CHOLERA

of 2 /2
647 of sulphuric asid ; and 3et, according to a case recently reported ip the daily papers, a man engaged upon the Gay-Lussac tower, which in sulphuric acid works is em- ployed to recover the nitrous vapours issuing from the vitriol chambers, was overpowered by nitrous fumes. Accord- ing’,to the evidence given in the court, in which the manu- facturers were summoned for failing to observe a special rule made for the regulation of chemical factories, the man was lowered into the tower for the purpose of repacking it (pre- sumably with coke), but shortly afterwards he was overcome by the gas, and in response to his calls was taken out, but mot soon enough, unfortunately, to be rescued from the deadly effect of the fumes. In the defence it was urged that the occurrence was a pure accident, while several - expert witnesses concurred that in such a case no known form of respirator could avail anything. That nitrous fumes are very dangerous, and also that they cannot be warded off by adopting respirators, is well known, and by none better than the manufacturers in whose works such emanations occur, whose duty it should be to warn work- men against going near a place where an escape of nitrous fumes (chiefly probably N02) may happen. On no account, obviously, should the Gay-Lussac tower, which is generally saturated with the fumes, be repaired until it has been thoroughly well ventilated. Manufacturers should be com- pelled to give notice, we think, to the proper authorities when the towers are about to be repacked, so that the regulations in regard to ventilation may first be properly carried out. ____ THE EFFECTS OF LIGHTNING. THE letter of Mr. Carmalt Jones, which is printed in another column, though it does not seem to present any absolutely new feature in connexion with occurrences of the kind in question, is interesting in more ways than one chiefly, perhaps, from the point of view of the rabbit. The "’skin" sent to us shows a space of about six inches in length and about one inch in width denuded of fur. The bare skin is slightly desiccated, but not discoloured, vesicated, or charred. It is presumed that there was no further sign of injury or disorganisation of tissue in the rest of the body of the animal. This is consistent with the known fact that electric discharges, even when fatal, do not necessarily kill by producing any gross change in the tissue and organs, or even, so far as is known, by altering the histological elements, of a structure. The damage to the tree is simply the disruptive effect of the lightning flash striking an im- perfect conductor. The men "felt more or less shaken." In other words, they experienced a shock due to induction. Owing to the presence of a "charged conductor " in their neighbourhood a charge of opposite sign had been induced in them. When the flash occurred—i.e., when the conductor was discharged-the induced charge in their bodies was also suddenly discharged. This is known as "return shock." The distance recorded in this case is not too great for such 0.fIects to be experienced. It was very different in the recent balloon accident at Aldershot, where four men holding a captive balloon by a wire rope were " struck " and seriously inj ared. In this case the unfortunate men had by means of their balloon simply angled for the lightning, and, having captured it, offered it a ready route to eaith through their own bodies. It is a source of astonishment as well as of regret that, in the light of historic experiments with lightning and kites, such an accident as this should not have been foreseen and provided against. FINE FOR NON-NOTIFICATION OF SMALL-POX. THE Birmingham Daily Post of Aug. 18th contains the report of a case in which a tradesman was summoned for failing to give notice to the authorities that his wife had small-pox. He did nct become aware of the fact till Aug. 3rd. He first called in a herbalist. Oa Aug. 7sh he called in Dr. Pogson, who immediately notified. The Bench said he should at once have called in a regular practitioner and when he became aware of the disease ought, irrespec- tively of personal business considerations, to have notified the case to the authorities. The Birmingham health autho- rities have done well to prosecute in this case, and to teach the public that the friends of the patient, equally with the medical man, are responsible for notification. IN our tabulated statement of fees chargeable to students seeking the diplomas under the Conjoint Scheme between the Royal College of Surgeons, Ireland, and Apothecaries’ Hall (vide the I Students’ Number" of THE LANCET, Sept. 1st, 1894, page 505) it should have been stated that the total fees for the diplomas of L.R.C.S.I. and L.A.H. are at present .626 5s.-i.e., E5 5s. for each of the first three examinations and f:10 10s. for the final. WE learn from Padua that his Excellency Dr. Baccelli, who has for some time been suffering from rheumatic gout, will shortly visit the neighbouring Stabilimento Terminale of Albano, there to undergo the " mud " treatment for which the place is famous. - A DEATH under chloroform has occurred at Kidderminster ; we hope to publish an account of the details of the case in our next issue. CHOLERA. CHOLERA continues to maintain a foothold in the same countries and places that it did last week, but has not mani- fested any decided signs of epidemic extension beyond those places already infected. It is in Russia, Galicia, and Buko- vina that the disease chiefly shows itself in any epidemic intensity ; in Germany, Holland, and at Antwerp its mani- festations have been much less extensive and severe. It is noteworthy that a case of the disease is stated to have been recently introduced into the Southern States of America in the person of a Bavarian emigrant, who embarked with other emigrants at Bremen, landed at New York from the Transatlantic liner else, and was removed from the train at Cumberland in Maryland, where he died collapsed in a few hours. No other attacks have been reported, and there is still some doubt as to the cdEe having been one of true Asiatic cholera. The latest official reports from St. Petersburg show that cholera still rages in many parts of Russia. The weekly omcial bulletin from the 1st to the 7th inst. returned 146 cases and 101 deaths in that capital during that period. From Aug. 26th to Sept. 1st there were 607 cases and 359 deaths in the government of Petrikow, 289 cases and 114 deaths in the government of St. Petersburg, 229 cases and- 109 deaths in that of Novgorod, and 1126 cases and 527 deaths in other parts of the country. In the period between Aug. 19th and Sept. 1st 1383 cases and 640 deaths occurred in the government of Warsaw, and from Aug, 19th to Aug. 25th 1017 cases and 571 deaths in the government of Kielce and 718 cases and 360 deaths in the government of Radom. According to one of Reuter’s recent telegrams the epidemic in Russian Poland is described as very severe, the weekly number of fresh cases averaging 5000, about half of which prove fatal. In Germany cholera has continued to manifest its presence, but to a comparatively slight extent, in East Prussia, in the Vistula district, and in the districts of Netze and Warthe, Oder, Upper Silesia, Hessen, Nassau, and the Rhine province. There was a sharp but circumscribed out- break at Burgein, the exact nature of which does not seem to have been determined. Professor Franckel appears to entertain the opinion that the disease-which was entirely confined to the small village of that name, and no history of the introduction of cholera into it could be

