ON MALIGNANT CHOLERA pTS ORIGIN, PATHOLOGY, TREATMENT, AND MODE OF PREVENTION, WITH THE OCCUPATIONS OF 5,568 MALES OVER 20 YEARS OF AGE jiXHAT DIED IN LONDON IN 1849, 1853, 1854, AND 1866 : WITH AN APPENDIX Cattle Plague as compared witlh Cholera and other human ; its history, pathology, treatment, and future preihtion. A Letter on Homoeopathy ; its false inferences and holloiu assumptions. With an Essay on the present state of the Medical and Veterinary Professions in this country. BY eJDWAEDS CRISP, M.D., M.R.0.5., L.A.O. late physician to the metropolitan dispensary; , voKMkbi/y one op the presidents op the gdy's hospital physical society; ywb-pkbsidbnt of the south london medical society, and onb of the committee 01? thb physiological society of london; a. , jbtxow of the patiiological, zoological, and agricultural societies op london ; cosrsBponding member op the medical society of nismes, and of the montreal, birmingham, and dumfries natural eistoby societies; p Editor of the London "Medical Examiner;" Author of "A Rejected Candidate at the "Royal . Qolleije of Physicians, and an Examination of the Examiners," 1849; Author of a Work on the 9truc(ure and Use of the Spleen, 185-1, with the weight of the Viscera and length of the BLfMnCίntary Canal in. more than 500 species of animals; Medallist at the Medical Society F qf London, 1843 ; Author of the Jacksonian Prize Essay on the Structure and Diseases "' of the Blood- Vessels, 18-15; the Jacksonian Prize Essay on Intestinal Obstructions, 1852; th. Astley Cooper Prize Essay (£300), on the Structure and Use of the Thyroid Gland, 1859; the Astley Cooper Prize Essay (£300) on the Struetwe and Use of the Pancreas, 1862; • the I3ath and West of England Prize Essay on Parasitic Diseases in the Lungs of Lambs, 186-1, SfC Sfe.

. »V\ Surgeon General's Office vH ) I « ) i & . \ ; '(^ {section, .'. II n...X£P\3 |a / nm a . ON MALIGNANT CHOLERA; ITS ORIGIN, PATHOLOGY, TREATMENT, AND MODE OF PREVENTION, WITH THE OCCUPATIONS OF 5,568 MALES OVER 20 YEAES OF AGE THAT DIED IN LONDON IN 1849, 1853, 1854, AND 1866 : WITH AN APPENDIX On Cattle Plague as compared with Cholera and other human maladies ; its history, pathology, treatment, and -future pre- vention. A Letter on Homoeopathy ; its false inferences and hollow assumptions. With an Essay on the present state of the Medical and Veterinary Professions in this country. /'' unt at the present time ; and because it was the first attempt le in this, or in any other country, to show the influence of occuon in the production of this fearful disease. The time allotted to reading of a paper at a Medical Society necessarily compelled me ondense the matter to a great extent, and I shall now endeavour, adding my subsequent information and experience, to make the ,y more practical and useful. I Another motive which especially induces me to publish this treatise he endeavour to controvert what I believe to be a dangerous doctrine, ensively circulated at the present time by the public press, viz., the sailed eliminative or aperient treatment of Cholera. Dr. Gr. John, the recent promulgator of thi3 theory, says, in his " Notes on )lera," a book which has been extensively circulated and noticed by public press :: — *" The main object of this publication is to sweep ty an erroneous theory with regard to the nature of Cholera, the ory in question being one which of necessity carries with it a misevous mode of practice, and an entirely wrong estimate of the influe of treatment in the disease." Bt behoves one to speak with great diffidence respecting the nature treatment of a disease about which so little is known ; but I think I Since this work appeared, Dr. Johnson has published a pamphlet upon the c subject, the greater part of which is composed of a laudatory review of his k in the Saturday Review, June 2, by Dr. Watson, the President of the iege of Physicians, "the most lucid account of the nature and treatment of ilera that Ims yet appeared," according to Dr. Johnson's opinion, as stated in Preface. The sanction of such a reputed authority as Dr. Watson's induces me nter more fully into this question than I otherwise should have done. 8 liall be able to show that the mischievous mode of practice applies i greater force to Dr. Johnson's treatment than to that which he so epingly condemns. If the suggestion I made in 1849 (p. 9), o the comparative treatment, had been adopted by the Government, might speak with more certainty and precision upon many points b are now involved in dobut and obscurity. It is not pretended that castor-oil in the latter stage of Cholera, my medicine of a mild form, can do much good or harm ; but ;lieve that castor-oil or any aperient in the primary stage would n produce injurious results, and hence the importance of guarding public against the so-called eliminative or aperient treatment in early stages of the disease. The poison, I believe, may often ren inert in the system until some disturbing force, such as fear, bad , and water, or aperient medicine, acts as an exciting cause in singing the constituent parts of the blood. There is one erroneous inference that might perhaps be drawn from the perusal of the re-published essay which I am anxious to prevent, viz., that I attach too little importance to sanitary measures. I believe now, as I did in 1849, that no amount of dirt, filth, or overcrowding will alone produce Cholera ; all these causes will predispose to the disease and increase the mortality, and therefore all sanitary regulations and house to house visitations, with a proper supply of medicine in all affected districts, should be strictly enforced ; but care must be taken not to increase the mischief, as in 1832, by over officious meddling ; by the removal of nuisances that may become more deadly the more they are disturbed. The time has passed for these disturbances, and better will it be to use disinfectants and shut out the deleterious gases than aggravate the evil by their greater dissemination. I^o some, the addition to this essay of a treatise on Cattle Plague, n in the shape of an appendix, may appear out of place ; but aye fully explained my reasons for this unusual combination, I hope that a profitable comparison may be made between this aan scourge and the bovine pestilence. As I have said on a aer occasion, most of our discoveries in physiology have been ved from experiments on the lower animals ; and I see no reason r brute pathology may not be turned to equally good account in the sidation of human maladies. i 2, Beaufort St., Chelsea, and 21, Parliament St., September, 1 860. MALINGNAT CHOLERA [Paper read at the Medical Society of London, October 28th, 1849, by the Author.*] There is no disease about which so much paper and ink have been so uselessly and, I fear, injuriously consumed, as the Malignant o- Asiatic Cholera ; and although the present epidemic has afforded most medical practitioners in large towns abundant opportunities of invesr tigating the nature and origin of the malady, as well as its treatment, I doubt whether much progress has been made towards the elucidation of these important subjects. I am old enough to remember the first case of this mysterious scourge, which occurred in Sunderlund in 1831. I heard the various and contradictory opinions advanced at that time respecting the disease, and I was present at this society when Dr. Tytler for several evenings endeavoured to persuade the members that damaged rice was the fons et origo of the mischief. He denominated the disease Cholera Oryzea, and. most ingeniously traced the connection between the progress of the malady and the circulation of damaged rice ; several of the members were deluded by his arguments, and readily became converts to his views. Dr. Tytler, whose honesty of purpose I will not for a moment question, is now numbered with the dead ; many of his hearers have also slept their last sleep. Amongst those who took a prominent part in the discussion I may mention Dr. James Johnson, whose sensible and practical remarks upon the nature and treatment of this and other diseases many in common with myself have often listened to with great interest and instruction. I well remember, after numerous plans of treatment had been recommended, that Dr. Walshman (then an octogenarian), following the example of Sydenham, expressed his opinion that diluents, such as weak chicken broth given in large quantities, would be the best means of treating the disease. Young and inexperienced, and, like most juvenile practitioners, placing too much confidence in the power of medicine, I laughed at the old physician's remedy, and * Reprinted from the London Medical Examiner and one Faculty Journal, B 2 THEORIES. Ised him with the cooks and nurses, whose office it is to prepare i-like slops. Profiting, however, by subsequent experience, and wing the thousand and one modes of treatment that have been pted and lauded by their respective promulgators, I am induced to , whether the chicken-broth system of Dr. Walshman would not many instances have been more efficacious than the host of mediis to which I have just alluded, and I am reluctantly compelled ,nswer this question in the affirmative. It is true that patients c recovered from' a state of collapse under almost every plan pted, but they have, I believe, often recovered in spite of the tor and his drugs. Let it not be supposed from these remarks that I have any doubt about the efficacy of medical treatment in this disease ; I believe that there is scarcely a complaint to which the human body is subjected more amenable to treatment in the early stage, if the remedies are judiciously and opportunely applied. In almost every fatal case that has come under my notice, the preliminary diarrhoea or serous hemorrhage has continued for a longer or shorter period, and no attempt has been made to arrest it. The patient often appears to himself and friends in no peril ; in a short time, however, the cold hand of death is upon him, and the muddy current of the blood ceases to flow. Medical aid is generally in this condition unavailing, and a disease, which a few hours before was under the control of the physician, now defies his art. The above is not an overdrawn picture ; it was one of daily, nay, almost of hourly occurrence, and the fault rested more frequently with the patient than with his medical attendant. Ifn the present communication my object is to direct the attention the members of the society to that which is practical, and I shall id, as much as the nature of the subject will admit of, all specula-3 considerations. I might occupy many pages in discussing the jstion as to whether the Malignant Cholera prevailed in this country ore 1831, and whether the disease was known in India before 1817. hall merely, however, express my opinion that the disease described Hippocrates, Celsus, Sauvages, Sydenham, and other writers, is ; the Malignant Cholera of the present time ; and when we examine i history of the black death, sweating sickness, and other epidemics the 14th, 15th, and J 6th. centuries, and observe their commencent and decline, the probability I think is greatly increased that olera is a new disease, and that, like the scourges of the middle 38, it will desolate the earth for a time, and then give place to some sh pestilence. II shall not dwell long on the various opinions which have been vanced respecting the cause of the disease. I believe that it is still solved in as much obscurity as ever ; for whether we look to earth, y, air, or water, insurmountable difficulties offer themselves. All : at present know about the matter is, that this inscrutable agent s certain powerful assistants in its train ; such as a moist atmosphere 3 ; animal and vegetable malaria ; depression and anxiety of mind ; certain articles of diet and drink, and probably some trades and occupations. But as a proof that these agents alone will not produce the disease, there are millions living in malarious districts where Cholera has not been seen ; thousands of the rural population are drinking water from ponds and wells near their cottages, which is swarming with animalculae, and contaminated with decayed vegetable matter ; numbers are in the midst of filth and wretchedness, and yet the pestilence comes not to their habitations. This scourge has decimated the inhabitants of one side of a river, whilst those on the opposite bank have remained unscathed. This hidden poison defies heat and cold, for its victims have been almost as numerous in the regions of Northern Europe as under the burning sun of India ; and what is especially remarkable in the present epidemic is the fact, that although man has been blighted, the lower order of animals has escaped the stroke, and the vegetable kingdom (especially the cereal species) has been more than usually productive. IBut I must quit this part of my subject, and proceed to the chief ects of my paper, which I shall divide into three parts :—l.: — 1. The uence of occupation. 2. The contagious nature of the disease ; and The most approved mode of treatment. In investigating the first [ second questions, I shall take for my text the reports of the ristrar- General, which I have carefully analysed. And here I not forbear yielding a just tribute of praise to Mr. Farr, for the 3 bestowed in the compilation of these reports, which I think are tined at a future period to elucidate some of the difficult points nected with the etiology of disease. I commence my analysis with the week ending June 30th, as the trades and occupations of those dying of Cholera are then more particularly given. Diarrhoea, too, had its victims ; but as these cases are not individually reported for the first seven weeks, I shall merely give the number of cases occurring during that time, viz. 872. It is necessary also to state, at the onset of the inquiry, that I consider that the greater number of deaths from Diarrhoea were produced by the choleraic poison, and that I believe serous purging is essentially one of the stages of Cholera. During the 17 weeks through which I have carried my analysis, and ending October 20th, the deaths from both diseases amount to 16,172: Cholera, 13,410; Diarrhoea (so called), 2,762; making a weekly average of rather more than 951. Nearly three-fourths of (victims to Diarrhoea die under 15 years of age, viz. 1,927 ; Ist from the age of 15 to 60 only 365 have died ; of those 60 years and upwards, 470. Not so with Cholera ; in this disease the itest number of deaths, or considerably above the half, have irred from 15 to 60 years of age ; the numbers being under 3,640; from 15 to 60, 7,710; 60 years and upwards, 2,060. ) cases of Diarrhoea before alluded to, numbering 872, in which b 2 4 OCCUPATIONS. Bsex is not named, reduce the cases analysed to 15,302 ; of these L 4 were males, 8,088 females. To ascertain the influence of occupation in the production of the disease, I have selected from these reports all the males 20 years of age and upwards, amounting to 4,258, and the following is the result of the investigation.* Accountants, clerks, and writers, 103 ; architects, builders, and surveyors, 13 ; actor, 1 ; agents, 10 ; artists, 6 ; bookbinders, printers, publishers, and compositors, 93 ; bakers, 49 ; butchers, 39 ; tripe-dressers, 2 ; bacon-drier, 1 ; pork-butcher, 1 ; poulterers, 5 ; pieman, 1 ; cat's-meat men, 2 ; horse-slaughterers, 2 ; drovers, 6 ; cattle-dealer, 1 ; skinners, fellmongers, and leatherdressers, 13 ; curriers and tanners, 26 ; bone-collector, 1 ; bricklayers, plasterers, and masons, 64 ; brickmakers, 8 ; beadles, 4 ; brewers, 6 ; brokers, 4 ; stock-brokers, 3 ; draymen, 2 ; basket-makers, 5 ; carpenters, cabinet-makers, coopers, millwrights, coach-makers, and all workers in wood, 338 (of these 119 are carpenters, 60 cabinet-makers, and 5 upholsterers) ; piano-forte makers, 6 ; coachmen, carmen, omnibus conductors and drivers, 111 ; grooms, 7 ; hostlers, 22 ; farriers, 11 ; horse-dealer, 1 ; horse-keepers, 6 ; livery-stable man, 1 ; coalheavers I The subjoined account of the principal occupations in the metropolis recently lished (Feb. 4), by the intelligent writer in the Morning Chronicle, on Labour the Poor, will enable our readers to make their own deductions:— -"Domestic r ants, 168,701; labourers, 50,279; boot and shoe makers, 28,574 ; tailors and ;ches makers, 23,517; clerks (commercial), 20,417; carpenters and joiners, $21 ; laundry-keepers, 16,220 ; porters, messengers, and errand boys, i 3,103 ; iters, plumbers, and glaziers, 11,517 ; bakers, 9,110 ; army, 8,043 ; cabinet:ers and upholsterers, 7,973 ; silk manufacturers, 7,151 ; schoolmasters, &c, J8; butchers, 6,450; bricklayers, 6,743; blacksmiths, 6,716; printers, 6,618; ksellers, &c, 5,499 ; coachmen, guards, &c, 5,428 ; weavers (all branches), 35." Prom the shoe makers 3,717 females must be deducted, and of the lestic servants, females will form a large proportion. I may mention an interesting fact in ray own parish. In one of the Ragged Schools (the Juvenile Refuge, Old Pye Street, Westminster) there are about 110 children, boys and girls, whose needful certificate of admission is their utter destitution and unfitness to appear in other schools, many not indulging in the luxury of shoe or stocking. The children are engaged in various ways from nine in the morning until eight at night, and each child has a bath three times a week. 90 of them have two meals a day at the school ; for dinner, 1 pint of pea soup, meat soup, or cocoa alternately, and half a pound of bread, excepting Sunday, when those who remain are regaled on treacle instead of soup. Their supper always consists of 4 oz. of bread with water to drink. Of the 90 thus cared for, only one child has died of Cholera, and this was at the first appearance of the disease, when the premonitory Diarrhoea was neglected (five people died in the same house). Under the windows of this school there are three open privies, the stench from which is sometimes scarcely bearable. In the New Pye Street Ragged School, where there are 200 children, not one death has occurred. In Pear Street School there is about the same number, and only one girl died. In the New Tothill Street School, there has not been a single death among 63 children. So that in nearly 600 children living in a close and badly ventilated neighbourhood, miserably clothed and worse fed (they are only fed at the Juvenile Refuge) only 2 died of Cholera. 5 OCCUPATIONS. and coal-whippers, 22 ; meters, dealers, and weighers, 8 ; cheesemongers, 1 4 ; chandlers, 6 ; corn-chandlers, 4 ; tallow-chandler, 1 ; cooks, pastry-cooks, and eating-house keepers, 13 ; chemists and druggists, 5 ; ministers of religion, 2 Episcopalians (one of them a lunatic), 1 doctor of divinity, 1 Wesleyan, 1 Unitarian, 1 dissenting ; costermongers, 10; green-grocers and fruiterers, 15; cow-keepers, 6 ; dairymen and milkmen, 9 ; dyers, 8 ; drapers and hosiers, 23 ; general dealers, 16 ; engineers, 40 ; furniture brokers and dealers, 3 ; furriers, 11 ; farmers, 6 ; millers, 2 ; maltster, 1 ; fishmongers, dealers in fish and fishermen, 22 ; gentlemen, 132 ; merchants, 21 ; retired ti'adesmen, 34 ; flusheraian of sewers, 1 ; sewers labourer, 1 ; ragsorter, 1 ; scavengers, 5 ; dustman, 1 (get. 81) ; chimney-sweeps, 7 ; sweeps, 4 ; well-sinker, 1 ; fireman, 1 ; french-polisher, 6 ; gas-men, 3; gas-stokers, 2; lamp-lighters, 6; link man, 1; gardeners, 52; grocers, 17 ; hatters, 26 ; hawkers, 32 ; inn-keepers, licensed victuallers, beer-shop keepers, and barmen, 40 ; potmen, 5 ; labourers, 689 ; lawyers, 1 4 ; (law clerks before stated, 1 4) ; master of workhouse, ]; medical men, 17; musicians, 12; oilmen, 6 ; officers, police 23, customs 12, relieving 1, sheriff's 1 ; pawnbrokers, 5 ; marine store keepers, 4 ; postmen, 6 ; painters, plumbers, and glaziers, 74 ; pensioners, 72 (old) ; porters, 111 ; servants, waiters, and messengers, 54 ; soap-makers, 2 ; sailors and men employed on the water, 307 ; soldiers, including the invalided, 46 ; salesmen, 8 ; schoolmasters and teachers, 6; shoemakers, 154; tailors, 78; travellers, commercial, 21 ; tobacconists, 8 ; weavers, 96 ; warehousemen, 9 ; watchmen, 5 ; undertakers, 5 ; vagrants, 2 ; workers in iron, 102 ; silver and gold, 25 ; brass and copper, 30 ; tin, 9 ; glass and earthenware, 24 ; colours, 4 ; leather (exclusive of shoemakers) 22 ; hair, 27 ; wool, 9 ; tow, 15 ; paper, 9 ; bone, 3 ; miscellaneous occupations, difficult to classify, 103 ; occupations not stated (the returns in the first papers being imperfectly given), 399. Amongst the last, convicts, prisoners, and paupers are included. Before commenting on these reports, I must premise that there are certain facts which it is especially necessary to bear in mind. First. The localities : and the interesting diagram of the Registrar-General, showing the deaths in every 10,000 inhabitants in each district, is important. In the 36 districts, Hampstead is the minimum, 8, and Rotherhithe the maximum, 263. On the north side the river the deaths amount to 42 only in 10,000, while on the south side they number 1 24. It must also be recollected that under the head of labourers, and those whose occupations are not stated, some important omissions may have occurred, although it is scarcely probable that any medical practitioner would tieglect the mention of a nightman, grave-digger, or any other employment that might be supposed likely to induce the UIsCJXSG. Inferences. First. As regards the influence of occupation. There is no particular employment, exclusive of locality, that 6 INFERENCES. I ears especially to predispose to, or excite the disease. These returns lose one extraordinary fact, viz., that those engaged in some of the it filthy and dirty occupations have been peculiarly exempt from : epidemic. Thus no nightmen, sextons, nor grave-diggers are >rted, and those employed about dead animal matter form but a ,11 proportion of the whole. There is only 1 flusherman of sewers, 1 sewers labourer ; the former was 66 years of age. One dustl aged 81. Only 2 male vagrants are reported, and 1 female d 80 ; but some may have died in the poor-houses whose occupations c not known. Is it probable that the use of sulphur by these people ias a prophylactic ? This notion is somewhat strengthened by fact that there are but 8 straw-bonnet makers reported, 1 male 7 females, and the male was a master furrier as well. Men )loyed about gas-works appear to have enjoyed a great immunity a the disease. Mr. Holl, the Registrar, says, Sept. 15th: — I It is perhaps singular that up to the 15th instant no death nor case of Cholera irred in the Imperial Gas- Works, Maiden Lane. I inquired of a gentleman nected "with the establishment, who told me he had not heard of any case at or the other establishments at Hackney and Shoreditch. Mr. Fogarty, the lical gentleman under whose care the workmen are, informed me that the i are the most healthy persons in the neighbourhood. However, two cases s occurred, but the first was not a strong man, and rather intemperate ; the ;r had been engaged but three days, and was a kind of superintendent. Is coal gas destructive of the poison in the atmosphere which induces Cholera ?" Irhe small number of persons attacked who sell spirituous liquors ds to the inference that the moderate use of alcohol rather tends ward off the complaint. I have no means of knowing the number teetotallers, but I learn that two members of our own profession o died of Cholera were water-drinkers. The dealers in fruit only ount to 25, including 10 costermongers. The mortality has been atest amongst the labourers, especially on the south side of the er: many of these men were employed about the docks, and in r , damp situations. Sailors also from the same cause have suffered a great extent, and amongst the latter the number of master riners and mates is remarkable. IPhese returns also entirely disprove the prevailing notion that olera is a disease confined chiefly to the poor. Gentlemen, master desmen, and people in good circumstances were very numerous, but y were generally advanced in age : thus of the 132 gentlemen who d, only 18 were under fifty years of age, and 10 of these 18 were ween forty and fifty. I\.Vi interesting question presents itself respecting the immunity of se labouring under chronic complaints. These returns show that atics (although they enjoy a comparative freedom from many ;ases) are not exempt from Cholera. There is reason to believe, rever, that although the law laid down by Hunter (" that two jases cannot exist in the body at the same time ") is often erroneous, 7 MEDICAL PRACTITIONERS. I, it is applicable to a certain extent to Cholera, and that those uring under chronic maladies are less frequently attacked. Pregt women appear to have no peculiar exemption. I have seen but instance during the parturient condition, but Dr. Lever has met i 13 deaths in his own practice, in the present epidemic, and the rds in the French journals for 1832 afford many examples. I now come to the subject of contagion. This question, especially 3gards the welfare of the sick poor, is one of great importance, authorities of Guy's Hospital closed their doors against the ission of Cholera patients, on the ground, as I understand, that disease might spread to the students and patients in the hospital, mst be borne in mind that this hospital possesses enormous funds ; isands in its vicinity fell victims to the disease ; but I believe, if fear of infection had not prevailed, and if temporary Cholera Is had been erected, that there would have been a great saving of lan life. |sut what proof do these returns afford of the contagious nature of malady ? First, of the members of our own profession, 2,567 of >m (according to an Analysis I have made of the London Medical ectory) are practising in London, 17 only have died of Cholera and rrhoea ; 10 resided on the south side of the river, and 7on the th ; but two of the latter— Dr. Burton and Mr. Key — were attached he Boro' Hospitals. The ages of these gentlemen were as follows : SO, 36, 39, 40, 40, 41, 42, 44, 45, 47, 47, 50, 53, 55, 57, 76 ; one death of a medical assistant, student, or pupil has been recorded ; lough hundreds of these, as well as of the senior members of the fession, have been in constant attendance upon the sick, harassed anxiety of mind and almost prostrated by bodily exertion. But trast these deaths with those that occurred in Ireland in 1847 n typhus fever (Parliamentary Evidence). Dr. Cusac says (2982), ¦We found that 179 Irish medical practitioners, exclusive of pupils and army cons, died in the year 1847, about 1 practitioner in every 15, and 64| per . of the whole died of fever." ILen in Edinburgh I learnt that about 12 students annually died of 3r in that city. Again only 5 chemists and druggists have died, of these a wholesale druggist and another a lunatic. Not one ggist's assistant nor apprentice has fallen a victim to the disease, 28 lawyers, including 14 clerks, have sunk under it. Take next ministers of religion, who it is presumed have been in close contact h the sick : of these there are 2 Episcopalian ministers (one a atic), 1 Doctor of Divinity, 1 Wesleyan, 1 Dissenting, and 1 Unian. Only 5 undertakers are mentioned, and no sextons norgravegers; but I know of one of the latter who recovered from a severe ick. Amongst the 8,088 females there are 38 nurses (7 or Bof se employed at hospitals), 71 charwomen, and 52 laundresses. The rths of 1,125 widows are recorded, and I have reason to believe that 8 XllG IlVTSDiillCl ttll (A. W IIG lIJWO OltCll UCCII CUt Oil L)V tJIIS riILIIIOSS DCStIIOHCO, although I am unable from the returns to give the numbers. It would, I think, be presumptuous for any one to state that Choler s not contagious under any circumstances ; but surely these return how that it is so, if at all, to a very small extent. It should be re collected that persons who are thought to have taken the disease from ;he infected, have been exposed to the same deleterious influence a those first attacked. I also believe that many of the supposed example of contagion, if thoroughly investigated, might be otherwise accountec 'or. Mental influence, as a predisposing or exciting cause, has probabl not been sufficiently estimated. The following example, which occurrec ;o me in 1832, is a good illustration. A healthy boy, Eet. 6, saw on of his companions fall into the Surrey Canal ; he ran home, hi )owels became relaxed, and he died two days afterwards of Asiati Cholera : — he had not been near a Cholera patient, but he was livin nan infected district. A gentleman whom I saw died at Brixton )is wife was much depressed in mind and was frequently over th corpse ; she died of Cholera a few days after her husband ; but bot were living in an infected district, and the lady from night-watchin and great anxiety of mind would be peculiarly liable to the disease A servant, act. 45 (a very timid woman), who was attended b my friend Dr. Parry, of St. John's Wood, went to visit a relation in Carey Street, Southwark, where she slept on Monday night. Ther were eight persons dead in the street, and the woman believed tha ;here was a corpse in the house. On Wednesday night she had diarrhoea and died of Cholera on the following evening. No case of Choler lad occurred in the street where she lived (Abbey Place) previous t ler death, nor has the disease appeared since. Fear and exposure t the noxious atmosphere, in this, and many other instances, are, I think alone sufficient to account for the occurrence of the disease. W enow little at present respecting the period of incubation of the poi son. The time probably varies much in different cases. In thi nstance it appears to have been about forty-eight hours. When th )oison, or a sufficient amount of it, has been received into the system he removal into a pure atmosphere does not always prevent the attack STumerous examples of this kind might be adduced. A gentleman, riend of mine, who had had slight diarrhoea, and who had been muc n the infected districts, went into Essex (60 miles from London) on Friday night, the 81st of August, intending to shoot on the following lay ; he said that "he felt better after his arrival/ but he was seize* with violent cramps and vomiting during the night, and died the fo] owing afternoon. This is the only case of Asiatic Cholera ever seen n this neighbourhood. And lastly, as regards the treatment of the disease. This question is, I fear, likely to remain long in as unsatisfactory and uncertain a state as at present, unless a different and more rigid method of investigation be adopted. If at such of our public hospitals whose 9 funds would have enabled them to have received Cholera patients, a different method had been pursued, we might by this time have arrived at more positive conclusions respecting the effects of medicines in this disease. The system I would suggest, if this frightful epidemic should again visit us, is the following :—: — Three large well- ventilated wards, con taining4o beds each, should be set apart exclusively for Cholera patients, and (according to the present state of our knowledge) three of the most approved modes of treatment should be fairly and extensively tried, in each, under the inspection of medical men appointed by Government. It may be said that the poor should not be subjected to this kind of experiment ; but do the rich fare better in this disease ? Is not the treatment experimental, and to a great extent empirical ? Heat, cold, brandy, ice, aperients and astringents, acids and alkalies, calomel and tartarized antimony, and nearly a thousand other methods, many of them apparently as opposite in their effects as fire and water, have been recommended by different practitioners. But to return to treatment. It is but fair to state in the onset, that although I saw many cases of Cholera in 1832 and opened several bodies, I have during the present epidemic attended only 20 cases of Asiatic Cholera, and, with one exception, they were all seen with other practitioners ; of these 13 died and 7 recovered. It is difficult to draw a useful or practical inference from the treatment, as although Dr. Ayre's plan was adopted in the great majority, other methods had been pursued at the commencement of the attack. I will allude to two or three remarkable cases. First, Mr. C, in the Westminster Road, seen with Mr. O'Shea. This patient was well at one o'clock in the morning (he assured me that he had had no premonitory diarrhoea),* and he died at seven (6 hours). Mrs. H., also seen with. Mr. O'Shea, appeared after a few hours to be dying. I injected 60 oz. of saline fluid into one of the brachial veins ; the effect, as in many cases recorded in 1832, was most remarkable ; the skin became warm, the pulse perceptible, the voice louder and a profuse perspiration bedewed the body, but after a few hours she got into her former state. I again injected about 40 oz. of the same fluid, and she lived nearly 24 hours from the first transfusion. Dr. Ayre's plan of treatment in this case was strictly adhered to, and carried on after the transfusion ; indeed, my principal object was to prolong life by the operation, so that the calomel, if of any efficacy, might have a better chance. One bilious evacuation occurred before death. I was anxious in this case, and in some others, to have tried the transfusion of blood and water, but 1 could not procure the blood. Believing with most practitioners that the loss of the serum of the blood is generally the cause of death, lam afraid transfusion has been too hastily abandoned. I think that * Since tins gentleman's death, Mr. O'Shea has ascertained that he had slight diarrhoea for two days before the attack. I mention this to show the difficulty we have often in obtaining accurate information from the patient. C 10 CASES in most cases life may be lengthened by it, and iri this way the action of medicines may be prolonged. But the most extraordinary case amongst the above was that of a gentleman, set. 18, residing in Nelson Square, whom I saw with Mr. Menzies of Stamford Street. He had taken, on the 10th of September (without advice), some blue pill, rhubarb, and effervescing medicine, which relaxed the bowels for a short time ; he was tolerably well, however, until Monday evening, when at seven o'clock he vomited once, and purged very profusely. The fluid from the bowels was the clearest I have seen, with a little flocculent sediment. He had taken effervescing medicine, calomel, and opium every half-hour, until I saw him at halfpast four in the morning. He was then nearly pulseless ; hands cold, feet warm, eyes sunk, voice feeble, great restlessness, and cramps in the legs and hands ; tongue and breath warm. I ordered 2 grs. of calomel every 10 minutes ; about 24 grs. were taken, but he died at eight, three hours and a half after I first visited him. After taking a few doses of calomel the symptoms appeared to improve ; the voice became louder, and the hands and forehead warm. A short time before death he had a sudden evacuation from the bowels ; I observed that the skin instantly changed to a blue colour, and he rapidly sunk. Soon after his death, when Mr. Menzies and myself were standing by the bedside, the arms, which were quite straight, were gradually flexed, so that the hands were brought up to the clavicles ; at this time no sound was heard, nor motion felt over the heart. I had sent for my transfusion apparatus, and on its arrival I injected a small quantity of saline fluid, but it did not pass readily through the vein. It is remarkable that in this patient the heat increased before death, and the body remained warm for 24 hours after. There is some resemblance between this case and the one which lately occurred at Bristol, in w r hich the warmth of the body continued for several days. I met with another instance of this kind during the present epidemic. I saw one remarkable case of suppression of urine with Mr. Taylor, of Camberwell. A man, set. 45, who had been in a state of extreme collapse, and whose life was despaired of, took 20 grains of calomel every 20 minutes, for several doses ; the quantity was gradually decreased, but altogether 360 grains were taken. When I saw him he was sitting up on the bed, and there was no evidence of oppression of the brain, although no urine had been passed since the attack, then 8 days. Mr. Taylor introduced the catheter, and drew off about a pint of urine, which appeared to have been recently secreted ; it was light-coloured, clear, and slightly acid ; had not a urinous smell, and on boiling it, no albumen was perceptible. This patient died comatose 12 days from the commencement of the disease, probably from the presence of urea in the blood. For several days before his death the secretion of bile had returned. Ei forming an estimate of the comparative value of the various es of treatment, I unhesitatingly give the preference to calomel aedicine often powerless, as all medicine must be in some cases of the disease), but I believe of more efficacy than any other we are at present acquainted with. I have heard that a learned lecturer on Materia Medica (duly licensed by the authorities), when calomel formed the subject of the discourse, said to his pupils: — "Gentlemen, we are told when we are at a loss at whist to know which card to play, let it be a trump ; so, in treating disease, if you are at a loss, give calomel." A late President of the College of Surgeons (Parliamentary Evidence) thought it was not necessary for a surgeon to know the composition of this medicine, so that he knew its effect. Strange doctrines these, but I fear too common amongst some of the members of our profession. But what is the effect of calomel on the liver ? Unless we have been greatly in the dark for more than two centuries, it promotes the secretion of bile, and the vast majority of Cholera patients, after this fluid enters the intestines, are in comparative safety. Hence the advocates for the calomel treatment have, at least, a motive for the administration of the medicine. Mr. Grainger, now a gentleman of high authority (if correctly reported in the Lancet January, 1849, p. 25), recently told the students of St. Thomas's Hospital, " That the secretion of the bile is not arrested in Cholera, but that it does not pass into the intestine." Now, as the gall-bladder is oftenonly two-thirds full, and the amount of bile daily secreted amounts probably to 12 or 16* ounces, it is difficult, according to Mr. Grainger's theory, to understand what becomes of the surplus. But is calomel to be given in all cases of Cholera ? In the bilious diarrhoea, the chalk mixture, opium, and catechu, as recommended by the Board of Health, are, I believe, the best medicines ; emetics may assist, and other modes of treatment may accomplish the same object : but stop the purging in all cases without delay ; keep the patient in a state of quietude, and continue the astringents for some time after the cessation of the diarrhoea. |[n the serous diarrhoea, where there is an absence of bile in the estines, I would at once commence with a grain of calomel and eat it every half- hour. If the above mode of treatment had been re generally adopted, I believe