ALLEGED CHOLERA AT YORK

1854 The Lancet  
ALTHOUGH it must be allowed that the most valuable portion of our medical literature is found in monographs, yet the present book suggests a doubt whether this mode of conveying information may not be carried to excess. There is scarcely a student, however zealous and anxious to master the wide and daily-expanding field of investigation opened out before him, ' who would not feel that his task was becoming arduous indeed, when a very rare disease of a single tunic of the eye requires for its
more » ... requires for its development a work consisting of 260 large pages. The work before us is evidently written by a clever man: a confessedly rare and obscure disease has been grappled with; original cases have been carefully recorded; the literature of Europe has been ransacked every theory or hypothesis as to the cause and the morbid anatomy of the disease is discussed; every suggestion as to treatment is described. And yet there are some serious defects in the work : though rich in information, it sadly wants arrangement and condensation. The reader is presented with the readings and musings of the author, and the materials out of which the work should have been built are scattered in rich and chaotic profusion before him. There is abundance of ore, but the reader has to provide the crucible. No chapters are given, nor even a table of contents. After these remarks, it will readily be conceived, that to present our readers with anything like a summary or digest of the work would be attended with considerable difficulty, even if our limited space permitted such an attempt. We shall therefore imitate the plan of our author so far as to offer some cursory remarks that were suggested by the perusal of the work. One of the most interesting questions connected with the curious and rare disease of conical cornea is the morbid change upon which it depends. First. Is there atrophy or hypertrophy of the corneal tissue ? Secondly. Is such change in the cornea the cause of the cone, or merely one result of a previous abnormal condition of the eye ? Thirdly. Are these changes the result of defective nutrition, or of inflammatory action ? It is difficult to arrive at the opinion of the author upon these points. Cases are quoted, and the views of several writers are given, exhibiting remarkable discrepancy on these points; and it must be admitted that the opportunities of resorting to postmortem examinations are exceedingly rare. The preponderance of evidence adduced is in favour of the doctrine that the cornea is thinned towards its centre from defective nutrition, and that this is the cause of the abnormal change; and in this view we are disposed to agree. We think that cases of softening and bulging of the cornea, from inflammatory action, are widely different from the disease now under consideration; and though largely quoted and dwelt upon, and mixed up with true conical cornea, we believe the subject is only complicated and confused by bringing together the two diseases. Thus, at page 98, a case of severe injury, with opaque, dislocated lens, and wound of cornea, is quoted; and at pp. 126-7, cases of ulcers of cornea, with partial staphyloma; and at another place, a case of staphyloma of the sclerotic is given. We must think that the subject is not only unduly expanded, but mystified, by grouping together diseases so different in their very essence. The author gives us two original remarks on this division of the subject. In accounting for the occurrence of conical cornea, he says :-It is not difficult to conceive how a disturbance of the nisus formativus (an arrest of development) may give to the child and to the adult an anatomical condition which properly belongs to an earlier era, by introducing the embryo type to a stage of existence behind the scene of which it ought to have been left, and presenting that as a morbid condition in man which at one time may have been a natural or normal state during intra-uterine life." This is a long and obscure sentence, but the thought contained in it is both original and ingenious. Again, the author suggests that, if the alteration in the shape of the cornea were due to thickening of the apex, that it would in fact be converted into a small magnifying glass, that would alter the appearance of the pupil and iris, which is not found to be the case. The question of treatment is discussed in a very philosophic spirit, and with no bias towards any particular plan; indeed the fault is rather the admission of every suggestion, however far-fetched in proof of which we would refer to the American invention, at p. 210; and to Florer's suggestion, of draining away part of the aqueous humour by means of a fine seton. On this point the author wittily remarks,-" That the sight of the patient may hang on a very delicate thread. " We would venture to go a step further, and predict that the sight of the patient would inevitably be suspended and ultimately destroyed by such a proceeding. The author makes some ingenious suggestions with regard to the optical management of conical cornea, and seems to have been very successful in some of his own cases, and he very properly urges that all such contrivances should be exhausted before recourse is had to surgical operations. He then quotes all the various experiments that have been made to obviate this condition by operative means, even mentioning Himly's plan of transplanting the cornea, and Trussbaum's suggestion of " glazing" the cornea, which consists in making a small slit in the cornea, and introducing a little glass button, or rather stnd, in such a way as to fix it in the slit, and thus let in a small window. What a pity it is that the human eye so resents the presence of a foreign body! We have now rapidly glanced at some of the more important points discussed by Mr. Nottingham, and have endeavoured to give some faint idea of the character of his work. In conclusion, we would suggest to him, when he again appeals to the public, more condensation and arrangement, the exclusion of such cases as have nothing whatever to do with the subject, the cultivation of a brief and clear style of writing, and the firmer assertion and development of his own opinions; and we venture to predict that, with the talents he possesses for research and observation, he will attain to a high professional position and a well-earned literary fame. ALLEGED CHOLERA AT YORK. To the Editor of THE LANCET. SIR, -An impression having gone abroad that this city is now being visited by this dreadful epidemic, to allay the public mind, we, the physicians and surgeons of the city of York, certify that no case of Asiatic cholera has occurred under our observation, and that the health of this city is in a better state than usual at a corresponding period of the year.
doi:10.1016/s0140-6736(02)54646-8 fatcat:jh7j6eoef5dnvndlg4azag2ige