Transcript of CHOLERA

647

of sulphuric asid ; and 3et, according to a case recentlyreported ip the daily papers, a man engaged upon theGay-Lussac tower, which in sulphuric acid works is em-

ployed to recover the nitrous vapours issuing from thevitriol chambers, was overpowered by nitrous fumes. Accord-

ing’,to the evidence given in the court, in which the manu-facturers were summoned for failing to observe a special rulemade for the regulation of chemical factories, the man waslowered into the tower for the purpose of repacking it (pre-sumably with coke), but shortly afterwards he was overcomeby the gas, and in response to his calls was taken out, butmot soon enough, unfortunately, to be rescued from the

deadly effect of the fumes. In the defence it was urgedthat the occurrence was a pure accident, while several

- expert witnesses concurred that in such a case no

known form of respirator could avail anything. Thatnitrous fumes are very dangerous, and also that they cannotbe warded off by adopting respirators, is well known, and bynone better than the manufacturers in whose works suchemanations occur, whose duty it should be to warn work-men against going near a place where an escape of nitrousfumes (chiefly probably N02) may happen. On no account,obviously, should the Gay-Lussac tower, which is generallysaturated with the fumes, be repaired until it has been

thoroughly well ventilated. Manufacturers should be com-

pelled to give notice, we think, to the proper authoritieswhen the towers are about to be repacked, so that the

regulations in regard to ventilation may first be properlycarried out.

____

THE EFFECTS OF LIGHTNING.

