1
488 ment" have been inflicted on the prospects of union surgeons throughout this kingdom by the disgraceful conduct of the profession. We say profession, for until the whole body adopts a summary mode of ridding itself of such unworthy members as have sold themselves individually to do the work, and obey the beliests, of those who oppress them gene- rally, the crime and its consequences must be charged on the whole profession. Four men have been found capable of betraying their brethren, and of sacrificing a great cause for the sake of a few paltry pounds. As long as the profession exhibits such examples, of what possible use are representations to Government, expostulations with poor-law boards, or memorials to boards of guardians? The more the question is agitated the more notorious does the degraded state of the profession become. We invoke on our own heads the con- tumely of the many, and win by our own exertions and personal sacrifices the disrespect and reproaches of the public.. The utter hopelessness of any appeal to the poor-law board for the rehess of our grievances has been rendered apparent by the Upton case. We have appealed to that board. It has ad- mitted the justice of our claims, and yet allows the guardians to continue to perpetuate their injustice ; the poor-law board recommends, without the power, or, at any rate, the courage, to enforce its recommendation. It orders, and yet lacks the spirit to compel obedience to its mandates. Where, then, is the remedy ? It lies in the hands of the profession, and thcre only. We were aware of this at the onset, and we tried the experiment, the experiment of appealing to our own body, .and truly it has been an experiment, and one which has signally failed. The partial countenance and support which were at first afforded us have been withdrawn. The medical officers of the Upton union’have been defeated, and by their defeat the deepest possible injury has been inflicted on the cause of poor-law medical reform. A more insane act of sui- cide (to the destruction of the best interests of the profession) was never perpetrated than has just been committed by Messrs. Marsh, Sheward, Waddam, and Crosse. To the medical profession we say, and we say it emphatically, "Awake, arise, or be for ever fallen !" We remain Cir your obliged and fait.hfnl servants. CHARLES BRADDON, WM. TODD WHITE, The deputation of the late medical officers of the Upton-on-Severn union. EPIDEMIC CHOLERA.—RESOLUTIONS ADOPTED BY THE WESTERN MEDICAL SOCIETY. To the Editor of THE LANCET. SIR,—I beg to forward for insertion in THE LANCET, a copy of resolutions unanimously agreed to at a special meeting oi the Western Medical and Surgical Society, on the 3th inst.* The object which the Society has in view is so fully set forth in the foregoing resolutions, that it does not appear necessary to enter into a very lengthened explanation. It is quite ob- vious, that if we can only obtain a faithful record of every case of cholera which may occur, the careful analysis and compa- rison of such records will not only yield us a complete history of the epidemic,—perhaps the most complete history ever afforded of any epidemic; but will in all probability lead to certain and positive results, throwing light on the pathology, and thereby on the rational treatment, of this fearful and hitherto obscure malady. The greater part of our profession is, however, so unceasingly occupied, and on that account so Iittle in the habit of recording cases, that it would be scarcely possible to obtain from them the reports desired unless their labours be facilitated by a plan in which attention is called to the various points to be noted. But with such a plan to help them, and with the good spirit which I know to prevail in the profession, the object in view does not appear to be difficult of attainment. The committee of this Society is at this moment engaged with great care and anxiety in the preparation of this plan, on the fitness of which for its purpose much depends; for it must be sufficiently simple to be easily filled up—suffi- ciently comprehensive to comprise everything necessary to be observed. As soon as it is matured, it will be submitted, through you, to the profession, for imitation or for correction. It is to be remarked, that epidemic cholera is a disease peculiarly favourable to investigation of the kind proposed. Frightfully fatal as it is to those whom it attacks, it does not, like influenza, invade the majority, or even a large proportion, of the population. Each practitioner is not overwhelmed, * The resolutions referred to were published in THE LANCET of last week. —ED. L. therefore, with a multiplicity of cases, and the phenomena in each case are of a striking and obvious kind. The investigation which the Western Medical and Surgical Society is about to attempt within its own district, (Chelsea, Pimlico, Knightsbridge, Brompton, Kensington, Putney, and Fulham,) can only be carried out to its full extent by the zealous co-operation of the profession throughout the United Kingdom. Such co-operation can be easily brought to bear. Thevarious metropolitan medical societies- -the London Medi- cal, the Westminster Medical, the South London, &c.