once a month. He then detailed the improvements in instruments and apparatus, and the invention of new, more satisfactory, and expeditious methods of microscopical investigation, calling attention particularly to Mr. How’s new student’s microscope, and those of Mr. Bishop and Mr. Cole, "Audi alteram partem." the two latter of which aimed to secure a large instrument with the least possible weight, but are not made for sale ; the sea-side microscopes of Highley, Beck, and Murray ; and a THE PATHOLOGY AND TREATMENT OF fourth by Baker, exhibited by Murray and Heath. ImproveCHOLERA. ments have been effected in the construction of the binocular To the Editor of THE LANCET. microscope. The stops usually employed in the application of Wenham’s prism curtail the amount of light, and when the to make a brief comment on Dr. Owen SIR, -I beg permission single body is required for high powers oblique light cannot be Rees’s recently published " Clinical Remarks on Cholera." used. Mr. Baker has remedied this. Many changes in diaDr. Rees says the statement that during the collapse stage phragms were referred to. The economic condensers of Hislop, of cholera there is an arrest of blood in its passage through the and Rickett Webster were noticed, also the Highley, Collins, lamp ; Dr. Beale’s neutral tint glass for drawing objects in lungs is erroneous, "inasmuch as we have now before us ten the microscope, with Mr. Collins’s modification, in which a consecutive cases of fatal collapse, in all of which the blood prism inserted into the same fitting converts it into a camera was not arrested in the branches of the pulmonary artery, but Powell and Leland’s, and Smith and Beck’s apparatus was found filling the pulmonary veins quite as completely as for the illumination of opaque objects ; a binocular adapted to the examination of opaque objects with high powers the arteries ; and more than this, it had passed through those and the 1/50 object glass, by the former firm ; the advocacy veins, and reached the left cavities of the heart." No mention of the millimetre as the standard measurement, by the is made of the weight of the lungs or the state of the large author of the paper. With regard to literary contri- systemic veins ; but the substance of Dr. Rees’s statement is, butions, no other periodical, perhaps, observed the author, that he finds no post-mortem evidence of an arrested or im has done more for microscopy through the past year peded pulmonary circulation during the collapse stage of choin this country than Hardwicke’s "Science Gossip," lera. It is very remarkable that the anatomical facts of the diswhich has contained no less than 150 communications on ease at Guy’s Hospital should differ so much from those which

interesting paper was read by Mr. M. C. Cooke " On Microscopy in 1866," which was intended to furnish a sketch of last year’s progress, and contained reference to many papers An

’

of

Correspondence.

lucida ;

