Reports of Societies

1874 BMJ (Clinical Research Edition)  
the conditions calling for abscission of the anterior portion of the eyeball, and the way in which the operation once practised was improved by Mr. Critchett, the author related a case in which Critchett's operation was followed by sympathetic ophthalmia and loss of sight. Hle attributed this result either to traction upon the ciliary nerves in the cicatrix, or to laceration of one of them by one of the needles used to transfix the eye. In order to set aside these dangers, and at the same time
more » ... d at the same time to obtain a stump well calculated to carry an artificial eye, he had devised a plan of operating which w%vas described. It consistecl of uniting the tendons of the recti muscles by catgut sutures, and then uniting the conjunctival wound over them, no sutures being passed through the ocular tunics themselves. A patient who had been operated upon in this manner was exhibited to the Society. -Mr. HIGGINS said the usual plan at Guy's Hospital was to cut out the anterior portion of the eyeball, and then bring the conjunctival edge together; and they found this a better plan.-Mr. BRUDENELL CARTER had had no experience of this, and did not think it would give so good a stump as that formed by the tendons, etc. RECENT EXPERIENCE OF CHOLERA IN INDIA. BY JAS. MACKAY CUNINGHAM, M.D. After some introductory observations on the importance of the cholera question, especially at the present time, Dr. CUNINGHAM proceeded to remark on the special opportunities afforded by India for the study of cholera, and the great value of the information to be obtained there. He then entered into an examination of the evidence derived from the history of the epidemic of 1872 in Northern India. Two great points had to be determined-first, the influence of human intercourse in spreading the disease; and, secondly, the practical measures to be adopted for protection. I. The evidence as regards human intercourse was considered with reference to the geographical distribution of cholera in India; the great areas of prevalence and exemption ; the experience of the same tract in different epidemics ; the endemic area, the seasonal and periodic rise and fall of cholera within this area ; and the singular immunity of certain places. Further, with reference to this question, Dr. Cuningham dwelt upon the detailed evidence afforded by the history of one hundred outbreaks in I872. There was an entire absence of all evidence of commuinication of the disease, and the previous considerations were fatal, Dr. Cunningham believed, to this doctrine. The epidemic was not propagated along highways of communication, and did not travel any quicker in these days of railways than it did in olden times. Singular evidence against the contagiousness of the disease was derived from the St. Peter's College outbreak, many cases having been sent thence into various localities without, in one single instance, disseminating the disease. The experience of attendants on the sick was against all suggestion of contagion, a small proportion of those only being attacked, and there was an absence of all evidence of contagion in regard to those who were attacked. As to indirect contagion, the facts bearing on the water theory, as illustrated by the outbreak at Peshawur and Mlean Meer and other places, were wholly against its accuracy. Dr. Cuningham dwelt on the importance of local conditions in connection with the singular localisation of the disease, as illustrated by the outbreaks at St. Peter's College, and amongst the troops at Kussoulie, in the camps at Mean Meer, etc.; and he urged the necessity for studying these local conditions much more closely. The incidence of the outbreak as regards time among different sections of the community next received attention. 2. In considering the practical measures to be a(lopted to afford protection from cholera, the impossibility of carrying out an efficient quarantine was considered, and the great evils attending any attempt at it shown by the experience of Upper India oni this point. The primary importance of sanitary improvements was next urged, and a strong opinion was expressed on the tendency of the contagion views to initerfere with progress in this respect. Dr. H1-ARDIE had had experience of cholera in Mauritius during two epidemics, and ill both cases it had been imported by ships bringing coolies from Calcutta. In a previous epideemic, it was introduced in the same way, through the quarantine rules being broken. He did not think India was a good place to experiment upon cholera. In the epidemics he had seen, if there were immunity, he thought it was on the estates where the people were supplied with water from wsells. He thought the water-streams were thc great cause of its spreadl.