« PreviousContinue »
eyes, and she heard distinctly what I said, as likewise when both her mouth and nose were quite closed. Putting a cloth over her mouth, and nipping her nose, have made a slight difference now and then; but nothing more than I could suppose would happen from the extent of the face the sound was thus kept from. I have pressed my fingers on the parts where the external auditory meatus should be, but she heard just as well as before. I have put a thick cloth over them, and at the same time pressed this as close as I could, but it made no difference. I stood four feet from her after
having put a linen cloth over her face, and when I addressed her, she heard distinctly. I then put over the linen a piece of flannel, and she still heard me. I then put over the flannel a large woollen cloth coat, and asked her several questions, but she could not hear any of them. I removed all the coverings, and used the same words in the same tone, which she told me immediately. I made the same experiment another day, but she heard all the questions I asked, though more faintly, according to the covering put on her face. Some variation will always exist in these experiments, for it is impossible always to remember the exact tone of voice made use of in them, and some little difference may likewise exist in the coverings. She could hear distinctly tunes played on the pianoforte at the distance of seven or eight feet, and I covered her face, as in the other experiments, and the sounds were fainter. pressed on her ears with a cloth, but she heard the tunes just as well. I placed her in a chair near the piano, and covered her face so as to hinder her from hearing so well; I then placed her hand on the piano, and she heard much better: I then tied a silk handkerchief tight round the arm, and she did not hear so well, and she heard better again when I loosened it. She cannot hear the sound of bells at a distance; nor hear the cathedral clock strike unless she is very near, though the hammer strikes on a bell, which is one of the largest in the kingdom, and can be heard at different times at the distance of several miles.
"When her face or teeth are in contact with the piano, on which any one is playing, the sound is very loud to her." (P. 283.)
The knowledge of this fact will be of inestimable value in the education of the deaf and dumb; as in many cases these unfortunate beings do not suffer from any defect of the auditory nerve.
The plates with which this treatise is illustrated do 'great credit to the artists whom Mr. Swan has employed: two of them are of extraordinary beauty; one representing the sciatic nerve, with some of its fibrils lacerated, and surrounded by a coagulum of blood; the other shewing a partial division of one of the digital nerves.
It is needless to repeat our opinion of this admirable treatise. Its price is very moderate; the book ought to be in everybody's hands, and the substance in everybody's head.
The Croonian Lectures, delivered at the Royal College of Physicians, in 1833, on Cholera. By GEORGE LEITH ROUPELL, M.D. -London, 1833. 8vo. pp. 91.
WHEN We open a book on cholera, it is almost with despair of being much the wiser for its contents: the obscurity, however, which pervades this subject, only augments the merit of every well-directed attempt to dispel it, and all contributions from those whose experience and judgment entitle them to be heard have a right to the careful attention of the profession. Dr. Roupell has enjoyed considerable opportunities of witnessing the disease of which he writes, and has stated the results of his experience in a judicious, practical, and unostentatious
We quite agree with him in considering the malignant cholera as a disease of modern origin; he correctly states, however, that it was certainly known as early as the year 1782: Mr. Curtis's description, quoted from the Madras Reports, puts it beyond a doubt that the disease prevalent in Sir Edward Hughes's squadron, and believed to have arisen from communication with an infected port in Ceylon, was in all respects identical with that which, in its epidemic form, has since devastated the East, and spread over the greater portion of the globe. Our author adds,
"Mr. Barnes, who was the medical superintendent at Jessore from the year 1810, mentions, in a letter addressed to me as one of the medical officers of the City board of health, that he had become acquainted with the disease since he had joined the station; that it was to him entirely new, and one which had superseded the periodical remittent fever, formerly endemic. He states that, twice previously to 1817, this disease prevailed to such an extent in Jessore, and its immediate neighbourhood, as to render it necessary to shut the courts of justice, and suspend all business, for a considerable length of time. The origin of this monstrous birth may then be dated earlier than the period usually assigned to it. Its origin, too, as an epidemic may be ascribed to other places than Jessore, as Dr. Christie relates that it existed in the various parts of the southern districts of Bengal, in the months of May and June, 1817; that it did not create alarm in Jessore till August; that several cases took place in Calcutta on the 5th of September, and from that day forward the disease became daily more frequent." (P. 16.)
After a judicious review of some of the principal circumstances which have been supposed to constitute the remote causes of this singular pestilence, Dr. Roupell justly concludes that we are still entirely in the dark upon the subject,
nor less so on the causes which favour or impede its epidemic extension.
In intimating his own conviction of the contagious nature of the disease, he expresses himself with becoming candour. It appears to us that this question must for the present remain open. The evidence hitherto brought on either side is altogether inconclusive: the apparent importation of the disease from places where it is prevalent, its appearance on board vessels shortly after their leaving port, and other cir cumstances on which the doctrine of contagion has been made to rest, admitting, in our opinion, of as satisfactory an explanation on the opposite supposition.
There is, we think, only one way of setting this disputed point at rest, namely, by a diligent comparison of the relative number of cases which occur among those who are in continual communication with the sick, and those who are not; other circumstances being the same, or nearly so. The observations should be made in various localities, and at different times, and the comparison should be instituted between the attendants on the sick in a cholera hospital, and the surrounding population in the immediate vicinity of that hospital. A very small town, or a village, is evidently the best place for such observations.