-

28 Our examinations at King’s CLITORIDECTOMY. with those which were made with so much care and accuracy by Dr. Parkes, To tlae Editor of THE LANCET. who thus summarises his conclusions:-" The essential sympSIR, -In your impression of last week, there appears a toms of the algide cholera-namely, the loss of animal heat; the loss of voice, proceeding from the diminished volume of letter from Dr. Greenhalgh, to which I beg leave to offer a air in the lungs; the colour of the surface; and the arrest of word or two in reply. the circulation; coupled with the collapsed state of the lungs 1. In reference to a case sent to me for operation by Dr. after death, their deficiency in blood (although blood may be he says :- " We know, on the best and most unGreenhalgh, in the large vessels), the contraction of the left cavities of the questionable authority, that Dr. West never has advised, and heart, with the empty arterial system,-prove satisfactorily, never would advise, clitoridectomy for the object specified, as it appears to me, that there is a failure more or less comand we are asked to believe that he made an exception to this plete in the transmission of the blood through the lungs."* rule in favour of a patient whose case he had not personally diaDr. Rees admits that collapse may occur with but a mode- gnosed, and whom he had never even seen....... I deny that I rate amount of discharges; and he believes that the cholera ever recommended removal of the clitoris for self-abuse. The poison has a depressing influence on the heart somewhat patient just referred to stated that she could not and would similar to that exerted by tobacco, " the blood passing freely not discontinue the habit to which she was addicted....... Mr. through the lungs and stopping on the left side of the heart." Brown urged the excision, and promised it would effect a cure. This theory is not in accordance with the morbid anatomy of Mr. Brown must know as well as I do that when I was apthe disease as I have observed it, and as described by Dr. Parkes pealed to I declined to express an opinion, stating that I had and others; neither is it supported by the results of treatment. ’I no experience, and could have no faith in the result thus conHow can Dr. Rees reconcile with this theory the marvellous fidently promised." These are Dr. Greenhalgh’s own words temporary benefit from hot injections into the veins, the great on the 26th December, 1866. Nothing material is omitted and permanent relief sometimes afforded by venesection, and from the sentence, as your readers will see by referring to the acknowledged failure of alcoholic stimulants to improve your last number. My reply is also in Dr. Greenhalgh’s own the pulse and relieve the other symptoms of cholera collapse ?‘? words, written in May, 1865, and, of course, sent to me before Dr. Rees is surprised that one patient who inhaled nitrous I ever saw the patient. I enclose you the original docuoxide gas, and another who inhaled diluted oxygen, got no ment :benefit from the inhalation; and he therefore assumes that " 76, Grosvenor-street, Grosvenor-square, May 24th, 1865. the blood undergoes some change " which destroys its attrac"IVIr DEAR BROWN,-I am ashamed at this tardy reply to tion for oxygen." This assumption is unnecessary, and it is your kind and satisfactory note, which is all I can wish, and opposed to undoubted facts. It is unnecessary if we admit believe me removes any and every unfavourable impression I that the mass of blood is arrested in the minute branches of entertained concerning your transactions with me.** I hope to the pulmonary artery before it reaches the capillaries, where a case for removal of the clitoris in a few days. you it should be exposed to the air. The small volume of blood bring The subject is a single lady, about 44 years of age, who has which passes through the lungs is sufficiently aerated : what been under Simpson, A. Farre, and, I think, Dr. West, for is required is, not more oxygen to combine with the blood, months without any permanent, and but slight tempomany to take the but more moving blood up oxygen in its passage relief from pruritus, from which she has suffered about through the lungs. Again, Dr. Rees’s assumption is opposed rary, eight years. Simpson some time ago divided the nerves of to the fact that when cholera blood is brought into contact the clitoris on one side without the slightest benefit. I have with air it immediately undergoes the usual chemical changes. exhausted remedy, I think I may say, ever suggested This is seen when either the hot venous injection or venesec- for the cureevery of pruritus, so there is no other course open but tion sets free the pulmonary circulation, and thus removes the removal, which perform with such great dexterity. I impediment to the respiratory changes ; when a thin layer of enclose her niece’syou letter. blood out of the body exposed to the air at once assumes the " Believe me. sincerelv vours. arterial hue; and when the lung artificially inflated after "R. GREENHALGH. death rapidly becomes florid. These are unquestionable facts, "P.S. Please return the niece’s letter, which is sent conand they cannot be reconciled with the hypothesis of a mysterious change which destroys the natural affinity of the blood fidentially." Is a single word of comment necessary ? I regret deeply for oxygen. Dr. Rees compares the choleraic discharges with the sweats that any disagreement should have arisen upon a matter of of acute rheumatism. The comparison is a fair one, but there facts ; but I was not the aggressor. Into the other matters in Dr. Greenhalgh’s letter I shall not is one important difference between the two diseases. The acid sweats of rheumatism, when they reach the surface of enter. Indeed, the most material parts of my complaints the skin, are out of the body, and they require only to be ab- against his conduct he absolutely admits. Dr. Greenhalgh sorbed and removed by woollen clothing; whereas the choleraic attended the Home for three years and a half, and paid us, as secretions, when thrown into the bowel, may be retained and the book will show, numerous visits : he would have conferred reabsorbed into the blood. If Dr. Rees has read the book to an obligation upon me, if, on any occasion during that long which he refers, he is aware that I do not propose to increase period, he had pointed out anything in any way objectionable. I am. Sir. vour obedient servant the choleraic discharges, but only to prevent their retention I. BAKER BROWN. and accumulation within the bowel; and I would ask him Harley-street, January 1st, 1867. whether a practitioner who looks upon cholera as only an intestinal flux to be arrested by opiates and astringents is more To the Editor of THE LANCET. scientific, or likely to be more successful, than one who, bebe rheumatic fever to a skin sickness only lieving sweating deep, SiR,-I am sorry you have brought me into the clitoridecmakes it his chief business to repress the sweating by exposure convictions were clearly stated before of the surface to cold ? In both diseases the discharges are a tomy controversy. My the Obstetrical nor is it needful that I should again Society ; necessary part of that process by which the vis medicatrix effects a cure ; and the business of the physician is to assist, refer to them. Upon one point, however, I trust you will and not to oppose, the curative process. allow me to reply. I stated that I believed clitoridectomy Dr. Rees has " not heard that anyone presumes, in the pre- was only extensive circumcision, and the following reasons sent day, to attack rheumatism with diaphoretics." I presume I bear me to Dr. reference out. Savage’s work By that the hot-air and Turkish baths must be considered diapho- will, hope, on the Female Pelvic Organs, you will see the following views, retics. These means have been largely used by many practitioners in the treatment of rheumatism, and I can assure both figured and detailed, and I gather from subsequent conDr. Rees that I have found them more efficacious than any versation with him that such are his opinions. (See plates ii. ,drugs, not even excepting lemon-juice. I believe that for and iv., with explanatory notes thereon.) cutting short an attack of acute rheumatism we have no means The clitoris consists of the two corpora cavernosa (" the so effective as the diaphoretic action of the hot-air bath, when latter greater in proportion than in the male"). Owing, how. employed at the very commencement of the disease. ever, to the position of urethra only a small portion of the I am, Sir, your obedient servant, corpus spongiosum extends into it. The analogues of the GEORGE JOHNSON. Savile-row, Dec. 31st, 1866. * * This was in reference to a disagreement between Dr. Greenhalgh and Researches into the Pathology and Treatment of Cholera; by E. A. myself, in which he had imputed to me a breach of professional etiquette. Parkes, M.D.; p. 105.

have been observed elsewhere.

College Hospital

are

entirely in accordance