THE letter of Mr. Carmalt Jones, which is printed in

another column, though it does not seem to present anyabsolutely new feature in connexion with occurrences of thekind in question, is interesting in more ways than onechiefly, perhaps, from the point of view of the rabbit. The"’skin" sent to us shows a space of about six inches in lengthand about one inch in width denuded of fur. The bare skin

is slightly desiccated, but not discoloured, vesicated, or

charred. It is presumed that there was no further sign ofinjury or disorganisation of tissue in the rest of the body ofthe animal. This is consistent with the known fact thatelectric discharges, even when fatal, do not necessarily killby producing any gross change in the tissue and organs,or even, so far as is known, by altering the histologicalelements, of a structure. The damage to the tree is simplythe disruptive effect of the lightning flash striking an im-perfect conductor. The men "felt more or less shaken."In other words, they experienced a shock due to induction.Owing to the presence of a "charged conductor " in theirneighbourhood a charge of opposite sign had been inducedin them. When the flash occurred—i.e., when the conductorwas discharged-the induced charge in their bodies was also

suddenly discharged. This is known as "return shock."The distance recorded in this case is not too great for such0.fIects to be experienced. It was very different in therecent balloon accident at Aldershot, where four men holdinga captive balloon by a wire rope were " struck " and seriouslyinj ared. In this case the unfortunate men had by means oftheir balloon simply angled for the lightning, and, havingcaptured it, offered it a ready route to eaith through theirown bodies. It is a source of astonishment as well as of

regret that, in the light of historic experiments with lightningand kites, such an accident as this should not have beenforeseen and provided against.

FINE FOR NON-NOTIFICATION OF SMALL-POX.

THE Birmingham Daily Post of Aug. 18th contains thereport of a case in which a tradesman was summoned forfailing to give notice to the authorities that his wife had

small-pox. He did nct become aware of the fact till

Aug. 3rd. He first called in a herbalist. Oa Aug. 7sh hecalled in Dr. Pogson, who immediately notified. The Bench

said he should at once have called in a regular practitionerand when he became aware of the disease ought, irrespec-tively of personal business considerations, to have notifiedthe case to the authorities. The Birmingham health autho-

rities have done well to prosecute in this case, and to teachthe public that the friends of the patient, equally with themedical man, are responsible for notification.

IN our tabulated statement of fees chargeable to studentsseeking the diplomas under the Conjoint Scheme between theRoyal College of Surgeons, Ireland, and Apothecaries’ Hall(vide the I Students’ Number" of THE LANCET, Sept. 1st,1894, page 505) it should have been stated that the

total fees for the diplomas of L.R.C.S.I. and L.A.H.

are at present .626 5s.-i.e., E5 5s. for each of the first threeexaminations and f:10 10s. for the final.

WE learn from Padua that his Excellency Dr. Baccelli, whohas for some time been suffering from rheumatic gout, willshortly visit the neighbouring Stabilimento Terminale of

Albano, there to undergo the " mud " treatment for whichthe place is famous.

-

A DEATH under chloroform has occurred at Kidderminster ;we hope to publish an account of the details of the case inour next issue.

CHOLERA.

CHOLERA continues to maintain a foothold in the samecountries and places that it did last week, but has not mani-fested any decided signs of epidemic extension beyond thoseplaces already infected. It is in Russia, Galicia, and Buko-vina that the disease chiefly shows itself in any epidemicintensity ; in Germany, Holland, and at Antwerp its mani-festations have been much less extensive and severe. It is

noteworthy that a case of the disease is stated to have beenrecently introduced into the Southern States of Americain the person of a Bavarian emigrant, who embarked withother emigrants at Bremen, landed at New York from theTransatlantic liner else, and was removed from the train atCumberland in Maryland, where he died collapsed in a fewhours. No other attacks have been reported, and there isstill some doubt as to the cdEe having been one of trueAsiatic cholera.The latest official reports from St. Petersburg show that

cholera still rages in many parts of Russia. The weeklyomcial bulletin from the 1st to the 7th inst. returned 146cases and 101 deaths in that capital during that period.From Aug. 26th to Sept. 1st there were 607 cases and359 deaths in the government of Petrikow, 289 cases

and 114 deaths in the government of St. Petersburg, 229cases and- 109 deaths in that of Novgorod, and 1126cases and 527 deaths in other parts of the country. In the

period between Aug. 19th and Sept. 1st 1383 cases and 640deaths occurred in the government of Warsaw, and fromAug, 19th to Aug. 25th 1017 cases and 571 deaths in thegovernment of Kielce and 718 cases and 360 deaths in thegovernment of Radom. According to one of Reuter’s recenttelegrams the epidemic in Russian Poland is described asvery severe, the weekly number of fresh cases averaging 5000,about half of which prove fatal.

