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From the Saturday Review, 2d Oct.
NEUROPATHY.*

(Cholera like Sea-Sickness.)

it is based upon a general theory so free from mere empiricism, and so remarkably accordant with the ripest physiological doctrines, as to merit the most careful examination on the part of all students and prac titioners of the art of medicine. Dr. Chapman does not come forward with an isolated nostrum for the cure of cholera, but his doctrine of the character and treatment of this disease is only a branch of a much wider theory as to the cause of a great variety of maladies and the curative agency by which they can best be overcome. A brief account of the general doctrine is necessary to render the grounds of its application to the particular case of cholera intelligible.

THE few cases of cholera at Southampton, and the fierce little outburst at Epping, may very probably not be the precursors of an immediate epidemic attack, but they are, or should be, a warning to all people, professional or other, to put themselves and their patients in a position of defence, and to furbish up the old and examine the new weapons by which it is proposed to meet the disease. The hint becomes the more significant from the marked similarity of the cholera-track of the present year to that which has on former occasions been followed, after a twelvemonth's interval, by a It is beyond dispute that local or general regular invasion of epidemic cholera. The hyperæmia or anæmia is an incident, if not subject may be discussed the more safely a cause, of a very large proportion of all now because the real danger is probably at known maladies, and any discovery which a distance, and there is little risk of excit- should enable the physician to control at ing a mischievous panic. Nothing is better will the circulation in any part of the body settled about cholera than that its cause and would give him a command over many discharacter have not been understood. Most orders which have too often baffled the physicians will tell you, as a convenient highest medical skill. To form any opinion rough guess, that it is a disease of the blood, whether such a power is really attainable, which is certainly true in the sense that no the forces which increase and diminish the attack of cholera ever occurs without a flow of the blood, and with it all vital acstrange corruption of the blood accompany- tion, have first to be ascertained. The ing it. Whether this is the real cause of broad doctrine of Harvey, that the blood the disease, or merely an incidental symp- flows through the arteries and back through tom, is a question to which past experience the veins in obedience to the motive power has not supplied an answer. All the theories of the central pump-the heart-though of the action of animalcules, or of the malefic no doubt in the main true, has long been influence of air or water, equally fail of seen to be inadequate to the full explana proof, the only well authenticated result of tion of many familiar symptoms. It furnishobservation being that cholera rejoices in es no explanation whatever of the cause of low levels, and commonly, though by no local inflammation, and is hardly reconcilameans universally, avoids the hills. This is ble with the actual circulation of the blood not much for medical science to have found observed in creatures without a heart, or in out about a disease which has been familiar in which the heart does not act as it does in India as long as we have known the country, the higher animals. Taking Harvey's docand has been naturalized all over Europe trine as the basis, there must be something for more than thirty years. The legitimate beyond it to account for local variations in inference from this negative condition of the circulating energy in different parts medical knowledge on the subject is that of the body at different times, and under every new suggestion as to the nature and different circumstances of excitement or cause of the malady which is based on the reverse. One theory which has been scientific grounds deserves to be considered started to account for such phenomena atas a possible solution of an enigma which tributes the movement of the blood in great has hitherto puzzled the faculty. Such a measure to a quasi-chemical affinity between suggestion, accompanied by a correspond- its particles and the tissues which it coning scheme of treatment, has been put stantly feeds, or, in the case of the lungs, forward by Dr. Chapman; and though ex-between the venous blood and the air which perience alone can demonstrate its accuracy,

*Diarrhea and Cholera; their Origin, Proxi

mate Cause, and Cure, through the agency of the Nervous System, by Means of Ice. By John Chap

man, M. D. Trübner & Co.