that there would have been a great ing of human life. If an artery is bleeding, we endeavour to est the hemorrhage, and I think it is equally or more important stop the flow of serum in this disease, for it is the want of propori between the serous and red particles that is probably the ise of the stagnation that occurs. A larger quantity of pure od might be lost, and the discharge would be perhaps less injurious ! ere is one important fact to bear in mind in the treatment of this ease, and it is one that should lead us not to despair of any patient ; ? that in the worst cases there is no disorganization of structure, the extreme cases of collapse (I can only depend upon the stateats of others) I have not witnessed a single recovery ; but it is fair * 24 or 30 oz. would probably have been more correct. c 2 11 12 CALOMEL TREATMENT. I state that in the ten cases of extreme collapse which I saw, Dr. re's plan of giving two grains of calomel (without any other iicine) every ten minutes had not been fully carried out. In five of se cases I have reason to believe that life was prolonged by calomel ; in five others it appeared to be of no efficacy whatr. In 1832 I treated nearly all my patients with emetics, calomel, I opium ; in some I combined sulphate of zinc injections per anum; a treatment which appeared to be tolerably successful in the first iemic would, probably, from the greater malignancy of the present, I[ have omitted many important subjects connected with the origin I treatment of Cholera, but I have already occupied too large a re of the time usually allotted to discussion. I have not spoken the fungoid theory of Cholera, because I believe there are many ts which militate materially against this mode of origin, and that, 3 the rice theory of Dr. Tytler, it will soon give place to some new trine. I also anticipate that, when the matter is more fully estigated, these cells will be found (both in and out of the body) districts where Cholera has not yet appeared. Kr. Ayre, of Hull, has furnished me with the following interesting ment, which he permits me to use : — " I am preparing my report, and shall have it out in a day or two, when I will send you a copy of it ; the results are somewhat striking. Our medical staff had of necessity a large proportion of the practice in the two parishes ; and yet, whilst we have had but 6 deaths in nearly 3,000 cases of diarrhoea, the rest of the practitioners attending in these parishes, and following another treatment, have had 146 deaths. And in the same way, whilst we have 360 deaths from Cholera, they have upwards of 900. There has been no report made of anything but the deaths, excepting by the medical staff, but they cannot have had, it is thought, one-half the paupers that we have had, if even one-quarter, and yet the deaths exceed ours nearly three-fourths." tarn pleased to find that the guardians of Hull have presented Ayre with £100 for his exertions during the Cholera. IMie above paper it must be borne in mind was read four months ;e, and although the numbers would be somewhat different if all returns were included, yet these would not affect materially the eral inferences. I am anxious not to be misunderstood upon one it, viz. the benefit likely to result from sanitary measures in all large cities and towns. But the ill effects arising from impure air, er, and diet are not confined to Cholera, and this disease I believe ever solely produced by these agents. For example, in the first week September the mortality in London was 3,183, and in the following ks 2,865, 1,981, 1,611, 1,290, 1,075, 1,028, 902, 837, c 5.93, I, 892, 931, 1,053, 1,002, 1,043, 1,053. So that from the 13th October to the 29th of December, the deaths for the twelve weeks c 2,348 below the average of the estimated mortality of the son. Now it will occur to every one that during this extraordinary 13 HISTORY AND SYMPTOMS. Irease of mortality we had the same drains, cesspools, sewers, ti ditches, and burial-grounds, and in addition to the facts I have >re mentioned, viz. that persons engaged in some of the most filthy doyments have enjoyed a comparative exemption from the disease, aye known certain localities near the river where the stench from sewers has been almost insufferable and Cholera has not appeared ; the other hand, in places where this disease has been very fatal, perceptible change existed in the atmosphere. In the event of ther visitation of this fearful pestilence, I think great benefit might c from the burning of certain substances, such as sulphur, tar, n, nitre, &c. in the infected districts ; but I purpose on a future Lsion to enter more fully into this matter. i?he above paper was published sixteen years since, and it will now my object to investigate the leading points connected with the ses, pathology, treatment, prevention, and cure of Cholera, and to uire what advances have been made in these important matters se I last wrote upon the subject. HISTORY AND SYMPTOMS OF CHOLERA. I need say little about the history of Cholera, as it has been fully alluded to by various authors ; some trace it back to 1769, and others to a later date; it was not, however, until 1817, that it especially attracted the notice of Europeans, when it occasioned great mortality in the delta- of the Ganges ; from this point it extended westward in various directions. After hovering about the western parts of Europe, it first appeared in Turkey, 1830. It reached Hamburg in the autumn of 183 J, and the first case in this country occurred at Sunderland, October 26, 1831, the disease having been brought from Hamburg in an infected vessel. In the outbreak of 1848-49, the first case in London occurred September, 1848, in a seaman who came from Hamburg, an infected city. In the autumn of 1853, the third invasion of Cholera occurred, but it was in 1854 that it became so fatal, commencing in London with one death in July, increasing weekly until in the week ending September 9, the deaths amounted to 2,050, after which the disease gradually declined. As is well known, the present epidemic can be traced to the Mecca pilgrims, who died in vast numbers, and according to the Lancet (1832), where a history of the progress of the Cholera is given, more than 20,000 of the Mecca pilgrims died of Cholera before it reached this country. In nearly every instance it has travelled westward, and it is said that it always appears first at a seaport, and never attacks the crews of ships going from an uninfected country. The weekly trns of the Registrar- General for London, beginning June 2nd, as follows: 2, 3, 3, 1, 6, 14, 32, 396, .904, 1,053, 781, 455. rhe appearance of the disease at Liverpool, Southampton, Epping, other places, is too well known to need repetition here. Symptoms. — These may be comprised in a few words. In the great majority of cases more or less uneasiness of the bowels succeeded by diarrhoea often painless, and of a serous character ; this may continue for several days before the accession of grave symptoms ; at other times the invasion is very sudden and without warning, violent cramps of the muscles of the abdomen and of the extremities, vomiting and purging of ricewater-like fluid, thirst, feeble pulse, the voice often reduced to a whisper, clammy coldness of the skin, anxious countenance, cold tongue and breath, sunken eyes, blueness of the face and lips, blue finger-nails, shrivelled ends of the fingers, and a death-like change in a short time, that is produced by no other disease. Although, as I have said, preliminary diarrhoea is not in every case present in Cholera, in the vast majority of cases it goes on internally, so that the intestines contain a large amount of fluid before any evacuation takes place. In some instances a large amount of water in the shape of cold, clammy perspirations, is lost by the skin, the diarrhoea in such examples being generally lessened. After the stage of collapse comes one of reaction and fever ; the tongue is furred ; delirium not unfrequently occurs, or a stupid listless condition supervenes, owing to the presence of urea, carbonic acid, and other deleterious matters in the system ; the pulse becomes full and frequent, the skin hot, and the patient often gets into a low typhoid state. Sometimes an eruption appears on the skin of a rosealous character, but this only occasionally. Of about 190 patients under the care of Dr. Clarke, seven only have been affected with this eruption. The symptoms vary much in different cases ; complications may occur, such as pneumonia, quick breathing from stagnation and clotting of blood in the right side of the heart, and in the pulmonary vessels. I scarcely need say, that the return of pulsation at the wrist, improvement in the voice, and the restoration of the biliary and urinary secretions, are some of the most favourable signs. In children there is a remarkable difference in many of the ptoms ; the cramp in the extremities and abdomen are seldom vent, and the alteration of the features and the blueness of surface less marked. Of the numerous children admitted into the idon Hospital, under the care of Dr. Clarke, Mr. M'Carthy rms me that not one has had cramps of the extremities. I may ark that I have not seen in this epidemic the same marked ration of features and loss of voice that I witnessed in 1832 1849, although the disease has been equally or more fatal ; eruption I have mentioned I did not see in the previous iemics- 14 15 CASES — PREGNANCY. (he temperature, as is well known, is very variable in Cholera, careful observations have been taken at the London Hospital on •ge scale. Mr. McCarthy tells me that the highest temperature hie met with was 105° Fahr., and the lowest 92. K'he pulse varies much even in the same stage of the disease ; in c persons at the onset being apparently but little affected, whilst thers it is rapid, feeble, almost imperceptible, or absent. The respiration varies from 18 to 60 in the minute, the rapid breathing taking place when the right cardiac cavities are loaded with blood, and when the nearly stagnant current is scarcely moved by the heart's feeble impulse. I have recently several times seen a great many patients (more than 100), under the care of Dr. Andrew Clarke, at the London Hospital, who kindly permitted me, with the assistance of his clinical clerks, to make such observations as I desired. I do not allude to the treatment as at present ; but little practical good can be drawn from it. Dr. Clarke will probably give a summary hereafter. Mr. M'Carthy, a gentleman whose assiduity and great attention to the patients deserves all praise, has kindly furnished me with notes of the leading features of most of the cases. Among these patients, and others in the Hospital, aarte t many of great interest. I will allude only to a few of the symptoms in some of the patients, that cannot fail to interest the reader. Several have suffered from ulceration of the cornea, and one little girl, about two years of age, has lost the sight of both eyes from this cause. One patient that I saw had a semilunar patch of ecchymosis on the inner side of the pupil of each eye, and another had a round ecchymosed spot of the same form on the inner part of each eye. One man had gangrene of the nose and feet ; a boy suffered with dry gangrene of the right foot, with loss of pulsation of the femoral artery at the groin. I Pregnancy, as I said in 1849 (p. 7\ appears to have no in:nce on the prevention of Cholera ; a great many pregnant nen have been admitted into the London Hospital during the sent epidemic ; of these, nearly all miscarried or aborted. One ient I saw who was at the ninth month of pregnancy, and she I not felt the child for more than a week. On the 15th of gust labour came on, and the woman was delivered of a dead Id ; on the 1 7th she was doing well ; the labour was not longed, and was comparatively painless ; I saw this woman on i 20th with Mr. M'Carthy, and she continued to improve. On i 20th of August, when the epidemic appeared to be on the line, a man was admitted in the blue stage of Cholera, whose -cuations were of a pinkish colour from the presence of bloodpuscles, and other similar cases have occurred. I In my paper in 1849, I spoke of a case where the heat of the in increased before death, and continued for twenty-four hours er dissolution. A similar case has occurred at the London 16 duration; of diajrrhcea. Kpital ; so great was the heat of the body twenty-four hours f death, in this instance, that Dr. Sutton ordered cold water to oured upon it before the autopsy was made. I select from the notes kindly furnished by Mr. M'Carthy, some of the leading symptoms of 80 patients admitted in succession, who died of Cholera in the London Hospital, under the care of Dr. Andrew Clarke. 1. Blood from the bowels, extreme restlessness. 2. Delirium. 3. Never rallied. 4. Great desire for bottled ale, which was given. 5. Stupor, great intolerance of covering, convalescent, again comatose before death. 6. Coma, 12 hours. 7. Fearful cramps. 8. Died on admission. 9. Coma. 10. Dozed until death. 11. Ditto. 13. Cramps and lividity of surface. 14. Dull in intellect and slow in answering questions. 15. Convalescent, then sleepy stage, from which he could not be roused. 15. Never rallied. 16. Ditto. 17. Ditto. 19. Under treatment for diarrhoea a fortnight before, never rallied. 20. Never rallied. 21. Passed into the sleepy stage, hardly waking to take food. 22. Delirious before death. 23. Recovered from collapse, bloody motions, much dyspnoea. 24. Stupor, death in 24 hours. 25. Collapse, rejected the castor-oil. 26. Died in collapse. 27. Reaction set in on the third day, became sleepy and unconscious. 28. Never rallied. 29. Great pain in the abdomen, no reaction. 30. No reaction. Duration of the Preliminary Diarrhoea. — This is an interesting question, although often a difficult one to solve. Patients when asked will say frequently that they have had no bowel-complaint, but when closely pressed they often remember that the bowels have been relaxed, and the diarrhoea often in the first stage of Cholera is so painless that it excites but little notice. Many of the undermentioned patients, too, were children, from whom it was difficult to obtain accurate information. It must also be borne in mind that a large amount of fluid may have accumulated in the intestinal tube before the first evacuation. From the same notes I extract the period of the occurrence of diarrhoea before admission into Hospital in 68 cases of Cholera. I[ divide the cases into those where diarrhoea had existed for irs before admission, and into those where it had continued for ! day or more. I need scarcely say that perfect accuracy is not led at. Hours: 10, 6, 12, 6, 4, 6, 8, 2, 2, 6, 2, 4, 6, 8, 7, 2, 6, 6, 2, 12, 6, 6, 10, 6, 8, 7, 7, 7. I Days: 4, 3, 3, 1, 3, 2, 2, 1, 1, 5, 7, 6, 2, 5, 6, 7, 2, 4, 1, 2, 3, 4, 4, 4, 4, I|, li, 2, 3, 4, 3, 11, 8, 10, 10, 1, 1, 3. In one tance it is said that no diarrhoea or vomiting occurred. |[t should be remembered that in the eastern districts of London, ii which these patients came, many thousands of persons k opium and astringent medicines for the early diarrhoea, and •c quickly cured by locking-up the poison (so called). In vvcastlc, during the epidemic of 1849, of 25,583 persons treated by opium and astringents in trhe early stage of diarrhoea, only sixteen went into the second stage ; and innumerable instances of a like kind might be quoted. Duration of Cholera. — This is a difficult matter to determine, because the preliminary stage, that of internal serous hemorrhage, may have existed for some time before evacuations from the bowels take place, and patients are generally very loose and careless in their statements respecting the existence of diarrhoea. In the subjoined statements respecting the duration of Cholera, it must not be inferred that the time mentioned includes the whole period of the attack. In many instances it is recorded that neglected diarrhoea preceded the Cholera symptoms, and I believe that the choleraic diarrhoea is as much a stage of Cholera as that of collapse. I select from the daily returns for the present month, August 6th to August 25th, the duration of the disease, as stated by 192 medical practitioners, of adult males over twenty years of age. The period of death of women and children I find to be nearly the same. Hours : 5, 6, 6, 6, 7, 8, 8, 8, 9, 9, 9, 9, 9, 10, 10, 10, 10, 10, 10, 11, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 12, 13, 13, 14, 14,14, 14, 14, 14, 14, 14, 14, 14, 14, 14, 15, 15, 15, 15, 16, 16, 16, 16, 16, 16, 16, 17, 17, 17, 18, 18, 18, 18, 18, 18, 19, 20, 20, 20, 21, 23, 26, 28, 28, 28, 29, 29, 29, 29, 30, 30, 30, 34, 34, 36, 36, 36, 60, 64. Days: 1, 1, 1, 1, 1, 1, 1, 1,1, 1, 1, 1, 2, 2, 2, 2, 2, 2, 2, 2, 2, 2}2 } 2, jj, 2}2 } 2, 3, 3, 3, 3, 3, 3, 3, 3, 3, 3, o, 3, o, 3, 3, 3, 3, 3, 3, 3, 3, 3, 3, 4, 4, 4, 4, 4, 4, 4, 4, 4, 4, 4, 4, 5, 5, 5, 5, 5, 5, 6, 6, 6, 6, 6, 6, 6, 6, 6, 7, 7, 7, 7, 7, 7, 7, 8, 8, 8, 8, 8, 8, 9, 9, 9, 11, 11, 14, 14. 3 It will be seen that 12 hours is the most common time of death after collapse ; at this period there are 21 cases, and that during the stage of reactionary fever the third is the day when most deaths occur ; 23 of the 181 deaths having been registered on that day. A larger number of returns will be necessary to arrive at accurate conclusions upon this subject. Mate of Mortality. — This varies greatly in different localities, so much depending upon the period of the epidemic, on its malignity, the class of patients attacked, and the time of treatment. I have reason to believe that in private practice the mortality is much less than that at hospitals, a fact that is readily accounted for. Patients whose circumstances will admit of it are seen earlier, and are kept at rest, a matter of vast importance in the treatment of Cholera ; whereas among the poor the exertion required to get to an hospital has often, I believe, an injurious effect. At the London Hospital up to the present time, according to the Secretary's report (Times, August 16), from July to August 16th, 431 patients have been admitted with Cholera, of whom 242 died and 108 recovered. Of 123 persons with choleraic diarrhoea, 84 r> 17 18 probably equal to that of any in London, and the ventilation of the wards, the nursing, and the various requisites for sick persons are superior to those at most similar establishments. The rate of mortality in different countries has varied from £ to f of those attacked ; some writers believe that the mortality has decreased during the recent epidemics, but of this I think we have no positive proof ; indeed, the evidence is somewhat contradictory. According to a statement in the Lancet. August 18th, in Russia 7,191 persons had been attacked and 2,856 recovered. In the Gazette Med. de Paris, July 14, p. 464, Dr. Duilboulin stated that Cholera in Holland had been more fatal than in 1849. Of 1,851 persons attacked in Leyden, Lahaye, Rotterdam, and Utrecht, 1,131 died. Dr. Prosper de Pietra Santa, Epidemic Cholerique, 1865, Paris, believes that the cholera poison has been less virulent during each epidemic. Thus, in 1832 the deaths were lin 40 of the whole population of Paris ; in 1849, 1 in 51 ; in 1853-4, 1 in 112 ; and in 1865, lin 270. This author quotes a large number of authorities to show that the quarantine laws as regards Cholera are entirely useless. Dr. Parkes estimates the mortality in India at about 58 per Cent. ; in Aleppo more than one-tenth of the population were cut off. In this country the ratio of deaths to recoveries is only obtainable hospitals, workhouses, and public institutions ; but as I have said are, great variations occur, according to the treatment, locality, and iod of the epidemic. The duration of Cholera too is equally ricious ; occasionally it remains only a few days in a place, in le localities for months and years. Dr. Macpherson ("Cholera; Home/ 1866) says " that it is never absent from Calcutta ;" in this pect bearing a great resemblance to the Cattle Plague in the ssian Steppes. OCCUPATIONS. I Occupations. — Some time after my essay was read and printed, Guy, of King's College Hospital, published a paper, in which he } the occupations of 4, 51 2 males over 15 years of age that died of lera in 1848-49. If this paper be referred to, it will be seen that c is no material difference between his conclusions and my own. Guy begins at the age of 15, and I at the age of 20 ; assuming i, until this age, occupations are not settled. Dr. Guy, by means he census returns and by the London Directory, endeavoured to a rough estimate of the ratio the deaths bore to the living. Thus gentlemen and men of independent means are put down at 1 in 200, the whole number of deaths being 135 ; whilst two fatal cases occurred in rag-sorters ; the assumption being that there were only 108 in London, whereas 700 to 1,000 would have been probably nearer the mark. It must be remembered, too, that most gentlemen and men of independent means get out of London during the prevalence of Cholera. Dr. Guy, if his statistics are examined, appears to have lost sight of the fact that the number of master tradesmen mentioned in the Directory is no indication of the number of men employed in the trade. Thus, the dustmen and scavengers are assumed to amount to 234, the ratio being lin 37 ; but the men employed in these trades would be at least five times the number here stated. As in my own table, the men employed in dirty occupations are but few, the tanners were all in a neighbourhood where the disease was specially virulent. But let me now analyze the Registrar- General's report for London, 1853-54, when 10,738 persons died from Cholera and Choleraic diarrhoea ; 5,093 males, and 5,645 females. I select, as before, all males twenty years of age and upwards ; they amount to 970. Auctioneer, 1 ; assistants, 3 ;*artists, 4 ; agent, 1 ; bookbinders, 7 ; basket-makers, 3 ; butchers, 14 ; boot and shoe makers, 49; bargemen, 3; builders, 2; ballast-heavers, 2; bakers, 14 ; bricklayers, 9 ; block-makers, 2 ; blacksmiths, 6 ; boiler-makers, 4 j brush-makers, 2 ; boat-builder, 1 ; beggar, 1 ; bonnet-presser, 1 ; brick-makers, 4; beadle, 1; butler, 1 ; billiard-table maker, 1 ; bootclosers, 2 ; box-maker, 1 ; bed-hayer, 1 ; barmen, 2 ; candle-maker, 1 ; clerks, 23 ; cabmen, 7 ; carpenters, 26 ; coach-maker, 1 ; coalheavers, whippers, &c, 12 ; commercial travellers, 2 ; custom-house officers, 2 ; carmen, 10 ; coopers, 6 ; cabinet-makers, 4 ; carter, 1 ; cheesemongers, 2 ; coach-painter, 1 ; cowkeeper, 1 ; coal and tar manufacturer, 1 ; coal-dealers, 2 ; compositors, 2 ; corn-trusser, 1 ; chaff-cutters, 3 ; coachmen, 5 ; carver, 1 ; carriage-greaser, 1 ; cricketer, a professional, 1 ; crossing-sweeper, 1 ; chimney-sweeper, 1 ; cap-makers, 2 ; co3termonger, 1 ; cloth-worker, 1 ; chemists, 2 ; chaser, 1 ; coach- trimmers, 2 ; cloak-maker, 1 ; cider-merchant, 1 ; chair-maker, 1 ; cordwainers, 2 ; cellarman, 1 ; dust collectors, 4 ; dyers, 2 ; dog fancier, 1 ; drover, 1 ; dentists, 2 ; designer, 1 ; diesinker, 1; excavators, 2; engineers, 8; edge-tool forger, 1 ; eatinghouse keepers, 2 ; engine smith, 1 ; farmers, 2 ; farriers, 5 ; fishmonger, 1 ; firewood dealer, 1 ; feather-dresser, 1 ; firemen, 2 ; furniture dealer, 2 ; general dealers, 2 ; ginger-beer makers, 2 ; gunmaker, 1 ; gunner, 1 ; gun-case fitter, 1 ; gun-smiths, 7 ; gardeners, 10 ; grocers, 2 ; gentlemen, 30 ; gate-keeper, 1 ; greengrocers, 4 ; grooms, 5 ; glazier, 1 ; gas-fitter, I ; glove-maker, 1 ; gold-beater, 1 ; grave-digger, 1 ; hatters, 4 ; hawkers, 9 ; house agent, 1 ; hammerman, 1 ; hair-dressers, 5 ; house-painter, 1 ; hotel-keeper, 1 ; housekeeper, 1 ; horse-keeper, 1 ; husbandman, 1 ; instrument-maker, 1 ; ironmoulderers, 3 ; iron-planer, 1 ; jeweller, 1 ; labourers, 154 ; (dock) i) 2 19 Ic*U\JUa cITDj J. T? y llLLlloL'l \lvllltlllLlisj O j ILtlLllCl" Ul L*.oL I t>, — 1 L it 1 1 X1 — dyer, 1 ; lithographic printer, 1 ; lead-pencil maker, 1 ; locksmith, 1 ; lithographer, 1 ; livery-stable keeper, 1 ; licentiate of Apothecaries' Company, 1 ; mendicant, 1 ; ministers, 2 ; maltster, 1 ; music engraver, 1 ; (males unknown, 15) ; milkman, ] ; miner, 1 ; millwright, 1 ; musicians, 6 ; mariners, seamen, &c, 60 ; messengers, 2 ; missionary, 1 ; mat-maker, 1 ; metal-planer, 1 ; oil-cloth painter, 1 ; ostlers, 2 ; oilman, 1 ; oil boiler, 1 ; porters, 37 ; polishers, 5 ; pensioners, 4 ; printers, 7 ; postmen, 4 ; packers, 3 ; pawnbroker, 1 ; prisoners, 9 ; paper-hangers, 2 ; plasterers, 5 ; pressman, 1 ; plumbers, 2 ; painters, 14 ; piano-forte makers, 3 ; percussion-cap maker, 1 ; paper-stainer, 1 ; plate powder manufacturer, 1 ; railway inspectors, 2 ; railway plate-layer, 1 ; silversmith, 1 ; sugar-bakers, 2 ; male servants, 8 ; sawyers, 4 ; ship-caulker, 1 ; shepherd, 1 ; silk-printer, 1 ; stokers, 8 ; stonemasons, 3 ; shawlsmaker, 1 ; stock-maker, 1 ; stay-makers, 2 ; salesmen, 5 ; seal engraver, 1 ; singers, 2 ; schoolmasters, 2 ; scripture-reader, 1 ; stationers, 3 ; surgeons, 2 ; soldiers, 5 ; shopmen, 2 ; scavenger, 1 ; sadler, 1 ; silk-winders, 2 ; shoebinders, 2 ; tailors, 61 ; tanners, 5 ; tin-plate workers, 6 ; toy-maker, 1 ; tallow-chandler, 1 ; tobacco-pipe maker, 1 ; toll collector, 1 ; theatrical dresser, 1 ; undertakers, 3 ; upholsterers, 2 ; umbrellamaker, 1 ; vagrant, 1 ; venetian-blind maker, 1 ; watermen, 3 ; watchmakers, 3 ; weavers, 6 ; wheelwrights, 2 ; whitesmiths, 4 ; woolsorter, 1 ; wool stapler, 1 ; wine merchants, 3 ; wood-cutters, 2 ; waiters, 3 ; waistcoat-makers, 4 ; warehousemen, 3 ; wire- worker, 1 ; whitening manufacturer, 1 ; wine cooper, 1. |[n these 970 returns it will be seen that there are only two geons, one member of the Apothecaries' Company, and two nisters ; and among the occupations that might be supposed to prepose to Cholera are only one scavenger, one grave-digger, and four itmen. There are 30 gentlemen ; and tailors and shoemakers, as in i last return, form a large proportion, 61 of the former, and 49 of the 'er. The sedentary occupations of the members of these trades and ir remaining so long in the same atmosphere may account for the great rtality among them. It is worthy of note that there is one coal I tar manufacturer. Labourers, as in all the returns, form a large portion, as do sailors and mariners. I Let us now take the printed returns for the Metropolis during the sent epidemic. These daily returns were commenced on the 6th August and extend to the 25th. Before this date the number of ;kly cases of Cholera, beginning June the 2nd, was 2, 2, 3, 1, 6, 14, 346, 904, 1,053 ending August 4, so that a large number of the ployments are not obtainable. The occupations of 340 males 20 rs of age and upwards are as follows : — Auctioneer, 1 ; barman, 1 ; kbinder, 1 ; basket-maker, 1 ; butchers, 4 ; bootbinder, 1 ; bargea, 3 ; builders, 2 ; ballast-heavers, 4 ; bakers, 4 ; bricklayer, 1 ; sksmiths, 3 ; blockmaker, 1 ; candlemaker, 1 ; clerks, 6 ; cabmen, 20 DIRTY OCCUPATIONS, 1866. 21 2 ; carpenters, 12 ; chairmaker, 1 ; coachmaker, 1 ; coal-heavers, 3 ; commercial traveller, 1 ; custom officer, 1 ; carmen, 6 ; coopers, 5 ; cabinet-makers, 3 ; coal merchant, 1 ; carter, 1 ; carvers, 2 ; cowmen, 2 ; cheesemonger, 1 ; dyers, 4 ; dock constable, 1 ; earthenware dealer, 1 ; engineers, 2 ; farriers, 4 ; fishmonger, 1 ; fruit salesman, I ; foremen, 3 ; furniture dealer, 1 ; fur-puller, 1 ; general dealers, 4 ; gunsmiths, 2 ; glass-blower, 1 ; gardener, 1 ; grocers, 2 ; hatters, 3 ; hawkers, 4 ; house proprietor, 1 ; instrument maker, 1 ; iron-founder, 1 ; iron-moulder, 1 ; jeweller, ] ; labourers, 75 ; labourers (dock), 14 ; licensed victuallers, 3 ; letter-carrier, 1 ; looking-glass maker, 1 ; musicians, 2 ; mariners, sailors, &c, 20 ; messengers, 2 ; organ player, 1 ; porters, 15 ; polishers, 2 ; policemen, 4 ; pensioners, 3 ; printers, 4 ; packers, 2 ; pewterer, 1 ; pawnbroker, 1 ; potman, 1 ; pier-master, 1 ; poulterer, 1 ; railway inspectors, 2 ; rag-sorter, 1 ; tailors, 8 ; traveller, 1 ; travelling snowman, ] ; tobacco operative, 1 ; tinplate worker, ] ; tobacco-pipe makers, 2 ; umbrella-maker, 1 ; upholsterer, ] ; shoemakers, 1 3 ; saddler, 1 ; silk-weavers, 7 ; silversmiths, 2 ; sugar- bakers, 6; shipwrights, 5; stovemaker, 1; stereotyper, 1; servant, 1 ; sawyer, 1 ; silk-dyer, 1 ; stokers, 2 ; shopkeeper, 1 ; waterman, 1 ; watchmaker, 1 ; weavers, 5 ; wadding-maker, 1 ; warehouseman, 1 ; wheelwright, 1 ; watchman, 1 ; whitesmith, 1 . lis I have said before, the occupations were first published on the of August, previous to which period more than 2,000 persons had lof Cholera in London. In comparing the occupations of persons lg during this present epidemic and those of 1849, 1853, 1854, it is ;ssary especially to take into account the rank and grade of the ibitants in the localities affected. Thus, in 1849 the returns ined 132 gentlemen ; in 1853, 1854, 30 gentlemen were registered ; among these 348 persons that died during the present month, not death among gentlemen (so-called) is recorded, the locality being •ly sufficient to account for the circumstance. As I have said where, one medical man, Dr. Ansell, of Bow, died before the 6th August, and therefore his death is not recorded in these returns. As regards the influence of dirty and filthy occupations, these returns, like those of 1849 and 1854, fully bear out the correctness of my first conclusion, so that the addition of the 1,310 occupations to the 4,258 already published, when class and locality are taken into account, makes but little difference in the inference. There is a prevailing error that only the ill-fed and destitute are generally affected with Cholera. During the present epidemic in the east of London, some of the most filthy and overcrowded neighbourhoods have been specially exempt from the visitation. Thus in Poplar, Bow, and Stepney, the mortality has been more than double that of Bethnal- Green. Those who have seen the great number of fine, strong, muscular men, women, and children in the deadhouse of the London Hospita.l must have come to the conclusion that it is not a question of strength, or power of constitution, but that Cholera poison is as likely to kill the strong and the muscular man as it is the weak and enfeebled, although those living in a pure atmosphere are less likely to take the disease. To repeat my words used in 1849 (p. 2), this inscrutable agent has certain powerful assistants in its train, such as a moist atmosphere, animal and vegetable malaria, depression and anxiety of mind, certain articles of diet and drink, and probably some trades and professions. If the west end of London should again unhappily be visited by Cholera, let not the residents who are well fed and well cared for indulge in any such false security as the belief that Cholera is a disease chiefly confined to the poor. The upper and middle classes have many advantages over their poorer brethren, such as early treatment and nursing, a purer atmosphere ; but the history of Cholera in all countries shows that although the disease has been more fatal among the lower orders, those living in crowded localities and in a damp and vitiated atmosphere, yet it has numbered amongst its victims a great many of what are called the " better classes " of society. I mention this that all may be impressed with the importance of early treatment, and of the necessity of at once arresting the diarrhoea. Before I conclude this chapter, let me allude to some prevailing errors that have been extensively circulated by the public press. It has been said that people employed about gas-works have been exempt from Cholera. It is probable that in the returns for 1849 and 1854 some of these are classed among labourers; but during the present epidemic I have met with two men in the London Hospital employed in gas works, and I have reason to know that many so employed have been affected. Another error is the belief that Jews are specially exempt from Cholera. During previous epidemics this may have been the case to a certain extent in this country, but I have seen a great many Jews in the London Hospital with Cholera during the present month ; and I believe in other countries they have not escaped the disease. The statement about the exemption of cider-drinkers has probably no better foundation. In my essay, 1849, I stated that of the 1 7 medical men who died in London, two were water-drinkers, and that the moderate use of alcohol probably tended to ward off the Dr. Snow, in his excellent work on " Cholera," 1855, p. 122, quoting from Dr. Guy's table, says, " One master brewer died of cholera, being 1 in ] 60 of the trade ; but no brewer's man or brewer's servant is mentioned as having died of this malady ; Dr. Snow naturally attributing these exemptions to their abhorrence of water." He further states, p. 124, " that on looking over the returns he has met with two or three of these persons, and that there must be a few thousands of them in London." In my first return there are 6 brewers, and 40 licensed victuallers, rshop-keepers, and barmen. In the returns for 1853 and 1854 re are 2 barmen and 8 licensed victuallers. In the imperfect rens for the present month there are % licensed victuallers ; so that 22 23 i.ii aiia -\q n +« -l |» m*oT^oT*i"i fin of sin ti f°— (ifm kpt*^ I 'irn n. writer** drinker myself, and I am fully alive to the evils resulting from the immoderate use of alcohol — poverty, crime, dirt, laziness, and bodily decay and suffering are its almost constant attendants ; but I am not sure that a moderate use of alcohol during a Cholera epidemic is not desirable, and probably good unadulterated malt beverage is the best. CAUSES. Water. — One of the most frequent causes of Cholera is supposed to be water which contains the germs of the disease from excreta that have entered it by means of sewers, water-closets, and other methods. As is well known, the late Dr. Snow* was one of the first to promulgate his belief that the great majority of choleraic cases were occasioned in this manner, and the example so often quoted of the Broad Street pump was especially given in proof of the correctness of his theory. To quote from his own report on the Cholera outbreak in the parish of St. James's, Westminster, during the autumn of 1854, — " The evacuations of Cholera patients found their way into this well. From the 19th of August, 1854, 616 persons died of Cholera in this district, but after the handle of the pump was removed, on the 9th of September, the mortality fell to one or two daily." Mr. Whitehead, in the same report (page 132), says, — " Of the drinkers of the pump-water, the ratio of those attacked to those who escaped is at least 80 to 57, whilst the corresponding ratio of non-drinkers of that water was but 20 to 279." Mr. Yorke (page 170) also adduces evidence of a like nature. Dr. Snow and others have produced other facts to show that the water has generally much to do in the production of the disease ; and the result of the present epidemic in the east end of the metropolis appears to confirm the correctness of Dr. Snow's opinion, for at the present time (August 24th), of those who have died of Cholera in the east of London, nearly all have drunk the water of the river Lea. According to the Registrar-General's report, the six districts supplied from the Old Ford reservoir of the East London Water Company have suffered from the ravages of Cholera to a remarkable extent. Thus, the mortality in Bethnal Green has been 30 per 1,000 ; Mile End, 50 ; St. George's-in-the-East, 60 ; Whitechapel, 70 ; Poplar and Bow, 70 ; and Stepney, 80 per 1,000 ; whilst the other metropolitan districts have suffered comparatively but little from the epidemic. It must be observed that the rate of mortality does not correspond with the poverty of the inhabitants. During the * " Mode of Communication of Cholera," 1855. Bemic of 1848-9, the greatest sufferers were those who drank the mes water, then in a very impure state. But in these instances, and in others that have been adduced, what proof is there that human excreta have entered the water ? In the case of the Broad Street pump, and in the remarkable instance that recently occurred at Epping it is more than probable that such a contamination occurred, and so with the Thames and other rivers polluted by sewage. There are some facts, however, that appear to militate against this theory, especially the remarkable exemption that I was the first to notice in 1849, of sewers-men and nightmen from Cholera. It may be said that these men are not water-drinkers, but their habits are not very cleanly, and they are constantly exposed to the influence of sewage. Again, if the water produces the deleterious effect attributed to it, how does it happen that Cholera subsides often very suddenly, although it is impossible to suppose that any material change can quickly take place as regards its purification ? And it is a curious fact, as shown in the report of the Medical Officers of Health, and in Dr. Letheby's report, that London water has been unusually free from impurities. It may be said, however, that the germs of Cholera poison from human excreta may multiply rapidly, and that it is impossible to detect them by any means that we are acquainted with. There is another fact that I think is beyond dispute, viz., admitting that the water drunk is the most frequent cause of Cholera, a vast number of cases cannot originate in this manner. The important matter to determine hereafter will be whether certain impurities exist in the water, irrespective of choleraic contamination, that may act as exciting or predisposing causes ? I have carefully examined several specimens of water microscopically before mixture with Cholera evacuations, and some time after this adulteration. Let me briefly allude to some of them. To 2 oz. of water, taken from a water-butt, I added on August 20th twenty drops of recent Cholera evacuation. On the 15th of August I carefully examined this fluid under various powers from 60 to 1,000, and the only remarkable change was the enormous quantity of one species of infusoria {paramwcium), and also of active monads. There were present also fungous threads and some of the supposed Cholera cells, or bodies very like them, as figured by Drs. Brittain and Swayne, in the London Journal of 1849. In the Cholera water where the fishes had been confined, I did not find one infusorial animal. I mention this to show that fresh-water fishes are great scavengers and purifiers of water, although I believe that all the infusoria in the world would not alone produce Cholera. I gave some of the fluid first named to a rabbit, a white mouse, and a pigeon, without producing any apparent effect upon any of them. Effect of Cholera Evacuations upon the Lower Animals. — In the Medical Times and Gazette, 1854, vol. i. p. 182, it is stated that a dispenser at the Newcastle Infirmary drank, by mistake, some riceler 24 25 EXPERIMENTS BY THE AUTHOR. evacuation without any injurious effects. I am not aware that well-conducted experiments have heen made upon the lower mals, for the purpose of showing the effect of this assumed Cholera son. I have performed the following experiments not without ;ure and due consideration, for I hold that no experiment should made upon any animal without it can be clearly shown that it is sly to be of service to suffering humanity. The question as to the influence of human excreta in the production of Cholera is one of great importance, and it is on this account that I have instituted the inquiry. The experiments were made in a detached building, under lock and key, and I took care to bury all the excreta of the animals employed. liug. 18, 1866. — A drachm of the rice-water fluid from the bowels . Cholera patient taken the day before, was put into a glass globe conling two quarts of water, in which was a small carp and two gudgeons. sse fishes were watched for some time, and no perceptible effect i produced upon them. The next morning the gudgeons had diseared in a mysterious manner, but the carp was lively and appatly healthy ; it remained for three days, apparently unaffected. t'.ug. 22. — Two small carp were placed in a glass jar containing tart of water ; to this a fluid drachm of rice-water from the bowels added, the fluid having been taken five days before and kept in a pered bottle. It was in a state of ferment ; the fish were kept for days in this fluid ; and, like the last named, were, a3 far as I d judge, uninjured. Aug. 20. — A healthy frog was treated in the same manner as the above. After remaining two days, it was apparently unaffected, and was set at liberty. A second, with the above discharge in a state of ferment, afforded the same result. 