-can, if they will, obtain returns, each within its own district, from the rest of the metropolis, and tabulate and analyze them by com- mittees of their own. In most large towns there are already societies capable of undertaking the same work; where such societies do not exist, let voluntary associations be formed for the purpose. Even in villages and outlying places, let the record of every case-if cases occur—be kept, and let it be sent to the society or association of some neighbouring town, or to our own Society, if it be preferred, for tabulation; for it is one of the merits of this scheme, that by it a single isolated case, useful otherwise only as a means of experience to the individual observer, will have its scientific value. , In the discussion in our Society on these resolutions, a most useful suggestion was thrown out—that it would be desirable, if possible, in every district, to have the post-mortem inspec- tions conducted by the same person-one well familiar with morbid appearances. This cannot, of course, always be done; but in London,and in large towns, there must be many men well competent to the task, having sufficient leisure to under- take it, and sufficient zeal to make them glad of an opportu- nity of acquiring experience in a disease offering so wide a field for iuvestigation and discovery. I am induced to send these resolutions and this letter to you, without waiting till our plan for case-reporting is ma- tured, because it is necessary that the attention of the profes- sion should be stirred up betimes, unless they are willing to let this epidemic slip by, like the last, without deriving from it the scientific results it is capable of yielding. If a similar plan to this had been adopted in 1831-2, how much more posi. tive and precise would our knowledge have been! At present, not a great deal of time has been lost. The cases which have occurred hitherto, undoubted cases as they are, can hardly be considered more than sporadic ones-the precursors, the mer- ciful warnings, of that outbreak which sooner or later will surely come. I have the honour to be. Sir. vour faithful servant. EDWARD CATOR SEATON, M.D., Hon. Sec. of the Western Medical and Surgical Society. ON THE PATHOLOGY AND TREATMENT OF CHOLERA. To t7te Editor of THE LANCET. SIR,—At a period when the cholera is a subject of great moment, I am inclined to make a few remarks, for the purpose of accelerating a more advanced or a better plan of treat. ment for this disorder; and I have been more induced to do so, by remembering that after the return of the late Sir David Barry from Russia, he candidly confessed to me that his know- ledge of the treatment of this disorder had been but little in- creased, even after having seen many thousand cases. A more active inquiry should now be made, and every investigation ought to take place, for the purpose] of benefiting science and the public at large. The composition of the blood varies under certain circumstances, according to the matter absorbed from the intestinal canal, the skin, and other membranes, all which matter immediately mixes with the venous blood, and conse- quently, that fluid varies according to what has been absorbed. Upon analysis, the blood has been found to contain alcohol, ether, camphor, and salts, which do not usually enter into its composition, and this has resulted after these agents have been administered. Now this knowledge becomes of use to us at a period when we are visited by the cholera. Everybody is fully aware of the antiseptic properties of camphor, and some other chemical agents, such as chlorine, carbon, &c. It has been stated that camphor and other matters have been detected by the analyses of the blood-does it not become reasonable for us to suppose that when the blood has entering into its composition such a disinfecting agent as camphor, the body should be less likely to become affected by such a distressing disease as the cholera ! g Carbon and carbonic acid gas have been already recommended as means for the prevention of cholera, and the tincture of angelica has been esteemed of use by some foreign physician. The effect produced upon the