If it should be found, on comparing a very large number of results, that the proportion of cases among the hospital attendants is only a little greater than that among the rest of the population, such difference may fairly be attributed to the fatigue, apprehension, and confinement, which render the former more obnoxious to any prevailing disease; but, should it be found that the hospital attendants are affected in a ratio double or triple that of the other inhabitants of the place, the disease may then be set down, without hesitation, as contagious.
It is but justice to the contagionists to say, that, after the experience we have lately had of the disease in this country, their doctrine is decidedly gaining ground; but, though we ourselves incline to it, we conceive that there are hitherto no data for a positive conclusion.
There are few diseases which are, on the whole, more homogeneous in their aspect than cholera : it presents, however, occasional varieties, on which our author has some interesting remarks.
"Mr. Curtis, in his description of the disease as observed in India, mentions several varieties of it, one distinguished by the absence of vomiting and the prevalence of diarrhoea; another by the excess of vomiting and occasional absence of the dejections;
and a third by very slight commotion of the system, indicated either by the evacuations or by spasm; this last, he says, he considered the least manageable of all. The form in which it most frequently presented itself to him, was that in which the alvine dejections were particularly frequent. There are, however, two other forms which this disorder has occasionally put on. One in which spasms alone have been observed, and another in which copious determinations of blood have taken place to the thorax and abdomen. Of the former of these I have met with but few examples in this country; they were, however, more frequent in India, the practitioners having repeatedly noticed this variety; and this in all probability is the convulsive disorder noticed during the prevalence of cholera, and denominated by Girdlestone and others idiopathic spasm.'
"But the other form, that, namely, characterized by large effusions of blood, is but rarely referred to by foreign writers, if indeed distinctly described by any, though a form which it seems to me clearly to have assumed, and is one which may perhaps throw some light on the actual nature of the complaint." (P. 17.)
Dr. Roupell alludes more fully to the last-mentioned form, when speaking of those diseases which have occasionally prevailed immediately before the invasion of epidemic cholera.
"That form of the disease which I have mentioned as indicated by discharges of blood from the mucous membrane, seemed here to be the first in advance; and if not entitled to be considered as the disease itself, might be called premonitory. Several cases, it may be recollected, excited some notice before the disease was proclaimed in London, and on the 16th of January a coroner's inquest sat on the body of a man at Shadwell, who died with urgent cramps, pain in the abdomen, and vomiting of blood. This man was a seaman, and had arrived from North Shields a week before. In this case the jury, guided by the opinion of several practitioners, some of whom had seen the cholera in India, and had been appointed to the superintendence of the metropolitan districts, came to the conclusion that the disease was not cholera. But many cases which I saw about that time and previously, occurring in persons connected with vessels trading from Sunderland, indicated a very intimate connexion with the disease in question. I may briefly mention one, which was under my own care. A man named Webster, twenty-eight years of age, sailed from Sunderland on the 20th of January, and arrived in London about the 30th. The vessel immediately obtained pratique; but a few days after, this man was seized with extreme pain in the epigastrium, the abdomen was forcibly drawn in, he had urgent vomiting, with coldness of the hands and paleness of the countenance; a warm bath being ordered and some castor oil given, the urgency of the symptoms was removed, and evacuations were produced free from any admixture of blood; the next morning an inclination to empty the bowels was felt; an enema was administered, which returned unmixed with fæcal
matter; but rising to go to the chair he fainted, fell back, and died. No cause could be assigned for the attack, except some slight exposure to cold incident to a seaman's life, and which the patient in this instance seemed well able to resist, being remarkably powerful, not addicted to any excess, and living in a manner least likely to predispose to any disorder; but he mentioned that he had had a similar attack at Sunderland six weeks before. On examination after death, twenty ounces of blood, apparently venous in character, was found in the cavity of the abdomen. The peritoneum was slightly vascular. On removing the abdominal contents, and examining the intestines externally, the stomach and the small intestines to the extent of five feet were natural; when suddenly the tube was found firmly contracted, as if tied round by a thread, and from this point downwards to the ileo-colic valve the intestines were of a deep purple colour. Internally, nothing at all deviating from health was remarked in the upper part of the intestines, but below the point of stricture described the intestine was filled with dark-coloured blood, some of which was found as far as the rectum. The mucous membrane when held up to the light did not appear more vascular than usual in this part. The consistence or texture of the intestines was not altered, although they exhaled an extremely offensive odour. This case corresponded in some degree with that already alluded to at Shadwell, but differed from it in the collection of blood in the abdomen. Another example of sudden death occurred under my own observation, in the preceding December, in a man also engaged in the Sunderland trade, who was attacked with very similar symptoms, but who referred the pain more directly to the neighbourhood of the heart. By appropriate means he appeared to be relieved, yet on the morning following his admission into the hospital, on sitting up to take his breakfast, having declared he felt sufficiently well to return to his duty, he suddenly sank back, and immediately expired. The post-mortem examination shewed the small intestines and its vessels congested, some effusion of blood having taken place in the neighbourhood of the spleen, but to no considerable extent. These cases seem fairly to be attributable to the impression of the same agency which produces cholera, and in its most aggravated degree. Instances of death by hemorrhage, I know, have taken place long before the introduction of cholera maligna into our nosology; but I think the time when these happened, and the class of persons amongst whom they occurred, justify me in considering them as other than ordinary occurrences." (P. 32.)
Dr. Roupell considers the treatment of cholera under the heads of Bleeding, Emetics, Salines, Stimulants, Purgatives, Sedatives.
Bleeding. Our author has found no advantage from this remedy in the advanced stage of cholera. He combats the a that bleeding can act, as supposed by many, simply by