1^ healthy pigeon was fed upon peas. These had been immersed the same fluid, after having been kept for five days in a stoppered tie. The bird, after five days, was to all appearances well, although Iso drank water mixed with the Cholera discharges. Slug. 19. — A hedgehog was fed on meat and egg, containing the ; day a drachm of the same fluid, and the next day the same ntity was taken. After four days the animal was liberated from box, no perceptible effect having been produced. BA.ug. 19. — A kitten three-fourths grown was treated in the same nner and with a similar result. A rabbit about one-third grown had Cholera evacuations that had been kept from five to eight dfcys mixed with its oats and cabbage : after three days it was liberated without apparent injury. As I shall endeavour to show in the Appendix, the diseases of man and those of the lower animals differ so materially that I scarcely expected that these evacuations would produce an injurious effect upon the animals taking them. The animals were all kept so that the evacuations could be carefully examined. No important good E Cholera, the experiments, would have given great support to the water theory. I may add that I have had an opportunity of watching most of the animals up to the present time, and that they appear to be perfectly healthy. Other modes of experiment, such as injections into the veins, have occurred to me ; hut I am glad to escape on this occasion with an easy conscience, and I gladly abandon them, believing that no positive good would result. CONTAGION. I Contagion and Infection. — Although as I have said in my first Br (p. 7) that Cholera is contagious only to a certain extent and , very limited degree when compared with small-pox, scarlatina, other zymotic diseases ; yet there can be no doubt that a vast iber of cases can be traced to infection, and in a great many in- Lees where it appears in a fresh locality some clue is afforded as to mode of ingress ; thus, it is tolerably certain that the late outiks in Dublin and Belfast may be traced to the importations from erpool, and so with the remarkable case at Epping, and a great ly others that could be enumerated. In commenting upon the influence of trades and occupations (in 1849, p. 5), I have fully shown that persons especially exposed to the influence of the poison, such as medical men, students, clergymen, and nurses, have not been more affected than others who have been away from Cholera patients. In 1849 only 17 medical men died in London of Cholera, and not one medical student, whilst 28 lawyers and law-clerks, 14 of each, fell victims to the disease. |[n 1853-1854, as will be seen by the statistics, only two medical ,ctitioners died of Cholera in London, whilst during the present demic I only know of one medical man in England, Dr. Ansell Bow, who has died from this cause. I During the recent outbreak of Cholera at Amiens two physicians re died and several inmates of the hospital, but those acquainted h this town, which possesses all the requisites for the propagation I spread of Cholera, will not be surprised at this. During the sent outbreak, of 70 nurses at the London Hospital, who have ended upon 559 patients with Cholera and choleraic diarrhoea, four re been attacked, three of them slept out of the hospital, and one ? a regular nurse. It must be borne in mind that this hospital, as 3 the case at Amiens, is in an infected district. In the medical 26 and surgical wards not a single patient, I believe, has been affected with the disease ; but at Vienna, Amiens, and other places, many inmates of hospitals where Cholera patients have been introduced have Irhere is one circumstance that demands especial attention, viz., the ?ility of women who wash the clothes of the infected to take the ;ase. Many examples of this kind are on record ; but then it must •emembered that these persons are mostly in infected localities. Asling that the disease is conveyed in this manner, does the poison er the body by the skin or by the lungs, and what influence has increase of temperature in favouring its ingress? From the abers of persons employed about dead bodies and their singular mption from the disease, I am induced to believe that warm water f have favoured the introduction of the poison in the cases first In the Report of the Cholera Committee of St. James, Westminster, •5, page 19, from which I have before quoted, occurs the following : •f the 825 houses in this area, fatal attacks of residents occurred •13 ; there were 159 houses having single deaths ; 85 with 2 deaths ; with 3 ; 15 with 4 ; 12 with 5 ; 3 with 6 ; 4 with 8 ; and 1 with There were no less than 21 instances of husband and wife dying bin a few days of each other," a circumstance I have alluded to in first essay ; grief, I believe, acting as a depressing cause. I'o show that something has been done towards the elucidation of question of contagion I extract the following recommendations of Board -of Health, with Sir H. Halford, the President of the ege of Physicians, at its head, October 20th, 1831 : " Rags, ?rs, and cordage should be burnt, and the victims burried in deed ground." " All articles of food shall be placed in front of house, and taken in when the person carrying them shall have •cd." " Convalescents should be kept under observation for twenty i." "It may be necessary to draw troops and police around the jted place." Before I finish this chapter I refer the reader to page 7, to the unt of the mortality among medical practitioners during the ne fever in Ireland by way of contrast. PATHOLOGY. I 'ore I speak of the pathology of Cholera, let me briefly allude to hysiological question of great importance upon which the theory )r. Johnson mainly hinges, viz. spasm of the minute pulmonary ries. Dr Johnson says, — " I suppose that no physiologist of 27 28 as spasm of the muscles." (P. 50.) Dr. Johnson will not, perhaps, class me with the physiologists of the present day ; but I have devoted a good deal of attention to this study for the last fourteen years, and I hope that my labours are not altogether fruitless. I first deny that spasm can take place in any but a muscular structure, and I moreover assert that there is no proof that spasm ever takes place in an artery or in an extreme I have long been looking for the proof, and shall be pleased if Dr. Johnson or any physiologist will furnish me with it. In 1848 Dr. Hughes Bennet was a candidate for a university chair in Edinburgh. He told the learned Town Councillors in his trial dissertation by a kind of Scotch concours, which very properly elected him, that the doctrine taught by Cullen in that university of spasm of the extreme vessels was proved to be perfectly true. In the next room to the lecture-room were a large number of microscopes, some of them showing the circulation of the blood, and I asked Dr. Bennet to give us proof of the correctness of his assertion. Dr. Bennet and others assume that the application of stimulants and other agents to a vessel, and the consequent stoppage of the blood, is a proof of its muscularity ; but I believe the effect is simply mechanical. If spasm of the extreme vessels were possible, I fear that we should be often subject to greater evils than those even occasioned by the Cholera. It is a mere assumption unsupported by proof. But, assuming that Dr. Johnson's theory of spasm of the minute arteries is correct, what a labyrinth of difficulties we get into if we take the doctor's views of the question. If these pulmonary arteries possessed muscular fibres, and they were in a state of spasm, what so likely as opium to relieve them ? And could the advocates of the opium treatment, if they are converts to Dr t Johnson's spasmodic theory, have a better proof of its correctness ? But, unfortunately for them, Dr. Johnson ignores both opium and the warm bath. This question in relation to spasm of the minute arteries does not refer to Cholera alone, but it is one of very wide application, and therefore I have made it prominent. |[n Cholera there is no special disorganization of structure in the t and second stages, except the loss of a large amount of the thelial lining of the intestines and other parts, as evidenced by microscopical examination of the alvine evacuations, and by the >earances after death. The hyperemia that is seen in some organs, >ears to me to be due rather to the loss of the via a tergo, the ing powers of the heart, and to the thickened state of the blood, c central organ is unable to propel the thickened blood through the tern ; hence the loaded condition of the right cardiac cavities, and comparatively anaemic state in many instances of the pulmonary ans. In the third or reactionary stage, congestion of the lungs, neys, and other organs, may be met with, that are not present in 29 I stage of collapse. The small size of the spleen and its firm ;ure in most cases, forms a remarkable contrast to its appearance ever and in other diseases of a low type. There is one important umstance in the pathology of Cholera that demands, I think, c consideration than it has met with from pathologists and siologists. The suppression of the urinary secretion and the irious influence of urea, have been fully alluded to by some lologists, but the effect upon the system of the bile secretion has been, I think, properly appreciated. The gall-bladder is, in the it majority of cases, distended with thick bile ; the liver is ewhat congested, and bile may be squeezed out of the cut -tubes ; but, judging from the contents of the intestines, but c bile passes into the alimentary canal ; indeed, one of the most )urable signs in Cholera is the presence of bile in the evacuations, lat becomes of this secretion ? I have already alluded to this in former paper, the liver, the great depuratory, blood-forming (as )elieve), and heat-giving organ, ceases to secrete, its normal ,ntity of bile being from 20 to 24 oz. daily. I quote from my ay " On the Morbid Conditions of the Bile and Gall-Bladder, " idoti Medical Examiner, p. 227, vol. ii. I have ascertained by measurement that the gall-bladder of an It holds from ten to twelve fluid drachms of bile, and that of a d fourteen months old two drachms. It is difficult to ascertain exact quantity of the fluid secreted daily by an animal in a lthy state. In cases of fistulous openings, where the bile has been y collected, it may be said that the liver is in an unnatural condition, that its secretion may be more abundant. Taking the size of i organ into account, as well as the experiments that have been le by various physiologists, it is probable, I think, that the amount of the secretion has not been much overrated. L'Heretier mentions a case of biliary fistula, in which about 16 oz. of bile escaped in twenty-four hours, and probably all the secretion did not pass through the fistulous opening. Haller estimated the quantity at 24 oz. in the twenty-four hours in man ; Burdach from 17 to 24 oz. ; Liebig 24 oz. In the horse the quantity daily secreted is supposed to amount to 36 lb. ; in the ox 37^ lb. ; and in the dog to 36 oz. If the greater part of this fluid in a normal state is burnt in the circulation and affords fuel for the respiratory apparatus, the loss of temperature and the sudden sinking can readily be accounted for, without having recourse to the speculative theory of spasm in the extreme vessels. I believe, moreover, as I have often publicly stated, that the liver has more to do with blood-formation than any other organ, and that the assertion made by Professor Bennet, of Edinburgh, that the spleen and other ductless glands secrete the blood, and that of Kolliker and others, that the corpuscles are destroyed in the spleen, are equally erroneous. But to return to morbid influences. Unfortunately many of nature's secrets are at present hidden from us, till vi. vllvOv vviilivvlvlA •» A vLX vU\s L/Cv v 11 UX vq ₯ \J L V/ilvlvl (A) (U C vSUCviUII Jf U\5C Lf and obscure ; but although we may not be able properly to interpret the phenomena, the suppression of the biliary and urinary secretions and the disintegration of the blood, are alone sufficient to account for the fatal results. The feeble heart, the pulseless wrist, often for many hours before death, and the loss of the suction power of the auricle, are, I think, amply sufficient to account for the condition of the heart and lungs, without having recourse to such speculative theories as spasm of the minute pulmonary arteries. But what do Dr. Johnson's own cases prove? In his work on Epidemic Cholera and Diarrhoea, 1854-55, cases of Cholera and diarrhoea treated at King's College Hospital are recorded, and as far as the pathology is concerned, it does not, I think, tend to support his conclusions. Fourteen of the fifty-four cases were fatal, but examinations were not permitted in all. Let us see the condition of the heart and lungs in the inspections that were made. The numbers indicate the cases, which can readily be referred to. " Case 9. — Heart contained a small quantity of blood ; lungs pale and sanguineous. Case 10. — Intestines pink ; other viscera healthy. Case 11. — Lungs pale and exsanguineous ; heart healthy. Case 23. — Viscera of chest healthy ; lungs not so anaemic as usual. Case 35. — Lungs much congested ; reactionary stage. Case 37. — Fatty heart ; lungs healthy. Case 45. — Coma during reaction ; heart healthy ; lungs congested at the back and base." I^hat the lungs are specifically lighter in the vast majority of ilera cases Dr. Parkes and many others have long since determined, I believe that the anaemic condition arises from the causes I have merated, and not from spasm of the arteries. Assuming that the >page of the blood depends upon spasm of the pulmonary arteries, Johnson is wrong in supposing that the spasm is relaxed during ;tion, for in a great many cases this anaemic condition of the 3rior parts of the lungs is found in the reactionary stage. If Dr. kes' cases are carefully examined, I believe it will be found that ¦f give no support to this doctrine of spasm of the pulmonary As I have said before, I made several autopsies in ] 832 of persons dying of Cholera. Through the kindness of Dr. Andrew Clarke and Drs. Hughlings Jackson and Sutton, I have been present at the undermentioned inspections at the London Hospital, with a view especially to test the correctness of Dr. Johnson's statement respecting the condition of the lungs and heart in reference to the assumed existence of spasm in the minute pulmonary arteries during life. The notes are taken from my own observations. Aug. 7. Case No. 1. — Girl, act. 5 years ; collapse. Examined by Dr. H. Jackson. Brain normal ; no serum in the ventricles ; lungs, upper part anaemic, but not destitute of blood, and on exposure to the air when a section was made, the surface became red. The lower and 30 31 PATHOLOGY-CASES. I ending parts congested with fluid blood ; heart in situ ; the right icular appendix distended. On cutting into the auricle and tricle, a large quantity of thickish black blood was seen, some of it i-coagulated ; a less quantity was present in the left cavities ; in se it amounted to about one ounce. The liver slightly congested ; -bladder full of thick dark bile ; the kidneys normal in structure ; cortical part pale, the medullary portions red and congested ; the sen firm and healthy, but very small. The stomach contained a te pultaceous matter ; in the duodenum, and in other parts of the c, a thick white creamy greenish fluid was present. Ixamined, with Dr. H. Jackson and Dr. Sutton, the bodies of two !, one about sixteen years of age, the other fourteen, who died of lera in the stage of collapse. One boy came from Guernsey, and lk the same water on board the ship that the other sailors drank, declared that he had not tasted any other water. Case 2. Aug. 7. — A strong muscular boy. I need not recapitulate all the morbid appearances, as they much resembled those above described, except that in this case the right cavity of the heart was more distended with dark fluid, semi-coagulated blood, with a soft fibrinous clot adhering loosely to the parietes. The left ventricle contained about three ounces of semi-fluid blood. In this case the pericardium at the base of the heart was studded with minute ecchymoses and extravasations, not unlike those seen in cattle plague under the endocardium in the left ventricle. The stomach of this boy was lined with a greyish- white pultaceous matter, that somewhat resembled calomel, and as calomel had been given in rather large doses it was at first inferred that the medicine had remained unabsorbed on the mucous membrane. On careful examination, however, the matter appeared to be composed chiefly of curdled milk, but no chemical* examination was made. The liver, kidneys, and spleen were in the same condition as last described. In this boy the mesenteric glands were more than double their natural size, and the intestinal solitary glands were also large. Peyer's patches were more vascular than usual. The large intestines likewise contained the same pultaceous fluid, and small yellow excrementitious masses were present in some parts. Peyer's patches presented no abnormal appearance, nor did the solitary glands. Externally some parts of the small intestines were of a pinkish hue, the lower and depending parts being more congested. The urinary bladder contained about an ounce of urine. I3ase 3. — The morbid appearances in this boy were much the same in the first case, but in some parts of the small intestine there c ecchymoses and red patches, producing a mottled appearance. 3 aorta contained an unusual quantity of semi-fluid blood ; the nary bladder empty ; gall-bladder full of thick bile. * In a somewhat similar instance Mr. Dove told me that the deposit was chemically examined, and no calomel found. 32 cases it was less so. I carefully examined the blood, intestinal con- E'he blood-corpuscles were lax, yielding, not assuming the same ided form as in healthy blood, but when dried on glass, the appear) was more natural. The intestinal discharges all contained a c amount of epithelial cells, and the villi were generally denuded. IjASE 4. August 13. — A girl about 20 years of age died in the ly part of the reactionary stage ; the left side of the heart contained ut 3^ oz of dark fluid blood, the right side about 5 oz., the spleen mal. The stomach contained a dark grumous fluid, the lining mbrane ecchymosed in several parts with round small spots of ravasated blood ; a few of these were seen in the intestines. The 1-bladder full, the urinary bladder empty, and coated with thick , The brain congested externally, but the interior free from blood ; serum in the ventricles. IDase 5. — Boy, act. 6, died in the early stage of collapse. The , ventricle of the heart contained 1^ oz. of blood, the right six chms ; a portion of the right lung soft, and, from recent inflamtion, left congested. The bronchial tubes lined with purulent tter. The stomach ecchymosed in several parts, and the lower t of the oesophagus stained and spotted from extravasation of od. Small patches of ecchymosis were also seen in the intestines. Ease 6. — A girl, set. 4, died in the early stage of reaction. The s anaemic. The quantity of dark fluid blood in the sides of the t about equal. The right lung weighed 2 oz., the left 2^ oz. vessels of the brain congested externally. The cerebral substance aal. No fluid in the ventricles. Ease 7. — Child, set. 2. The morbid appearances differed but little l those last named, and the brain was much in the same condition. IJase 8. August 15. — Autopsies performed by Dr. Sutton. A mg powerful woman, about 30 years of age, died in the reactionary ye, five days after the commencement of the attack. The lungs eh congested ; both sides of the heart contained fluid black blood about equal quantities, with a small fibrinous clot in each of the ities. The whole tract of the alimentary canal was singularly free n congestions or ecchymoses ; the external part of a pinkish hue. c lining membrane covered with the white pappy matter before cribed. The cortical part of the kidney pale ;. the medullary por-3S of a dark-red colour. Urinary bladder empty. Case 9. — A girl, 6 years of age, died in a state of collapse. The lungs rather anaemic anteriorly, congested posteriorly ; weight 9 oz. The heart contained less blood than usual. The intestinal canal of this girl, like that described in the preceding patient, was to the naked eye apparently free from any trace of disease. Peyer's glands and the solitary glands were quite normal, and the intestinal mucous membrane of a pale whitish colour. En all the above autopsies the viscera were weighed, and in those noticed nothing remarkable was observed. I3ase 10. August 20. — A man, 45 years of age, died in the reonary stage. The lungs much congested ; left 18^ oz., right i oz. The right side of the heart contained about 4 oz. of blood ; left 2£ oz. The intestinal tube contained a greenish-yellow ;ter, the colour apparently produced by bile ; the mucous surface he naked eye healthy. The gall-bladder distended with about 5. of bile. Spleen small. Cortical portion of the kidney pale ; mamillary part red and congested. The renal bodies and the roid gland normal, as was the pancreas. IjASE 11. — A woman, get. 40, died in the reactionary stage, after eral days. The anterior part of the lungs anaemic, posterior parts gested ; weight of right lung 16 oz., of the left 11^ oz. ; a long, se, fibrinous clot extending into the pulmonary artery. A large mtity of dark-colcured blood on the right side of the heart, less in left cavities. Other organs as described in the last-named autopsy. IJase 12. — A woman, aged about 30. Both lungs much congested, c heart contained black fluid blood on both sides, but no clots fibrinous deposits. The gall-bladder much distended, and some iow faecal matter in the large intestines, of an offensive smell. The cous surface, as in the preceding cases, healthy to the naked eye. thing worthy of note about the remaining organs, except an ovarian lour, about the size of a cocoa-nut. I could add largely to these autopsies, but the above twelve examinations will suffice, I think, to give the general characters of the morbid appearances in cholera ; viz., congestion of the right side of the heart, a smaller amount of blood in the pulmonary structure, and the consequent diminution of weight of the lungs ; a somewhat congested liver and full gall-bladder. The cortical part of the kidneys pale, the medullary portions red and congested, with a small quantity ; a viscid urinary secretion in the pelves. The renal bodies normal, as are the pancreas and spleen, the last-named organ firm and diminished in weight. The intestines often externally present a pinkish appearance, in other cases they are partially congested. The mucous membrane of the stomach, and the lower part of the oesophagus, often ecchymosed and stained ; the gastric membrane not unfrequently covered with a white viscid pap-like matter, as is the lining membrane of the intestines. The intestinal tube often contains a large quantity of the peculiar rice-water secretion ; the mucous membrane being in many instances unusually pale and white. The urinary bladder is contracted and empty ; the vessels of the dura mater somewhat congested ; the substance of the brain normal, and the ventricles free from fluid. Other lesions may be present, depending upon the stage of the disease, such as emphysema, extreme congestion of the lungs, inflammation of these organs, extravasations of blood into the alimentary canal, great congestion of the brain, enlargement of the P 33 34 BLOOD- CORPUSCLES. Ktid and other salivary glands, stains and ecchymoses of the periium at the base of the heart. B^he great loss of epithelial scales on nearly all the thoracic and ominal mucous surfaces, is another point of particular interest. Eudging from my own observations, persons labouring under chronic adies are less liable to cholera ; but a more extensive examination ecessary to determine this. The state of the blood demands especial notice. I The Blood. — There is one expression in the first published essay it requires explanation ; the blood is described as tarry and treacly, t this was intended to refer more to the appearance than to the ual consistence of the sanguineous fluid ; the blood is generally ck, black, fluid, and some portions of it semi-coagulated. It has ;n chemically examined by O'Shaughnessy, Parkes, 'Schmidt, Bec¦el, Garrod, and others. Dr. Garrod {London Journal of Medicine, i 9, p. 436) says "that cholera blood can readily be distinguished in any other blood." Taking Beckerel's standard for healthy blood, ,le 1,062, female 1,060, Dr. Garrod found the specific gravity of )lera blood in males 1,076— 1,081 , in females 1,068— 1,074— 1,076 ; s blood globules increased from 140 to 166 — 171 in 1,000 parts, c density of the serum was greatly augmented ; the fibrine changed quality, so that it could scarcely be collected ; the urea was in ;ess, especially during the reactionary stage. In one case the urn of the blood taken during life yielded I*l4 parts of urea in )00. It can scarcely be wondered at that with such a condition of >od as this, combined with the other causes I have named, the ht side of the heart should be generally loaded, and the capillary isels of the lungs nearly free from blood. In eight specimens of blood that I have preserved and kept in stoppered bottles, there is no separation of the serum, the blood remaining of uniform consistence ; of a deep claret-colour when shaken upon the glass. There is one peculiarity in cholera blood that I believe has not been before noticed. In all the recent specimens of blood that I have examined under the microscope, I have found the corpuscles, when in motion, more yielding and changeable in form than in blood taken from patients labouring under other diseases ; and when at rest, before the corpuscle is dry, there is generally a central depression, although, after a short time, when the blood is dried on the glass, this is less apparent. Does this laxity of the corpuscle (as I believe) arise from the partial escape of its serous contents, and if so, will this account for some of the morbid appearances in Cholera ? This is a matter that requires further investigation ; but from the examination of the blood of man, and of a very large number of the lower animals, suffering from various diseases, I am enabled to speak with some degree of confidence upon this matter ; and here let me very briefly allude to an interesting question respecting the cause of the coagulation of the blood, and of its tendency to stagnate in the vessels of the living body. I was a candidate for the Astley Cooper " Prize Essay on the Cause of the Coagulation of the Blood," obtained by my friend Dr. Richardson, in 1856. My essay was a, very imperfect one, for I devoted too much time to the investigation of the size and formation of the blood-corpuscle of the lower animals, including the thickness of the parietes of the heart and large arteries, to allow of the prosecution of experiments that I intended to have made. During my microscopical examinations, I came to the conclusion, from repeated observation, that the escape of the fluid in the corpuscle by exosmosis played an important, part in the coagulation of the blood ; a conclusion, as far as I know, not before made. That the chief cause of the coagulation of the blood was the loss, or partial loss, of its vital or electric influence, and that the corpuscles became aggregated in consequence of the loss of their fluid contents. I believe I was the first, in my " Prize Essay on the Structure and Use of the Thyroid Gland/ to protest against the correctness of Dr. Richardson's conclusion that the loss of ammonia is the cause of the blood's coagulation, believing that no such cause could exist within the vessels, and believing, also, that the blood begins to die as soon as it leaves the body, and that the escape of ammonia is a necessary consequence of such death. The papers of Mr. Lister, Mr. Gamgee, and others who have attempted to refute Dr. Richardson's conclusions, were published after my Essay was sent to Guy's Hospital. I hope to make this matter plainer on a future occasion, and to show that the state of the blood in Cholera has a material bearing upon this question. TREATMENT. When investigating such a mysterious and fatal malady as Cholera, it behoves one to speak with great modesty and diffidence, and to confess that we are now, as in 1832, utterly and entirely ignorant both of the cause and nature of this disease. We know that a subtle poison, which probably first exercises deleterious influence upon the nerves, pervades the system, and it may be is now in the blood of more than half the inhabitants of London. We know also that any depressing cause, such as fear, great bodily labour, vitiated air and water, improper diet, may so derange the atomic constituents of the vital fluid that a great proportion of the serous particles filter away, leaving the red corpuscles in excess, and thus the poison to a great extent destroys the heart's power, the blood remaining in many of the vessels still and stagnant ; and hence, as I fully explained in 1849, the necessity of arresting the serous discharge at the onset, and maintaining the integrity of the blood. It is in the early stage that the benefit of medicine is positive and unmistakable, and probably in this stage in the great majority of cases there is no disease so amenable to treatment. 35 36 It is true in some instances, especially in hot climates, the patient is struck down without vomiting or purging ; but these are exceptions to the general rule, and I have never seen a fatal case in this country where these symptoms have been absent ; and it must be borne in mind that in many fatal cases the intestines are filled with a large amount of the serous portion of the blood. Dr. Macpherson, who has seen a large number of Cholera cases in India, in his recent work on " Cholera at Home " says, " I have never seen a- case in which there has not been vomiting and purging." Dr. Hardie, Surgeon 73rd Regiment {British Medical Journal, August 25th, page 209), who has seen the disease in India as well as in two epidemics in the Mauritius, says he has never met with a case of the so-called dry Cholera ; and I believe that this statement will be confirmed by the majority of medical practitioners who have fully investigated the cases of malignant Cholera that have come under their notice. In all diseases we find occasionally strange deviations from the general type, and so in Cholera examples may occur of what is called dry Cholera (Cholera sicca), but these are rare and unfrequent. Comparative Methods of Treatment. — As I have before said, much will depend upon the period of the epidemic, the locality, and probably on the mode of treatment, although in all localities this is varied enough, and we have had vaunted remedies of all kinds, and many that appeared to be successful when first tried, but have afterwards lost their reputed efficacy. Dr. Bushman, in his work' on " Cholera and its Cure," 1850, gives the preference to the saline treatment, and of 446 cases, he says " only eight were fatal " under Dr. Stevens' plan (page 164), and yet so little confidence is placed in this treatment that it has scarcely been resorted to during the present epidemic. Under the calomel treatment and under various other methods of cure, or of reputed cure, I could quote examples of success equally startling. It is evident, that if the hospital establishment which I advocated in 1849 (page 9), had been formed by the Government in 1854, or during the present outbreak, and three of the most approved modes of treatment had been carefully and accurately tested, we should not be in our present state of doubt and uncertainty. As I said in 1849 no objection could fairly be made on the ground that the poor should not be the subjects of experiment, for at the present time, if we look to the Hospital Reports, all treatment is to a great extent experimental. Irrespective of family ties, what medicil man would object, if he Cholera, to enter such an hospital ? Instead of the niggardly sum £500, employed by Mr. Simon (as reported in the medical journals), amount required for the building of one iron-clad ship for the truction of life would scarcely have been sufficient for the establishlt of temporary experimental hospitals, and for the prosecution of ntific investigation of a comprehensive kind. The treatment of Cholera may conveniently be divided into the ctuu. liiiLi lull, iuc luruicr iiicm .