EPIDEMIC CHOLERA.?RESOLUTIONS ADOPTED BY THE WESTERN MEDICAL SOCIETY

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488

ment" have been inflicted on the prospects of union surgeonsthroughout this kingdom by the disgraceful conduct of theprofession. We say profession, for until the whole bodyadopts a summary mode of ridding itself of such unworthymembers as have sold themselves individually to do the

work, and obey the beliests, of those who oppress them gene-rally, the crime and its consequences must be charged on thewhole profession. Four men have been found capable ofbetraying their brethren, and of sacrificing a great cause for thesake of a few paltry pounds. As long as the profession exhibitssuch examples, of what possible use are representations toGovernment, expostulations with poor-law boards, or

memorials to boards of guardians? The more the question isagitated the more notorious does the degraded state of theprofession become. We invoke on our own heads the con-tumely of the many, and win by our own exertions and personalsacrifices the disrespect and reproaches of the public.. Theutter hopelessness of any appeal to the poor-law board for therehess of our grievances has been rendered apparent by theUpton case. We have appealed to that board. It has ad-mitted the justice of our claims, and yet allows the guardiansto continue to perpetuate their injustice ; the poor-law boardrecommends, without the power, or, at any rate, the courage,to enforce its recommendation. It orders, and yet lacks thespirit to compel obedience to its mandates. Where, then, isthe remedy ? It lies in the hands of the profession, and thcreonly. We were aware of this at the onset, and we tried theexperiment, the experiment of appealing to our own body,.and truly it has been an experiment, and one which hassignally failed. The partial countenance and support whichwere at first afforded us have been withdrawn. The medicalofficers of the Upton union’have been defeated, and by theirdefeat the deepest possible injury has been inflicted on thecause of poor-law medical reform. A more insane act of sui-cide (to the destruction of the best interests of the profession)was never perpetrated than has just been committed byMessrs. Marsh, Sheward, Waddam, and Crosse. To themedical profession we say, and we say it emphatically, "Awake,arise, or be for ever fallen !"

We remain Cir your obliged and fait.hfnl servants.

CHARLES BRADDON,WM. TODD WHITE,

The deputation of the late medical officersof the Upton-on-Severn union.

EPIDEMIC CHOLERA.—RESOLUTIONS ADOPTEDBY THE WESTERN MEDICAL SOCIETY.

To the Editor of THE LANCET.

SIR,—I beg to forward for insertion in THE LANCET, a copyof resolutions unanimously agreed to at a special meeting oithe Western Medical and Surgical Society, on the 3th inst.*The object which the Society has in view is so fully set forth

in the foregoing resolutions, that it does not appear necessaryto enter into a very lengthened explanation. It is quite ob-vious, that if we can only obtain a faithful record of every caseof cholera which may occur, the careful analysis and compa-rison of such records will not only yield us a complete historyof the epidemic,—perhaps the most complete history everafforded of any epidemic; but will in all probability lead tocertain and positive results, throwing light on the pathology,and thereby on the rational treatment, of this fearful andhitherto obscure malady. The greater part of our professionis, however, so unceasingly occupied, and on that account soIittle in the habit of recording cases, that it would be scarcelypossible to obtain from them the reports desired unless theirlabours be facilitated by a plan in which attention is called tothe various points to be noted. But with such a plan to helpthem, and with the good spirit which I know to prevail in theprofession, the object in view does not appear to be difficult ofattainment. The committee of this Society is at this momentengaged with great care and anxiety in the preparation of thisplan, on the fitness of which for its purpose much depends;for it must be sufficiently simple to be easily filled up—suffi-ciently comprehensive to comprise everything necessary to beobserved. As soon as it is matured, it will be submitted,through you, to the profession, for imitation or for correction.

