584

THE LANCET.

LONDON: SATURDAY, APRIL 27, 1872.

THE CHOLERA.

AT the meeting of the Association of Medical Officers ofHealth on the 20th inst., in a paper on the prospects ofthis country as to cholera during the present year, Mr.NETTEN RADCLIFFE took occasion to review the history ofthe recent diffusion of the disease in Europe, and made an

attempt to forecast the future of the diffusion. Forecast,the word used by Mr. RADCLIFFE, obviously in the sense inwhich it was applied by the late Admiral FITZROY to wea-ther prognostications-namely, a scientific opinion foundedupon data from which disturbing elements cannot be eli-

minated,-may be commended to the prophetically inclinedamong epidemiologists. In this sense, the word aptly re-

presents the limits within which epidemiological previsionshould be restrained, and its general adoption by epide-miologists might be advantageous, if, following the ex-

ample of Dr. BRYDEN, a proclivity to prediction shouldbecome common among them. ’’,Mr. RADCLIFFE discussed the prospects of this country

as to cholera during the year-first, with reference to the ’,facts of the recent diffusion; and, next, with reference to Ithe state of the country in respect to conditions favouringthe development of cholera. He holds that the recent dif-

fusion, in development and progress, approaches more

closely in character to that of 1852-55 than of any otherprevious diffusion. Both diffusions apparently originatedin Europe as recrudescences of a preceding epidemic; butin both, he maintains, there are cogent reasons for thebelief that the phenomena of recrudescence masked a newinvasion of Europe by cholera from India. He infers,therefore, the probability of a further extension of cholerain Europe during the present year. Europe, also, is

threatened with an invasion of the disease by way of theMediterranean. About the same time in 1871 that cholera

began to spread actively in Northern Europe, the diseasealso broke out at the head of the Persian Gulf, and ex-tended widely in the province of Bagdad. Early in thesummer of the year a Turkish expeditionary force, whichhad contracted cholera at Bassora, carried the disease intoEastern Arabia; and a caravan conveyed it also to Hayelin Northern Arabia. From Hayel the malady spread succes-

sively to Khaiber and Medina; and in November it appearedin Mecca, and the disease was present there, it is asserted,when pilgrims were beginning to assemble for this year’spilgrimage. Later in the year Gonfudah was attacked, andcases were reported at Jeddah and Yembo. Egypt is thus

gravely threatened, and through Egypt Southern Europe.We await with some anxiety authentic reports of the stateof health of the pilgrim caravans returning homewards.The reports already received are contradictory. Our most

recent information is to the effect that the vessels carryingpilgrims which had reached Suez from Jeddah carried foulbills of health, and that the Egyptian Government was

exercising the most energetic quarantine measures againstthem.

With cholera probably now about to become active inNorthern Europe, and Southern Europe threatened with afresh invasion of the disease by way of the Mediterranean, un-

questionably the prospects of the Continent with regard to theepidemic this year are gloomy. The position of this countryin respect to the epidemic Mr. RADCLIFFE considered, first,from the point of view of previous outbreaks, and confessed an

inability to offer an opinion. He remarked that all generaldiffusions of the cholera here had hitherto been precededby outbreaks of the disease in the year previous to that ofthe general diffusion. Cholera had been twice importedinto England last year, but there had not been any out-breaks of a character similar to those which preceded thediffusions of 1832, 1847, 1854, and 1866. Dr. BUCHANAN,however, pertinently observed, in the course of the discus-sion which followed the reading of Mr. RADCLIFFE’S paper,that, if cholera should spread in England in the course ofthe present year, it would be precipitate to assume thatthis was the second and not the first year of an epidemicoutbreak in the country. t

Mr. RADCLIFFE’S observations on the state of the countryin respect to conditions favouring the development of cho-lera were substantially in accordance with the opinionswhich have been expressed by THE LANCET. He stated

that the permanent sanitary works which had been carriedout in the claolera fields of previous epidemics, the improvedstate of the law as to the abatement of nuisances and the

preventive dealing with infectious diseases, and the bettersanitary organisation of urban districts since the epidemicof 1866, all tended to the conclusion that cholera, if againintroduced into England, would meet with local causes

capable of fostering its development in less amount

than in previous epidemics. A cardinal condition of com-parative immunity from the disease would, however, be, heinsisted, energetic action on the part of local authoritiesfor carrying out the important powers entrusted to themfor the prevention of infectious diseases.