—.. — . «"*' «t*iiii uai , water with or without spirits of turpentine, ice to the spine, chloroform, counter irritants and rubefacients of various kinds, such as mustard, turpentine, ammonia, horseradish, galvanism, dry cupping, and exhaustion of the air from the surface of some parts of the body. Among the internal remedies are catechu, aromatic confection, diacetate of lead, kino, dilute sulphuric acid, ipecacuanha, common salt, saline salts, as sesquicarbonate of soda, chloride of soda, chlorate of potash, castor oil, calomel, bichloride of mercury, the mineral and the vegetable acids, preparations of arsenic, iron, copper, and zinc, sulphite of lime, bisulphuret of carbon, nitrous oxide, chloroform, chlorodyne, camphor, ether, oxide of silver, strychnine, quinine, chlorate of gold, bismuth, starch, various emetics, ammonia, tobacco, carbolic acid, permanganate of potash, elaterium, yeast, cannabine, tartarized antimony, oxygen gas, aloes, alum, sugar, charcoal, turpentine, Epsom salts, sulphur, rhubarb, asafoetida, black pepper, colchicum, Indian hemp, terchloride of carbon, salacine, creasote, Cayenne pepper, prussic acid, phosphorus. In addition to these, various astringents and other medicines have been thrown up the rectum, blood and' saline substances have been injected into the veins, solutions of morphia, quinine, and other Impounds have been by the hypodermic method passed under the n, and the rectum has been plugged to prevent the escape" of serous id. Itt must not be supposed that I have enumerated half the medics and modes of treatment that have been tried in Cholera. I ak of those only I happen to remember, and I trust that I shall be riven by any of my readers who may suppose that I have omitted asures that they may think of greater importance than any I have imerated. Ilperient or Eliminative Treatment. — I have already endeavoured how that the theory upon which this treatment is based is unstable visionary, for there is no proof whatever that spasms of the small ries of the lungs take place in this or in any other disease, nor here any proof that vomiting or purging are efforts of nature to rid of the poison from the system. It would be as rational, I ik, to infer that the sweating stage of ague is an effort of nature id the system of the malarious poison, and that it would, therefore, mproper to stop it by means of quinine. I jet me give the following examples, which have been witnessed by usands of practitioners. Two persons have choleraic diarrhoea ; the takes the necessary precautions and the diarrhoea is at once sped, and although the poison remains in his system, he is ;ored to health in two or three days ; the other, as in the case menled at page 8, neglects the early treatment-, goes on with his al occupation, losing a large amount of serous fluid by the bowels, 37 liiting is soon present, the stage of collapse sets in, and all medical in too many instances is unavailing. This is not an overdrawn ;nre, but one of daily occurrence. It is not pretended that all is of Cholera are so amenable to treatment in the first stage ; ortunately too many patients have succumbed when early assiste has been had recourse to, and no means have been neglected, as as our present knowledge extends, to arrest the progress of the ady. It cannot be too often impressed upon the public that a rrhoea that in ordinary times may be salutary, during the prevalence Cholera, if neglected, leads to a fatal termination. But let us come to a practical question, and ask what evidence we have as to the efficacy of the castor-oil or eliminative treatment, so called, in Cholera ? Let us pause for a moment, and ask whether this treatment is really eliminative ? I think most of my readers will infer with me that the term eliminative is a misnomer. If we wished to adopt an eliminative mode of treatment, Elaterium, Epsom salts, Glauber's salts, or some saline aperient that would increase the serous discharge from the bowels, would surely be more appropriate, and more in accordance with common sense. There are few persons who have not experienced the action of castor oil ; and there are few, I believe, in the profession who will come to the conclusion that the poison of Cholera can be eliminated by castor oil, which removes only the contents of the alimentary tube. But again let us ask, what evidence have we of benefit that has accrued from this treatment ? In Dr. Johnson's 54 cases of Cholera and diarrhoea treated at the King's College Hospital in 1854, only 14 deaths occurred ; but many of these were examples of the first stage of Cholera, choleraic diarrhoea, and therefore more amenable to medicine. I could find examples where the success has been apparently much greater under various modes of treatment. But what evidence have we of the efficacy of this mode of treating the disease during the present epidemic ? According to the reports of the Lancet and Medical Times, Aug. 11, Drs. Frazer and Davis, of the London Hospital, have tried it and abandoned it. Dr. Barlow, Physician to Guy's Hospital, in his excellent and practical articles on Cholera in the Medical Times and Gazette (Aug., 1866), neither favours Dr. Johnson's practice nor his pathology ; nor do the vast majority of the members of the profession. I could quote numerous examples where the treatment has entirely failed ; indeed, where all the patients who took the oil died ; but this, it is fair to observe, will^apply to any mode of procedure in the treatment of Cholera. As I said in my preface, castor oil can do but little good or harm in the latter stages of the disease, and it may be more successful than many other medicines whose virtues have been equally lauded ; but people are told, through the public press, to take castor oil in repeated doses in the early stage of Cholera, to eliminate the poison, instead of having recourse to astringents and opium — a doctrine, I believe, alike dangerous in practice md false in theory 38 39 question as to the best treatment to be adopted ; and I now, as in 1849, give the preference to calomel. It may naturally be said, " But why administer calomel, and condemn the use of castor oil ? — they are both aperients." But all who have had sufficient experience of the use of these medicines know that their action is very different ; the one, calomel, often acting as a sedative by arresting the vomiting and assisting the passage of the bile into the intestines, whilst the other is too often an irritant as well as an aperient. Calomel, according to my experience, tends to diminish the gastric and alvine serous discharges, and does not act as an eliminative in the sense used by Dr. Johnson. Another great advantage in the calomel treatment is that the medicine is readily administered by placing it upon the tongue, whereas the castor oil is generally disagreeable to the patient ; and many, to my knowledge, have positively refused to take it. But lat is the calomel treatment ? By this I mean the simple administion of a grain of calomel, with the same quantity of sugar, every een minutes for a few hours ; after which the dose can be linished ; or two grains of calomel every half-hour, without opium stimulants of any kind. I have stated (p. 9) that in 1849 I ited twenty cases of Cholera ; and that, with one exception, they re all seen with other practitioners. Of these only seven recovered, i several were nearly moribund, and in the great majority the omel treatment was not fairly carried out ; stimulants, opiates, ines, and other medicines having been given before it was comnced. I have but little faith in this treatment unless it be early >pted. Let me give an example or two of its efficacy (or supposed cacy) when given at the onset of the attack of serous purging. In 1848-49 I attended three members of our profession for Cholera, IVIr. Smales, then living at Walworth, the late Mr. Jos. Beane, of ikham, and my brother, Mr. F. Crisp, of Walworth. All had tnps, cold skin, and serous vomiting and purging. I need only >rd the particulars of one case. Mr. Smales, after neglected rrhoea for two or three days, was seized with serous vomiting and ging early in the morning when in bed (the most common period of tck). He had partial loss of voice, severe cramps of the legs and omen ; the skin and tongue were cold, the eyes sunken, and the ntenance much altered. I gave him a grain of calomel and a grain of sugar on his tongue every fifteen minutes, with a little ice and soda-water occasionally. After a few hours the vomiting, or, rather, the gulping up of fluid from the stomach, diminished ; the diarrhoea became less frequent ; the countenance and the pulse improved. The next day a bilious motion was passed, the secretion of urine returned, and the patient gradually recovered after taking about forty grains of calomel. The other cases were rather less severe, but the result of treatment was the same. I believe, in these examples, as in many others that might be adduced, it was the early administration I the calomel, without injurious complications, that favoured recovery, rould never administer astringents after the appearance of serous niting and purging, not because I believe that the vomiting and rging are the means of eliminating the poison, but because the omel appears to me by its action on the mucous lining of the mach and intestines to arrest the discharge of serous fluid, and to p those actions that are called eliminative. To use a homely rase, an astringent that may act as a plug in the bilious stage of ,rrhcea has but little influence in checking the discharge at a later iod, when the intestinal villi are rapidly losing their epithelial ering. The reader must not suppose that I put much faith in calomel, or any other medicine, in the latter stages of Cholera ; but in the early ge, although admitting its failure in a great many instances, I ye more confidence in this medicine than in any other, not judging ne from my own experience, but from the testimony of the great ik of those who have written upon the treatment of Cholera. I Two very contradictory objections have been urged against the use calomel ; the one is that it is not absorbed, the other that it fduces salivation. Who would not be glad to escape with a sore uth from an attack of Cholera? I may remark that calomel jcted the gums only in one of the cases above mentioned. The tement so often made that the calomel remains on the coats of the mach, and does not enter the system, I believe, is generally founded ; in two cases I have alluded to, what appeared to be omel, proved on examination to be other matter. In the last ge of collapse, with a loaded and oppressed heart and a highly soned blood, neither calomel nor any other medicine can be of much vice ; the time for calomel is at the onset of the serous purging and niting. I Best Means of Prevention. — I believe that no person in a Cholera trict, whatever his occupation or station in life, is free from the bility to an attack of this disease. The statistics I have given indantly show this. The best plan for all who can afford it is to ye the infected district and seek, a pure atmosphere. For those o are compelled to remain, from conscientious or other motives, I ieve the best precautions that can be taken are to keep to the t and drink that they are accustomed to ; to avoid excesses of kinds ; and especially to stop diarrhoea at the onset, by opium 1 astringent medicines ; to avoid so-called specifics ; and to send once for their medical attendants, who are best acquainted with peculiarities of constitution that may exist, and who can vary the itment according to circumstances. For those who cannot at once cure medical advice, I recommend the following mixture, a fourth t to be taken every two or three hours, until the diarrhoea is eyed. One dose will generally suffice until medical aid is 40 U Tinct: Opii, si. Tinct: Catechu, 3ii. , Spts: Aramon: Aromat: s'. Vini: Ipecac: 5i- Aquae Cinnamomi, Jvi. ft. Mistura. Other means, such as three grains of diacetate of lead, with a quarter of a grain of opium, repeated every two or three hours, if necessary, may accomplish the same end. But above all things, as I said in 1849, stop the diarrhoea at once. Attention to drains, to water-closets, and to good ventilation in all parts of the house is highly necessary. The use of disinfectants, such as carbolic acid, permanganate of potash, chloride of lime, vinegar, burnt tar, and sulphur, may also be had recourse to. During a cholera epidemic, as I said in 1849, I believe the making of large fires in infected districts, and the burning of tar, rosin, nitre, charcoal, and sulphur would have a good effect ; and in all private houses I think it is a good plan two or three times daily to burn brown paper, with a small quantity of tar and sulphur. These measures may not altogether prevent attacks of cholera, but I believe that they would diminish their number. Boiling the water that is drank is a matter of special importance ; and in addition to this, filtration through animal charcoal may be resorted to. Hereafter it is to be hoped that the water of London, and that of all our large towns, will be obtained from a greater distance than at present. The Thames, although comparatively pure, contains abominations of all kinds ; and so with the greater number of rivers supplying large cities. The necessity of disinfecting and of properly disposing of all cholera evacuations is most important, and it is better, where it can be done, to have a hole dug in a suitable locality, and cover them with a ler of earth. Sulphate of iron should also be mixed with them. I ?d scarcely say that cleanliness on the part of all nurses should be ictly enforced, and all bedding, clothes, and linen should be destroyed carefully disinfected. Dr. Jules Worms, in an able pamphlet on " The Diffusion of Cholera," Paris, 1865 (p. 43), says, " Cholera patients were admitted at the Military Hospital of Gros Caillou, during six weeks. All the lections were received into closed vessels, and mixed with sulphate iron, and all the linen plunged into a solution of chloride of lime, ice this, not a single case has appeared among the wards occupied by the other patients, although they are only 30 metres from the special service wards, and no medical officer has been attacked." In closing this chapter on the prevention of Cholera, I cannot help alluding to a remarkable circumstance mentioned by Dr. Hardie, whose paper I have before referred to. During the outbreak of Cholera at the Mauritius, June, 1854, 1,800 Chinamen were in the midst of the disease, and of these only two died. Did the use of opium and a 41 42 ROYAL COLLEGE OF PHYSICIANS. 1 occasion this immunity? I think it more than probable that is the correct explanation. I Before I conclude this chapter on treatment I cannot help comnting upon the widely-circulated directions given by the Cholera mmittee of the Royal College of Physicians, at the solicitation of i Privy Council, to captains of ships, and to the public generally, the treatment of Cholera. Of all things commend me to a conve of doctors ! The greater the number, I believe, the greater the lger to the patient. All have their pet crotchets, and the result is it instead of plain common-sense directions, the whims and caprices all must be consulted, and too often a namby-pamby, half-and-half itment is adopted. The President's and Dr. Johnson's (soled) eliminative medicine must have its due influence, so castor-oil y be given at the onset, if " bad or obviously indigestible food has sn taken, or if the discharges are unnaturally offensive." Fancy the •tain of a ship attending to offensive discharges or obviously indiitible food. Better invoke the aid of Neptune. I jet me give, at the risk of again being charged with presumption in ering from such learned authorities, the treatment I have recently pted in my own case when suffering from diarrhoea. On the 7th August I saw a large number of Cholera cases at the London spital, through the kindness of Dr. Andrew Clarke. I also spent ie time in the dead-house, as well as in the examination of the )d and excreta under the microscope ; added to this, my diet at per was not of the most orthodox kind. In the night I was icked with diarrhoea, and in a short time I took catechu, chalk, rain and a half of opium, with some ipecacuanha, and I was well a, few hours. Ido not assert that I had Cholera, but I think no son can be long in Cholera wards and over dead bodies without >ibing some of the poison. Let no one with diarrhoea in Cholera es trust to five-drop doses of laudanum, or to ten grains of aromatic rder of chalk and opium. En too many cases patients, when seen at the earliest stage, will die er every mode of treatment, but I believe the best plan is to stop purging at the onset with a sensible dose of opium, combined with c astringent. GENERAL CONCLUSIONS. Conclusions. — 1. That cholera is a disease occasioned by a specific poison that affects first the nervous centres, paralyzes the heart and the most important organs of secretion, the liver and the kidneys ; disorganizes the intestinal secretory apparatus, disintegrates the blood, thereby allowing a large portion of its serous constituents to escape from the system. and the consequent sinking in Cholera, depends upon spasm of the pulmonary arteries, is not founded upon correct physiological inference nor upon pathological proof. 11. That the belief that the vomiting and purging are efforts of ure to get rid of the morbific matter from the system has little 10 real foundation, and that the general adoption of the so-called linative or aperient treatment in the early stage of Cholera is likely cad to injurious results. 4. That, judging from the occupations of 5,566 males dying in London in 1849, 1853, 1854, and 1866 over 20 years of age (some of them engaged in the most dirty and filthy employments), occupation alone exercises but little influence in the production of the 5. That there is every reason to believe that under certain circumstances Cholera is a communicable disease, but to a much less extent than small-pox, scarlatina, and other zymotic affections. 13. That bad water, improper food, a vitiated atmosphere, want cleanliness, intemperate habits, fear, the incautious use of aperient iicines, and other depressing agents, all act as predisposing and iting causes of the disease. 17.I 7 . That the general belief that Cholera is a disease confined especir to the poor and destitute is entirely disproved by the statistics t I have adduced. 11. That the great majority of Cholera cases, when seen at the onset he first stage of choleraic diarrhoea, are for the most part readily ler the control of opium, combined with astringent medicines. I). That, judging from our present knowledge, the calomel treatat when commenced early in the second stage of Cholera and perly carried out offers the best chance of cure, but that, like every er medicine, in many cases it appears to have no salutary effect. 10. That, as shown by my experiments, Cholera evacuations proe no injurious effect upon fishes, reptiles, birds, and quadrupeds ; that, from the evidence I have adduced, the lower animals and the abers of the vegetable kingdom during Cholera epidemics in this ltry have been as healthy as usual. COMMENTS ON THE PUBLIC HEALTH ACT. Public Health Act. It will not be out of place at the present time to say a few words on the Public Health Act, August, 1866, especially as regards the conveyance in public vehicles of persons labouring under infectious diseases. 1 was the first in the London Medical Examiner, January, 1851, to bring this matter before the medical 43 44 Ifession. No other medical journal had treated upon the subject. *py the article to show that after fifteen years my suggestion has n but very imperfectly carried out. ON THE PUBLIC CONVEYANCES OF LONDON.* More than twenty years ago, we were in the habit of riding frequently in the Paris omnibus, a nice, roomy, well-ventilated vehicle, with plenty of room for knees and elbows, where a duchess might sit at her ease, and the asthmatic patient breathe with the same freedom as in his own chamber. The conductors well dressed and civil ; the coachman going a steady pace, but though rather tortoiselike, he reached his destination without loitering on the road; he gave his passengers time to get fairly seated before he started, and did not endanger their lives and limbs by jolting them off the steps at their departure. Drunken people, bundles of linen, sheep's heads, baskets of fish, and other offensive articles, were not permitted to annoy the eyes and noses of the travellers, and dirty straw did not encircle their feet. Moreover, for threepence a person could be put down in any quarter of Paris. The above description will apply to the present mode of travelling in Paris, as well as to that of 1829. At the latter period there was not an omnibus in London. But why are our vehicles so badly regulated ? Simply because government takes no concern about the matter, so long as it gets the duly; like the sale of quack medicines, the money is the object; the public welfare is a secondary consideration. But what has this question to do with a Medical Journal, it will be asked ? We have introduced the subject, because we believe it is one that materially concerns the public health. It is nothing to us if people wish to be squeezed and wedged together like the oxen at Smithfield ; this and other matters we could name, do not come within our province, but if we can show that many persons lose their lives, by the bad arrangement of our public conveyances in London, our time will not have been unprofitably occupied. We need not inform medical readers that a certain number of people require a given quantity of pure air, for proper respiration, and that, according to the present size and ventilation of the London omnibus, they cannot obtain this. That if a person predisposed to illness breathe such an atmosphere — as he is frequently subjected to — in one of these carriages, he must soon be on a sick bed. That an individual, during the prevalence of Cholera, or any other epidemic, when the tendency to disease, and the preservative powers of nature, are nicely balanced, need only get into an omnibus to turn the scale. If rheumatism should be his bane, he may obtain draughts without a doctor's prescription ; or he may inhale the vapours from bundles of dirty linen, reeking from the bed of contagion. I jet us now turn to another evil respecting the public health, that has been irely overlooked. At the commencement of the present year, we attended a y beautiful woman, who fell a victim to that former scourge of the human 3, small-pox. A few days before the eruption appeared, she was on board a imboat at Southampton. The man who gave the cheques, had his skin ered with small-pox pustules. This lady believed she had taken the disease, )re it appeared, and thought that it would prove fatal. But who can get into ired vehicle of any kind in London, and feel sure that the lining is not saturated h. the miasms of small-pox, scarlatina, or typhus ? IVe see no chance of redress for these evils, until we have a Board of Health )erly constituted, and a government that thinks more of the public good, than of He pensions. There is no reason why the conveyances of London should not .s comfortable and as salubrious as those of Paris. We would have vehicles arious districts for the express purpose of carrying those affected with conous diseases ; and we would inflict a severe penalty upon those who, by injing this law, endangered the health of the community. * from the London Medical Examiner, 1851, vol. i.. p. 243. Let me now ask how this Act will remove the clanger of which I complained in 1851. I copy clauses 24, 25, 38 : — 14. It shall be lawful at all times for the nuisance authority to provide and utain a carriage or carriages, suitable for the conveyance of persons suffering er any contagious or infectious disease, and to pay the expense of conveying person therein to an hospital or place for the reception of the sick, or to his i home. Ik If any person suffering from any dangerous or infectious disorder shall r any public conveyance without previously notifying to the owner or driver sof that he is so suffering, he shall on conviction thereof before any justice be c to a penalty not exceeding five pounds, and shall also be ordered by such cc to pay to such owner and driver all the losses and expenses they may r in carrying into effect the provisions of this Act, and no owner or driver of public conveyance shall be required to convey any person so suffering until shall have been first paid a sum sufficient to cover all such losses and nses. 18. Any person suffering from any dangerous infectious disorder, who ully exposes himself without proper precaution against spreading the same irder in any street, public place, or public conveyance, and any person in charge me so suffering, who so exposes the sufferer, and any owner or driver of a lie conveyance who does not immediately provide for the disinfection of his veyance after it has with the knowledge of such owner or driver conveyed such sufferer, and any person who without previous disinfection gives, lends, 3, transmits, or exposes any bedding, clothing, rags, or other things which c been exposed to infection from such disorders, shall, on conviction of such ace before any justice, be liable to a penalty not exceeding five pounds, proid that no proceedings under this section shall be taken against persons transting with proper precautions any such bedding, clothing, rags, or other things the purpose of having the same disinfected. I^s I interpret the Act, nuisance authorities may provide these icles ; but it is not compulsory, as it ought to be, for every Metrotan vestry, or two or three vestries, to have such a vehicle in liness, for which those using it should pay ; and clauses 24 and 25 so easily evaded that it will be almost impossible for a magistrate :onvict under them, and the same remark will apply to clause 08. lirrangements can easily be made with cabmen ; and all who carry ctious bundles of linen in omnibuses will continue to do so with unity. It is a difficult matter for the law to reach. IPhe only remedy, I believe, will be to have proper vehicles for the pose, thoroughly disinfected, so that people may have no excuse evading the Act ; and railway authorities should be compelled to c a carriage to be used only by those who are affected with tagious diseases. Adults and children recovering from small, scarlatina, and measles, are constantly removed in first-class •iages, leaving the fomites on the cloth for the benefit of the t occupant. There is less danger in second or third-class carriages. : a matter of greater importance is the establishment by the rernment of two Metropolitan Hospitals on a large scale, the one small-pox and the other for fever, so that poor people arc not jeeted to the formalities, delays, and expenses that they are put 45 GOVERNMENT HOSPITALS. lit present. This is a national question, and it is not one that ild be left to private charity. Small-pox has been fearfully prent of late, and I need not say that the delay and difficulty often irienced in getting patients to the small-pox hospital is often the ns of spreading the disease. When shall we have anything national in this country ? The very ducks before the Queen's palace in k James's Park belong to a private company, although they are conred to be Royal ducks by the public. What slow steps will be le in advance during the next sixteen years ? ¦he Act contains some good clauses ; but I fear, as regards the enlents I have named, that they will be nearly inoperative. ADDENDUM. Since these pages were in print I learn that a full account of the Cholera cases at the London Hospital will appear in the forthcoming Hospital Reports. lam ture, from the great assiduity and zeal of all engaged in this inquiry, tl at this report will well repay perusal. In my letter on "Cattle Plague as Compared with Cholera and other Human Maladies," I sha.l have occasion again to speak of this pestilence. APPENDIX. I the origin, cause, pathology, treatment, and best mode of prevention of Cattle Plague — A comparison between Cattle Plague, Cholera, and other human maladies — A Letter on the treatment of the diseases of man and brute by Homoeopathy, with an expose of the false inferences and hollow assumptions of this pretended science, and on the present state of the Veterinary and Medical professions. PREFACE The first eleven letters were sent to the Lords of the Privy Council, and I publish them verbatim,* because I am anxious that they should form a record of the outbreak of Rinderpest in this country, and of the tardy and inefficient steps taken by those in authority to stamp out the pestilence at an early period. The letters were sent in manuscript to the Lords of the Privy Council, and then forwarded to the Mark Lane Express, where they were published, my object being to circulate my opinions amongst the agricultural community. In addition to this I had slips struck off, and these were forwarded to the London daily press, and to many of the Provincial newspapers. I now purpose, in addition to other matter, to add my comments to each letter, as the communications were for the most part hastily written By this means I hope to make the essay more valuable than it would have been, had it appeared at an earlier period. It was my intention to have published a larger treatise, with numercoloured drawings that I have made, many of which were exhibited he Pathological Society of London ; but the advent of Cholera, a belief that a comparison of • the two diseases may be profitably ituted, have induced me to alter nay plau, and to publish without her delay. Xl man who " sounds his own trumpet," does not generally gain good opinion of his readers, but at the risk of being charged with umption I state some of the results of my investigations. 1. I was the first to show, by experiments made upon myself and * Some few additions were occasionally made to the manuscript letters to the ii > Cattle Plague in its first stage was not injurious to man when used for food. (Letter 2, September 30th.) 2. That the poison of Cattle Plague, when introduced into the human system by means of inoculation, occasioned no injurious effects, with the exception of papular eruptions on the skin, and that the reported deaths from supposed Cattle Plague inoculation arose from splenic apoplexy. (Letter 2, September 30th.) 11. That the disease was a malignant spotted fever (febris maligna tata), and had little or no resemblance to typhus or typhoid fever nan, and that the ulceration of the stomach and intestines, spoken by the Government advisers and others, but rarely existed. (Let-2, October 31st.) I That the disease not only affected sheep and goats, as shown in fourth letter (p. 66), but that I knew of six different species iiminants that had died of it. 5. That an hospital should be formed by the Government in a suitable locality, with a staff of competent officers. (Letter 1, September 21st, 1865.) I). That experiments should be made by the Government on a large le, irrespective of cost, at the suggested hospital ; and the prophytic powers of small-pock matter, and that of scarlet fever, measles, hus, and typhoid fever virus by inoculation, should be tested, as 1 as the virtues of various medicines as prophylactics or otherwise, jtter 2, September 30th.) 7. That all fairs and markets should be suspended, the movements of sheep and cattle by rail or road should be stopped, that dead meat markets should be established, and that all foreign animals should be killed at the ports of landing, that all dogs should be shut or tied up, and all hunting prevented. (Letter 1, September 21st.) EThat an animal may be affected with this plague in an incit form so that no inspector can detect its presence, and that in manner the plague has been disseminated in all directions to a *ul extent. (Letter 3, October 7th.) K. That the Cattle Plague has been extended by means of hounds hunting. (Letters 7 and 10, December 20th.) 50 l\j. i nut tne tneory fis to the identity 01 small-pox and vyiittlc Plague is not founded on correct evidence. (Letter 8, January 4th.) It will naturally be asked by some of my readers whether, if I had obtained a government appointment, my strictures upon the proceedings of the Privy Council would have been equally severe. My answer is that the views I have enunciated respecting the state of our medical and scientific institutions have been long publicly expressed, and I think this a good opportunity of repeating them. Redtapeism would probably have had some soporific influence upon myself, as it appears to have had on all who have been encircled by it. All new matter is in a larger print. The chapters relating to treatment, future prevention, and the comparison between Cattle Plague, Cholera, and the diseases of man and the lower animals, have not been before published, nor has the letter on the homoeopathic treatment of Cattle Plague and other diseases, nor that on the state of the medical profession. I have pursued this investigation, as I have all my inquiries respecting the diseases of the lower animals and of plants, under the belief that I shall be able to throw much light hereafter on human pathology and treatment. The only proper method of studying the structure of organized beings is to begin with the lowest forms and work upwards to man : so I believe in the disorders and derangements of these structures, Nature's secrets are best revealed in the lowest grades of organization ; and I predict that hereafte — the period it is impossible to calculate — all students will study morbid derangement, as they now do, or should do, anatomy and physiology, by adopting the ascending scale. If my life be spared a short time, I hope to be the pioneer of this new method of investigating 51 APPENDIX. I LETTER I.— ON THE STOPPAGE OF THE MOVEMENTS OF LETTER I CATTLE, AND ON THE ESTABLISHMENT OF DEADMEAT MARKETS. TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. My Lords, — When the Cattle Plague first made its appeai'ance in this country, I placed before the Clerk in Waiting various documents, to show that I had for many years been investigating the diseases of the lower animals and of plants, for the purpose of throwing light upon human pathology and treatment, believing that in the study of disease the same system should be pursued as in the study of organized beings — viz., the ascent from the lowest to the highest, a mode of investigation which, I believe, is exclusively my own. Among the publications forwarded were my prize essay *on " Lamb Disease " (awarded by Lord Portman) ; my essay on the " Causes of Death of the Animals dying at the Regent's Park Gardens, from 1851 to 1862;" my essay on 11 Splenic Apoplexy in the Ox, Sheep, and Horse " (a disease that kills sooner than the Cattle Plague), and a numerous list of my papers and morbid specimens of diseases of the lower animals, exhibited at the Pathological Society of London. I have, moreover, made the largest collection of the diseases of the lower animals yet formed (many of them in wax). I offered my services to the Government, to investigate the cattle murrain in this or in any other country ; and I presume to think, my Lords, that, if my offer had been accepted, I could ere this have placed before the Government and the people such a history of the origin, cause, extension, mode of prevention, &c, of this disease as would have been of service to the country and to the cause of science. In answer to my letter to Sir G. Grey, I am informed by Mr. Waddington "that the appointment of inspectors is made by the Privy Council." Believing that my long and unrequited labours in the cause of science entitle me to a better and more useful post than that of a I* None of these are sold for my own benefit, or I should not have noticed them. Pur Lordships, from time to time, certain facts connected with se that will, I hope, throw some light upon the subject. The 3 one of national importance ; and I can, therefore, well afford any charge of presumption and vanity that may be brought le. I-iet me first place before your Lordships the line of investigation t I have chalked out in studying this disease ; and then, without owing the programme, I will in this and other papers touch upon a ¦ points that I consider of immediate and pressing importance. B. A brief history of epidemic and endemic diseases in man, in the er animals, and in the vegetable kingdom. I}. The history of the Cattle Plague in this and in other countries ; variation and abatement, according to season, locality, and the pretionary measures adopted. tThe origin and cause of the disease in this country, the localities hich it has appeared in the United Kingdom, with statistics of age sex, the number of animals affected, and the amount of mortality. X, The symptoms, duration of the disease, and its morbid appearis, especially in relation to the microscopical and chemical condition he blood. B. Is the milk or flesh of animals affected with this disease injurious luman beings when taken as food 1 I. What resemblance does the disease bear, in the symptoms and bid appearances, to the typhus or typhoid fever in the human ject? 7. Is the disease now prevailing the rinderpest of Prussia 1 8. On the parasitic origin of the disease. I. The normal visceral anatomy of the ox, sheep, and other ruminants, l a view to ascertain the peculiarities in the structure of the bovine ily that especially render them liable to be affected by this mystes poison. 80. The most practical and efficacious means of prevention, especially egards the prophylactic treatment by the internal administration of licine and the distribution of gases through the atmosphere. Kl. An estimate of the success attending the various modes of treatt, with suggestions as to the best methods to be pursued. K2. The best and most practical modes of disinfection, and an investion as to the efficacy of chloride of lime, and other agents as disin- K3. On the importation of foreign cattle as a means of engendering disease, with practical suggestions for the better regulation of this ort in future ; and on the necessity of restrictions in the conveys of cattle by rail. 14. A general summary of the above, with practical conclusions for guidance of the Government, of agriculturists, cow-keepers, and k-dealers. El said before, my Lords, it is not my intention to trouble you the series of investigations enumerated above, but rather to place 3 you, from time to time, such selections from my labours in this 54 difficulty presents itself at the onset in the proper investigation of this disease, in consequence of there being no scientific central authority in this country, to which the Government can refer in a calamity like the present ; and the same remark will apply to the medical profession. We have in the one profession * twenty licensing bodies, all requiring different curricula and different examinations ; and in the other a college granting a degree, but one which is not compulsory ; so that nine-tenths of the veterinary practitioners of this country have had no proper education or examination ! Again : let us look to agriculture, where, instead of an agricultural university and museum (the establishment of which I have long publicly advocated), where a good education might be obtained, degrees granted, and professors paid by the State, some of whom might be consulted in such an emergency as the present, we have another club (of which I am a member) in the shape of the Royal Agricultural Society, who eke out education by driblets at their model establishment at Girencester. My Lords, all is clubism in this country, and there is nothing national or universal about any one of our scientific institutions. But let me suppose, my Lords, for the sake of exemplification, that when this " Cattle Plague " first made its appearance, we had had in this country a representative Faculty of Medicine in England, Ireland, and Scotland ; a veterinary college in each of the three kingdoms, the examination at which all who (as in France) act as veterinarians would be compelled to pass ; and an agricultural university, in which the study of the lower animals would form an important item in the curriculum ; and that selected from these faculties or colleges a commission had been formed to investigate this disease, and to report upon it ; is it likely, my Lords, that many important matters would be in the same state of doubt and uncertainty as at present 1 Let me explain. In the lengthy document by Dr. Thudicum (approved of by the Privy Council), constant reference is made to the use of chloride of lime — " A healthy animal is to be washed with chloride of lime, with tepid water ; then fodder, both dry and green, is to be given ; then sop and pure cold water ; and next, the animal is to be rubbed dry with wisps of straw and hay." My Lords, there is no proof whatever that chloride of lime will prevent the noxious effects of this poison when received by the lungs, its ordinary and perhaps sole mode of access ; but assuming that the poison may be introduced by the skin, I can conceive no method so likely as this washing, wetting, and rubbing to effect the introduction of the poison ; and as to " pure water," everybody connected with cattle knows that these animals give the preference to, and do better upon, the water of ponds and ditches, which is so impure that it would be considered unfit for human beings. The occurrence of this disease is not a question of health. A diseased animal would probably be more likely to escape the malady which the strongest and healthiest readily succumb to. As I shall have occasion to allude to this curious document hereafter, I will * See my evidence before the Parliamentary Committee ou the Phurmacy Bill, Blue Book, 1852, pp. 156—165. 55 I the present confine myself to the chloride of lime question— viz , a this substance the disinfecting influence imputed to it ? How are to determine this 1 My Lords, if the imaginary commission I have ken of had been formed, a large sanitarium or hospital would have n established in an open space near London, where experiments ;ht have been made to determine this and fifty other matters that now in doubt and uncertainty. Experiments to be useful must be formed on a large scale ; few and isolated experiments only lead to c inferences. To such an establishment formed by the Government, jased animals, in closed vehicles constructed for the purpose, might c been taken ; cows and oxen of little value might have been surnded with chloride of lime, and introduced among the diseased mals ; others that had had their systems saturated with sulphur, tar, , and many other substances, might have been similarly tested ; and Jical and other modes of treatment might have been tried ; and in i way, as I believe, a vast number of important facts would have n elicited. On the score of cruelty, some would object to these teriments ; but they (the experiments) would be " cruel kind," as Irish say, as the sacrifice of the lives of a few cattle might be the ms of saving a large number, and the extension of the malady by ti a method as I advocate would not, I believe, be likely to occur. fefore concluding this my first letter, let me, my Lords, urge upon the necessity of at once placing restrictions upon the conveyance of ig cattle by railroads ; it is by this means that the disease has been tly disseminated and conveyed, to almost every part of England ; I think that the transport of all living cows, bulls, oxen, and calves ild be at once prevented, and all large gatherings of cattle at fairs agricultural shows prohibited. |>cad-meat markets should be established in various parts of London, in all our large cities and towns ; and the flesh only of oxen, cows, calves should be admitted, when properly dressed, and inspected by petent persons. lam aware that such a prohibition would excite a ,t deal of opposition and discontent in certain quarters ; but the sssity of taking stringent and active measures for preventing the ad of this disease is so urgent that all should be willing to make ifices for the general good. All foreign cattle (like our home-bred ts), for the present, should be slaughtered out of London, and the i sent to the dead-meat mai'ket, after proper inspection ; and so at >ur seaports where foreign oxen are landed. I have the honour to be, my Lord, Yours respectfully, Edwards Crisp, M.D. 42, Beaufoit Street, Chelsea, Sept. 21, 1865. Remarks. — Circumstances occurred that obliged me to deviate somewhat from the plan of investigation I had chalked out. The state of our medical and scientific institutions in connection with the progress of Cattle Plague I shall speak of hereafter. 