The Press. — London, England, 1854-09-09 00:00:00

SEPTEMBER 9, 1854. chinery called into action by its actual pre sence may inspire confidence and gratify our sense of duty, but, we fear, can have little effect in arresting its ravages. The appoint ment of medical commissions, with all other measures inspired by a sense of danger, comes too late to eradicate the seeds of mortality which the pestilence has been suffered to sow without heed. It is to be feared that the very steps taken to mitigate its virulence may but rouse it to new fury, just as fire is nourished by stirring. - - - Of all physical laws, those connected with pestilence are the most awful and mysterious. Science has yet done nothing to elucidate them, though we can trace in their operations a kind of order and regularity, showing that they work by rule, and have their parts as signed them in the economy of nature. The progress of the cholera at present is much like its progress in 1849. We see some broad features of resemblance, but, when we attempt to systematise, we meet with conditions which no theory will satisfy. Till within these last few days it was conceived that the low-lying districts of the metropolis were most exposed to the pest ; but the outbreak in the neigh bourhood of Golden-square, which, from its elevation, should be a healthy district, warns us that no absolute reliance can be placed upon this principle, rational as it appears. It has been suggested that the disturbance of the ground for the construction of sewers may have origin ated the pest. Strange facts are revealed when the soil on which our thickly-populated streets are built is broken. It was said that this excavation ran through the ground used for a huge burial pit at the Limo of the great plague ; but the fact does not appear to be so. Great Marlborough street stands on that site, and when, some time ago, the ground was broken, the earth was found to be black and foul, and the soil was hastily replaced. Yet the outbreak of pestilence in immediate prox imity to this great plague-sepulchre suggests some connection between the two, more espe cially as the ground will long retain infection in its bosom. Scarcely yet has one point been settled as to the causes, nature, or treatment of this great pestilence of modern times. Its title is a mis nomer. Derived from xoxel, bile, and pew, to flow, the evacuations are remarkably destitute of bile. We know not yet in what element it specially resides—whether it floats in the air, or issues from the earth, or is contained in water—whether or no it be contagious—whe ther it primarily affects the blood, the brain, or the bowels. In this uncertainty, all kinds of nostrums are confidently put forward as certain remedies. One fool recommends salt, another ice, while medical men seem pretty equally divided between opium and castor oil. The College of Physicians is silent, and the Board of Health has no more sensible advice to give than "live just as usual, and don't be " alarmed,"—advice which can very little com fort the poor, panic-stricken inhabitants of an infected district. In what are termed the premonitory stages cholera medical aid may do much; but, when we are told that the disorder, as a general rule, is amenable to medical treatment, we are compelled to look at ugly facts which negative the assertion. In a vast number of cases, and in most of the fatal ones, there are no premonitory symptoms. The patient is seized with sudden prostration, nature has scarcely power to make an effort to throw off the disorder, and dissolution ensues as surely as from the most virulent of poisons. There are cases in which the victim has died within an hour from the first seizure ; and commonly the disease runs its course in from six to eight hours. In these cases medical skill is powerless—it scarcely attempts a remedy. The prescribed modes of treatment are clearly useless, and it becomes a question whether, if but as an experiment, some more energetic course might not be advisable. Diseases, in translation from one country to another, may be modified in form, yet in the case of cholera the Asiatic type is marked among us with sufficient distinctness to raise a presumption that the treatment which proved most success ful in the country of its birth may be tried here with some hope of favourable results. THE PRESS. It first appeared in the zillah of Jessoro, about a hundred miles N.E. of Calcutta, in August, 1817, and then, travelling across the peninsula against the prevailing winds, which are westerly, reached the Bombay coast exactly in one year, having committed frightful ravages in its progress. Thus early its move ments were remarked as singularly capricious. " Sometimes," said the Bengal report, "it " would take a circle round a village, and, " leaving it untouched, pass on, as if it were " about to depart from the district ; then, after " a lapse of weeks or months, it would suddenly " return, and, scarcely touching the parts which " had lately undergone its ravages, would " almost depopulate the spot which had con " gratulated itself on its escape." Following one shore of the Ganges, it would suddenly stop, take a rapid sweep across the river, lay all waste before it, and then return to continue its direct line of travel. The natives regarded it as an evil deity, to be kept at distance by charms or propitiated by prayers and sacrifice. The medical boards in India paid more minute attention to its nature and symptoms than they have perhaps received since. The general conclusion arrived at was that stated by the Bombay board :—" There is a somewhat " which presses heavily and suddenly upon the " vital functions, and in many cases resembles " the effect of a poison taken into the stomach " or applied to the blood ; but whether it acts " more immediately upon the circulating or " the nervous system we cannot determine.' The point remains to this day unsettled, but, in many cases of post-mortem examination, when the brain was exposed it was found sur charged with blood; and hence Dr. HARTI.EY KENNEDY, Physician-General at Bombay, in ferred that in cases of cholera some such de rangement of the nervous system takes place as in concussion of the brain. The dizziness and stupor which are the first symptoms in the most fatal cases support this view. When the disease first appeared in Punderpoor the people tumbled over each other by hundreds lifeless in the public streets. But theories as to the cause of cholera are of less importance than rules for its treatment. Mr. CRAW, an eminent surgeon, was one of the first to perceive that the disease was not a mere bowel complaint. In the course of his practice he found that bleeding afforded the best chance