Reports of Societies and Academies
BMJ (Clinical Research Edition)
WEBSTER made the following observations with reference to the health of the metropolis. "W With regard to CHOLERA, it is interesting to know that, notwithstanding the anxiety now prevalent, it hitherto has not made much progress in the metropolis; and that if its present fatality be compaxed with other epidemic maladies, we have as yet really not much cause for alarm; for during the six weeks, ending on Saturday, the 16th of October, 1847, the number of fatal Cholera cases, m London was
... ix; whilst the total number of deaths caused by the same malady, throughout the entire metropolitan population, during the six weeks ending on Saturday last, the 14th instant, amounted to sixty-seven, being, as yet, only a little more than double the mortality by Cholera during the same number of weeks in the previous yeax. Compared with this, it is instructive to mark the different results observed in another epidemic now prevailing in London with great severity, but which does not cause anxiety to the extent it deserves-I mean ScAR-LATINA. Hundreds of victims have been recently sent to an untimely grave by this pestilence. In the Registrar-general's tables it is stated, that during the six weeks terminating on Saturday, the 16th of October, 1847, 302 individuals died in London from Scarlatina; whereas, during the six weeks ending on Saturday last, the 14th instant, as many as 972 persons have sunk under that virulent complaint; or upwards of quadruple the average mor-1046, the ordinary weekly average. Contrasted with this plaguelike mortality, it must bc gratifying to hear that London, comparatively speaking, is not at present unusually unhealthy, notwithstanding the actual presence of Cholera, the great malignity of Scarlatina, and the prevalence of Typhus, by which disease 424 persons have died in the metropolis during the last six weeks, instead of 260, the averaged deaths by Typhus of a similar period, during the five preceding autumns. Such facts are important ; and although the Cholera now occasions considerable anxiety, the total deaths from all causes, throughout the metropolitan population, have actually diminished, especially during the last fortnight, notwithstanding the prevailing epidemics. This is proved by the mortality tables, which show that instead of the weekly average of 1154 deaths, as in the last five seasons, during the week ending on Saturday, the 7th October instant, 1005 persons died from all causes in the metropolis, and only 991 in the week terminating last Saturday, the 14th: thus making a diminution of not less than 312 deaths in the two weeks now referred to, REPORTS OF SOCIETIES AND ACADEMIES. being an excess of fifteen and a halfper cent. last year, over the two corresponding weeks of the present season.' APPARATUE FOR RELIEVING TRE BREAST, when over-distended with milk, was exhibited by MR. HANCOCK. It consisted of a very stout bottle, surrounded by a ring, with an ivory shield, which firmly fitted the nozzle. The bottle having been filled with boiling water, to heat it, is emptied, the ivory shield replaced, and the mouth-piece placed against, but not pressed upon, the nipple,-which would beimmediately drawn out, as well as some of the superabundant milk. PATHOLOGY AND TREATMENT OF CHOLERA. By FRANCISiHIAD, EsQ. Mr. Hird dwelt upon the differential diagnosis between the malignant or Asiatic Cholera, and the ordinary autumnal affection observed in this country. The symptoms by which the malignant form may be recognized, he stated to be, the absence of bile, both in the matters vomited, and discharged from the bowels-the suppression of urine-the cold breaththe veiled unearthly voice-the rapid sinking of the heart's action-and the great fatality of the disease. In speaking of the mode of invasion, the author stated that, as a rule, the disease is preceded by an attack of diarrhoea, which may continue for an hour or two, or may be protracted to one, two, or three days, before the symptoms characteristic of the pestilential malady develop themselves. This diaxrhoea should never be overlooked, and the absence of pain was no proof that it would not terminate in Cholera. He divided the disease into three stagwe,-the first, diarrhoal or premonitory; the second, or algide stage, marked by great depression, and b the peculiar dejections, of a watery character, loaded with flakes of whitish matter, which under the microscope appear to be composed of cells, rather larger in size than exudation corpuscles, of scaly epithelium, of a few blood cpuscles, and of other matters, differing in each individual case, according to the severity of the symptoms; and the third stage, indicative of reaction. The author stated that, although the disease did not usually spread from person to person so rapidly as scarlatina, small-pox, or measles, it was very analogous, in reference to its mode of communication, to typhus fever and erysipelas. A patient labouring under typhus, when conveyed into a goodsized and well-ventilated apartment, would rarely communcate the disease to the attendants; whereas, the same patient, placd in an unfavourable locality, and surrounded by poverty and distress, would very probably spread the disease to those in attendance. Cholra he believd to be contaiowu, and that it had been traced to spread in accordance with the ordinary laws of contagion. The frequent immunity from the disease of the professional and other attendants, was no proof of the non-contagious nature of the disease; for the same objection might be adduced, against the contagiousness of any of the acknowledged infectious diseases. -The leading symptoms of the disease, the mode of its fatal termination, and more especially the spontaneous favourable termination occasionally observed, under every variety of treatment, all tend, in the author's opinion, to assimilate it to the effects of poisons on the animal economy. However great the obscurity may be which overhangs the question, respecting the generation or exciting cause of Cholera, most satisfactory evidence can be adduced to prove, that many circumstances predispose to its influence. Persons wbo exceed in spimrts, wines, fruits, or unwholesome food-the debilitated from any cause-the poor, who live in badly drained, and ill-ventilated residences-and especially those who have suffered from previous diarrhoea, rarely escape when the pestilence prevails. The post-mortem appearances, which the author had observed in several fatal cases of the disease, were detailed. In those who died during the algide stage, the body had undergone great diminution in bulk, and become almost as emaciated as a body in the last stage of consumption; the peculiar blue colour of the skin frequently disappeared shortly after death; the tempera-9¢4 REPORTS OF SOCIETIES AND ACADEMIES.