56 57 LETTER lI— EXPERIMENTAL GOVERNMENT HOSPITAL. LETTER II TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. My Lords, — I learn from the Clerk in Waiting, Mr. Helps, that my letter published in the Mark Lane Express, September 25, was placed in the hands of Professor Simonds ; but, my Lords, as I have informed Mr. Helps, these letters are intended for your Lordships' perusal, and not for that of Professor Simonds, for whom I scarcely need say I entertain no unfriendly feeling, and you will pardon me, I hope, for repeating what I stated in my first letter, where I offered to investigate this disease. I trust that the special researches respecting the diseases of the lower lals, which have so long occupied my time and attention, will be a cient excuse for the present application, and that it will not be mid that I am desirous of infringing upon the province of the veterinary ossion. lefore entering upon the question of prophylactic treatment, and of best means of testing this treatment, let me observe that, as far as researches have gone, I do not find the same resemblance, either in symptoms or morbid appearances, to the so-called typhus and typhoid rs, that many have insisted upon ; but this is a question that I shall 3 to bring more fully before your notice hereafter. Let us now, my Lords, consider the important and vital question of prophylactic, or preventive treatment ; for, by this method chiefly, combined with the precautionary measures recommended in my <3rsb letter, I believe, we are likely to stay the progress of the pestilence ; and I may here remark, that although I am an advocate for a large experimental hospital in the first instance, in the neighbourhood of London, I see many objections to the establishment of numerous sanitaria in cities and towns ; for I believe, if such hospitals were numerous, the plague would be greatly extended, and from the inadequacy of the funds at the disposal of private persons no experiments could be performed of a sufficient magnitude to lead to satisfactory results. The failure of the City Sanitarium, partly patronized by your Lordships, and the return of the money to the subscribers, are surely sufficient to show that such undertakings are not likely to succeed in the hands of private individuals. The .£1,500 subscribed would scarcely be sufficient to supply the closed vehicles that would be required for the conveyance of the diseased animals. My Lords, to carry out this scheme effectually £100,000 at least would be inquired ; a very small sum when the magnitude of the evil is considered and when the probable good that might accrue from the undertaking is contemplated. There is one objection that may be brought against the establishment of this experimental hospital, viz., " that it may become, by the accumulation of a large number of diseased animals, a focus of contagion ;" but I believe if proper precautions were taken no such evil would result, but on the contrary, diseased and dead animals that are I 58 PLAN OF THE HOSPITAL. now driven about the streets*, and their bodies exposed in open carts, would here be leas likely, by their greater seclusion and the proper disposal of their bodies after death, to be the means of disseminating the disease. It must not be supposed that I advocate the attempt to treat the generality of animals affected with this disease ; I believe, according to the present state of our knowledge, as suggested by the advisers of the Government, the best plan is to kill a diseased animal at once, and by this means endeavour to prevent the extension of the plague. But where is this killing and slaying to end 1 Are we to rest satisfied with our present knowledge, or rather ignorance, of the nature of the disease and its treatment 1 A remedy has been found for small-pox ; and Asiatic cholera (a disease now in our midst) is, in its first stage, I believe, more amenable to treatment than many others. Why may not a remedy be found for the " Cattle Plague " "] Why should we sit with our hands folded, and say, " The disease is incurable ; doctors know nothing about it, and the animal must die." Let certain modes of treatment, my Lords, be fairly tested before we arrive at so unsatisfactory and so un philosophical a conclusion ; and let us not suppose, because the disease has hitherto baffled our efforts, that a remedy may not yet be found. Have we tried the right method of searching out Nature's secrets and of unveiling one of her hidden mysteries? Have we endeavoured to trace the incipient and early effects of this subtle poison 1 t*et me now, my Lords, briefly sketch an outline of the mode of inigation I recommend to the Government : many modifications and rovements may be made by others. I\. space of five acres on Wandsworth-common, or in any suitable ility near London, should be covered with temporary wooden builds, for the reception of 300 or 400 cattle, especial care being taken t the floors where the cattle are placed are of brick or asphalte, and t suitable means be taken to ensure good drainage — that large pits be ; for the reception of dead animals, and a good supply of fuel, quickc, and of various substances for the fumigation of the atmosphere, be vided. I Attached to this hospital should be a commission composed of a good ilytical chemist, a good pathological microscopist, four or six veteriy practitioners, and two medical men, who would at once make a ies of experiments and investigations respecting the progress of the rbid changes in this disease, as shown by chemical analyses of the ious organs and their secretions— by the changes of structure as iudied by the microscope, and especially by the investigation of the effect certain medical treatment, external and internal, upon diseased and m healthy animals, with the view to test the efficacy of supposed phylactic or preventive measures. The introduction of two members ;ne medical profession to this commission would scarcely be objected I think, by the veterinarians; as, without any disparagement to the ;er, it is well known that members of the former profession have been re minute in their investigations of disease than the practitioners of veterinary art. If such a commission were formed, the members would need no guide TRIAL OF VARIOUS MEDICINE, ETC. 59 to direct them as to the line of experiment to be pursued ; but no harm will result from my giving a short outline of my own plan. First, as to the efficacy of chloride of lime. In addition to the test suggested in my last letter, six healthy oxen might be inoculated with ten parts of the secretion from the mouth of a diseased animal, mixed with one or more parts of chloride of lime. Many experiments of various kinds might be made with other disinfectants, or supposed disinfectants, to test their efficacy. It is worthy of remark that in the directions put forth by the Royal Agricultural Society of England, chloride of lime is not mentioned. Eealthy animals, that had been for some time under the influence of me, iron, sulphur, tar, salt, vegetable and mineral acids, mercury, antiy, arsenic, hellebore, and other agents, might be introduced among the diseased cattle, and in this way the virtue of certain substances now of doubtful repute be thoroughly tested, and the important question answered, as to whether by any mode of treatment we can so alter the blood of an animal as to render it unsusceptible to the effects of this poison 1 The efficacy of quinine as a prophylactic might be especially tested by giving animals from 40 to 60 grains twice daily for a fortnight, and then introducing them among diseased cattle. It is not pretended that such an expensive medicine could be generally employed ; but, my Lords, we have a great number of animals in this country, worth hundreds and thousands of pounds, animals upon which the continuance of the present superiority of English stock depends, and in the treatment of these no expense should be spared. The question is not only one that concerns the food and health of the people, but it is one that especially affects us as breeders of cattle ; for if measures of a more stringent and active character are not taken by the Government, many of our most valuable stock will be lost. Although, as I have said before, Ido not see so great an analogy between this disease and typhus or typhoid fever as is generally supposed, yet I should in the present state of our knowledge place more confidence in the administration of quinine as a prophylactic than in any other medicine, and I would advise all stock-keepers who have very valuable animals to put them at once under this treatment. We have abundant evidence of the efficacy of quinine in preventing fever in the malarious and poisonous districts of Africa and other countries. A gentleman, who in one of the Nile expeditions was the only one to escape fever, told me " that he attributed his exemption to the circumstance of his having taken five grains of quinine twice daily for several months." I jet me, in conclusion, my Lords, mention a few medicines, the efficacy which may be fairly tested at this experimental hospital, in the itment of diseased animals. First, let twenty diseased animals be left rely to nature ; let the same number be treated with stimulants, and twenty be subjected to the saline treatment without alcohol ; the c or a greater number might be treated with turpentine, nitrate of er, decoction of oak-bark, the vegetable or mineral acids, alum, nuth, sulphur, sulphate of copper and opium, sulphate of zinc, acetate cad, sulphate of iron, pepper, catechu, and many other medicines, ie or in combination. Again, the effect of the injection of certain substances into the veins, in the treatment of valuable animals. |?o many the purport of my letter is already sufficiently Quixotic ; there is one matter that 1 cannot refrain from mentioning, viz., the ct of inoculation (under guarded circumstances) of the virus of r -pock, typhus, measles, and scarlatina from the human subject, as phylactics or as remedial measures. It is surely worthy of trial. c of the direct scourges of humanity has been kept in abeyance by introduction of vaccine matter from the cow into the human body. Irhese, my Lords, and many other matters crowd upon the mind in estigafcing this all-important and vital question. We are now in the rth month of the disease. The members of Lord Stanley's model liament are taking their ease, and are not to be disturbed ; a Royal nmission, composed of men learned in comparative anatomy and in te pathology, is "looming in the distance;" and when thousands re of cattle, and perhaps of sheep, have fallen victims to the disease shall have their report. Xi my next letter, my Lords, I will touch upon the peculiarities of structure of the ox, sheep, and other ruminants in relation to this ise. I have the honour to be, my Lords, Yours respectfully, Edwards Crisp, M.D. 42, Beaufort Street, Chelsea, Sept. 30d may be taken from the body in typhus fever without killing the ent ; and lastly, to especially exhibit the great difference between mortality of the Cattle Plague and human typhus. B'ith these preliminary remarks, I proceed to the main purport of etter — viz., as to the resemblance the so-called cattle murrain bears L 73 74 THE FOUR BRITISH FEVERS. Iyphus or typhoid fever in the human subject. On Monday last, at meeting alluded to, Professor Simonds told the farmers that the ase .was of a typhus or typhoid nature, but that he thought it more typhus fever. As you are probably unacquainted, my Lords, with history and practice of medicine, I will endeavour to make my larks as plain and intelligible as possible, so that they may be ierstood by all. My previous conclusions have been the result of my 1 observations ; but in the following resume I shall have to borrow ;ely from the best writers upon the subject of fever, many of whom c added valuable statistical information to their works. In this country we have four fevers that prevail at certain times ; one (the typhoid) may be said to be endemic, as it is rarely or never >nt : — Ist, the simple fever; 2nd, the typhus; 3rd, the relapsing or mine " fever ; 4th, typhoid fever. Some suppose that these fevers not specifically distinct, but only varieties of the same affection ; , however, is not the general belief, and it was only until about year 1835 that the difference between these fevers was clearly >gnized. I! need say but little about simple fever, as it does not arise like the ers from a specific poison. These fevers may be generated spontausly, or they may arise, as is generally the case, from causes that are ler human control. There are some who deny that these fevers are tagious ; but their number is gradually diminishing. As my object to make a brief comparison between the symptoms and morbid learances of the three last-named fevers and those of Cattle Plague, I I give a short outline of the important features of each. In all there pi'emonitory symptoms which are well known — heat, chills, languor, ,dache, dry skin, and quick pulse. The exact period of incubation is ¦mown, but it may probably vary from one to twenty-one days ; some ieve the period may be much longer. In the relapsing fever the monitory symptoms are generally less marked. ICpyhus, as is well known, has at various times made fearful ravages ;amps, jails, and crowded and unhealthy localities ; but in no instance record has it spread in the same manner as Cattle Plague ; indeed, as ¦aid before, there are some who question its contagious nature — ated cases both of typhus and typhoid fever often occurring with, their being communicated to the attendants ; in this respect ining a remarkable contrast to the contagion of Cattle Plague, ere is another most important symptom absent in typhus and in apsing fever — viz., diarrhoea ; for, as a general rule, the bowels are istipated in these affections. In typhus a rash appeal's upon the n from the third to the eighth day ; but is not renewed as in typhoid In the relapsing or famine fever there is no eruption. This fever, as is well known, is the attendant on partial starvation, and on the deprivation of the ordinary necessaries of life ; whereas the typhoid fever, unlike the two former, attacks people that are well fed and in good circumstances. In this fever a relapse generally takes place on the fourteenth day, and this may be repeated two or three times. The typhoid fever, constantly present in this country, is, like typhus, 75 attended with a skin eruption, appearing between the seventh am fourteenth days, sometimes very slight, and scarcely perceptible ; bu unlike the eruption of typhus, it appeal's and disappears, its duratio varying from fourteen to twenty-one days. This fever is not, like tl others, so dependent upon unhealthy localities, bad ventilation, and aggr gation of persons. It more frequently attacks young persons ; an< after a certain period, is attended with tenderness about the abdomen diarrhoea of an offensive character, the evacuations being of a dirty yellow colour, and showing a great tendency to fermentation. Tl appetite is less impaired than in typhus, and the fever is not so contagion The duration of these fevers varies from three to six weeks, and tl mortality in hospital and workhouse practice from 2 to 18 per eem the famine fever being much less fatal. 1 believe in private practic the fatality is less. I have only given a brief outline of the charactei of these fevers ; but it is enough for my present purpose. Deliriun twitching of muscles, brown and dry tongue, petichial spots, and othe symptoms may be present, according to the nature of the fever and th stage of the disease. By some, typhus and typhoid fever are classes with the exanthemata \ but in speaking of exantheinatous affections, adopt the ordinary acceptation of the term, including scarlatina, measle small-pox, &c. We now come to the morbid appearances in these fevers, which are very important by way of comparison. For typhus fever there is no specific lesion ; the organs genei'ally, from the impure state of the blood, are preternaturally vascular, the lungs congested, and the spleen and other parts softened ; ecchymoses may occur in the intestinal mucous membrane, and other accidental complications may exist, as in the other fevers. In the relapsing fever the spleen and liver are generally enlarged, especially the former, and these are the chief morbid alterations. In the typhoid fever, Peyer's glands, and the solitary glands in the er part of the ileum, are generally enlarged and ulcerated, forming, this respect, a remarkable contrast to the state of the intestinal 3ous membrane in Cattle and Sheep Plague. The mesenteric glands, ,in this fever are enlarged, and contain a peculiar deposit ; whereas battle Plague they are nearly in a normal state. So, my Lords, if we look to the chain of symptoms — to the morbid appeai'ances — to the duration, the rate of mortality, and to the comparative contagious nature of the fevers of this country, and to the like matters in Cattle and Sheep Plague, we find such manifest and essential differences that the terms "typhus" and "typhoid," as employed by the Government and its advisers, must be abandoned. It is this error on the part of your Lordships' advisers, I believe, that has led to such disastrous results as regai'ds treatment ; for persons believing, on what they consider to be high authority that this disease is typhus fever, have poured stimulants and irritants into the stomachs of oxen, cows, and calves without limit, and in this way, as I believe, have greatly increased the mortality ; globules and infinitesimals, although I deny their efficacy, would have had this merit at least, that they could have done no harm, and nature might in some cases have righted herself. The subject of my next letter, my Lords, will be the question as to the liability of the Government to compensate all who have lost their cattle and sheep, and are still losing them, in consequence, as I believe, of the negligence of preventive measures that should have been taken at an early period of the outbreak. I am, my Lords, yours respectfully, Edwards Crisp, M.D.- 42, Beaufort Street, Chelsea, Nov. 11, 1865. BemarJcs.— I have nothing to add to the above descriptions. Hopathy and stimulating treatment will be spoken of hereafter. LETTER VI. - rTER VI.— THE REPORT OF THE ROYAL COMMISSIONERS, AND THE LIABILITY OF THE GOVERNMENT. TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. My Lords, — The noblemen and gentlemen employed in investigating the nature and origin of Cattle Plague (so called) deserve the thanks of the country for their disinterested and arduous services, although I differ from them materially as to the means to be adopted to stay the spread of this pestilence, believing that their recommendations are inconsistent and inefficient. I am, at the same time, my Lords, fully aware of the difficulties the Government has had to contend with, and the vast difference between the possibility of adopting sharp and stringent measures in this country and on the European continent. Another great difficulty in which the Government has been placed, and which I have already alluded to in my first letter, is the fact that we have nothing national in any of our scientific institutions ! The opinions I now express are not new.* Since the year 1831, I have publicly advocated the establishment of a Faculty of Medicine in England, Irelaud, and Scotland, the payment of professors by the State, and election by concours, as in France. We have medical, surgical, veterinary, and agricultural clubs in abundance, but no bodies like the Faculties of France, Austria, and Prussia, that the Government could consult on an emergency like the present. In this country, my Lords, the " ruling powers " give no encouragement to science ; and the man who is exclusively its votary has only starvation and a garret before him. In the medical profession, many young men who have started well in the scientific race for fame have soon abandoned the pursuit, knowing that Government held out no rewards, and that fees were more likely to support them in comfort and respectability. But let me, my Lords, give a damning and convincing fact of the badness Lancet, 1&37, p- 606, vol. i. 76 ill VA A \s \JI. \J\AL, "^* OUvIIJO \/A LAI ' £3 CJ. 1-1 IXI Uj ¦. ) 1 L ₯» IJIJOV the schools of Paris are crowded with English and American students, such a rara avis in this country as a foreign student is seldom, or ever met with. In France, men obtain their appointments by concours, and public competition ; but here, my Lords, the statement made in Punch, sonre years since, that " Smith got his pictures well hung at the Royal Academy because his mother washed for an Academician," is a good illustration of the motives that govern scientific appointments in this United Kingdom. But there is no evil, it is said, without its attendant good ; and what a lesson does this calamity teach the Government ! So inefficient and incompetent are the members of the veterinary profession considered, that, in a matter that especially and exclusively comes under their province, only one is thought fit to sit among the twelve Royal Commissioners ! Such, at any rate, is the inference naturally drawn by the public. My Lords, if we had had a veterinary college (as in France) of which all who practise on the lower animals as veterinarians would be compelled to become members by examination, we might have had a commission chiefly composed of veterinary professors, who would have done honour to the country and to the cause of science ; for it must be apparent to all, that those only are competent to investigate scientifically this disease who are acquainted with the anatomy, pathology, and habits of our domestic animals, and with the animal kingdom generally. I will now speak as briefly as possible of some of the recommendations of the Commissioners. In my fourth letter I showed, from a careful and extensive examination of twenty-eight lambs, that the same disease now so fatal among cattle may also affect sheep ; that it may be transmitted from oxen to sheep, and vice versd ; and that it may probably affect every species of ruminant ;* that, therefore, the terms " rinderpest " and " Cattle Plague " must be abandoned, as well as those of typhoid or typhus fever ; that the disease partakes more of the character of an exanthematous affection, and that the most appropriate name for it is the " malignant spotted fever" (febris maligna guttata), the spotted and mottled appearance of some of the mucous membranes in ruminants being peculiar to this disease. Now, my Lords, as the existence of this plague (as admitted by the Commissioners) is not confined to the bovine race, and as sheep in various parts of England are affected, it must appear strange to your Lordships and to the community at large, that, if it is right (as I have long advocated) to stop for a time all movements of cattle, the same law should not apply to sheep — animals that are more likely, from the nature of their woolly covering, to convey the disease than oxen. A flock of sheep driven along a public road would be more likely to disseminate the plague than a herd of oxen ; but a greater evil than this even exists, for many skins of sheep dying of this murrain have not been disinfected, so that the fomites of the fever may be reserved for another occasion, and stored * I now know of six species, hut I helievc the disease is confined to this class. 77 78 REPORT OF COMMISSIONERS. away for future mischief. Let me, my Lords, bring a practical example to your notice, in a disease less infectious and contagions than that of sheep plague. Some children were affected with scarlatina, and during the fever a small woolly dog (a well-known toy) was given to them, to play with. After the children had recovered, the dog was wrapped in paper and put into a drawer. Ten months after this, other children visited the house, and the same toy was given to them to play with. They all, in a few days, took scarlet-fever. If this were a solitary case, some doubt might be expressed respecting the correctness of the inference ; but examples of a like kind, both in small-pox and scarlatina, might be greatly multiplied ; and a sheep's skin from a plague-stricken animal, or from a sheep that has been with diseased oxen, may hereafter be the source of wide-spreading mischief and destruction ; and yet, my Lords, the Commissioners' recommendations apply only to cattle ! Again, the power of inspectors to destroy cattle in districts where the disease first makes its appearance is to be withdrawn, although it is admitted that " this power is right and useful when the disease appears in isolated spots." If right and useful, why should it not be exercised? The statistics of Mr. Maclean, and the permission given for foreign cattle to be sent to any market in Great Britain, I shall not comment upon. Mr. Maclean's errors are too transparent to need notice ; and the proposition of allowing foreign cattle, that may have the plague in an incipient and in an undiscoverable form, to be carried over England, whilst our homebred beasts from unaffected districts are to remain still, is so startling and inconsistent that I can scarcely believe it will become the law of the land. I now proceed to discuss the main question of this letter, viz., the liability of the Government. The Commissioners state, in relation to the slaughter of cattle by inspectors, that, "as the hope of diminishing the disease is lessened, the inevitable waste increases, and the sense of hardship "tends to become insupportable ; but the objections to promising compensation to individuals out of the public treasury on an extensive scale appear to us insurmountable." The insupportable hardship endured by the losers of cattle from the Government poleaxe, and the insurmountable difficulty respecting compensation, appear to me to be as inconsistent as some of the conclusions I have already alluded to. But, my Lords, let us carefully and dispassionately consider this matter, not as special pleaders who try to make the bad appear the better reason, but in an honest and fair spirit, allowing always for the difficulties of the Government, and bearing in mind the well-known adage that "it is easier to find fault than to suggest a remedy." The question, my Lords, is a very important one, because Englishmen of all shades of politics, whatever they may think of the Government in other matters, believe that the rights of property are to be respected, and that those who suffer losses for the imhlic good are entitled to remuneration ; and if, as I hope to show, these losses, to a great extent, have arisen from the negligence of the Government in not having taken early and proper precautions to prevent the spread of the disease, the justice of the claim for compensation is placed, I think, beyond doubt or cavil. My Lords, I will endeavour to avoid personalities ; but this is not a time to bandy PROFESSOR SIMONDS' REPORT. 79 fair words and compliments — the matter is too grave and important. When Professor Simonds, at the Farmers' Club, repeated more than once that " the Government had acted nobly in this matter," there was a general cry of dissent ; and Professor Simonds scarcely believed, perhaps, that, in giving utterance to this " toadyism," he was complimenting himself as well as the Government. But let us inquire into this nobility of conduct ; and I proceed to give your Lordships information that should have been elicited from Professor Simonds by the Royal Commissioners in his evidence, questions 1 to 401. In May, 185G, Mr. Blackwell informed her Majesty's Government, through the Consul- General of Hamburg, of the presence of this murrain in' Mecklenburg. In September following, he tells the Government: "As this highly contagious murrain has spread from the Steppes of South Russia, through Poland, Prussia, and Mecklenburg, to Holstein, a district from which the English market is supplied with cattle, I must beg leave to call the attention of her Majesty's Government to my report of its origin, progress, treatment, &c, transmitted on the 30th of May last." It might be supposed, my Lords, that, after this and other information from various sources that such danger menaced the herds and flocks of this country, the Government would at once have sent out a Commission to investigate this disease, and to guard against its introduction into this country ; but instead of this, Professor Simonds was deputed by the three Royal Agricultural Societies of the United Kingdom to visit the Continent with Mr. Earnes (who was acquainted with the German language). Belgium, Holland, Westphalia, part of Denmark, Schleswig and Holstein, Hanover, Mecklenburg, Prussia, Silesia, and Galicia were visited. The last-named country was the only place in which the disease was seen, and in the Report, which is now before me, the symptoms and morbid appearances are described, about eight or ten inspections Laving been witnessed. Notwithstanding thisflying visit, Professor Simonds states (Parliamentary evidence, question 17), "that after the satisfactory examination we had made, we did not think it necessary to go to the Steppes or to Lemberg." I think the Report in some respects does great credit to the gentlemen employed, considering the short time they had to investigate the disease ; but I also think it will be admitted by your Lordships, that if a commission had been formed by the Government, of scientific and practical men, who had had time thoroughly to investigate the disease, and report to the Government upon it, that the result might have been very different. I beg especially to draw your Lordships' attention to two important conclusions in this Report, that would not have been arrived at if more time and labour had been given to the subject. It is said in the Report, and the error has several times been repeated by the Professor, " that the disease especially belongs to the ox-tribe, and that it has never been known to attack any other domesticated animal" (Report to the Privy Council, Aug. 3, 18Go). If foreign authors had been consulted, it would have been seen that several had named its occurrence in sheep and goats. But it is the concluding part of the Report which I have especially to condemn, and such a vital error I believe could not have been made by a commission properly appointed by the Government. Professor Simonds gives no warning of need be entertained that this destructive disease will ever reach our shores, not only on account of the distance, but on account of the hundreds of military cordons that it must pass through. All alarm, we believe, may cease with reference to its introduction into the British Isles." My Lords, the great wonder is, considering the laxity of the Government, a,nd the facilities of import, that England lias so long escaped the malady ! As reported to the Commissioners (q. 2,588, and note p. 6), in July, 18G0, three years after Professor Simonds's Report, 20 Russian oxen were landed at London from St. Petersburg, and the Commissioners add that " the point is of no importance ;" but to my mind, taken in connection with Professor Simonds's Report, it is a matter of vast importance, as showing how readily this disease might have been introduced in a direct manner from Russia. I Jut let us, my Lords, briefly consider some weighty circumstances in nection with the "Revel" cargo. Mr. Burchell's evidence, I think, res but little doubt that the disease was imported from Russia, by the wring (q. 3,221 to 3,349) : for it must be remembered that both oxen sheep that have been amongst diseased animals may convey the plague hout having it themselves. But a matter that much more concerns the ponsibility of the Government is the fact that, although according to evidence of Mr. Lockwood, inspector of Hull, the animals were known iave come from Russia, no special order with regard to the Tonniny . been issued by the Customs, and that it took the two inspectors only hours to examine the 600 sheep and oxen (q. 3,479), nearly three minute ! Some of the cattle were " mouthed," and two out of five the sheep were turned on their backs (q. 3,464). My Lords, those who have seeu much of this disease know that every one of the oxen (321 in all) might have had this plague in an incipient form, without the possibility of detecting it, and that in an examination like that above described, a dozen animals that showed external signs of the disease might at this time have easily escaped detection. I jet us look to the orders of the Privy Council from the first, issued y 24th, to the present time, and nearly all will be found, as regards prevention of the spread of the disease, useless and inefficient ; eed, the poison — by means of skins, hides, manure exposure, and usrnission of carcases, transit by railroads of diseased animals, and gatherings of sheep and cattle — has been so thickly sown throughthe country that it would require a prophet to foretel its decadence I extermination ; and yet, my Lords, we have hud one of the ministers, Charles Wood, in Yorkshire, telling his audience that "he looked >n the Fenian movement in Ireland and the Cattle Plague to be of same calibre." |!t appears to me, my Lords, that another strange piece of neglect on part of the Government was the tardy announcement of the name ,his disease, so that more stringent measures might have been taken guard against it at an earlier period. Professor Simonds (q. 164) r the stomach and intestines of a cow of Mrs. Nichols, of Islington, y 4th; and on the 9th of July Professor Simonds made up his mind 80 I; it was the rinderpest ; but in the Order issued by your Lordships late as the 24th of July, when a great many animals had fallen ims to the malady, we are told that it is a contagious and infectious ady, " but that its nature is uucertain." I need not comment on various Orders of Council, as they are well known. The London eowkeepers, as the evidence abundantly shows, when the disease first appeared in London, knowing that their animals would be killed by the order of the inspectors without compensation, practised all kinds of evasion to cheat the Government. Dr. Tripe, Medical Officer of Health to the Hackney district, states (q. 3,732) "that, out of 1,220 cows in his locality, 596 from infected places were removed to the Islington market, 136 sent to the knackers, and that only nine of these were buried, and that no precaution was taken to prevent contagion." Mr. Field, dairyman of Westminster, who had lost a great many cows from the murrain, says (q. 4,012), when asked what becomes of his manure, "he thinks it goes down into Kent." Professor Simonds (q. 335) did not know positively about the disposal of the manure from the Islington market ; but he thought there was great liability for the spread of the disease on account of the manure, and he had no doubt whatever that the disease had sometimes been conveyed by the inspectors themselves (q. 387). Ilut, my Lords, the evidence respectiug the nature of this disease, in existiug in this country in 1715-45, when the Government jred animals to be buried, their hides slashed, and the owners to be pensated for body and skin, should surely have taught us a useful an respecting the danger of playing with this pestilence. In the )rt I have already alluded to by Professor Simonds, to which the eminent had free access, it is stated, so contagious was the plague, at people going into some districts were compelled to leave their lies behind them, and that in some places all congregations of persons c forbidden, even at church." So that the nature of the plague, sn it recently made its appearance in this country, was nearly as well wn to the Government and its advisers as at the present time. I'he excuse, my Lords, that the Privy Council has not had sufficient r er is too futile and impotent to need comment. Parliament might should have been assembled long ere this, although Mr. Disraeli has iiitly told his audience in Buckinghamshire that it would take sixteen s to effect this important object. I jet me, my Lords, in conclusion, allude specially to the evidence of , Helps, clerk to the Privy Council, as it is a fair epitome of the ceedings of the Government. Questions 1,823 to 1,878 : " The ice of the outbreak was given first on the 10th of July, and Professor londs was instituted to make an inquiry into it. Papers were pubed by Professor Simonds, and one on disinfection by Dr. Thudicum. sal authorities could exclude certain animals from fairs ; and on the h of October (four months nearly after the appearance of the disease) angements were completed for burial in the metropolitan districts. 3 precautionary measures of the Privy Council had worked well, quests were made that the orders should be more stringent. Many gistrates had said that it was useless to prevent a fair, if fairs were M 81 82 KILL AND COMPENSATE. II adjacent to it. Beasts were not directly slaughtered, but found in jhers' places for two or three days. No Orders in Council had been ed in Ireland." In speaking as a private individual, Mr. Helps would give the king of the orders to local authorities, by whom they would be •ied out patiently and carefully; they will work as well as the rernment. In the next few weeks fairs and markets will be conirably stopped. "Q. 1,863, 1,866, 1,867 : Good feeling and patriotism ild overcome petty local interests. Except in Prussia, efforts in sign countries have not been wonderfully successful." All must lire Mr. Helps's amiability; but few, I think, will applaud his ient method of putting out a raging pestilence ! I! have, my Lords, adduced the above evidence for the purpose ot wing that, if a man's property is destroyed for the public good, he uld obtain some compensation from the State ; but if, as I have wn, and as it might have been demonstrated more clearly by evidence t could have been obtained by the Commissioners, that the spread of i plague has been greatly increased and extended by the inefficient, perative, and inconsistent measures of the Government, I can rcely believe, notwithstanding the recommendation of the Royal nmissioners, that Parliament will turn a deaf ear to those who are, L believe, justly entitled to compensation. Inspectors, it is true, are not now to kill and slay at their pleasure, even in districts freshly infected, where they ought to exercise such a power ; but the Government has allowed this poison, now wide- spread and almost indestructible (unless very prompt means are taken), to do the deadly work of the pole-axe, and hence the liability to compensate the sufferers. |[n my next letter, my Lords, I will speak of the treatment of this lignant fever by homoeopathy ; and of the efficacy of this pretended ;nce as applied to the treatment of disease generally. I am, my Lords, yours respectfully, Edwards Crisp, M.D. 42, Beaufort-street, Chelsea, Nov. 18. I?.S. — That I may not be accused, my Lords, of fault-finding without gesting a remedy, I again presume to advise your Lordships in this remity. Parliament should be assembled at once; the Government uld take the matter entirely into its own hands ; destroy all animals in necessary, and compensate all losses; appoint a chief inspector for ry county; kill all foreign animals at the ports, and all sheep ,and in where they now are ; destroy all hides and skins of infected mals; stop all movements of sheep and cattle for six weeks, except ler special circumstances, when permission must be obtained from chief inspector; establish dead-meat markets in all lai-ge towns; er all dogs to be tied or shut up, and prevent hunting in every part England. Better put up with any temporary inconvenience than c the loss of our home stock, which, remember, can never be replaced foreign breeds. Simple means will stop a fire at its commencement; ; when it is raging in all parts of a city, private and public conveniie must be disregarded. DOGS AND DISINFECTANTS. 