It would have been instructive to have learned how far

this view of the subject was accepted by the members ofthe Association present at the meeting. But, excepting a

slight expression of dissent from Dr. DRUITT, and some in-terrogative comments by Dr. TIDY, the discussion was suf-fered to wander into a very seductive by-path, and themain object of the paper dropped out of sight. Inspector-General MURRAY and Dr. DE RENZY, the Sanitary Com-missioner of the Punjab, were both present at the meeting,and both spoke upon the probable source of the recent dif-fusion of cholera in Europe. Listening to these distin-guished authorities on cholera-one the oldest, the otherperhaps the youngest, of the eminent physicians whohave made cholera in India a subject of special study,-themeeting suffered itself to be wiled away from a considera-tion of the immediate prospects of our own country as tothe disease, to a consideration of the probable future ofIndia under the energetic measures now being taken toamend the water-supply of its population-measures whichDr. DE RENZY has taken so considerable a part in initiating.

585THE LICENSING BILL.

THE Licensing Bill of the Government has of course been probable that no harm would follow from allowing a public-anxiously expected, not only by the large number of persons house to be opened by anyone who wished to engage inwho are directly or indirectly interested in the profits of the the trade; subject of course to police regulations aboutliquor trade, but also by the far larger number who are hours of closing and orderly conduct, and to disqualifica-desirous to remove some, at least, of the evils with which tion as a penalty for disregard or violation of the law.that trade has become associated in the public mind. Lord If every man of sufficient character and substance were

KIMBERLEY, by whom the Bill was introduced into the licensed as a matter of course, on the condition that he

Upper House, in a very clear, able, and temperate address, should actually manage his business himself, there wouldfrankly enough confessed that it was not ambitious in its probably be no more beer-shops than at present, and thosecharacter, and that it aimed chiefly at the control of mani- which existed would no longer be held under a sort of im-fest abuses. He confessed, further, that the elaborate plied guarantee of their valuable privileges.system of licensing which he described was in direct opposi- Another point to which the attention of the Legislaturetion to the report of Mr. VILLIERS’S Committee, which re- might be directed with advantage would be the fosteringcommended that the sale of intoxicating drinks should be of houses where drink was sold to be carried away, in con-

left free; and he did not conceal his own assent to the tradistinction to those where it is sold to be consumed.

wisdom of the recommendation, at least from certain points One used to see, in former times, the words 11 Not to be

of view. Still, he said, public opinion was in favour of a drunk on the premises" on many a village signboard; and

well-regulated monopoly; and it is well known that the it is by means of the drinking on the premises that beer-

Ministry entertain a humble view of the nature of their shops chiefly demoralise. No man would be the worse for

own functions. It is not for them to seek to lead opinion, sending out for a pot of beer to be drunk at his own fire-or to instruct people from the vantage-ground given by side, and to be shared with his wife and children, if onlyaccess to the most extended information; but rather to for the reason that he would be little likely to send forfollow at a modest distance in the wake of those who more when the first supply was nnished. But, in the beer-observe and think, and to frame little compromises be- shop itself, one pint too often leads to five or six in suc-

tween the parties to the eternal strife of good against evil cession, until the hard-earned and sorely-needed wages arewhich rages in the world. Fortunately this policy does not squandered, and trouble and privations entailed upon thestand in the way of accepting suggestions for improvement family at home.made to them by others, when not of a kind to call forth Nearly kindred to this part of the question is that of

active opposition ; and hence we may always hope that the adulteration, on which Lord KIMBERLEY spoke in a manner

shortcomings of a Government measure may be amended well calculated to amuse all who understand the questionin committee. It therefore behoves all persons who are and the common practices of the trade. He read to the