In Germany cholera has continued to manifest itspresence, but to a comparatively slight extent, in EastPrussia, in the Vistula district, and in the districts of Netzeand Warthe, Oder, Upper Silesia, Hessen, Nassau, and theRhine province. There was a sharp but circumscribed out-break at Burgein, the exact nature of which does not seemto have been determined. Professor Franckel appears toentertain the opinion that the disease-which was entirelyconfined to the small village of that name, and no

history of the introduction of cholera into it could be

648

traced from any infected place -had been generatedlocally from insanitary conditions. Although the water usedby the affected families was impure, no comma bacilli weredetected in it on bacteriological examination. At the villageof Grieslienen in East Prussia 15 cases have also been officiallyreported, 4 of which have already proved fatal. Theseisolated outbreaks in small communities dnrirg this epidemichave been apparently as frequent abroad as they were inthis country. The authorities of the district of Oppeln inSilesia have prohibited the holding of pilgrimages, and per-sons coming from Russia and Austria are subjected to rigorousexamination.From Vienna we learn that cholera still prevails with

severity in Galicia and Bukovina, but the numbers showsome decrease, attributable, it is thought, to the decreasingheat in the affected provinces. According to a recent purveyof the progress of the disease by the Central Sanitary Councilit appears that the total number of cases which have occurredin Galicia amount to 5367 and in Bukovina to 591. Thedeaths in both provinces have been over 50 per cent. of thoseattacked. The latest cholera bulletin returns 533 fresh casesand 304 deaths during three days for these two provinces.The most important news, probably, is the extension of thedisease to Lemberg, where there is an exhibition, at whichthe Emperor of Austria was present. Eight cases and fourdeaths are reported as having occurred there in the course oftwenty-four hours. The projected military manoeuvres inEast Galicia have been abandoned in consequence of theprevalence of the epidemic.

Cholera-in the sporadic form-continues to prevail atmany places in Holland-as, for example, at Amsterdam,Maestricht, Laandam, Kralingen, Alblasserdam, Dordrecht,and at Nieuwerkerk and Kapelle on the Yssel, and otherlocalities and villages.A telegram from Ostend contradicts the report that a case

had occurred there.There is no fresh news as to the occurrence of cholera at

Antwerp. It will be remembered that there have been threeintimations to the Local Government Board of this countryin regard to the occurrence of cholera on shipboard in con-nexion with this port, the latest having come from Cardiff.The schooner Vol7tnteer has since arrived in the Lough withthe history that the vessel left Antwerp on the 27th ult., thaton the following day a sailor died from cholera, and thatanother seaman was affected with choleraic diarrhoea, butrecovered.

So far for the medical history of cholera in Europe. Turn-

ing to India, where cholera seems to be very prevalent atpresent, we have to chronicle an outbreak of terrible severityat Lucknow in the East Lancashire Regiment. Accordingto the Pioneer ]}IaiZ, the regiment was only some 600 strongwhen the disease suddenly broke out. In the course of afew days there were 140 seizures and 90 deaths, an occur-rence which recalls to mind what frequently used to occerfifty or sixty years ago. Of late years, however, Europeanregiments cantoned in India have been undergoing a

marked improvement as regards their liability to cholera.The disease in the Lucknow garrison was mainly con-

fined to one regiment, which was, as socn as practicable,marched out of its cantonments, with the result that theattacks began to decrease almost immediately after itsremoval. These sudden, vuulent, and very circumscribedoutbreaks of cholera in India, now happily much rarerthan formerly, together with the occurrence of nume:-ous isolated cases in different parts of the country,are extremely difficult of explanation, but no painsshould be spared to search out the clue to their occur-

rence. According to a telegram in the Times, some of themen of the regiment who had undergone M. Haffkine’sinoculation treatment were attacked, and the disease provedto be about as fatal among them as among those who had not