-Sir WILLIA-:4 GULL was interested to finid that fresh statements added nothing to what Dr. Baly had already said. He thought it was to be regretted that the report of the Royal College of Physicians was so little klnoNsn and referred to. Occasionally water w%as a means of diffusion. During the last epidemic, a cholera-hospital as established at ANhitechapel, und(ler the care of Dr. Sutton. The disease never spread to the niurses or the attendants, for the reason, he thouglht, that, as soon as a patienit enterced, his clothes w%vere taken away, the patient sponged wi-itlh Coindy's fluid, and the hair cut. Hie did not believe in the evidence of the contagiousne .s of cholera. l-Ie thought the statement that it was spread by the evacuations was a good workiig theory, as it acted by frightening lpeople, hot proof of it as a scientific fact was wanting. Ile believed it alwvays canme by ship, but sporadic cases were always met xwith before an outbreak. He referred to the outbreak of Asiatic cholera in Mr. Druit's farm in Surrey for poor children, in the epidemic of I848. About half of the children died, and it was at first supposed that their deaths had becn hastened by bad food, poison, etc., and Mr. Druit died broken-heairted on account of the way in which he was judged by public opiinion. After a time, it was clearly seen that it was the beginning of the outbreak. At present, there was no scientific theory of the spread by contagioni and evacuations. It was singular how heights above the sea-level had to do with the origin of cholera. Cholera did not descend streams, but ascended them. Sanitary improvement fortified the body against epidemics by means of good air, ventilation, and cleanliness ; it also i-moved telluric inifluences, as damp, dirt, etc., and so improved the health of the people. -Dr. BUCHANAN thought the remarks made about cholera in the first part of the paper were equally applicable to feve-, both typhus and typhoid. When Dr. Cuningham said he looked to India for evidence, he would ask him to look afresh at that brought forward in England. He did not think the circumstances in India were favourable for the investigation of cholera. If -%ve ished to stu(ly measles or scarlet fever, would e go to a lar-ge place like Londoni, or to a remote village, or to a place where its introduction is easily ascertained ? Could outbreaks of yellow fever be as well wx orked out in the West Indies as the outbreak at Swansea was ? WVith regard to the arrest of cholera, he thought by preventing filth from being out of its place we did a great deal. He regarded atmospheric influence and telluric influence as inoperative.-Mr. NETTENT RADCLIFFE said, with regard to the contagiousness of cholera, anid the so-called water theory, Dr. Cuningham's views were founded on fallacies. The " contagion" of which he spoke was not the " conitagion" undlerstood in this country; the " water-theory" had hardly the faintest resemblance to what was meant here by the term. Dr. Cuningham judged of the contagion of cholera as if it were operative in the same way as the contagion of small-pox, and were, moreover, some self-operative agency acting irrespectively of conditions. Such a doctrine of the conitagiousness of cholera had no place in English teaching, so far as MIr. Radcliffe was aware. The very characteristic of etiological study in this country for many years, in respect to contagious diseases, had beeni, and still was, the determination of the conditions under hich the particular conitagions of the several diseases operated. To argue that because the contagion of a disease did n-ot operate unconditionally, therefore coIntagion did not exist, was much the same thinig as to argue against the germinative power potentially present in a potato or a grain of wheat, because germination did not occur and growvth followv except the potato or the grain of wheat were place(d in certain well understood conditions. The water-theory wvas used to explain certaini facts of localisation aloile. Dr. Cuningham spoke of the theory as incolnsistenit with the geographical distribution of the disease, as being negatived by the fact that bodies of troops widely separated from each other, and drinking from different sources of water, had been nevertlheless severely attacked wvith cholera, and so forth. Such arguments proved that Dr. Cuninglham was not dealing ith the wvater-theory understood here, but with something far different. Even in one particular instance-the St. Peter's College, Agra-where an outbr-eak had occurred wlhich wvould have led most English inquirers to make minute investigation into the sources of the water-supply, such inquiry, so far as the detailed report permitted a judgment to be made, had missed the very point to be inquired about. Mr. Radcliffe referred briefly to Dr. Cuninlgham's observations as to the absence of any evidence in India that a quickened traffic had accelerated the movements of cholera, and pointed out that the data given did not contain the materials for a judgment. lie asked if the facts could be set aside that wsere obtained from the study of the great migrations of 1832, I848, and I865, in which, for example, the questioni of time o0 carriage from East Europe to America was a siml-ple matter of observation. The first cargo of cholera carried to America in I832 wNas carrie(l in a sailing ship ; the first cargo carried in I866 was carried in a quiick-481
doi:10.1136/bmj.1.693.481 fatcat:bowr3gv5pndyhb7ccndunfod7i