concerned (and who indeed is there that is not concerned ?) House of Lords an account of the way in which beer was

to look at the Licensing Bill with a view to the improve- actually adulterated with water, and with coarse sugar,

ment of its provisions, and to urge any suggestions that and with a very small bit of copperas to give it a head,

may occur to them upon the notice of members of Parlia- and was then fined by some preparation made from fish-ment. There are probably none who have such oppor- skin, and supplied by brewers for the purpose, and wastunities of observing the ill-effects of public-houses as the drunk by confiding customers almost immediately. He said

members of our own profession; and there is no class of nothing of the way in which the beer thus weakened ismen more likely, if indeed so likely, to point out practical rendered intoxicating by poisonous drugs, such as tobaccoflaws in a measure by which these ill-effects are to be con- and cocculus indicus, with other admixtures that onlytrolled. " brewers’ druggists" understand. The base and cruel

With regard to the licensing question, it seems to us frauds of the publican and the brewer would be impossiblethat all forms of magisterial discretion with respect to the without this assistance; for the consumers of beer, in

granting of licences would be liable to be abused. No one many places, have learned to take its power of fuddlingsupposes that publicans will multiply in excess of their them as the measure of its excellence. Lord KIMBERLEY

means of living, or that liquor-shops would be opened, or did not tell the House how he meant to repress even the

at least continuously carried on, in any number greatly comparatively innocent adulterations that he described;larger than the demands of the public would require. But, but he distinctly pledged himself that their repressionon the other hand, there is a real danger lest, if the trade should at least be aimed at, and, a fortiori, he must alsowere free, large numbers of liquor-shops would be made endeavour to prevent the use of the poisons which nowsources of profit subsidiary to some other calling. To a form part of the poor man’s drink. Lord KIMBERLEY

certain extent this is the case already; and there are at rightly said that, under present arrangements-that is,least many beer-houses, if not public-houses, from which under the existing reign of brewers,-the publican couldthe master and licensee is almost constantly absent during not live by his trade if he did not adulterate; and we be-the day. The business is thus left to the management of lieve that, in many cases, he could not live if he did nothis wife until the evening; and the margin of profit over adulterate poisonously. If beer were only watered andexpenses, however narrow it may be, is still something sweetened, and then cleared by coarse isinglass, nobodyadded to the resources of the family. If it were possible, as would have the least desire to drink it. The addition ofa rule, to forbid this sort of thing, and the indefinite mul- salt is necessary in order to create thirst, the addition of a

tiplication of drinking-places which it might produce, it is narcotic in order to abolish self-control. To deal with

586 DISEASES OF THR HEART.

these abominations successfully would not only be a difficult logical relation was made distinct which is now so well

task, but would be the greatest piece of statesmanship that understood by every tyro in medicine. The detection and

has been accomplished in England for a century. If Mr. differentiation of heart-disease could not have advanced

GLADSTONE’S Government can carry into law a Bill that as it has done apart from the introduction of the stetho-will really regulate the liquor traffic, pruning away its scope by LAENNEC. But it is gratifying to know that Eng-associated evils and abuses, and leaving its usefulness and lish, Irish, and Scotch physicians have greatly distinguishedits convenience untouched, they will earn a lasting claim to themselves by their labours in this branch of pathology,the gratitude of their fellow-countrymen. especially that the researches of PITCAIRN, DUNDAS, BRIGHT,

LATHAM, and HoPE have been brilliantly continued byT.aE subject of Diseases of the Heart is one of great in- STOKES, CORRIGAN, GRAVES, QUAIN, GEORGE JOHNSON,

terest, both practical and pathological. It is, comparatively RICHARDSON, FOTHERGILL, and a hst of others.