83 Remarks. — As is well known, in the report which appeared October 31, 1865, five months after the appearance of the disease, Messrs. Lowe, Playfair, Quain, Parkes, Wormald, Ceely, and Spooner advised the stoppage of all movements of cattle, whilst Earl Spencer, Viscount Cranborne, Mr. Read, and Dr. Bence Jones recommend measures of a less stringent character. Mr. McClean would leave matters as they were. It will be observed that the movements of sheep were not prevented, and the treatment of cattle was allowed as usual ; the members of Parliament were not to be disturbed, and a great many important measures for the eradication of the disease were neglected. The Government, with its leaning to local authorities, went blundering on, and it was not until February, 1866, when the House of Commons met, that an efficient Act was passed, but so badly were its provisions carried out, that the Government stultified its proceedings by reporting in about six months after the Act had passed 11,878 cases of recovery. The Royal Agricultural Society lagged behind the Parliament, and when all the mischief was done began to lock the door. I hope it will not be considered that I allude to the report of Messrs. Earnes and Simonds for the purpose of reflecting upon the conduct of those gentlemen, for their visit was too short for them to obtain much important information. I mention it to show that the Government, when it was known that such a disease was likely to reach our shores, instead of depending upon the Agricultural Societies, should have sent out a proper commission, who would have had full time for the investigation of the matter. LETTER VII LETTER VIL— DOGS AND DISINFECTANTS. TO THE RIGHT HONOURABLE THE LORDS OF THE PRIVY COUNCIL. ILy Lords, — I am about to place before your Lordships two subjects lected with the prevention of the spread of Cattle and Sheep Plague, I believe have not received that amount of consideration from the ernment advisers and the Royal Commissioners that their importance its ; these are : — first, the destruction of the plague virus by fire, the purification of skins ; secondly, the extension of the pestilence aeans of dogs and packs of hounds that are daily in this country ing from affected to unaffected districts. In the supplement to the report of the Royal Commissioners, XXIL, chloride of lime, carbolic acid, or the powder containing carbolate of lime or sulphide of lime, are recommended, and the latter (last) is supposed to be the best disinfectant. Bn the interesting lecture on disinfectants delivered at the Royal •icultural* Society (Dec. 12), by Professor Voelker, the professor * Mark Lane Express, December 18th. M 2 19, " Articles of small value, such as ropes and half used up straps, uld be burnt or buried. Shovels and stable utensils should be cleaned h soft soap and chloride of lime, half pound to a pailful of water." I After the proper fumigation the floors were to be taken up, cleansed, i relaid, and the sheds afterwards whitewashed, &c. " Inspectors >uld visit the cattle in pattens. Chloride of lime, carbolic acid, ndy's liquid, McDougalFs and Thomlinson's disinfectants, and many lers, are named, but Professor Voelker admitted that he did not ow of a single case where these and other supposed disinfectants jvented the occurrence of the plague, and he goes on to recommend it sawdust saturated with carbolic acid should be scattered over a vshed ; then six healthy cows should have a weak solution of this d applied to them, and then a diseased cow should be introduced ong them. This experiment should be made by Government" (the n I suggested in my first letter, Sept. 21.) My Lords, we are now in the seventh month of the plague, and we are still in the dark about the efficacy of the so-called disinfectants, and about the power and action of all medicines in this fearful disease, save and except Government " dynamics and ovations." I Let me again ask if the plan suggested in my first letter, Sept. 21, I been adopted by the Government, whether the same state of bederment and chaos would now exist 1 The pestilence ere this might re been entirely eradicated. But let me briefly touch upon the first ject of my letter, viz., purification by fire, which appears to have n overlooked by the Commissioners and by the learned Professor to Royal Agricultural Society. In the use of fire I presume that the >prietor will superintend the operation himself, and have all necessary ans at hand to put out flame if required, and moreover I infer that : common sense of every man will guide him in the careful employnt of this agent. Instead of washing spades and other implements with chloride of lime put them for a short time into a flame. If the wood is a little charred, they will last the longer. Take a link made of rope yarn and tar and apply the flame to all gates, posts, rails, mangers, crates, cattle trucks, and other suitable things that may have been in contact with diseased cattle. Instead of taking up brick and other floors, as recommended by the Professor, keep a smouldering fire upon them for some time. Let the flame from the link pass over the sides of the building to the height of seven or eight feet. Where brick, stone, plaster, and wood are concerned, there can be no danger if proper precautions are used, and I believe this method to be the most effectual and the cheapest where it can be safely employed. In addition to this, sulphur may afterwards be burnt, and the building limewashed and aired as much as possible. All clothes, rugs, sacks, and other suitable things, should be exposed to a dry heat of 212° Fahr., or placed in the solution, to be hereafter described, for one hour. In this country many oxen are in open sheds and yards, the former ered with straw or reed, and the yards surrounded by furze or other jots. In such instances fire cannot be used as a disinfectant, and the eration of various gases in the sheds would be of little use unless the 84 gases could be confined for a time, a difficult matter under such circumstances. The only effectual way of purification will be to burn the faggots or bury them with the manure, with a good supply of quicklime. My Lords, I have placed before you this method of purification by fire, believing that its importance has not been sufficiently appreciated. I now bring before your notice a mode of disinfecting skins that I believe to be one of the best and cheapest that can be used. At the same time, my Lords, I contend that no skin should be disinfected, but that it should be buried at once with the carcase of the animal, as in 1745, and the Government should compensate the owner. The plague has been extended to a vast extent by means of skins, and so sure were the majority of the farmers that this disease would not attack sheep, that I believe thousands of sheep skins have been distributed about the country charged with fomites of this poison, and no attempt at disinfection was made. We are told in the Times, December 19, that the plague was introduced into Spilsby, Lincolnshire, by means of infected hides. if the Government still persist in its present waiting policy and jhwork legislation, and hides and skins are preserved, I believe, a numerous experiments that I have made, that the following is the ; solution that can be used. A large tub-full may be kept, and it . serve for many skins, which need only be in the solution a few rs. The subjoiued are the proportions :—: — Corrosive Sublimate, 100 grains. Bay-salt, 6 lb. Alum, 2 lb. Water, 24 gallons. The skins to be hung up over the tub, so that the solution may not be lost. But, my Lords, as I said before, no skins should be preserved and no animals flayed. The hundreds of men who have had their clothes and skins impregnated with this poison during the operation of flaying are sufficient to contaminate all the cattle on the habitable globe. A man who has skinned a dozen animals may become a focus of infection for weeks. I now come to the subject of dogs, all of which I said in my last er should be shut or tied up. A pack of hounds may be the means ufecting all England. I first drew the attention of agriculturists to this subject in a letter he Mark Lane Express, October 23. But let us ask what evidence have that dogs are likely to convey the poison. It is notorious that sre diseased animals are buried that dogs from the farms where the jue has not appeared have been attracted by the smell of the carcases, in this manner the disease is disseminated. At Norwich the plague eared in a dairy of cows that had, as it was thought, been strictly rded ; but it was found that a neighbour's dog was in the habit of ping under the manger, and this dog belonged to a dairyman whose s had the plague. Mr. Freeman, of Bath, in the Medical Times \ Gazette, October 30th, in describing the Cattle Plague in sheep, says b the pestilence was probably carried by foxes, which are very 85 numerous in that district. But let me, for the benefit of those who obstinately deny the existence of the plague except in animals of the bovine race, allude to an example that will likewise show the extremely contagious nature of the poison, and how readily it may be conveyed. A cow, July 29th, affected with the Cattle Plague, was driven along a public road where the gate of a stackyard was open. The cow entered, and went once round a straw stack, and was driven into the road. A short time after this two goats and several cows came into the stackyard from an adjoining meadow to be milked. On the 10th of August one of the goats died, and on the following day the plague proved fatal to the other ; and after this eleven cows, one bull, three calves, a fat ox, and a heifer were lost by the same disease. These examples could be readily multiplied. Let us now consider the more important question of hunting, and I may premise that I am not a cockney, and that I have been as fond of the sport as most men, and could now distance many of my deriders across a good hunting country ; but this is not a question of taste or pleasure, it is a matter of vital importance, and one that concerns the health of the people and the prosperity of the nation, and all should sacrifice selfish pursuits for the eradication of this pestilence. I could readily, my Lords, trace a pack of hounds and horses over an infected district with the urinary discharges of diseased cattle ou their feet, into a district where the plague has not yet appeared, and show the great probability that the disease would be conveyed, but I am happy in being able to give a graphic description of a hunting field in Norfolk, where the plague had been so prevalent, by one of the Commissioners, Mr. Sewell Head, M.P., at the recent Farmers' Club dinner, December 12 th. He said :—": — " Mention had been made by the Chairman of the honour conferred upon the county of Norfolk by the Prince of Wales becoming a Norfolk landowner and farmer. No one appreciated that honour more than he did, and it was a noble and soulstirring sight to see the Prince of Wales in the hunting field in Norfolk. Whenever his Royal Highness was pleased to intimate his intention to join a ' meet,' every farmer within twenty or thirty miles round who could ride thought it necessary to go and meet him, so that as many as 400 or 500 mustered at one time in the field." I' Now, if the fox happened to escape such a mob of sportsmen, away y went over the clover, the young wheat, and the fences, &c." Mr. ad goes on then to describe the evils of game preserving in excess, ; it does not appear to have struck him, although the evidence before ! commission fully shows the subtlety and ready communicability of s poison, that a greater evil than the latter might lurk in the feet of s hounds and on the hoofs of the 400 or 500 horses that scampered :r the country. It reminds one of the play of Hamlet with the tracter of Hamlet left out. I know it may be said diseased cattle confined and secluded, but who, let me ask, knows when they are eased 1 A pack of hounds may pass over a meadow where cattle grazing, apparently in perfect health, and yet their alvine and nary evacuations, carried by means of hounds and horses' feet, may I believe) infect a whole county. I hope, my Lords, that I have 1 enough to show that this matter is of great importance, and the 86 better. English noblemen and gentlemen, and especially fox-hunters, ¦would be the last men in the world to pursue this sport if they thought it likely to be injurious to their neighbours or detrimental to the country at large, and I believe it is only from want of proper consideration that the sport is now continued. I am, my Lords, Yours respectfully, Edwards Crisp, M.D. 42, Beaufort-street, Chelsea, Dece?nber 20th, 1865. I Remarks. — We have no proof whatever that any of the agents ;ribed as disinfectants possess this power as regards Cattle Plague, we have abundant evidence to show that animals surrounded by bhese so-called disinfectants have been frequently affected. If the eriments I suggested in my first letter had been performed by the rernment, this matter might have been long since set at rest, this time skins were disinfected by mopping with chloride of lime — rocess not likely to be properly carried out. I believe two or three rs' immersion in the fluid I have named, and subsequent immer) for five or six hours in cold water, would be far preferable ; all skins should be buried with the animal. As I shall have to :ik of hunting in my tenth letter, I reserve my comments upon that ject. LETTER VIII LETTER YIIL— ON THE ASSUMED IDENTITY OF CATTLE PLAGUE AND SMALL-POX. TO THE RIGHT HONOURABLE THE LORDS OP THE PRIVY COUNCIL. My Lords, — The communication made to you officially by Dr. Murchison, and published in the .Lancet (December 30), and in the journals generally, is of so much importance that I shall devote my eighth letter to its consideration ; and, to understand the matter fully, it will be necessary to speak of a few circumstances relating to the recent occurrence of the disease in this country. At the meeting of the British Medical Association (August Ist, 1865), Dr. Budd, of Clifton, read a paper on the cattle plague, in which he endeavoured to show " that the rinderpest was the precise pathological equivalent to human typhoid or enteric fever ." Three weeks after this, Dr. Murchison [Lancet, August 24) showed that neither the solitaiy nor the aggregate glands were affected in this disease, as supposed by Dr. Budd — no mention is made of an eruption upon the skin ! but Dr. Murchison speaks of minute superficial ulcers in the intestinal tube. It is important to remember that Dr. Budd (as far as I know) was the first and only person in this country to make the analogy between this fever and that of typhoid fever in the human subject. 87 88 DR. MURCHISON'S VIEWS. I have fully pointed out the distinction between the typhus, typhoid, and famine fevers, in my fifth letter. Typhus fever was not mentioned either by Dr. Budd or Dr. Murchison, although Professor Sinionds, the Government adviser, stated, at the Farmers' Club, as mentioned in my fifth letter, "that the disease was more like typhus fever."* On the 17th of October, as published in the Medical Times and Gazette (October 21). p. 445, I stated, at the Pathological Society of London, where I showed a large number of specimens of the morbid changes in this disease, that this plague bore little or no resemblance to typhus, or typhoid fever, in the human subject ; that it was an exanthematous disease of a specific character, attended with a specific eruption, and affecting more or less all the mucous membranes of the body ; that the red patclws were formed by slight effusion of serum under the cuticle, and by the detachment of the epithelium ; that the term " ulceration " was not applicable. I had repeatedly looked for eruption upon the skin in sheep and oxen ; and I had often been told by men who flayed the carcases of both, that they had never seen any appearance of eruption. Of late, I have witnessed many examples of this eruption ; but I fail to see the resemblance between it and the small-pox pustule that Dr. Murchison has observed. Mr. Moore, the homoeopathic practitioner, says, in his pamphlet (August 20th, 1865), that, in white cows, he has observed a dark red eruption upon the body, and that the dewy part of white noses are marked with numerous small slate-coloured spots, flat, and not raised above the surface. He believes the observation to be original and important ; " but whether," he says, "an accidental or an essential symptom, further observation must decide." In the report of the medical committee of the Norfolk Cattle Plague Association (December Btb, 1865), it is remarked (p. 15) : " Quite recently the attention of your committee has been directed to the state of the skin ; that in a large proportion of cases certain spottings or markings are present upon some portions of the skin ; that these are papulae, imperfect vesicles, or stains, «fee, rendered more distinct during the first process of tanning." The committee came to the same conclusion as I had done three months before — that it is an eruptive disease, the discovery of the skin spots supplying the only link wanting. iihe small pox in sheep is seldom or never absent from the European tinent ; and three attacks of this disease have appeared iv this ntry— l7lo, 1847, 1862 ; the first described by Dr. Fuller, 1730; L the two last by Professor Simonds, 1848 and 1864 ; the former in a arate work, and the latter in the Journal of the Royal Agricultural iety (1864, p. 549). Dr. Budd, of Clifton, in the British Medical vrnal (1863), has also given a good account of small-pox in sheep. It must appear strange, my Lords, to men of common sense, when we c satisfactory evidence to show that the Cattle Plague may be comnicated from sheep to oxen, and from oxen to sheep, that during the breaks of sheep plague in this and other countries, the cattle have * This word is generally used by the Trench ; and Hurtrel, in his work (to be mentioned hereafter), says: " The term 'contagious-typhus' originated with the Germans. r lhe term ' ox-typhus 'is also used." 89 ANALYSIS OF SYMPTOMS. invariably escaped the infection, and that goats — which are so liable to take Cattle Plague — when inoculated with sheep-pox mutter have never been affected with the disease (sheep-pox). Ib must appear equally strange that this supposed small-pox eruption, rominent and readily distinguishable in the sheep when affected with U-pox, should have been discovered only during the process of tanning, n sheep have been affected with what is called " Cattle Plague." he ox — judging from a great many animals that I have examined — appearance of eruption was present externally, and often no spots or looking excoriations could be seen on the gums, lips, or cheeks. Dr. Murchison says that the anatomical lesions of the two diseases are identical, viz., inflammation of the mucous membranes of the air passages and digestive canal, dark coloured blood, ecchymosis, and a pustular eruption on the skin ; and, in confirmation of the truth of this statement, " Copeland's Dictionary "is appealed to. Let me quote a better authority than Copeland, viz., the late Dr. Gregory, physician for many years to the Small-pox Hospital, who in his work on the Practice of Medicine (1825, p. 105), says : "The appearances, on dissection, of those who have died of small-pox are confined, as far as my observation extends, to the mucous membrane of the trachea and to the pleura. The abdominal viscera appear to be singularly exempt from the influence of the variolus virus. No vestiges of pustules have ever been traced in the f-avity of the abdomen." The same statement is repeated in his later work on " The Exanthemata" (1843). Ihe alvine flux, spoken of by Dr. Murchison, is only an occasional ptom of small-pox, both in the human subject and in sheep. It may dd to be characteristic of Cattle Plague ; for it is in the alimentary s chiefly that the gravity of the disease exists ; whereas in small-pox respiratory apparatus is more affected. According to Dr. Gregory, ose who die in the first week of small-pox generally succumb to the c malignancy of the disease, but there is no marked lesion ; in the nd week, to affections of the larynx and trachea ; in the third and th weeks, to pleurisy and pneumonia, laryngitis effusion into the ,t, gangrene of the skin, debility, sinking, nded the animals, and who had reported to the Government that y laboured under Cattle Plague. I saw several sheep in various jes of the disease ; and Mr. Denny was kind enough to have one I It must not be supposed that I take cattle fees, or that I infringe upon the mice of the veterinary surgeon. I pursue this investigation without hope of ard. •f I learn from Mr. Barthropp, that since my visit Professor Simonds and Mr. Shorten, M.X.C.V.8., of Ipswich, have seen these sheep, and pronounced the disease to be similar to that of Cattle Plague. 103 repeat the symptoms and morbid appearances that I have so fully described in my fourth letter ; but there was no question about the nature of the disease — dry nose at first ; then discharge from nostrils and eyes ; congested rectum and vagina ; dull, anxious countenance ; drooping of the ears ; a disposition to lie down ; often a peculiar cough ; groaning and grinding of teeth ; non-rumination, and frequent purging of dirty-coloured mucopurulent matter, with occasional twitchings of the muscles in some cases. In these sheep there was no perceptible eruption in any part of the mouth or skin ; nor have I seen this in any sheep that I have inspected, although spots are seen on the hide sometimes during the process of tanning. The chief morbid appearances — fluid, or semi-coagulated state of blood, a general redness or spotting of the fourth stomach, with a red, streaky state of many parts of the intestinal tube, with a pappy matter between, as described in my former letter. On the 15th December the Plague broke out among Mr. Denny's eighteen oxen, of which seventeen died. The hundred sheep (hoggets) were close to these oxen — so close, indeed, that their noses nearly touched. On the 15th of January the sheep became affected, and yesterday thirty-five had died ; and probably about half of them will be lost, for several were ailing, but a great many were convalescent. I mention this case, my Lords, to show the importance of separating ased sheep from healthy oxen, and more especially to point out the jssity of including sheep among the animals that should not be r ed alive, unless under special circumstances. In my sixth letter, the Report of the Royal Commissioners, I have pointed out the >nsistency of stopping the movements of cattle, as advised by the ority of the Commissioners, and of allowing sheep to be driven ig public roads. IVe have a desperate enemy to contend with ; and our means of sublg him have been about as effectual as the grass binding of the putians was to the subjection of Gulliver. The famous Hydra of had a hundred heads ; but the demon of Cattle Plague has now, in country, many thousand ; and unless they are simultaneously ipitated, there is no chance of crushing him. The task is an hersan one ; but the longer it is deferred the more difficult it will I am, my Lords, yours respectfully, Edwards Crisp, M.D. 42, Beaufort-street, Chelsea, Feb. 9. P.S. — As the Government, on Monday, Feb. 12th, will introduce a bill for the extermination of the Cattle Plague, it will be seen that this matter of " sheep plague "is one of great importance. The concealment of this disease in sheep from the weekly returns accounts, I believe, in a great measure for the ignorance that generally prevails on the subject. Remarks.— l can now mention a fact respecting these antelopes sent to Paris that I could not at the time make public. Mr. Jamrack, the extensive dealer in foreign animals, sent me a dead mufflon to examine. I soon discovered that it died of Cattle Plague. Mr. Jamrack, before I communicated the circumstance to him, had sent the two antelopes to Paris, supposing that they were perfectly healthy. Mr. Jamrack/s animals were next door to a cow-shed where several cows had died" of the plague. A short time after this lex amined a zebu that at another dealer's had died of Cattle Plague. As far as I know, the mufflon is the first foreign ruminant that is recorded to have died of Cattle Plague, in this or in any other country. I believe that the disease in the peccary was not Cattle Plague, as described by M. Bouley, but the so-called typhoid fever in pigs. I have seen the same appearances where pigs were supposed to have died of Cattle Plague, and I believe that ruminating animals only will take the disease. Recently, in the Field, it is stated that two elands had been attacked with Cattle Plague in Cheshire, and that the male had died. Up to the present time there are a great many ignorant people who maintain that sheep are not affected with Cattle Plague. It is useless to argue with men whose assurance and presumption is even greater than their ignorance. The propagation of such a doctrine, and the absence of sheep returns until recently by the officials of the Privy Council, have been the means of spreading the disease to a great extent among oxen. In the last return (Aug. 25), it is stated that 6,625 sheep have been affected, and that 102 were attacked during the week ; but I believe that more than double this number have had the plague, and the disease has not been recognized or purposely concealed, under the pretended belief that sheep cannot take this murrain. In the House of Commons, Tuesday, February 21st, three members stated that sheep were not subject to Cattle Plague, and the members present appeared by their silence to believe in the correctness of this opinion, so it was decided that sheep might be driven along a public road. In the return ending Sept. Ist, 206 sheep are reported, and only 99 cases in bovine animals. Kn estimating the value of these letters, the reader is requested to : to their dates, to the date of the various reports of the Commisicrs, and to the orders of the Privy Council. 104 105 LETTER XII.- rTER XII.— ON THE HISTORY, TREATMENT, AND FUTURE PREVENTION OF CATTLE PLAGUE. TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. K[y Lords, — I need not say much about the history of this pesti-3, as the subject is nearly threadbare ; but let me, in a few words, h upon a few of the leading facts. The Cattle Plague, as far as we can learn, has always existed in the Asiatic Russian Steppes, extending into Hungary, Poland, and European Russia ; from which countries all the European outbreaks can be traced. It made its appearance in Italy in 1709, in the neighbourhood of the Po. Lancisi and Ramazzini, in their works, De Bovilla Peste, 1711, and De Contagiosa Epidemica, 1712, have both given a good account of the plague. The disease made its way from Italy, through the Netherlands to England, in 1714-1715, where it continued, chiefly in London, for a short time. Mr. Bates, Surgeon to the King, Phil. Trans. Nos. 1818, 1871, gives an account of a contagious disease in milch cows which commenced, July, 1813, at Islington, and he appears to have had a better notion of the nature and malignancy of the affection than many of our modern writers. He says : " Kill and burn all, smoke houses and sheds with pitch, tar, and wormwood;" and he makes the following significant remark, equally applicable to the present time : " Cow r keepers will not own the disease, nor was there ever wanting one or other who gave them hopes In 1745, the plague again appeared in London, being imported n Holland by means of two calves that were sent to Poplar. It tinued in this country from 1745 to 1757 ; several accounts of it . be found in the Gentleman's Magazine between these dates. Brocklesby, in his book on the Mortality prevalent among horned ,tle, 1746, has described the disease, and Layard, in his " Essay the Contagious Distemper among Horned Cattle," has given a d account of the plague, 17a 7. I^. partial outbreak again occurred in 1769, and lasted about three rs, Hampshire and Banffshire being affected about the same time. b plague was introduced into the latter county by hay imported n Holland. Other slight outbreaks are said to have occurred, but correctness of this statement is doubtful. Let me quote a few of Orders of Council, 1746, " Compensation at the rate of 40s. per d, to be given for cows and oxen — for calves 10s. Infected beasts je shot, their hides slashed and buried ; entire herds to be divided ; mals to be examined on the public roads." What a lesson does following teach us : " The disease was extinguished in many ntics but lurked in others where the local authorities had been lax J l Pose who are curious in these matters may consult >bb, Lanzoni, Vie d'Azyr, Paulet, Billard, Vesoul, Burma, Camper, Hering, and Youatt. The more iters are too well known to need mention here, and >f the Commissioners should be referred to by all who information. I now come to the history of the present outbreak, which, as is well known, is involved in some little obscurity. As I have said in my sixth letter, I have no doubt but thai; it was introduced by the Bevel cargo, and that several cases had occurred during the twentythree days which elapsed between the introduction of the Russian cargo and the first case at Islington, on the 19th of June, 1865. To show how little was known of the disease, it is stated, on the 24th of July, more than a month after the outbreak, in the Veterinarian, p. 22, of which Professor Simonds is one of the editors, that " a fatal bovine disease of an uncertain character had appeared." I need not trace it from the Metropolitan Market to Surrey, Essex, Sussex, and other places, as its progress is now too well known ; its spread by means of fairs and markets, the driving of sheep and cattle along public roads, and by the dissemination of manure and skins, and the introduction of Dutch cattle, I have described in my former letters. Let us look to the progress of the disease for the last 1 7 weeks, from the 21st of April, 1866, to the 11th of August, in North and South Holland, and in Utrecht. The figures indicate the number of cases weekly :— 1,102, 879, 828, 714, 401, 371, 415, 321, 294, 366, 335, 597, 526, 776, 971, 989, 1,225. So that, after 17 weeks of treatment, and of tampering with the disease by globules and other simples, the attacks in the week ending the 11th of August amount to 1,225. We may well ask when will the Dutch get rid of the Cattle Plague ? In Cheshire, according to the High Sheriff's statement in the Times, April 25th, in five months no less than 65,000 cattle were lost. In this county, again, we had infinitesimals, vaccinators, and onions palmed upon the farmers usque ad nauseam, and so in Scotland, Yorkshire, and in all places where very clever people have abused the veterinary surgeons, stepped out of their province, and taken the matter into their own hands, has the plague increased. But convincing proof is given of the benefit of the stamping-out system by the weekly returns since the commencement of the disease to the present time (September Ist). The figures indicate the numbers weekly attacked, beginning June 24th, 1865, and ending August 25th, 1866: —30, 147, 575, 321, 490, 757, 1,145, 1,2.31, 1,175, 1,270, 922, 847, 1,354, 1,333, 1,666, 1,436, 2,364, 1,955, 2,210, 3,158, 3,761, 4,316, 5,011, 5,679, 6,988, 8,011, 8,351, 9,506, 10,922, 12,468, 13,146, 12,734, 13,397, 14,325, 15,706 (February 17th), 13,040, 9,183, 9,875, 7,871, 6,744, 6,579, 4,600, 3,764, 3,947, 3,314,2,609,2,776,2,126,1,366,1,116,1,004,565,439,260,313,304, 106 107 RATE OF MORTALITY. I\ 208, 221, 156, 127, 148. Sheep attacked are said to amount to 31 ; no less than 206 cases are reported during the last week, but elieve that, for the total, 12,000 would be much nearer the number. |[t will be seen by these returns that 15,706 was the largest weekly nber of attacks, and this was before the new Act in February, ice this time the disease has gradually decreased, although the urrence of 26 cases more last week over the previous week tells plainly that, when cattle are brought together, unless more strinit means are used, the disease may increase to a great extent ; who return recoveries should be subjected to a heavy fine. If take the returns for the last 27 weeks, beginning February 24th I ending August 25th, we find that 15,618 bovine animals have cl, and 11,878 have recovered. Why animals should be allowed lie or be treated for Cattle Plague, I am at a loss to discover, and sk again, when are we to get rid of this pestilence ? I Mortality of Cattle Plague. — In the first report of the Commisoers, November, 1865, it is stated from Schmidt's " Jahrbuch der sammten Medicin," 1865 (p. 95), that the per centage of deaths in following countries was as follows : — Hungary, 65 ; East Galicia, ; Croatia and Slavonia, 81*6; Military Frontier, 83 ; Moravia, ; Lower Austria, 92 ; West Galicia, 94 ; Bukowina and Styria, j. The number attacked in the last two provinces was small. >m the weekly returns in this country it is difficult to form an estite, as many are killed, some die, and others are allowed to recover, dng the week ending February 17th, when treatment of all kinds i tried, of the 15,706 attacks 996 were killed, 10,879 died, and 10 recovered. In 1862, 296,000 bovine animals were attacked h. plague in the Austrian dominions, and of these 152,000 died. Up to the present time, August 30, 1866, during about 14| months, 253,211 bovine animals have been attacked with Cattle Plague in this country. Of these, 84,620 were killed ; 124,283 died ; 33,314 recovered ; and 10,994 were unaccounted for. The estimated number of bovine animals in Great Britain (excluding Ireland), March sth, 1866, was 4,785,836 ; of sheep, 22,048,281. Of the former the per centage of attacks has been in England, 5 861 ; Wales, 1*436; and Scotland, 4*481. But the above per centage will give but a very imperfect notion of the number of cattle destroyed by Cattle Plague. A London dairyman in my own immediate neighbourhood found one of his cows sick of Cattle Plague, and probably the others were all affected ; the owner, knowing that he would get no proper compensation, sent all of them to the market ; they were killed and eaten. My friend, Mr. , has 40 lean oxen at grass — Cattle Plague is in his neighbours' fields ; all these lean oxen are sent to market, and sold at any sacrifice, and so with thousands of others. The losses from Cattle Plague are not to be estimated by Government per centages. Treatment. — Before I enter upon this question, let me again beg the attention of my reader to the structure of the ox and sheep, a very p 2 108 liri i")Oi' ttiii fc in 'it t t'l* in £*^ti miit in f* f* Tip T^i*oh*Lnlf* success 01 n 1 otlio* il trcxt"* ment. In my third letter (Oct. 7th) I have given from my own measurements tjie length of the alimentary canal of more than forty species of ruminants that I have dissected ; and this tube, as has been seen, varies in length from 30 to 254 feet, and in addition to this there are innumerable complications in the shape of folds and villi. I have, moreover, shown that this exanthematous redness, with its peculiar eruption, not only affects this great extent of intestinal surface, but that the buccal, pharingeal, laryngeal, tracheal, bronchial, vaginal, and vesical mucous membranes are also implicated, and that the same exanthem in many instances probably affects more or less the whole surface of the body. When, in addition to this, we have a fluid and diseased state of the blood, the cessation of rumination generally, and in the ox a large quantity of dried food in the first and third stomachs, the chances of recovery, it must be apparent to all, by any mode of treatment, are very slender and unpromising. In such a state of membrane, with a stomach so loaded, and with such a condition of blood, and often, as in Cholera, with a greut loss of the epithelial covering of the intestinal villi and other parts, what does common sense dictate ? To leave matters alone to a great extent, and to avoid above all things violent and irritating medicines. A pint of linseed oil at first, with gruel ; hay-tea, treacle ; thick beer, milk, linseed, bran, and nourishment of this kind, some of which may pass the paunch and be absorbed, thus supporting the strength until the critical period is over and the veterinary surgeon can use medicines with more effect. In spite all treatment, the greater proportion will die ; and so with those animals that have had nothing done for them, as shown in my fourth letter, page 70. I could say a great deal upon this matter, if I thought that treatment under any circumstances was justifiable. I believe that many animals may be saved by judicious treatment ; but if in trying to save one you endanger the lives of thousands it is better to kill at once. Let no one try to treat an animal in Cattle Plague ; it is this system that now keeps up the disease and prevents its extinction. For the purpose of ascertaining the effect of treatment and of other practical matters relating to rinderpest, I sent the subjoined questions to many members of the Veterinary College, to several practical agriculturalists, and to a few medical men, who had paid attention to the disease. I now beg to thank all these gentlemen for their prompt answers to my questions : — 1. Has any mode of treatment that you know of been successful? 2. Has the disease been extended in your district by the attempt to cure it ? 3. Are cows in calf more likely to recover from the plague ? 4. Has any eruption been observed on the skin of the diseased animals, and if so in what proportion ? 5. Have any sheep been affected with plague in your district ? 