of relief, and, as his experience established the benefit of this treatment, he lamented that he should have been prevented from employing it earlier "by the scarecrow "of imaginary debility." Dr. JUKES, and many other eminent India surgeons, came to the like conclusion. They bled freely to remove the congestion of the internal vessels, and then administered stimulants to rouse the vital powers. Dr. KENNEDY, in his work on " Epidemic Cholera," had no doubt whatever that bleeding, followed by an emetic or cathar tic, was the system most plausible in theory and safest in practice. But a distinction was drawn between the real exhaustion caused by long-continued purging and vomiting, and the apparent de bility which was merely symptomatic of the disease. If native strength was inherent, and only prostrated by sudden attack, then bleed ing was often found to alleviate spasms, relieve congestion, and promote animal warmth. " When I cannot bleed," writes Dr. KENNEDY, "it is to my mind next to signing " the patient's death warrant. The venous " evacuation is always less exhausting than " the unnatural visceral secretion it inter " rupts." The subsequent remedies were commonly castor oil, to excite the bowels to action, and laudanum to soothe the irritability of the stomach. How far this mode of treatment might prove successful in our clime it is for the medical profession to decide. In the worst cases here the symptoms are the same as in India—stupor, dizziness, prostration, cramps. Desperate disorders justify extreme remedies. Com monly we are afraid our practitioners give up the worst cases as soon as seen, hut any course is better than hopelessly to abandon the patient to the rigour of this mcst rapid and fatal disorder, or to order formularies to maintain professional etiquette. The re sources of medicine are not exhausted till the 843 practitioner believes them to be so. The mystery which surrounds tl•is terrible scourge should stimulate his invention, and lead him to try conclusions with it by new modes of practice, when satisfied of the inefficiency of the old. It is satisfactory to find that exertions are being used to dispel the vulgar prejudice that the efforts which nature makes to throw off the choleraic poison by the stomach or bowels should be abruptly checked by opiates. This, indeed, as SYDENHAM remarks, is "to shut up "an enemy in the bowels." From the medical commission which has been nominated we may hope at least for a clear and intelligible view of the general character of the disease, and rules of treatment adapted to its several stages, and to the widely-different forms under which it appears. PURE NONSENSE. CHICORY—for some inexplicable reason—continues to enjoy the favour and protection of the Govern ment. Why, in defiance of the general principle of the excise laws, chicory should be permitted to b e sold for coffee, any more than sloe leaves for tea, or cabbage for tobacco, is beyond our comprehension. The adulteration is as plain in one case as in the other, and is equally a fraud to tae consumer, and an injury to the revenue. We have adverted to this subject before. To allow a mixture of chicory and coffee to be sold under any circumstances was bad enough, because the purchaser could never know what proportion of the genuine article he received. Plain sense suggested that the two articles,--on e taxed highly, the other not taxed at all,—ought to be kept separate, and sold separate. But a recent Treasury order, with the interpretation authoritatively given to it, goes much further than sanctioning the mixture, as it allows the compound to be sold though coffee should be asked for. This order, dated the 10th of August, states that the Board of Inland Reveuue, having ascertaiued that "a practice prevails among grocers of selling a " mixture of chicory and coffee in cases where pure " coffee is asked for by the purchaser," gives notice to the trade that in such cases a sale of the mixture, though labelled with the words " a mixture of chicory " and coffee," will subject the vender to prosecution for a fraudulent sale. On a cursory perusal this order appears fair enough,—supposing it were right to allow the mixture to be sold at all,—but on closer examination the words " pure coffee," constantly used throughout the order, raised a question whether the chicory mixture might not still be sold to a buyer for coffee provided "pure coffee" were not expressly asked for. In answer to inquiries on this point the Secretary to the Treasury replies, through the Economist, that persons will not be exposed to prosecution who bell the mixture when coffee is asked for, but only when " pure coffee" is demanded. It is said : " The very object of the notification seems to be to draw a distinction between those cases when the mixture is supplied when coffee generally is asked for, but with proper printed intimation that it is so, and those cases where pure coffee is distinctly asked for and still a mixture is furnished. The distinction, in fact, is where trade se rarried on honestly without intention of deceit or fraud, and where a mere form is used to cover frauds." The public, we are sure, will conclude that the Government must be rather anxious to encourage fraud than to check it, when it sanctions such verbal juggling as this. The prevalence of the fraud is admitted—the mixture is sold when coffee is asked for—yet, instead of compelling the grocer to furnish the article required, it screens his fraud by requiring the buyer to particularly express that he requires pure coffee. How are the mass of persons who frequent grocers' shops to comprehend this nice distinction' How, indeed, are they to be made acquainted with it? The Economist is not sent to them gratis, nor will the Treasury circular, with its official interpretation, be distributed among all coffee•buyers in the kingdom. In fact, the order, under pretence of restraining the fraud, virtually legalises it. "What is sauce for the goose is sauce for the gander." Traders may not unnaturally think that the recognised practice as regards coffee may legiti mately apply to other commodities. The grocer, when asked for sugar withoutthe prefix "pure," may suppose that his excellent sand mixture is required; and the baker, when merely bread is demanded by his customers, may infer from the Treasury circular that he is justified in selling a loaf compounded of bone•dust and flour. The plain way to prevent fraud would be to prohibit adulteration; or, if the mixture be thought desirable, why should there be a duty on the genuine article, while the spurious one goes free? Are we to conclude that it is no offence to cheat the revenue when the public are cheated at the same time ?