Sea-Sicknss, its Nature and Treatment. By John Chapman, M. D. Trübner & Co.

is to oxydize it. This doctrine has not yet been universally accepted, and can only be regarded as an ingenious, though very pos sibly an accurate, hypothesis still waiting the forces which cause circulation may not for experimental confirmation. But if all

the nerve.

be certainly known, little, if any, doubt remains as to the seat of the power which restrains it within due limits. The well-known experiment of cutting the cervical sympathetic nerve solved this mystery. The instant effect was to cause dilatation of the blood-vessels, increase of blood, and development of all vital faculties in the regions connected with the severed nerve. The opposite effects are produced by galvanizing, and thereby stimulating, the action of Dr. Chapman infers- and his experience seems to show that the main, if not the only, function of the whole sympathetic system is to act as a sort of break upon the circulation through the arteries. Stimulate the sympathetic ganglia which lie on either side of the spinal column, and instantly, according to Dr. Chapman, a corresponding diminution of blood will be observed in that region of the body which is controlled from the ganglionic centres to which the stimulus is applied. Partially paralyze the same nervous system, and its power of contracting the arteries is diminished; the vessels dilate, and offer less obstacle to the passage of blood, the whole region affected receives an accession of vital energy, and if it has previously been suffering from anæmia, the malady and its consequences speedily disappear. To a great extent this theory is a legitimate and almost unavoidable inference from the generally accepted doctrine that the function of the sympathetic nerve is to contract the arteries and limit the flow of blood. From the theory to its application is not a very long step. Galvanism was known by experiment to be an affective stimulant of this kind of nervous action, and it was not an unreasonable conjecture that heat applied over the sympathetic ganglia would add to their vigour, and that cold would in like manner reduce their action. If this were so, the physician might deal with the circulation almost at pleasure. If any region was inadequately supplied with blood, it would only be necessary to apply ice to the corresponding ganglia, when their operation as self-acting breaks would be diminished, the arteries would dilate, and a more copious flow of blood would result. Hyperæmia should, on the same theory, yield to the opposite treatment, and any local congestion or inflammation ought to be relieved by applying heat to the governing parts of the sympathetie nervous system. All this Dr. Chapman says that he has abundantly verified, and the detailed cases given in his pamphlets seem very like a demonstration of his general theory. The

common malady of cold feet is said to yield invariably to the application of ice to the lower regions of the back; and a similar treatment is described as giving to the physician an almost absolute control over the ordinary functional diseases of women.

This seems to have been the first step which Dr. Chapman made in the verification of his doctrine and the development of his practise of Neuropathy. But no one could doubt that, if the principle was sound, a power of controlling the circulation, either generally or locally, by the application of heat or cold to the appropriate nervous centres, must be available in the treatment of a great variety of diseases. Dr. Chapman is convinced that cholera is one of these, and as his theory involves some steps which are less obvious than in cases where the disorder is palpably anæmia or hyperæmia of a particular region, it is interesting and important to note the path by which the conclusion was arrived at. One of the early applications which Dr. Chapman made of his system of Neuropathy was to cases of sea-sickness. It is not at first very obvious why ice on the back should check a disorder the essence of which is not generally supposed to consist in anæmia, although that is one of its invariable accompaniments. It is true that frightful pallor and cold sweat are among the most marked symptoms of sea-sickness, and, according to the new theory, this would be fairly attributable to excessive action of the whole sympathetic system, and might be expected to yield to the application of cold over the nervous centres. But the other symptoms of sea-sickness are not so easily referable to the group of nerves, whose action (so far as is yet known) is limited to the control of the circulation. Dr. Chapman's explanation is shortly this. Sea-sickness is itself the result of hyperæmia of the spinal cord caused by the internal concussions produced by the motion of the vessels, and accompanied by excessive activity of the vaso-motor nerves. This derangement not only checks the circulation, but propagates itself to the stomach and bowels in some manner not very definitely explained, causing the recognized phenomena of this uncomfortable malady. A few very remarkable cases are described, in which sea-sickness was absolutely conquered by the application of ice along the spine; and Dr. Chapman was not long in inferring that the ordinary symptoms of summer diarrhea were themselves due to an analogous cause — - namely, the over-excitement of the spinal column and the corresponding sympathetic system