6. Any other practical facts, such as food, prevention, bleeding, disinfectants, ofcC. . 1 received lour answers from medical men ; forty-seven from members of the Veterinary College ; and twenty-three from practical agriculturalists. I was induced to put the third question, with regard to influence of pregnancy, because I had seen about twenty cows in calf that recovered from rinderpest, and at that time only two of them had slipped their calves, although subsequently all of them aborted. Kwill now, in as brief a manner as possible, analyze the evidence I ined ; my space will not allow me to quote the many valuable rvations contained in the letters of my correspondents. It must be remembered that my correspondents were all living in infected districts, and had seen much of the disease. I take the questions seriatim. As regards the efficacy of treatment, all, with the exception of five, have seen no benefit from it ; two of these have reported cures by stimulants, one by a powder, the composition of which is not given, and the other two do not name the mode of cure. As regards the extension of the disease by treatment, thirteen believe that it has not been extended by this means ; ten are doubtful about it ; and fifty-one believe that it has been increased by the attempts to cure it. In relation to cows in calf, twenty are doubtful ; thirty believe that the disease is not: less fatal ; six think that it is ; and eight suppose that it is more fatal when cows are in this condition. Of the eruption, thirty-five out of the seventy-four have not seen it ; ten have seen it in a few cases ; three in all instances ; and the rest have not noticed it, or have not looked for it. Colonel Talbot says, "all his animals that recovered had it." Mr. Lewis, V.S., Crewe, has seen several hundred cases, and a very small proportion of them had any eruption. Mr. Bland, V.S., Boston, " has seen the eruption in the proportion of 7to 200." Mr. Leigh, V.S., Bristol, " saw no eruption on 110 examined." I cannot help quoting a few remarks from these letters. Mr. Duckham, of Hereford, says, " Some cows are buried near to a brook ; the water, I believe, became impregnated, and the result is the disease has followed its course along the stream with fearful virulence. The manure was also washed into this brook." Mr. W. Pate, of St. Mary's, Ely, " has generally found that the stock that were in the best condition and best cared for, the first attacked and the least likely to recover." Mr. Biddell, Hawkstcad Hall, Bury, Suffolk, " believes that his oxen caught the disease from some that were 400 or 500 yards off." Mr. Alexander Black, North Navy, Scotland, mentions a neighbour of his who lost seventy of his oxen, and had but seven left ; these were put into a shippen and left to themselves, and all recovered. As regards treatment, all the veterinary surgeons nearly are agreed that it is better to kill at once, a conclusion that must, at least, be considered disinterested ; they have been lustily abused, whilst the quack and the charlatan, who promised everything and did nothing, got all the praise. If the reader will turn to page 37, where I have given a list of 109 of Cholera, he will see that a vast proportion of them have been employed also in the treatment of Cattle Plague. Arsenic, chlorate of potash, Condy's fluid, or permanganate of potash, salt, warbena, globules, vapour bath, vaccination, onions, and chloroform have all had their brief day and their enthusiastic admirers. I In my second letter (p. 60) I was the first to mention the trial the transfusion of blood in the case of rare and valuable animals. : P. Smith has, of late, suggested the same thing in the columns the Times, but if treatment were justifiable the general use of nsfusion would be impossible. In the same letter I recommended ) trial of various medicines as prophylactics, and upon this subject, well as upon the efficacy of disinfectants, we are as much in the rk as ever. I have seen a bull that had taken hydrochloric acid several months, and was unaffected, whilst the cattle around were ing ; and I could mention many examples of the assumed efficacy certain medicines as prophylactics, but the evidence we at present 3sess is entirely worthless. Future Prevention. — Lastly comes the important question as to how we are to avoid Cattle Plague in future. I believe that our only security will consist in the establishment of dead-meat markets in all cities and large towns, and the slaughter of all foreign cattle at the ports where they are landed, unless they undergo a seclusion of twelve or fourteen days. Our recent experience has taught us a lesson that we shall not easily forget, and in all future outbreaks the plan will be to kill and compensate the owners, not for diseased cattle and sheep only, but all that have been in contact with them. The efficacy of this plan has been recently fully and practically tested in Belgium, France, and Ireland. It is difficult to say when we shall get rid of the plague ; but if it should ever make similar ravages in this country, it will be the fault of the Government. An agricultural university and college, with a board of agriculture, supported entirely by the State, would form a central authority that would not commit the mistakes that have been made during the present epidemic. There should be, moreover, a chief Government inspector for cattle, sheep, pigs, and horses, with a sub-inspector for each county, so that a record might be kept of the existence of all infectious or contagious diseases, and their extension guarded against. By this means I believe the people would get a better and cheaper supply of animal food, and the country generally would be benefited. The large supplies of oxen and sheep in South America, Canada, and Australia, that will hereafter be sent to this country when the meat is properly prepared, will in a great measure, it is hoped, compensate for the deficiency of our home supplies. I am, my Lords, yours respectfully, Edwards Crisp, M.D. 42, Beaufort-street , Chelsea, September 1, 1866. 110 LETTER XIII TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. My Lords, — Haller, in speaking of Linnaeus, says, "He almost dares to place man and a monkey in the same category ; " and there are some, perhaps, who may think that the diseases of brutes are better excluded when human maladies are considered, forgetting that to the presence of cow-pock matter in their own bodies they probably owe their exemption from small-pox. As I have said before, I hope hereafter to show that a great amount of light may be thrown upon human maladies by the investigation of the diseases of the lower animals and of plants. My object on the present occasion will be to take only a cursory glance of the prevailing diseases of our domestic animals by way of contrast with those of man, and then make the comparison I have named between Cholera and Cattle Plague. A prevailing error exists, that there is a great similarity between the diseases of man and of the brute ; # but on a careful investigation it will be found that, as there is a wide line of separation between man and the inferior animals, so his diseases differ materially from theirs. Obstruction to the circulation, in the shape of what is called inflammation, congestions, and stagnations of various kinds, combined with a vitiated state of the circulating fluid, are the causes of the greater number of lesions in all living bodies. Inflammation, and some of its effects, are nearly the same in all vertebrate animals ; and I have seen in a cold-blooded animal — the python (P. molurns) — as good a specimen of pericarditis, with effusion of lymph, as I have done in the human subject, and so with other organs affected with inflammation ; but when we come to investigate special diseases, we shall find a vast amount of difference. In my essay on the causes of death of many of the animals dying at the Zoological Gardens, Regent's Park, from February, 1851, to February, 1860 ("Proceedings of the Zoological Society," 1860), I have given an account of the diseases of foreign animals in confinement ; and in the " Transactions of the Pathological Society of London," from 1856 to the present time, I have described many lesions of these animals. Let me now briefly consider some of the more important diseases of our domesticated animals — the horse, the bovine race, the sheep, and the pig. I need scarcely say that all these animals, like human beings, are liable to inflammation of the lungs, intestines, brain, and other parts ; but that nervous affections and lesions of the brainular and nervous apparatus are much less frequent than in the human species. Again, the bony and atheromatous state of the arteries, so common in man, is but rarely met with in the brute ; and aneurism is of very unfrequent occurrence. When * See a recent paper in the Medical Times and Gazette on " Cattle Plague in Man," by Mr. Harbord. it may generally be traced to violence. I have found one example of aneurism in a monkey, out of about 230 apes and monkeys I have now examined {Lancet, "1854, p. #87) ; and this leads me to digress for a moment to say a word or two about the diseases of the quadrumana. Those who have placed these brutes in so elevated a position uppear to me to have performed the part of special pleaders, or, like the " Knights and the Shield " in the fable, have seen but one side, as I have shown in my paper on the quadrumana, read at the British Association, 1864. My discovery of a penis bone in the anthropoid apes ("Proceedings of the Zoological Society," January, 1865) tends, I think, to make the line of demarcation so wide and definite that the most enthusiastic will pause before they claim relationship with the ape. But, as I have said in the paper alluded to, if we compare the diseases of man and the quadrumana, there is but little resemblance between them ; and the statement so often made, that most of the quadrumana in this country die of tubercular disease of the lungs, I have disproved long since. I have not space now to enter into this question ; but to return to our domestic animals. Of late years, from the importation of foreign cattle, three new diseases have been introduced, not including the Cattle Plague. Small-pox in sheep, as I have stated in my eighth letter (p. 88) in 1810 ; the next outbreak occurred in 1847, from Merino sheep imported from Tonning. As I have said in this letter, small-pox in sheep cannot be conveyed to man ; is not prevented by vaccination ; and in some other respects it differs materially from human small-pox. The next disease, imported about 1839, is the Murrain (Epizootic Aptha, or foot and mouth disease), affecting the ox, sheep, and pig, but especially the two former. It is, like small-pox in sheep, highly infectious and contagious ; and I think I have known instances where the virus has been conveyed three or four hundred yards by the wind. Unlike small-pox in sheep, it not unfrequently attacks the mouths and hands of persons attending upon the cattle. It is, however, seldom fatal to the beast, and human beings have not generally sustained any great injury from it. It is said that children have been affected by the milk of cows suffering from the disease. The next disease of recent introduction is Pleuro-pneumonia (1841). This disease, as is well known, has been very destructive, and has killed more bovine animals in this country than the Cattle Plague, and is nearly as infectious ; indeed, in some countries the same stringent measures have been taken to prevent its spread as those adopted against Cattle Plague. This affection is not communicable to man. Horses are not subject to epidemic affections to the same extent as ruminants ; and none of their diseases, excepting farcy, glanders, and scabies, are communicable to man. Influenza, which sometimes assumes a typhoid character; inflammation of the lungs, and diseases of the alimentary canal and its enveloping membrane, the peritoneum, are the most fatal. Strangles, 112 weed, colic, intestinal worms, and many other affections might be quoted ; but my object is to name chiefly the diseases that are more commonly fatal to our domestic animals. Diabetes in the horse is not an unfrequent disease. It is strange that two incurable diseases should be communicated to man by the horse and dog (glanders and hydrophobia). I was a student at St. Thomas's Hospital when the first case of glanders in the human subject was recognized by Dr. Elliotson, and since this period a large number of cases have occurred. It is one of the most frightful diseases to which humanity is liable. In the Lancet, 1854, p. 337, I have described this disease in lions, tigers, and jaguars that I examined at the Zoological Gardens. The disease was communicated by means of glandered horseflesh. Other diseases of the horse I need not allude to, except a passing notice of splenic apoplexy, a disease which I have treated upon in the Bath and West of England Journal, vol. ii., part 2. As I have shown in my work on the " Structure and Diseases of the Blood-vessels " (1847, p. 343), horses are very subject to worms {strongylus armatus) in the arteries of the abdomen, especially when bred in low, moory districts, and I believe that the ass is seldom found free from these parasites in the cseliac artery. The ox is liable also to splenic apoplexy, which kills quicker than Cattle Plague. The most fatal disease in bovine animals, as I have said before, is pleuropneumonia; black quarter or black leg, and charbon, are likewise fatal diseases. Epizootic aptha, as I have before mentioned, seldom kills. With the exception of epizootic aptha, scabies, and malignant pustule, there is no disease communicable from the ox to man. In Cattle Plague, as I have remarked in my fourth letter, p. 66, an eruption is produced on the human skin by the acridity of the matter applied, and in splenic apoplexy persons punctured have sometimes died. In sheep the diseases are more numerous than in the ox, and two entozootic affections are especially fatal to them ; the rot, from a worm in the bile ducts of the liver (Distoma kepaticum) and worms in the air tubes {strongylus filaria). From the latter affection, as I have shown in my " Prize Essay on Parasitic Diseases in the Lungs of Lambs," tens of thousands of lambs sometimes perish in this country. Two other verminous diseases are also fatal to sheep, the tape-worm (tarnia), and the carnur us cerebralis, or bladder- worjn in the brain. Adult bovine animals in this country are but rarely killed by verminous diseases, although they furnish in a larval form one very common human tape-worm, the tasnia mediocanellata. Calves, as is well known, often perish from the same worm in the air passages as that found in lambs and sheep, the affection familiarly known by the term " hoves." The other fatal diseases of sheep are abdominal affections, such as distension of the stomach, diarrhoea, softened and diseased liver, and inflammation of the bowels. Inflammation of the lungs also kills a great many lambs, as do some brainular and nervous affections in certain districts. Sheep are also subject to black water, splenic Q 113 i r J j *JM. cl .A V y __ (II siC v • Ivvt til 1 1 1 111.) 1.1 Ll l \\l ijvwijvj XW U iwUj D-UiwiX kvA cattle plague, and many other affections. Tubercles of the lungs are sometimes found in sheep and oxen, and parturient fever is often fatal. Malignant pustule is conveyed to man from the sheep, ox, and horse. I The diseases of pigs are less numerous than those of sheep, although ;reat many die when young. The most fatal disease is that to be deibed hereafter. Strangles or quinsy, catarrh, inflamed lungs and vels, colic, diarrhoea, inflammation of the brain, apoplexy, and other actions have been described. In some districts pigs are subject to >ercles of the lungs, and I have known many of them fatten remarky well in this condition ; but it may be observed that in all tuberar affections of the lungs of the lower animals, including the idrumana, cavities are seldom formed, and exhaustive expectoration ;herefore absent. The measles in pigs, as is well known, furnishes baby tape - worm (cysticercus celhdosce), which in the body of n becomes the common tape-worm (Tarnia solium). One of the most remarkable and fatal diseases of pigs is that which I have mentioned in my 10th letter, p. 101. Although it appears to have been known for some time in this country under the name of " soldier," from the redness of the skin about the neck, it is only during the last three or four years that it has been generally recognised by the veterinary profession of this country. Dr. Budd, of Clifton, read a paper on this disease at the Royal Agricultural Society, June, 1865 {Journal, part 1., p. 473). He calls the disease typhoid fever, and he thinks " the ulcerations of the intestines are the very counterpart of those in the typhoid fever of man ;" the disease is not identical, he thinks, " but bears the same relation that small-pox in sheep does to human small-pox." The symptoms are loss of appetite, constipation of the bowels, followed by frequent yellow coloured fluid evacuations, becoming of a dirty greenish colour in a more advanced stage of the disease, and often mixed with flakes of lymph. The conjunctiva are red and inflamed, and the skin for two or three days, and sometimes for a longer period, assumes a reddish hue, more conspicuous about the neck and sides of the body especially ; there is thirst, fever, dulness of countenance, sometimes paralysis, convulsions, and gradual sinking. In one instance I observed a brownish dry state of tongue. I have seen several pigs affected with this disease, and have examined them after death. I am sorry to differ again from Dr. Budd as to the nature of this affection. I The ulcerations do not resemble those seen in typhoid fever ; indeed, ;y present a very different aspect, for in some cases nearly the ole tract of the alimentary canal is covered with rupia-like elevads of a rounded form, many of them isolated, and not affecting :cially the aggregate glands. The appearance is more like that of all-pox than anything seen in Cattle Plague, and I am not sursed that M. Bouley should speak of it in the Peccary as " a consnt eruption like small- pox " (p. 101). I have found the blood in 114 115 EXPERIMENTS.— CHOLERA BLOOD. Is disease dark and fluid, and with the exception of the brain, ich is congested, the spleen and other organs are tolerably healthy, c skin, as I have said before, is covered with an exanthematous h, of a uniform red colour, not resembling the typhoid eruption in n. There is one remarkable fact in connexion with this disease, ? that it attacks chiefly young pigs, and in this respect bears a at resemblance to some of the human exanthemata, scarlet fever 1 measles. It is highly contagious ; I have known an instance ere a waggon that had conveyed diseased pigs was used again after month for healthy pigs, and these pigs took the disease. In ny instances the mortality is greater than in Cattle Plague ; the iths, too, are often very rapid. In the paper above alluded to, a •d account of the affection will be found by Dr. Budd, with some ctical remarks by Professor Simonds. Before I conclude this part of my subject I will allude to matter of great interest in relation to splenic apoplexy in the ox, sheep, and horse, a disease I have already alluded to in my third letter (p. 62). In my book on the Structure and Use of the Spleen (p. 168) I have mentioned the injurious effects of the blood of animals dying of this disease upon man and upon some of the lower animals. According to M. Devaine,* this arises from the presence of bacteria in the blood, but I have some doubt as to the correctness of his opinion. I was, however, anxious to ascertain whether Cholera blood would produce any injurious influence upon the lower animals, and I have recently instituted the following experiments : — A girl, affected with Cholera, was bled in a state of collapse, and ultimately recovered. Soon after the blood was taken from the arm I inoculated a puppy, a rabbit, a white mouse, and a pigeon, with this blood, but no perceptible effect was produced. The blood presented the appearance described at I Let me now consider certain statements regarding the prevalenc Cholera in the lower animals. Many of the older writers hay iken of the mortality of cattle and other animals during huma demies, and there are not wanting some who believe that quadru Is and birds may be affected with Cholera. The experimen ntioned above, and those described at p. 25, do not settle th 3stion, but they go some way to show that the lower animals canno :e the disease. In V Union Medicale, February 27, 1849, mpanzee at Brussels is said to have had Cholera, from which overed. In the same journal, October 27, 1849, M. Liezer de bes a case of Cholera in the horse. In 1881, at Marienverdu assia, great mortality occurred among fishes during the prevalence Cholera. In the Journal Hebdomadaire, 1832, at Choisi-lei, near Paris, during the prevalence of Cholera, about 500 of the lltry are said to have died of this disease. They had liquid alvine * Comptes Rendus, August 10, 1863. Q 2 the malady. If these and other cases, however, are carefully examined, it will, I think, be found that there is no good evidence of the existence I lastly come to the comparison between Cholera, Cattle Plague, and other human diseases. In my fifth letter, p. 72, I have already made a full comparison between the fevers of this country and Cattle Plague, and in my eighth letter, p. 87, the assumed identity of Cattle Plague and small -pox is also discussed. I have shown that this plague bears no great resemblances to any human affection, but that it is an exanthematous fever with a specific eruption, having a definite period of access and decline. Let us now consider its resemblance to Cholera. Cholera, like Cattle Plague, has its seat in the East, and travels westward. There is, moreover, some resemblance, as regards the spread of the disease from the gatherings of the Mecca pilgrims, and from the large congregations of cattle that have accompanied the Russian and Austrian armies. The invasion of Cholera is more sudden than that of Cattle Plague ; and although in both diseases the alimentary canal is the chief seat of the affection, yet in the one, diarrhoea generally appears at the onset, whilst in Cattle Plague the bowels are more or less constipated. In both affections there is a well-marked period of access and decline, although in Cholera the symptoms are less regular than in Cattle Plague. The rapid depression and sinking in both diseases indicate the virulent nature of the poison and its effect upon the nervous centres. As regards contagion, Cattle Plague is much more easily communicated, and probably with one exception, there is no human disease so contagious as Cattle Plague : I allude to puerperal fever. Both diseases are aggravated by a vitiated atmosphere, and in some degree by over-crowding, but not to the extent generally supposed ; for it is notorious that Cattle Plague has often been more fatal in healthy districts, where the animals have been better cared for, than in districts where dirt, over-crowding, and an impure air were all present. The bugbear about the London cow-houses served to amuse the people for a time ; but it is well known that the fatality in Cattle Plague has often been greatest where the animals have been better attended to than some of our London paupers. I need only mention the herds of Earl Granville and of Miss Burdett Coutts. The eruption of the skin is less frequent in Cholera than in Cattle Plague ; indeed, it is questionable whether strictly it belongs to the first-named disease, and whether, in the cases related, it may not have arisen from accidental circumstances. It appears to have little influence upon the mortality, whereas in Cattle Plague the appearance of the eruption is a favourable symptom. Of the 7 of Dr. Clarke's patients who had the eruption, out of 190, 4 died and 3 recovered. The eruption in Cattle Plague is also very frequently absent, as shown by the evidence at page 109 ; but it may have escaped the notice of some of my correspondents. 116 J.U tl OOIllj)ili(lll\C (. SlllS 1 1 1 lldl 001 tl i 1 11 111 all (.libCtlbC dllU UIIC dUCvwllJg wll\3 brute creation, it is necessary to take into account the peculiarities of structure in the latter, and especially the absence of mental causes, and the greater difficulty in interpreting some of the symptoms. The morbid anatomy of the two diseases affords us more interesting points of comparison. As I have said above, in both the alimentary tube is the part chiefly affected, and in both there is serous discharge from the bowels, and great loss of epithelium from most of the mucous surfaces ; but in Cattle Plague the congestions, extravasations, spottings, and stainings are seen to a much greater extent, and there is more disorganization than in Cholera. The blood in both is dark, fluid, and deficient in its serous portion, but to a less extent in Cattle Plague. Stainings and extravasations are common about the pericardium at the base of the heairtn Cholera, and they are almost constant under the endocardium of the left ventricle in Cattle Plague. The conjunctival, nasal, and labial discharges and eruptive excoriations of epithelium are peculiar to Cattle Plague, as well as the congestive patches on the fourth or digestive stomach. The air-passages, lungs, liver, spleen, and kidneys are generally more congested in Cattle Plague, and the right side of the heart and the pulmonary artery are not so loaded with blood ; but it must be remembered that although Cattle Plague is a more deadly disease than Cholera, that the human malady is sooner fatal. In Cattle Plague the time of death varies from the fifth to the seventh day ; in Cholera (as I have shown at page 1 7) the duration varies from five or six hours to seven or eight days. The period of incubation, too, differs much in the two affections. In Cholera, as far as we can ascertain, the period seldom or ever exceeds two or three days ; whilst in Cattle Plague the sixth or seventh day is the most usual time, and some have extended it to the twenty-first day. In both diseases, when recovery takes place, it is generally marked and sudden. The comparative rate of mortality is given at page 17 ; and as regards temperature, the highest I have met with in Cholera is 105° Fah. ; in Cattle Plague it is described as high as 107°. In both diseases the pulse and breathing are generally accelerated ; but in Cattle Plague the pulse does not fall so low in frequency (taking the natural rate of pulsation into account) as in many cases of Cholera. There is another remarkable difference in the two diseases — viz., that whilst in Cattle Plague the secretion of milk is suppressed, in Cholera, as shown by many examples at the London Hospital, the lacteal fluid is undiminished in quantity. The loss of the foetus (as I have shown at pp. 15, 109) occurs in both affections. Other differences might be enumerated, such as the blueness of the surface, the cold tongue and breath, cramps, sunken eyes, and altered voice, in Cholera ; and the tenderness over the spine, the unpleasant odour of the breath, the frequent presence of air in the cellular tissue of the back and loins, and in some cases convulsive twitchings of the muscles, in Cattle Plague. In this disease, too, 117 118 into the intestines, and the urinary secretion is not arrested to the same extent as in Cholera. Ibid, lastly, let me ask what practical facts do we derive from the ye comparison? Some, who believe in the unity of disease, may te to the conclusion that Cholera and Cattle Plague are the same ction, and that the difference in the symptoms and morbid appeares are only the result of difference of structure ; but, without ering into these speculative questions, let me point out one or two ctical inferences of more importance. The first is, that whilst tie Plague in all its stages is at present very little amenable to lical treatment, Cholera at its onset in the great majority of cases controllable disease, owing to the less amount of disorganization on mucous surfaces. The pathology of both diseases also teaches us t there can be no specific for either, and that in Cattle Plague (if treatment were allowable) the most rational would consist hat which I have advocated in mv last letter. I am, my Lords, yours respectfully, Edwards Crisp, M.D. 42, Beaufort Street, Chelsea, September 10, 1866. LETTER XIV. rTTEE, XIV. — ON THE PRETENDED SCIENCE OF HOMCEOPATHY AS APPLIED TO THE TREATMENT OF MAN AND OF THE LOWER ANIMALS. That which all reason does defy, No man of sense should ever try ; If premises are insecure, Conclusions never can be sure, And what on surface seems to be To some men, a reality, If sifted well, will soon be found At the core rotten and unsound. The Author. My Lords, — In addressing so many of noble blood and of refined intellect, it may be thought by some that I should speak with more modesty and deference ; but, my Lords, science knows no distinction, except at our Royal Society,* where the name of a commoner must tlf I were ever ambitious enough to desire the fellowship of this Society the re quotation of the laws would be quite sufficient to reject me. The late Mr. rell, who had done more for Zoological science than ninety-nine out of a dred of the fellows of the Royal Society, as shown by his works on British is and Fishes, and by his numerous papers, told me that after his name had i suspended for ten months he was privately told that he had better withdraw name, for he would be rejected because he was a tradesman. be posted for ten months before he can be balloted for, whilst one of noble birth is at once elected a Fellow without opposition, — a proof, if any were wanting, of the value set upon our aristocracy by men of science and erudition ; and if such is the opinion of erudite and learned men, what must be the influence upon many agriculturists and owners of cattle, when they read the list * of the president and committee of the Association for the Cure of Cattle Plague by the Homoeopathic method ? This committee consists of five dukes', one marquis, eight earls, four lords, four viscounts, seven baronets, two honourables, four colonels, and five commoners. Among these are six members of the Privy Council, and the late president and present journalist of the Royal Agricultural Society ; so that this association may be said to represent the government and the agricultural science As I said in my sixth letter, it is a proper beginning for the Government, which, in relation to this pestilence, have dealt in infinitesimals from the commencement of the plague ; and the same remark will apply to the Council of the Royal Agricultural Society, which, after six months, when the disease had been sown broadcast throughout the country, began to move, and came out with its patchwork resolutions (October 7th). Let me again ask, my Lords, if the plan I suggested in my first letter (September 21st) had been adopted, what advantages would have been obtained 1 how many plaguestricken animals should we now have in England ? There is another curious problem, my Lords, that it is impossible to answer — viz., how many animals have been sacrificed by this pretended homoeopathic cure — not by the medicines administered, but by the extension of the disease in the attempt to treat it under false pretensions ? But I have a higher motive for introducing this subject of homoeopathy than that in relation to Cattle Plague : it is one that concerns the whole human race ; for if this doctrine of similia similibus curentur is founded on fact, nearly all civilized people on the face of the globe are wrongly treated, and the art and science of medicine is a cheat and an imposition. If a man gifted with reasoning powers were told that he could get dinner off the decillionth part of a mutton chop, or that he could intoxicated by sniffing claret, he would call his adviser a fool or idiot ; yet, my Lords, the statement is quite as reasonable as the position that imponderable or infinitesimal doses of any medicine produce the slightest curative effect upon man or brute. ISut what is this pretended science of homoeopathy, this compound of losophic reasoning and logical deduction? My Lords, it is the y worst species of quackery, because, under a philosophic guise and tended stable basis, its very foundation is rotten at the core and eless as a shadow ! * Published by the Homoeopathic Association. 119 120 My reason blindfold, like a hamper d lion Check'd of its noble vigour ; then, when baited Down to obedient tameness, make it crouch And show strange tricks, which you call signs of faith So silly souls are gulled, and you get money. Otway. The study of organized beings, from the lowest plant to the more complex structure of man, requires deep thought, long and laborious application ; and those only can comprehend the workings and derangements of the animal machine who are well acquainted with its mechanism. " Pour connaitre I'homme malade il faut connaitre Vhomme sain." So, my Lords, in describing this pretended science of homoeo • pathy, as those I address have for the most part only a smattering of nature's mysteries, I must endeavour to make my remarks plain and intelligible to all. Man is naturally a superstitious and over- credulous animal, and often the higher his position the greater his gullibility and capacity of swallow. When the divine right of kings was a more fashionable doctrine than at present, for nearly six hundred years the royal touch was considered of great efficacy in the cure of most diseases, and even as late as the reign of Charles 11. the king touched 23,600 of his subjects for the evil in five years ; and Wiseman, his surgeon, says, — "I must needs profess that his Majesty cureth more in any one year than all the chirurgeons have done in an age." The repeated cures of Mr. Gratrix, the stroker of Prince Hohenloe, Johanna Southcote, St. John Long, and of a hundred others, need only be mentioned to show the credulity of mankind, and the love of the human race for novelty and fiction. Dr. Johnson said, " that if a man could get upon a tree, and preach with his head downwards, he would be sure to have a large congregation, whatever his Ihe vagaries of that pretended philosopher, Hahnemann, the founder his medley of false assumptions and imaginary inferences, as exted in his "Organon " and in his other works, are so palpable and evident, that the only rational and charitable conclusion is (as y of his contemporaries asserted) that he was insane. Listen to some of his wanderings : " The quintillionth attenuation of a grain of gold put into a small clean vial will restore, by ovation or smelling, despondency in an individual with a constant inclination to commit suicide, in less than an hour to a peaceful state, love of life, and to a sense of horror of his contemplated act." Eour Lordships well know the oroni potency of gold, as Fabian in one of his Fables (XIV. of the " Charlatan "), which I slate : — 121 fed, " Buy my powder, for it will remedy for every ill. Sirs," said he to wondering throng, " To this all virtues do belong : Twill cure all grief, make cowards bold, Give wives and husbands to the old. By it the fool, in the world's eyes, Becomes at once both learn'd and wise. Its influence is so great, that you May friends obtain, and all things do. In fact 'tis known, both wide and far, As the Encyclopaedia." The Charlatan his powder sold, 'Twas found to be a mite of gold. I But gold does more than even Fabian surmised ; it makes a British use of Commons, as exemplified by the exposures now going on at rmouth, Totnes, Lancaster, and Reigate. The purse, not the d, is the winner. But the mite of the charlatan, or the fifty ereigns of the candidate for parliamentary fame, had not the suped power of the imponderable and incomprehensible dose of Hahtiann. But there is something more tangible and positive about it ! Again, Hahnemann says, that " all chronic diseases arise from itch (psora), and can be cured by the remedies used for curing itch." Now, every tyro in the profession knows that the itch is caused by an acarus (mite) which traverses the human skin much as the mole does the earth, and that if you block up his breathing holes with lard, without any sulphur, you may kill the * acarus and cure the disease. So much for the power of homoeopathic sulphur. I Jut let us look to the origin of this wonderful discovery. Hahnem took twenty grains of cinchona bark for debility, and he supposed \ it produced ague ; and upon this false conclusion, this wrong rence, the whole system of infinitesimals, imponderables, trituras, and olfactions is based. I knew a blacksmith many years ago > cured ague sometimes, by giving the patient (an hour before the ected fit) a piece of paper to swallow upon which some dog Latin written, so much effect had the imagination upon the disease. Ilmong the few medicines that really can be called cures, or jifics, quinine for ague is the most potent, and if given in doses of grains three times daily, the disease, in the vast majority of ss, will be removed ; but try a homoeopathic dose, and I venture ay that, unless in some exceptional cases, where the imagination, n the example of the blacksmith, exerts some influence, the patient go on shaking in spite of the imponderables. But again, it is srly false that bark or quinine will produce ague ; tons of this icine have been given during the last twenty years, and there is example well authenticated on record where genuine ague has * I have seen my friend, Dr. Bazin of Paris, who is Physician to the Hospital St. Louis, cure many cases of psora with lard only. it iollowed its administration, although a shivering tit may occur sometimes as a coincidence. Bo this pretended basis must fall to the ground ; it is altogether orthy of credit. Let us next examine the effects of phosphorus on the human body. It is asserted by the homoeopaths " That it will produce inflamma lof the lungs and cure it." But this assertion is equally erroneou aye tabulated a great many cases of death from phosphorus, and i single instance was inflammation of the lungs found. But let m ;r to Taylor's "Medical Jurisprudence," 1865, where a number o es are given, and in no instance is pneumonia mentioned. Tha vapour of phosphorus may, like some other gases, produce irritatio the bronchial membrane, is tolerably certain, but this affection )gether different to inflammation of the lungs. I Look, again, to the effects of belladonna, which is said " to produce iptoms like scarlatina and to cure this disease." The rash, when loes appear, is unlike that of scarlatina, but the occurrence of the h is the exception, not the rule. Indeed, in the works of Beck 1 Taylor on Medical Jurisprudence, the authors of which write ;hout any reference to homoeopathy, the presence of the eruption not named ; but if it were present, what resemblance would the Ler symptoms bear to those of scarlatina ? Giddiness, dilated pupil, perfect vision or blindness, twitchings, convulsions, dryness of uth, and thirst, nausea, vomiting, &c. I Arsenic, say the disciples of Hahnemann, " will produce symptoms c Asiatic Cholera, and it will cure Cholera." The serum of the tod in Asiatic Cholera runs off by the bowels, leaving the vital fluid the vessels thick and tarry, but no such effects are produced by seme, nor do the character of the vomiting, the nature of the matter mited, the appearance of the evacuations, nor the intensity of the imps (in many cases) bear any resemblance to those occasioned by lenic. ITartarized antimony will, it is said, " like phosphorus, occasion i cure inflamed lungs," but in the majority of cases (as shown by ylor and others), this drug does not occasion pneumonia ; the effect chiefly upon the stomach and intestinal canal. In the dogs poisoned Majendie the lungs were of a violet colour and distended with >od ; the stomach and intestinal canal red and inflamed. In rabbits isoned by Brodie with tartarized antimony, the stomach was chiefly llt must not be supposed that the so-called homoeopathic doses for c cure of Cattle Plague and other diseases are all infinitesimal. If ahnemann were alive again, he would not recognize his own doctrine ! gentleman, whose cows I saw before giving the homoeopathic solution arsenic to a cow, administered two drops to a kitten, and the iimal was killed in a short time. But let us take a case of recovery ported by Dr. Kidd, of Blackheath, a professed homoeopath, in the 122 123 THE TIMES AND CHIASMODUS. Ines, November 7. Dr. Kidd gave a cow of a grain of arseni ry two hours on the first day, increased the dose to £ of a grai ry two hours on the second day, with of a grain of phosphoru ides the vapour bath. When the cow was supposed to be dying had old ale and four bottles of Barclay's stout ; and this is calle( loeopathic treatment ! Hahnemann would have put the arsem the cow's nose, for he came to the conclusion that all medicine inconceivable doses if given by the mouth were too potent, an< t smelling alone was sufficient ! He altogether protested agains administration of two medicines at the same time, and alcohol i shape he repudiated. I^e Times, so satisfied with this and other like examples, says >vember 29), — " If the prophylactic dose of arsenic should actually efficacious, our cows may be sent to market with perfect safety, i antidote will operate like vaccination in the case of small-pox, in the end the disease ought to disappear." There is a fish (Chiasmodus) in Dominica that not unfrequently swallows another fish much larger than itself, so that its skin is distended to bursting. The capacity of the swallow of the Times editor for the marvellous must exceed that of the fish in question ! IMj Lords, it is such namby-pamby twaddle as this, combined with spontaneous generation theory, so obstinately maintained by the ading journal," that will cost the country millions of pounds ! t there is one matter connected with the public health of great >ortance, viz., the effect the milk, flesh, and tripe are likely to r e on infants and delicate persons using them for food when an mal has long been under the influence of arsenic, not in homseohic doses, but in quantities that many of the pretended disciples of hnemann and others administer. I have recently been lustily :sed for cutting into the stomach of an ox that had been killed for ;tle Plague, because the owner said that it " spoilt its sale for tripe." this animal had been long under the influence of arsenic, what would have been the effect upon the person eating the tripe ? This Xi matter of more importance than at first sight appears, and it is unlikely that many persons have unknowingly suffered from this se. This is a question that appears hitherto to have escaped CG. lA.fter this expose I need not devote much time to the consideration the homoeopathic treatment of Cattle Plague, because the remarks ,t are applicable to man apply with equal or greater force to the ite creation. Let me quote a few more of these homoeopathic docles, although it is waste of time to consider them. Ist. " That there is no conservative power of nature (vis-medi~ catrix natural) as maintained by the allopathic school." 