speaking, a new subject. The older pathologists gave the It is not our intention to pursue this line of thoughtheart itself very little consideration. There was only one further. But if anybody doubts the progress of medicalcriterion to them of its action-namely, the pulsation of science let him compare the knowledge possessed bythe radial artery. Almost their whole attention was given physicians in the beginning of this century of the morbidto the blood which the heart pumped through the body: conditions of the heart with the knowledge possessed bythe condition of the pump itself was almost ignored. The physicians now, and he will admit that the advance isdiseases of the lungs were not so much overlooked. They enormous. An ungenial critic may say, cui bono? To whatrendered themselves more palpable by various objective end is all the elucidation of the different lesions of the dif-

symptoms, although the differentiation of the various dis- ferent tissues if it does not lead to a more enlightened andeases of these organs was only accomplished by the dis- efficient treatment? But this is jrst what it does lead to,coveries of LAENNEC, which have also enabled physicians to and there can be no doubt that the medical treatment of

test the condition of the heart by various physical methods. diseases of the heart is much improved. It is especiallyIt is very interesting to notice how little is made of the improved in two or three respects. In the first place, muchheart by older authors. HEBERDEN discusses palpitation, more attention is devoted to other local disorders and to

and obviously regarded it as occasionally having relations the constitutional states with which heart-disease is asso-

with grave constitutional states,.such as those produced by ciated. By a proper medical regard to these the sufferingtoo much care and business, asthma, gout, and general heart is often either completely relieved or greatly im-failure of the powers of life known by the name of a broken proved. Secondly, the physician of the present day directsconstitution. He gives, as an appendix to his Commenta- his treatment to improving the vital tissue-the muscle-

ries, an interesting paper entitled "Remarks on the Pulse/’ of the heart, and does not aim at impracticable alterationsin which he expresses himself dissatisfied with the minute of the condition of the valves. He knows that much maybedistinctions of the several pulses made by physicians, say- done to nourish, to rest, to save the muscular tissue, and his

ing that they do not exist save in the imagination; and treatment has these objects chiefly in view. Moreover, the

suggests that they should attend only to such circumstances use and action of cardiac medicines are much more accu-

concerning the pulse as cannot be misunderstood, and he rately defined than they were. Surely, too, we may hopespecifies the frequency of the pulse as a circumstance that that, despite the sceptics, a better treatment of rheumaticcould be accurately noted and should be chiefly attended to. fever does tend to save the heart-to save its muscular

HEBERDEN clearly sighed for accuracy, and thought this tissue if not its valves. There is a third grand advantagequality could attach only to observations of the number of in modern medicine. It can take a more hopeful view and

pulsations. CULLEN scarcely seems to have thought of the give a more hopeful prognosis. We do not think it neces-heart as an organ capable of being affected with structural sary to imitate that physician of whom Dr. STOKES hasdisease. somewhere spoken, who, on hearing a bruit in a patient’sThe detection and differentiation of the diseases of the heart, who up to that time had been working very well

heart; the relation of the most common of these to acute notwithstanding his bruit, said: "Sir, I hear your deathrheumatism; the study of morbid changes in the muscular knell"; and so felled the patient with prognosis. We see

structure of the heart; and the perception of the high im- too much of the recovery of heart-power by rest, food,

portance of attending, even in cases of valvular disease, and proper medicines; we know too many pulses that

largely if not mainly, to the condition of the muscular are beating happily now that we knew to intermit or to betissue,-these are a few of the most characteristic and irregular years ago. We know on such authority as that

creditable points in the medical work of the present cen- of Dr. STOKES that the patient with heart-disease does not,

tury. It is curious that HEBERDEN, who, with great saga- in the great proportion of cases, die suddenly, but gradu-

city, as we have shown, specified the serious constitutional ally, and with a failure that may by care on his part and a

condition with which palpitation was frequently associated, due regard to medical hints and helps be greatly retarded

contrived to leave out rheumatism. The honour of the and averted. On such grounds as these heart-disease has

discovery of the connexion of acute rheumatism with in- come to be a creditable and hopeful chapter in medical

flammations of the heart is, we believe, due to Dr. DAVID science.PITCAIRN, who first noticed the fact in 1788; but it was - TELEGRAPHIC advices from Berlin, dated the 24th inst.,not till Sir D. DUNDAS’S account of the disease called report that Asiatic cholera has broken out at Kamionck, in rheumatism of the heart," in 1809, that this great patho- Poland, and that 21 deaths had taken place in nine days.