from excessive heat, instead of (as in sea- with its nature, symptoms, and, if possible, sickness) from excessive motion and con- origin, in order to be prepared to meet the cussion. This hypothesis is also said to disease should it extend its work of dehave been abundantly verified by experi- struction to this country. At a very recent ment, and it was an easy step to bring meeting of the French Academy of Scicholera within the same class of disorders. ences a paper was read upon the subject of In fact, the cramps, the blueness, and the cholera, by Dr. Jules Guérin. As the wricollapse which are specially distinctive of ter gives the result of his experience of the true Asiatic cholera, suggested at once the epidemic in the year 1832 and at subseidea that extremely violent action of the quent periods, and as he concludes that it vaso-motor nerves was certainly an ac- is a malady characterized by premonitory companiment, if not the prime cause, of symptoms, and curable, we translate his every choleraic attack. Dr. Chapman's memoir: hypothesis, founded on these and similar considerations, is thus summarized. Cholera, he says, is simply the result of hyperæmia of the spinal and sympathetic nervous centres, and belongs to the same order of maladies as ordinary diarrhoea and sea sickness. It results from this, that it is not contagious or infectious, and that it may be averted and cured by the sedative action of ice along the spinal region.

era?"

The theory which we have attempted to sketch may or may not furnish a solution to the much-vexed question, "What is cholAssuming the foundation to be sound, the steps by which sea-sickness, diarrhea, and cholera are brought within the class of diseases attributable exclusively to spinal hyperæmia, though plausible, are not entirely conclusive. Enough, however, seems to be clearly made out to entitle the new curative agent to a careful trial; and whatever doubts may be entertained as to the soundness of some of Dr. Chapman's inferences, there can be none as to the thoroughly philosophical spirit in which the investigation has been pursued. Experience alone can show whether so terrible a scourge as cholera is really amenable to simple treatment by heat and cold; and though the cases treated by Dr. Chapman himself at Southampton seem to confirm the theory in a very remarkable way, they were not sufficiently numerous to do more than make out a primâ facie case, entitling Neuropathy to a full and candid trial by every practitioner who may be thrown in the path of the threatening epidemic. If this trial is given, the mystery may possibly be solved before the plague visits us in strength.

From the London Review. CHOLERA IN ITS CURABLE STAGE. WHEN cholera is almost at our doors it behoves us to make ourselves acquainted

"Before," says M. Guérin, "the epidemic of cholera which ravaged Europe in 1832, it was generally admitted that this terrible scourge attacked its victims in the most sudden manner, and struck them down with a degree of violence that was only comparable to the effects of a lightning-stroke. All the writings of this period take up this view of the disease. Meanwhile, at the commencement of the epidemic of 1832, I perceived that it was quite otherwise. About a week after the appearance of the disease I wrote in the following terms to the Gazette Medicale: Most of the patients attacked with cholera have been for several days, or even weeks, labouring under a disturbed condition of the digestive organs, which did not appear sufficiently serious to them to deserve careful attention; such even has been their carelessness on this point, that we have often been obliged to question them very closely in order to elicit information from them. It is only after having been asked three or four times whether they have had diarrhoea that they give a satisfactory reply. From this we conclude, (1) That in many cases where this diarrhoea has not been noted there is reason to suspect carelessness in observation on the part

of the patient. (2) That this diarrhoea, the precursor of cholera, should receive the careful attention of medical men, parents, and even of the authorities, who should recommend to the poorer classes and publish the recommendations by all the means at their disposal — to pay proper attention to this state of the digestive system, and should make known to them the fatal consequences of neglecting to treat the origin in facts, was developed and confirmed by diarrhoeal attack.' This opinion, which had its them. In proportion as the patients crowded into the wards of the Hôtel Dieu, where I especially carried on my observations, my conviction became more and more strengthened. Out of 600 patients questioned in the most careful manner, 540 had shown symptom of cholerine (premonitory diarrhoea) before their entry into the hospital. From this I concluded, on the 12th of April:

(1) “ That cholera is always preceded and announced by a series of symptoms, to whichwith a desire to caution the public-I have given the name of cholerine.

era.