It is to be remarked, that epidemic cholera is a diseasepeculiarly favourable to investigation of the kind proposed.Frightfully fatal as it is to those whom it attacks, it does not,like influenza, invade the majority, or even a large proportion,of the population. Each practitioner is not overwhelmed,

* The resolutions referred to were published in THE LANCET of last week.—ED. L.

therefore, with a multiplicity of cases, and the phenomenain each case are of a striking and obvious kind.The investigation which the Western Medical and Surgical

Society is about to attempt within its own district, (Chelsea,Pimlico, Knightsbridge, Brompton, Kensington, Putney, andFulham,) can only be carried out to its full extent by thezealous co-operation of the profession throughout the UnitedKingdom. Such co-operation can be easily brought to bear.Thevarious metropolitan medical societies- -the London Medi-cal, the Westminster Medical, the South London, &c.-can, ifthey will, obtain returns, each within its own district, from therest of the metropolis, and tabulate and analyze them by com-mittees of their own. In most large towns there are alreadysocieties capable of undertaking the same work; where suchsocieties do not exist, let voluntary associations be formed forthe purpose. Even in villages and outlying places, let therecord of every case-if cases occur—be kept, and let it besent to the society or association of some neighbouring town,or to our own Society, if it be preferred, for tabulation; for itis one of the merits of this scheme, that by it a single isolatedcase, useful otherwise only as a means of experience to theindividual observer, will have its scientific value.

, In the discussion in our Society on these resolutions, a mostuseful suggestion was thrown out—that it would be desirable,if possible, in every district, to have the post-mortem inspec-tions conducted by the same person-one well familiar withmorbid appearances. This cannot, of course, always be done;but in London,and in large towns, there must be many menwell competent to the task, having sufficient leisure to under-take it, and sufficient zeal to make them glad of an opportu-nity of acquiring experience in a disease offering so wide afield for iuvestigation and discovery.

I am induced to send these resolutions and this letter toyou, without waiting till our plan for case-reporting is ma-tured, because it is necessary that the attention of the profes-sion should be stirred up betimes, unless they are willing tolet this epidemic slip by, like the last, without deriving fromit the scientific results it is capable of yielding. If a similarplan to this had been adopted in 1831-2, how much more posi.tive and precise would our knowledge have been! At present,not a great deal of time has been lost. The cases which haveoccurred hitherto, undoubted cases as they are, can hardly beconsidered more than sporadic ones-the precursors, the mer-ciful warnings, of that outbreak which sooner or later willsurely come.

I have the honour to be. Sir. vour faithful servant.EDWARD CATOR SEATON, M.D.,

Hon. Sec. of the Western Medicaland Surgical Society.

ON THE PATHOLOGY AND TREATMENT OFCHOLERA.

To t7te Editor of THE LANCET.SIR,—At a period when the cholera is a subject of great

moment, I am inclined to make a few remarks, for the purposeof accelerating a more advanced or a better plan of treat.ment for this disorder; and I have been more induced to doso, by remembering that after the return of the late Sir DavidBarry from Russia, he candidly confessed to me that his know-ledge of the treatment of this disorder had been but little in-creased, even after having seen many thousand cases. A moreactive inquiry should now be made, and every investigationought to take place, for the purpose] of benefiting science andthe public at large. The composition of the blood varies undercertain circumstances, according to the matter absorbed fromthe intestinal canal, the skin, and other membranes, all whichmatter immediately mixes with the venous blood, and conse-quently, that fluid varies according to what has been absorbed.Upon analysis, the blood has been found to contain alcohol,ether, camphor, and salts, which do not usually enter into itscomposition, and this has resulted after these agents have beenadministered. Now this knowledge becomes of use to us at aperiod when we are visited by the cholera. Everybody is fullyaware of the antiseptic properties of camphor, and some otherchemical agents, such as chlorine, carbon, &c. It has beenstated that camphor and other matters have been detected bythe analyses of the blood-does it not become reasonable forus to suppose that when the blood has entering into itscomposition such a disinfecting agent as camphor, the bodyshould be less likely to become affected by such a distressingdisease as the cholera ! g Carbon and carbonic acid gas havebeen already recommended as means for the prevention ofcholera, and the tincture of angelica has been esteemed of useby some foreign physician. The effect produced upon the