undergone that treatment.Again, in the case of the largest native hospital at

Bombay a recent outbreak of cholera has excited greatattention. The Times of J.nàic{ of the 21st ult. containeda report of the proceedings of a meeting of the BombayMedical Union in regard to this outbreak, which occurred inthe large institution known as the Sir Jami>etjee JejeebhoyHospital; but as the members of the union had not succeededin obtaining any exact or official history of the detailsfrom the hospital or Government authorities it is evidentthat, in the absence of precise information, any attemptto trace out the causes of the outbreak would be futile at

present-indeed, we have failed to find in the report of the

proceedings any record of the exact dates of the out-

break, or even of the numbers attacked. Still there are afew facts recorded which are of much interest at the presenttime. The hospital has hitherto been free from any outbreaksof cholera, even when the disease has been present in aseverely epidemic form in the city, when the hospitalitself was in a far less sanitary condition than it is at thepresent time, and when it was the custom to admit cholera,patients into it for treatment. The disease was not pre-valent in Bombay at the time of the outbreak in question,which was confined to this hospital and did not affect

any buildings or other hospitals in its close vicinity ; andnotwithstanding the exodus that took place, by which ina week’s time only some twenty patients remained in thewards ous of 400 whom the building contained, thedisease was not communicated to a single individual inthe various crowded localities to which the patients repairedafter leaving the infected building. The water-supply wascommon to the affected and unaffected buildings and isperfectly good ; indeed, the relative freedom of the cityof Bombay from cholera of late years has been attributed,and no doubt rightly, to the purity of its water-supply. Ofcourse there are other directions, as in regard to food-supplyand other matters, in which strict investigation is calledfor ; but, in the absence of any exact information, it is

hopeless to attempt any explanation of the occurrence inquestion. We must await the publication of a report on thesubject until it has been exhaustively and scientificallythreshed out ; meanwhile the hospital building is beingthoroughly cleansed and disinfected.

ASPECTS OF PUBLIC HEALTH IN THESCANDINAVIAN CAPITALS.

(BY ONE OF OUR SPECIAL COMMISSIONERS.)

I IV.-MILK CONTROL IN COPENHAGEN ANDI STOCKHOLM.1

MANY medical officers of health have doubtless duringthe past six months been distributing in their districtscirculars as to the best means of preventing infantile diar-rhcea, laying special stress on the boiling of milk, so that itmay be of interest to describe what is being done in

Copenhagen and Stockholm in the matter of providinga pure milk-supply; for, unfortunately, it cannot be deniedthat the boiling of milk does not improve its flavour,and consequently the step is more often honoured in

the breach than in the observance. Since outbreaks ofscarlet fever, diphtheria, and enteric fever have in numerousinstances been traced to infected milk something has beendone by legislation to safeguard milk from contamination,notably by the Dairies, Cowsheds, and Milkshops Order of1885, with its section prohibiting a person suffering fromany dangerous infectious disease, or who has been recently incontact with a person so suffering, to participate in the pro-duction, distribution, or storage of milk. But still thereis every reason to doubt whether in country districts, beyondthe mere fact of being registered, the cowkeeper is muchaffected by the Order or at all realises its importance. Anadditional source of danger must be attributed to milk, sinceit has become agreed that human and bovine tuberculosis arethe same disease, and few educated persons would not now be

. prepared to admit the extreme probability of tubercle being,

caused in the human subject by the consumption of cow’s milkI containing tubercle bacilli. Certainly numerous experiments

have absolutely proved that calves may be infected when fed onsuch milk, and the large number of cases of tabes mesenterica

; occurring in children is not without considerable significance in; this respect. One is therefore justified in saying that the milkl from cows with tubercle of the udder is positively dangerous,and the supply of such milk should be regarded as little shortI of criminal. Fortunately, however, this condition is not veryr commonly met with, as it is usually secondary to tuberculousl deposits elsewhere and only appears late in the disease.

, Professor Bang of Copenhagen, who has made the subject of

t bovine tuberculosis peculiarly his own, states that the udderf was affEcted in but 1 per cent. of the cattle slaughtered in the

1 Parts I., II., and III. appeared in THE LANCET of July 14th and21st and Aug. 18th respectively.