(2) "That cholerine is the first stage of chol

(3) "That cholera, properly so called, is | A general inquiry, instituted by the Comité only an advanced stage of a disease which has Consulatif d'Hygiène,' during the epidemic of hitherto been unknown in its first or premoni- 1853, gives the following as part of its report: tory period.

(4) "That it is always possible to arrest the development of the mortal stage of cholera by attacking the disease in its curable one.

"The existence of a prodromic or premonitory period in cholera is certain. This truth was accepted and admitted at the period of its announcement by the majority of physicians. The exceptions have hardly an existence, and are more apparent than real, being due to the absence of powers of careful observation on the parts of the patients.

"Since 1832 there have been at short intervals three new epidemics of cholera. Moreover, this dreadful malady has spread during the same period, or successively, over the various countries of Europe and Asia. Has it in every instance conformed to the laws of its first evolution? Has the prodromic or premonitory period always preceded the mortal stage of this discase? It is of the highest importance that the reply to these questions should be in the affirmative. For if this view-re

"From the first of November, 1853, to the 22nd of January, 1854, of 974 choleraic patients admitted to the hospitals of the capital, 740 had been attacked with premonitory diarrhoea, the others appeared exempt or were unable to give exact evidence.' To these authentic statements I may add those which have been made by the different departments of France in reply to the questions of the authorities. Almost all the local physicians answer that cholera commences in the great majority of cases by diarrhoea and other premonitory symptoms. The cases of sudden cholera, if they really exist, do not exceed 5 or 6 per cent."

M. Guérin's report is important as being the one presented to the Academy, and is especially valuable for the extracts from the various official reports which he has appended to it.

FRANKLIN'S EXPEDITION.

(Morning Star, Oct. 14.)

garded in its origin as one of the conquests of THE SUPPOSED SURVIVORS OF SIR JOHN science and a benefit to humanity-receives from all recorded observation the character of an unimpeachable truth, it is essential that it be published in all populations and countries, as affording a sheet-anchor (une ancre de salut) in the perils which menace human beings. Now, having been requested by the Academy of Med icine to superintend the general report upon the epidemics of cholera, I have been placed in possession of all the scientific documents, home and foreign, relating to the subject. The result of an examination of these I have the honour to communicate to the Academy. Commencing with England, we find the following remarks in the report of the General Board of Health,' published in 1850:- Whatever doubts there may have been during the epidemic of 1832 as to the existence of prodromic symptoms (diarrhoea), the experience of the last epidemic solves the question completely. In one case where the first symptoms were minutely inquired into, it was found that of 500 patients almost all, without exception, had been previously attacked by choleraic diarrhoea of ten or twelve days' duration. Dr. Burrows states that the replies of the patients showed that the 'rice-water' discharge of cholera was always preceded by others of a different, though unhealthy, charac

ter.

Dr. M'Loughlin states:- I believe I am correct in concluding, that of 3,902 cases of cholera, I have not found one without prodromic diarrhoan. » Đây

"In France there are the same confirmations as in England. M. M. Lévy found that of 142 patients (at the Hospital of Val-de-Grâc,) there were only six without prodromic symptoms. In 95 cases the diarrhoea had lasted for two, three, four, and even a greater number of days. * Report of the General Board of Health on the Epidemic Cholera of 1818-19.