2ndly, "That two different medicines should not be given at the same time." 3rdly. " That the homoeopathic aggravation must be more intense than the primitive disease." n 2 oo to cure vjititic Jrlague tiic imponderables muse occasion rfolk trial has not sealed the fate, that is, shown the utter fallacy the homoeopathic mode of treatment, all I can say is it ought to ye done." Mr. Forrester, who had no prejudice against homoeopathy, re, it has been fully and fairly tried, and " it was wholly and entirely ailure." But the most amusing part of the affair is, that porter and mulants were freely given ; adjuncts, as I have said before, that ihnemann would have entirely repudiated. I Dr. Hamilton had stated in the Times that 75 per cent, had been red in Holland, and at the Cattle Plague Meeting at Norwich, member 11th, Viscount Bury increased the number to 85 per cent, stead of spreading* the disease by this means and wasting the public ney, would it not have been better, my Lords, to have established j one experimental hospital I advocated in September, where this, Eln the week ending August 11, 1866, no less than 1,225 cases are reported olland, and yet some people are complaining that Dutch oxen are excluded this country. 124 been quickly decided without danger of spreading the Plague by a thousand foci of contamination ? The pole-axe would have been used much sooner then it was, and the country would have been saved a vast amount of money. Eis painful, my Lords, to have wasted so much time in combating idow, but as this shadow by many Nobles and Priests is very tantly thrust upon the people as a real and substantial good, ye thought it right to lay bare the empty and hollow pretensions le system, and to expose its false and fatal inferences. That many people of fertile imaginations and with slight ailments, who have been making apothecaries' shops of their stomachs for years, may be benefited by this do nothing system, when combined with great attention to diet, I readily admit, but I moreover believe that a great number of lives are lost by tampering and playing with disease at its onset, when the ordinary appliances of the medical practitioner might have averted the danger, and have restored the patient to I am, my Lords, Yours respectfully, Edwards Crisp, M.D. 42, Beaufort-street, Chelsea, Dec, 1865. LETTER XV. ITTER XV. — ON THE STATE OF THE MEDICAL AND VETERINARY PROFESSIONS AS AFFECTING THE PUBLIC HEALTH AND THE WELFARE OF THE AGRICULTURIST. TO THE RIGHT HON. THE LORDS OF THE PRIVY COUNCIL. IMr Lords, — The subject of my letter may appear strange to many ) may think that science and politics should not appear in the le page, and that the one has no connexion with the other ; a koo cry, that has served the purpose of too many that have reoed it. I labour under the impression, my Lords, as I have said 3re, that if we had had a representative faculty of medicine in each ;he three kingdoms, a representative veterinary college in England, land, and Scotland, and a national agricultural university and rd of agriculture establishments that I have long advocated, that should not have waited four months for the report of a Royal nmission on the Cattle Plague, twelve months for a scientific report, [ eight months for the opening of Parliament ; nor should we 125 126 have had two gentlemen sent on a flying visit by the three agricultural societies to investigate Cattle Plague, and to report " that the disease could never reach our shores/ as stated at page 79. A commission would have been formed at once of the professors attached to the above-named colleges and universities, and the disease, as in France, Belgium, and Prussia, would have been quickly eradicated. If we had had a faculty of medicine in 1832, we should not, as I have mentioned at page 27, have had the President of the College of Physicians recommending that troops should be "drawn around infected places, and that the victims should be buried in detached ground ;" nor should we, during the present epidemic, have had a committee of a college of physicians (p. 42) expecting captains of ships to look for " obviously indigestible food, and unnaturally offensive discharges." My Lords, I hope that there is a brighter future for science in this country, and that the time is not far distant when many of the clogs and shackles that now encumber her progress will be removed, and when many of the changes I have long advocated will be carried out ; when scientific professors will be paid by the State, and when the poor and enthusiastic student will have some chance of reward for his labours ; not looking forward, as at present, to the prospect of starvation and a garret. When, at our British Museum of Natural History, our National Colleges of Chemistry, Geology, Mineralogy, Mechanics, Botany, and Agriculture, all the professors will be compelled to give gratuitous lectures to the public, so that things may be learnt instead of words, arid a taste given for pursuits that tend to expand the mind and elevate the sentiments more than all the formal and stereotyped studies of the schools. The weed that grows under the college window, if properly investigated, "will teach more than anything that can be gained from heathen poets and philosophers. But it will naturally be said, " look to the great men that England has produced," and I should be the last to detract from the merits of my countrymen, but the question is not what a field has produced, but what it might have produced under proper cultivation. Our medical, chemical, and other students go to foreign school?, but who ever heard of a foreign student coming to England to learn anatomy, medicine, chemistry, or any .other science ? Can anything, my Lords, be more condemnatory of our system than the fact, that whilst Paris and other Continental schools are full of English, American, and other students from all quarters of the globe, such a rara avis as a foreign student is seldom seen in this country, and then he is probably driven here, like our rarer British birds, by some accidental circumstance. The whole system is dead, stale, and unprofitable ; there is no life, spirit, nor energy about it. Go to the Hunterian Lectures at the College of Surgeons, and see the empty benches before the Lecturer, I have semetimes counted an audience of nine at these gatherings ; and so at our School of Mines and other scientific lectures, the hearers are few nnd lar between. As 1 said in my first letter, to borrow trora Punch, " Smith got his pictures well hung at the Royal Academy because his mother washed for a Royal Academician ;" and so, my Lords, with the scientific and other appointments in this country, money and interest are the ruling powers. The old Tory argument was that we were not to complain of corruption, because " dung produced melons ;" but as very few eat the melons, the people at large, I fear, are little benefited by the growth. But let us look to the career of Cuvier, Dupuytren, Louis, or any of the great men that France has produced, all have won their honours by dint of hard labour and talent ; step by step they have gained their elevations by concours ; but what a contrast does this country afford to that of France in this respect ? A city merchant or rich tradesman thinks it a good speculation to pay a hospital surgeon a thousand pounds for his son's apprenticeship, as the money will go far to insure his appointment as surgeon to the hospital. Mr. South, at an oration given to the Governors of St. Thomas's Hospital, January, 1851, at which I was present, said " That in 1710 the surgeons were not allowed to take more than three cubs or apprentices at the same time, and that in the whole history of the hospital no man had been a surgeon who had not been an apprentice," or, in other words, who had not, like many of our members of Parliament, bought his place. After this preamble, my Lords, let me come to the questions that form the heading of this letter, and first let me allude to the state of the veterinary profession in the three kingdoms, one that not only concerns the welfare of the agriculturists, but indirectly the health of the people. And here let me pay a well merited compliment to the members of the veterinary profession for their conduct during the present outbreak of Cattle Plague ; for, in spite of abuse and obloquy heaped upon them from all quarters, those who dared to speak out adhered to the honest, straightforward, and disinterested course, and plainly told the Government that the best plan " was to stamp out the disease." To Professor Gamgee, although I believe he made a great mistake in supposing that Cattle Plague could be eradicated without stopping fairs, markets, and all movements of cattle, I think the country is much indebted for his early warning to the Government, and for his outspoken and fearless denunciations of its policy. In speaking of the veterinary profession I include a great many respectable members of it who have not the diploma of the College, and I trust that no word will escape me that will be offensive to any one, for the farmers, shoemakers, tailors, and others who have acted as inspectors were not to blame, the honour was thrust upon them. tin France, and in many other countries, all who practise the ;erinary art are obliged to undergo a regular course of study, and to 3S an examination before they can practise. To take France as an ample, we have here three veterinary schools or universities (Alfort, mded 1765; Lyons, 1762; and Toulouse, 1761), where students 127 must spend four years in the acquisition of knowledge before they are eligible for examination. But what is the state of things in this country, where our stock of all kinds is of much greater value, and where the people are better able to pay for education and instruction ? In England we have a London Veterinary College, consisting of less than a thousand members, including those in the army, — a college that is more like a charitable dispensary, aided by the Royal Agricultural Society, all the members of which are privileged to send animals free of cost ; the students not examined by members of the veterinary profession ; and instead of four years' study, as in France, Belgium, Austria, and Prussia, they are let off with one. For thirtyseven years only one veterinary surgeon was thought qualified to sit among the examiners ; and when, in 1827, it was suggested that more veterinary examiners should be added, the medical committee objected. At the annual elections ladies and members of parliament were allowed to vote by proxy. To use the works of Mr. Fenwick ("Veterinarian," July, 1829), " A joint- stock company, where gentlemen may send their horses at the cheapest rate, and where human surgeons, ignorant of the anatomy and diseases of horses, are the examiners. Eiet us take the annual report of the governors of the Royal Veteriy College, as published in the "Journal of the Royal Agricultural iety/'1865, p. 166:— I Notwithstanding the advance which the science of cattle pathology is making er the system of co-operation, which exists between the Royal Agricultural iety and the Royal Veterinary College, the Governors have had under conration the question of rendering the College, if possible, even more effective; they entertain hopes of being able hereafter to adopt still more effectual sures for the promotion of the common objects of the College and the Society. Governors of the College, who are also members of the Council of the Royal icultural Society, will be able to inform the Council that at no period since system of co-operation between the two bodies was established, have the ernors paid more attention to the advancement of their common objects than ing the present year, or have made greater exertions in this sense." IDhis is the substance of the report of the non-professional governors ;he Royal Veterinary College of England ; and I seriously ask, my •ds, whether my statement that this institution is a mere club, t it has nothing national or universal about it, is not a correct ? Is it not a scientific farce ? And yet Mr. Newdegate, Mr. Hand, and other governors, pride themselves on their scientific aagement, and " hope that the system, if possible, may become n more effective." The italics are mine. I refer your Lordships to ! and other reports in the " Journal of the Royal Agricultural iety." A college or university, to be useful and efficient, must end upon the ability of its own professors, and must not be crip-1 and confined by money subscribers, and by those who are ignorant he very elements of the studies pursued. But how happens it that, 128 Ihe system is ?o "effective," the professors of this college were kept much in the back-ground in the scientific report of the Govern - tit, a matter in which they were specially concerned ? Their ence was a stigma upon the whole veterinary profession, and upon system so lauded. In Scotland the veterinary profession is in a worse state than in ;land ; a college, under the control of the Highland Agricultural lety, and, according to Professor Gamgee (" Veterinarian/ July, 6, p. 613), consisting only of about 200 members in Scotland. ¦n Ireland there is no veterinary college nor instruction of any d. IfVnd how, my Lords, is this strange and neglectful state of things be remedied? A bill is now before parliament to prevent those ) are not members of the London and Scotch Veterinary Colleges n calling themselves veterinary surgeons. Nothing is said about >tland, and protestations are made by the Scotch against the idon monopoly (" Veterinarian," June and July, 1866). As land cannot be in a worse condition than at present, she makes no test ; indeed, there are none to complain. My Lords, nothing rt of a grant of money from the government, the establishment of a ege in each of the three kingdoms upon a liberal footing, can meet requirements of the times. If this bill of the patrons of the idon Veterinary College should become law, it will only, like the Tinacy bill which I protested against in 1852, add to the corporate chwork which at present exists. The state of the medical profession in the United Kingdom will readily account for the condition of the veterinary art which I have described. It will scarcely be credited, in these days of manhood suffrage and of competitive examinations, that of the 20 bodies in this country, including the Archbishop of Canterbury, that confer medical and surgical degrees, nineteen out of twenty of the diplomaholders have no voice or power in the management of their own affairs, or in the election of their governors. Like the little boys at the peep show, they pay their money and there the matter ends. I belong to three of these corporations, and I have written to them all to ascertain how the money is expended, but I can get no satisfactory information. Among these bodies there are ranks and distinctions to suit all tastes and pockets, grades in the very chambers of death, physicians without surgical knowledge, surgeons without medical knowledge, and apothecaries who should do the bidding of both. In my^ evidence before the House of Commons on the Pharmacy Bill, 1852 (Minutes, pages 156 — 165), I have given the qualifications of 10,947 members of the profession in this country, and if this return be consulted, a strange medley it will be found ! I 'he subjoined device which I have sketched will at once tell you, Lords, the value of the parchment, and the lines I have appended convey some idea of the unity that prevails — S 129 130 PRICE OF PARCHMENT. Is r o\v discord reigns in Britain's favour'd clime, Three monstrous heads guard Med'cine's sacred shrine, More monstrous far than Cerberus of old, For twenty limbs an ugly body fold, And stop its progress, for when one would go In the right path, another holds it low, And Fashion, curse of science, Folly's tool, Measures all parchment by a golden rule. 27/ e Author. I\ need not, my Lords, enter upon the history of these corporations, 3 too well known to the members of the profession. They have only ked to their own petty interests, and have never thought of the leral good. To quote from Mr. Lawrence's speeches of 1826: — Self-elected and irresponsible bodies have always been found the st unsafe depositories of power." i[n the Lancet and other medical journals ; in the evidence taken ore Mr. Warburton's Committee of the House of Commons, 1834, I the Parliamentary Report of the Medical Registration 1847-1848, Ibe found abundant proofs of this. I commend these reports to ir Lordships' perusal. |[n 1836 the British Medical Association was formed. Among its mbers were Marshall Hall, Professor Grant, Drs. James Johnson, mville, G. Webster, and Messrs. Wakley, Liston, Grainger, Pilcher, I many other men of note. The objects advocated were a represenive Faculty of Medicine and Surgery in each of the three kingds with one portal for all, and to show, my Lords, how early my itical opinions were formed, I quote an abstract of my speech at first meeting of this Association. I have never deviated from the nions I entertained when I first entered the profession, and I am eh prouder of these., and of the efforts I have made to carry them , than of any little contributions I may have made to science. Mr. Crisp. — The argument used by Dr. Thompson has been this — that the publi* are not sufficiently enlightened to distinguish men of talent. If they are 131 pose will effect that end. According to the present state of medical affairs, the public have no opportunity of drawing the distinction. (Applause.) Every man who puts a coloured bottle in a shop-window is called a ""Doctor," and chemists and surgeons have that appellation commonly assigned to them. But if there be a Faculty of Medicine, and if all be compelled to undergo one description of examination, and our public institutions and hospitals be thrown open, then will the public be better able to appreciate the man of talent. (Applause.) Dr. Thompson's arguments, therefore, fall to the ground. Certainly, his assertions ought not to be allowed to stand uncontradicted. {Lancet, January 21, 1837, p. 606.) i:n 1844 Sir James Graham's Bill would have repealed all charters, I would have established a Council of Health and Education ; the , after being patched and tinkered in various ways, was quietly dised of. As in the case of Mr. Warburton's Bill the corporate in-3st was too strong. Mr. Wakley's Registration Bill of 184G, [ its withdrawal from the same cause, is well known. |[n 1844 the National Institute of General Practitioner was formed, nbering more than four thousand members, all praying for a tional Institute of Medicine upon the representative principle and 'one portal for all." Then came the Committee of Inquiry, (•7-1848 ; the new charter of the Royal College of Physicians .bling this body during the "year of grace" to fill its empty coffers, 1 the new charter of the College of Surgeons allowing it to sell its owships, so that up to this period they have realized a large sum of ney. Then appeared the Registration and New Medical Act, conling the power of the corporations whose unjust and exclusive acts profession had so long protested against, compelling all to pay a istration fee, the government at the same time taking all it can get n the quack and the charlatan in the shape of licence duty, whilst lember of the swell mob, or a blacksmith, may open a chemist's shop i dispense the most deadly poisons.* Now vilest compounds are reputed cures For ev'ry evil that the flesh endures, And our wise rulers give a helping hand To secret nostrums that disgrace the land. Lift science with the right, then give a blow With other palm, that quickly lays it low, So that our Gallic neighbours, laughing say, " The Paradise of Quacks is o'er the way." The Author. * I was the first, in the London Medical Examiner, January, 1851, p. 241, to protest against the indiscriminate sale of poisons in this country. I quote the conclusion of the article: "We have surely said enough to convince the most incredulous of the necessity of an immediate remedy for this crying evil. The one we suggest is, that no person shall be allowed to procure a poison of any hind, without an order from a magistrate, a clergyman, a medical man, or the registrar of the district, and that arsenic, the most common instrument in the murderer's hands, shall be coloured and scented before it is retailed to the 132 ADJUDICATION OF PRIZES. I Phis council of 23 persons, by which we are governed, represents interests of all the corporate bodies, and without stating the exact ibers, the whole of them have been elected by less than 300 sons ; so that the medical profession, notwithstanding the numerous itions to the House of Commons in favour of representative ernment, has no voice in the matter. To quote from my evidence >re named on the Pharmacy Bill, question 2,321, " I look to the ire : I hope that we shall hereafter get a different class of men in House of Commons, and that they will frame a Bill that will be the public good." Those who petitioned for reform have got a King Stork, that, in the shape of a Medical Council of Education, has swallowed up representative government and all the just demands of the profession ; for in many respects we are in a worse condition than before the Act passed. Quackery and illegal practice are as rampant as formerly ; and, as I said before, the corporations have managed to get everything into their own hands, and the inequalities on the register, as regards qualification, are greater than heretofore. As the duty of this Medical Council is to regulate all matters relating to education and the good government of the profession, and to show the utter inefficiency of this body for the purpose, I may mention two circumstances of recent occurrence that I have already published,* and that I have placed before this Council for investigation : the one the Carmichael Prizes of £300 ; the other, the Triennial Prize of £50, at the Royal College of Surgeons, awarded April, 1862. According to the printed rules, all who compete for this prize "must use a motto, all recited cases must be placed in an appendix, and original facts are to be the principal points of excellence." But the gainer of the prize did not comply with one of these requirements. Shortly before the essay was sent in, he copied, verbatim, papers that were published four years before ; of the 208 pages composing the essay, not onetwentieth part is original, and nothing new is added ; the cases before published are in the body of the work, and on thirteen different occasions he tells the three adjudicators, one of them his own colleague, that he is the author of the essay ! The treatise, moreover, is full of positive and unmistakable errors, about which there can be no doubt nor cavil. My Lords, on this and on all former occasions when I have made such exposures, I have not been influenced by pecuniary motives or by personal spite. I mention the above examples of corporate injustice, and I could add largely to the list, for the purpose of showing- public. Some few rats and mice may escape death by this arrangement, but our business is with preservation of human life." Like the Public Health Act, mentioned at page 45, the law since past is a very inefficient one, as seen by the reports in the daily and weekly press. * Expose of the Carmichael and Harley Prizes, 1862, placed before the Council of the College of Surgeons and before the General Council of Education. 133 such a gross dereliction of duty, such a breach of a. sacred trust could not have occurred ; but there are two important questions involved in this matter, my Lords, to which I especially direct your attention. At this college, when a gentleman has arrived at the mature and respectable age of forty, if he can get six fellows to vouch for his respectability and honesty, and his character is apeed of by the Council, he (without examination) buys his fellowand his right to vote for ten guineas, and up to the present time c the new charter (1854), for the sale of these titles, the college has received about £10,000 ! 80 that the adjudicators of this prize may sit in secret conclave on the merits of the candidates for the fellowship, and reject or admit them at their pleasure ! It must not be supposed that I ever coveted this pecuniary honour. The other inference is this, that the Council of Education have refused to interfere in these tw r o questions that especially come within their province, so that the profession in such-like matters has no court of appeal. But let me give the other example that I have alluded to. The late Mr. Carmichael, of Dublin, was an enthusiastic reformer, and advocated the establishment of a Faculty of Medicine in each of the three kingdoms {Dublin Medical Press, 1840, p 361). In his will, Sept., 1849, he directed " That the interest of £3,000 should be applied every four years to two prizes (£2OO and £100) on medical reform. If the Essays in 1854 were not thought worthy, the Council of the Dublin College of Surgeons might postpone the grant till 1859." I was a candidate among many others, and although the will distinctly stated that the prizes w r ere to be aw-ardedin 1859, the award has been illegally withheld. I copy verbatim the summary and conclusion of my essay. SUMMARY. That a One-Faculty of Medicine and Surgery shall be established, in each of the Three Kingdoms, composed of Councillors, elected by Graduates, Members, and Licentiates, of the various Universities, Colleges, and Halls by means of a balloting paper ; that the individual so elected shall appoint a Senate for the regulation of Medical Education and Examination, under the supervision of the Privy Council. That all who enter the Medical Profession shall pass four examinations, conducted at various periods :—: — The Ist, a preliminary examination, in the Classics, Natural Philosophy, the lower branches of Mathematics, and the outlines of Natural History. The 2nd Examination shall be, in Anatomy, Physiology, and Chemistry. The 3rd in Medicine, Pharmacy, and Midwifery, including diseases of Women and Children. The 4th in Surgery, and in such branches of Anatomy and Physiology as especially relate thereto. That these Examinations shall be conducted in each of the Three Kingdoms, in such place or places as the Government shall direct; and that a proper Laboratory "and dissection room shall be attached, so that the examinations may be rendered as practical as possible. Kiat all who pass these Examinations shall receive the title of Licentiate ledicine and Surgery, which alone shall qualify for practice ; and that all r titles obtained at the various examining boards shall be honorary. I 'hat as the good of Ihe State and the general welfare of the people are intiely connected with the progress of Medical Science, — the Government shall t Professors in the various Capitals, giving them such salaries as will enable n to devote their exclusive attention to scientific pursuits; and that when mcies occur, these vacancies shall be filled up by persons recommended by the •esentative Senate; so that the selections will not be made, as is too often the i at present, by party bias and political influence. ihat after a time, all the Medical and Surgical Appointments at the Hospitals he Three Capitals, (not exclusively supported by private charity,) shall be petitive : — The Examiners to be composed of the Government Professors, mmended by the representative Senate ; and that these Examinations shall, those for the Licentiatcship, be conducted in public. Ihat the first and leading inquiry of the Examiners (as in Prance) shall be the :cedents of the Candidates : what are their published works (if any) ? what itical and beneficial additions have they made to Medicine, Surgery, or the aieral Sciences? Next, as shown by the public examination, what are their ibilitics of reasoning and of imparting knowledge to others? The first to be ded by a thesis on some given subject; the second, by a clinical lecture upon ?dical or surgical patient. Ihat as soon as the present arrangements can be sufficiently altered, no miner shall be a teacher for profit, as recommended by the late Sir A. Cooper 5 that all the Examiners shall be the Professors, heretofore named, paid by the eminent, and having no interest whatever in the examination fee. CONCLUSION. 11 this inquiry I have endeavoured, as briefly, and at the same time as compreively as possible, to make my readers acquainted with the past and present iry of the profession: — to put them in possession of practical facts and ctions, about which there can be no question or cavil, as they are all from I lie documents ;— -to show that there is nothing National about any of our porate institutions, as at present constituted;— that with few exceptions, as well expressed by Mr. Carmichael, they have rather resembled private 3S ; and that, like the shoemaker in the fable, they recommend and advertise r own parchment. . . ? 1 support of this evidence, I have given the opinions of men (and 1 could ; multiplied this testimony to a great extent) that are, or have been in high fcion and high favour with their professional brethren; amongst these 1 may :cially mention the donor of this prize, hope that I have not indulged in one unnecessary personality. As a taitlitul •niclerof events, I have been compelled to bring the public acts or men ninently before my readers, for the better elucidation of the subject, and rive force to my conclusions. I have only spoken of them in their Corporate I cities ; and I am especially anxious that it should not be inferred from my irks that 7 lay claim to any superior excellence or honesty; nor must it be osed that, if I had been in the same position as many of the individuals >c public acts I condemn, that I might not have taken the same part that have done The greatest brawlers, both in Medical and general politics, become silent as the grave when they have entered the dark and exclusive ibers which they had so long endeavoured to open to the "Commonalty ) quote again Mr. Lawrence's remark in 1826, "^Corporate bodies have ys been found the most unsafe depositories of power." hatever the fate of this essay may be, I have the consolation ot knowing 134 135 that I have not modified or altered my opinions to please any body or class of men ; that many of the suggestions here offered are in accordance with the views of the donor of this prize; and that they were publicly expressed, before Mr. Carmichael, in his memorable and graphic speech at the Medical Reform Congress in Dublin, in 1839, enunciated his opinions upon medical reform. The plan I have suggested, which must be gradual in its accomplishment, would interfere with no corporation ; no vested rights (so called) ; honorary and academical titles would be sought for with more avidity than at present ; and the poor man, in his extremity, would be able to command efficient medical attendance ;¦=— Scientific Maps and boundaries would not be made to suit men's pockets; — a stimulus would be given to industry and talent ; — the Three Heads, now snarling and sneering at each other, would gradually merge into one, with a smiling and honest face, the limbs having an interest in the body to which they are attached, would work for the general good; and some of the opulent Members of the various Corporations, like old Scrooge in Dickenss' "Christmas Carol," might be rejoiced at the change, become so liberal in spirit that they would do what they have never perhaps thought of before — send for their attorneys, alter their wills, and leave money for the advancement of science and the good of humanity ! Dublin, with her vast resources for Medical and Surgical instruction, might become one of the first Schools in Europe; and the great number of Irish practitioners, who now go to Scotland for their diplomas would, as I have fully shown, be proud to call the National Faculty of Medicine of Ireland their Alma Mater. To conclude, in the words of Mr. Carmichael, "We should not then have Physicians and Surgeons traducing each other en masse ; nor should we have the Dublin Apothecary, who aims at the rank and emolument of the general practitioner, playing off one against the other to his own advantage." IVnd now, my Lords, I bring this unfinished sketch to a conclusio las an important bearing upon Cholera, Cattle Plague, and upo ry disease that afflicts man and brute. I have never writte nymously, and if any think that I have placed some of my o\\ ;cedings too much in the foreground, it has been done under tl ef that I should benefit the cause I have so long advocated. r J te from the Hunterian Oration that I would have delivered befo Royal College of Surgeons {London Medical Examiner, Marc il), "As there is a beautiful harmony in the structure of all huma ies, so all who treat their diseases should possess a uniformity o lification, an accurate knowledge both of medicine and surger the peasant should be provided with the same amount of medica 1 as the lord :—: — " 'Pallida mors sequo pulsat pede pauperum tabernas, Itegumque turres.' " I have the honour to be, my Lords, Yours 'respectfully, Edwards Crisp, M.D. 4-2, Beaufort Street, Chelsea, & 21, Parliament Street Preparing for Publication, THE SAME AUTHOR, A WORK ON THE PEACTICE OF MEDICINE, BASED UPON AN INVESTIGATION OF THE DISEASES OF THE VARIOUS MEMBERS OF THE VEGETABLE AND ANIMAL KINGDOMS. PHYSIOLOGICAL PROEM. On the Uses of Organs and their Gradual development in Organized Bootes. Diseases of the members of the Vegetable kingdom — of those in a state of nature and of those in a cultivated state. Diseases of radiate, articulate, and molluscous animals. The effect of certain Drugs and Chemicals upon the vitality and circulation of these animals. Diseases of Fishes, Reptiles, Birds, and Quadrupeds, in a wild, and in a domesticated state, as influenced by food, climate, and other causes. Diseases of Man in his uncivilized or pristine state, compared with diseases of civilized countries. New diseases and lesions the result of civilization and of unnatural habits and food ; with statistical deductions. Zymotic Diseases. Diseases of tubular parts, including the nervous system ; the heart and blood-vessels ; the lungs and air-tubes ; the alimentary canal and the absorbent system. Special diseases of the thorax and abdominal viscera, and of the ductless glands, not included under the above heads. Malignant or cancerous diseases. Diseases of uncertain seat, as Diabetes, Hydrophobia, Dropsy, &c. Diseases of the generative organs. Diseases of Childhood and of Old Age. Skin diseases. Epizootic and entozootic affections, with statistical inferences as to sex, age, occupation, climate, rate of mortality, and treatment of all the above diseases. General conclusions as to the benefit derived from an investigation of the Diseases of Plants, and of the lower animals, and on the assumed virtue of certain Drugs and Chemicals in the cure of disease generally. LONDON : ROBERT HARDWICKE, 192, TICCADILLY, W. 7