481

Medical Socíetíes.

MEDICAL SOCIETY OF LONDON.

MONDAY, OCTOBER 23, 1848.—MR. HANCOCK, PRESIDENT.

CHOLERA AT PECKHAM—USE OF CHLCROFORM.

Dr. CLUTTERBUCK had seen, since last week, several cases ofcholera at the Lunatic Asylum at Peckham, which contains500 patients; of these, about thirty had been attacked, andfive had died. Many of the cases had been of the most severekind, with all the symptoms of malignant cholera. At thebeginning of the attack, two severe cases were treated withacetate of lead and opium, and both were fatal. He had found asimple plan of treatment the best. Calomel and opium couldnot be administered with safety, and large doses of laudanumdid great mischief. The administration of chloroform hadbeen productive of the greatest benefit. The spasms andpain were almost immediately relieved, and the patientsbecame composed, and enjoyed a kind of sleep. These resultstook place after the use of the chloroform for about a quarterof an hour. The effects, so far, had been immediately and uni-

formly good. He considered it much to be preferred to opium,for the relief of the painful spasms attendant upon cholera.In answer to questions, Dr. Clutterbuck said the Asiaticcholera, in his opinion, differed from the common cholera ofthis country only in degree. In the fatal cases at Peckham,all the worst features of what was called the Asiatic cholerapresented themselves. The pulse was imperceptible ; theskin cold and blue; the features sunken; the depression com-plete ; and the evacuations watery. The cases were quicklyfatal. There was no ground for questioning the identity ofthe disease. He insisted upon the necessity and value oftreating the disease by simple remedies. Moderate doses ofbrandy, and the application of external heat, were the chiefindications in the early stages. He believed that there wasno specific for the disease.Mr. DENDY differed from Dr. Clutterbuck as to the identity

of Asiatic and English cholera. He had thought, years ago,that Dr. Clutterbuck had acknowledged a difference betweenthese diseases. It had been his intention to try chloroform inthe first cases of cholera which lie might see; but he consi-dered it would only act as a substitute for opium by relievingspasm. This was, however, an important point in the treat-ment, and he was glad to hear of the success of the remedy.He considered it a great mistake to suppose that cholera wasalways preceded by diarrhoea; in the worst cases there wassometimes no disturbance of the bowels. The disease wouldcome on suddenly without any premonitory symptoms, andthe patients would succumb. He regarded cholera, in itsessential nature, as dependent on an alteration ’in the crasisof the blood; and if we could not get blood, the patient wouldsink. He had, in some cases, scraped away the solid particlesof the blood which had assumed the consistence of pitch. Ifyou could get rid of all the watery constituents of the blood,you would produce a state similar to cholera. As to treatment,why should not large doses of calomel, said to be so effectivein India, be equally beneficial here ? He was quite sure thatwhat was called "simple treatment," would have no effect inthe blue stage of cholera. With respect to the hot-air bath,he was quite sure that in the last visitation many patientswere boiled and baked to death.

Dr. CLUTTERBUCK said that no proof existed of the cholerabeing dependent on a condition of the blood. Previous to theappearance of the disease at Peckham, the drains and cess-’pools had been cleaned out. All were more or less affectedby the smells arising from this proceeding, and cholera madeits appearance in thirty persons.

Mr. HEADLAND agreed with the remarks of Mr. Dendy re-sp’ecting diarrhoea as a premonitory symptom of cholera in itsmore malignant form. Was there suppression of urine in Dr.Clutterbuck’s cases ? He hoped that chloroform might provea valuable agent in this disease, not only as relieving one ofthe more painful symptoms, but exerting a sort of antisepticinfluence on the blood. If the cases mentioned really de-pended on the effect of the sulphuretted hydrogen evolvedfrom the drains, we could understand why chloroform shoulddo good in the cases detailed. This, however, he did not re-gard as a common cause of cholera, because it existed inde-pendent of this cause. If chloroform did good in choleragenerally, then indeed we had made one important discovery.

Dr. CLUTTERBUCK did not think diarrhoea as essentially aforerunner of cholera. In some cases it had hardly existedat all; in some it was severe; in some, again, there was

vomiting; in others, none..tie regarded the term cholera as amisnomer. He did not recommend chloroform as a specific,but to relieve the painful symptoms. It was often given fromtime to time by the experienced nurses of the establishmentalluded to; and always afforded relief. The urine, in thesecases, had been scanty, but not quite suppressed.Dr. L. STEwART concurred that, like opium, chloroform

would be advantageous in relieving symptoms, but it did notaddress itself to the cause of the disease. With respect tothe cases of cholera at Peckham, he was by no means inclinedto undervalue the influence of impure air, but this could not bethe chief cause of cholera, though it was an auxiliary, forcholera occurred in districts where the air was pure and good,and there was plenty of ventilation. As to the cause it wasa morbific poison.Mr. GARRETT described the cases which had occurred in

Peckham Asylum. Some of them were of the most malignantkind, and the patients must have died in the stage of collapsehad not assistance been at hand. The attack came on verysuddenly, and all the worst symptoms of the disease imme-diately developed themselves. Brandy and capsicum werefirst administered, the patient being in bed. Chloroform wasthen resorted to: this agent he considered to be beneficial byproducing reaction. By forced respirations the pulse rose,and by the time the patient became fully under the influence ofthe chloroform, the body was warm. He believed that with-out the chloroform there would have been no reaction, foropium would not have developed its effects under two hours.The cases were undoubtedly those of spasmodic cholera. Theopening of the drains only acted by developing the disease,and did not produce it per se; for the drains were opened onthe Monday, and the first case of cholera developed itself onThursday. The urine was scanty, but not suppressed.

A PARAGRAPH AND A PROPOSITION.To the Editor of THE LANCET.

SIR,—It was with almost inexpressible amusement that Iread the letter at page 408 of THE LANCET of October 7th,signed " a Surgeon :’The good man is evidently overwhelmed with grief at the

malpractice of his brethren. Shopkeeping for a surgeon !Gracious heavens ! who ever heard of such a monstrosity ?Thus he addresses them: " Ye surgeons between Bishopsgateand Hackney, I call upon ye, in the name and for the honourof our profession, to close.;your shops for ever. Maintain withhonest dignity your professional honour," &c.Now, Mr. Editor, a vast deal has been said and written about

" the dignity of the profession," and it is no doubt very im-portant to uphold it ; but does our friend think that the " sur-geons between Bishopsgate and Hackney," even if they didgive up their shopkeeping, would thereby increase this saiddignity. Believe me, the honour of medicine as a science isnot to be added to by means so easy as that proposed.The man who, having well employed those valuable years of

early life, during which he was attendant upon the doors andgates of medical knowledge, and who, having entered the hallof science, and, feeling that he is a learner still, patiently andlaboriously marks and investigates the cause and progress ofdisease and the effects of treatment, who, also, making himselfacquainted with all that is done by his brethren in the scienceat home and abroad, stores up each important fact, and usesthe whole to illustrate and explain the pages of Nature’s bookas they are unfolded before him—this is the man who adds tothe real dignity of the profession.

And such a person, though he should labour eighteen hours! out of the twenty-four, and after all obtain little more than

sufficient to supply the necessaries of life, is indeed a dignifiedman. Science thanks him ; suffering humanity looks to himas a friend; and though he may at last go to his grave un-

. heeded by the multitude, the grateful remembrance of many

. a poor sufferer will long hang around his last resting-place-agarland such as many a nobler mansion than his cannot boast; of.. Do not think, Sir, that in writing thus, I attempt to excuse

the shopkeeping system. Far otherwise. I dont like" iles forrheumatiz." But I would wish verv much that those who

. talk about the dignity should consider in what that dignity

. really consists, and not fancy that it may be obtained merely byshutting up shop, any more than by filling out their waistcoats

. with beefsteaks and porter, or by puffing themselves red in the

. face with their own vanity and self-conceit.I am, Sir, yours truly,

i AN OLD SUBSCRIBER AND CONSTANT READER.