SIR JOHN FRANKLIN's ill-fated expedition appears destined to surpass in romantic interest every previous enterprise of a similar kind, and to excite hopes and fears which have in turn been either confirmed or dispelled. In the judgment of most persons Sir Leopold M-Clintock's expedition settled at once the fate of the great navigator himself and the whole of the officers and men under his command.. A few more relics might be discovered, and the burial place of some of the heroic adventurers might one day be made known, but beyond this there seemed to be no important object to be served by further explorations. Not so thought our American brethren. They of Sir John Franklin, and in this truly insent forth successive expeditions in search ternational work the name of Kane was rendered even more illustrious than that of Bellot. But while we have given up the search-while we are denying to science the benefits which it would derive from the exploration of the North Pole, the Americans are steadily prosecuting the task which we have abandoned. At least, brave Captain Charles Francis Hall, formerly of the whaling barque George Henry, after spending upwards of two years in the Arctic regions, and returning so recently as September, 1862, is now again encountering the perils and hardships of those dismal solitudes in the hope of discovering some further trace of the lost travellers. In his for

mer journey he entertained a sanguine be- | been startled by the unwonted sound, and lief that some of Franklin's men might still his surprise was increased by the dress, survive among the friendly and hospitable manner, and conversation of the Esquimaux

natives.

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lady. The civilized habits which she had acquired she imparted to many females of her own race, and altogether the portrait of her which Mr. Hall sketches is as attractive as can well be conceived. These intelligent natives acted as intèrpreters, and we do not doubt that they correctly translated the deeply interesting statements which the American has put on record.

Are we, then, to place implicit credence in the strange story which reaches us from "Rowe's Welcome," that long inlet which connects Melville peninsula with the northern waters of Hudson's Bay, and separates Southampton Island from the north-eastern shore of what, for want of a better name, may be called British Arctic Land? By no means. But, although at present we have no data before us which justify the expression of a confident opinion, there are, we think, no inherent improbabilities in Captain Hall's story. First, as to Hall himself. His book- "Life with the Esquiwhich attracted no little attention on its publication last year is a sure recommendation to the English reader No one who read that touching, simplehearted, and thoroughly human narrative could doubt either his veracity or his calm good sense. Having, moreover, previously lived among the Esquimaux, and being intimately acquainted with their habits and modes of thought, he was in such a position to weigh their statements and to judge of their credibility as to justify us in attaching to those statements all the importance which he attributes to them. There are, no doubt, some among the Esquimaux who are fond of drawing the long-bow, but they are far from being addicted to lying. In writing of the Innuits, from whom he received the story, and in whose villages he dwelt during his former journey, he pays the highest tribute both to their honesty and to their truthfulness. "Though," he says, "there is occasionally to be found among this people an evil person; yet, taken as a whole, they are worthy of great credit. They despise and shun one who will shagla-voo (tell a lie). Hence they are rarely troubled by this class." But every Arctic traveller is more or less dependent upon interpreters, and interpreters have at times an unfortunate knack of making much out of little. Fortunately we know something of the two Esquimaux, Ebierbing or Joe, and his wife Tookoolito or Hannah,| who performed this office for the good- IN good truth, we must affirm, not merely hearted and ingenuous American. Both the unfortunate companions of Sir John visited England in 1853, and dined with the Franklin, but the comrades of many other Queen and Prince Albert. The captain's gallant experimentalists, have been lured first interview with the lady took place in into those latitudes by false, yet not dishonNovember, 1860, on which day, while he est, accounts of their plenty. Here is a was writing in his cabin, he heard "a soft land and here is a water teeming, not with sweet voice" say, in correct English, "Good milk and honey, but with salmon, swans, morning, sir." Mr. Hall appears to have hares, partridges, and snipes, and when the

According to the Esquimaux narrative, Captain Crozier and three other survivors of Franklin's party were met by a cousin of three natives known to Hall at some point on the eastern side of Boothia Felix Peninsula, not far from Pelly Bay. Crozier was in an emaciated and starving condition, while his three companions had sustained life by cannibalism - a horrible idea, it is true, but not unprecedented in the records of Arctic suffering. Crozier, under the care of the good Esquimaux, was gradually restored to health, and when spring had returned he shifted his quarters, taking with him two men, the third having in the meanwhile died. Crozier and his companions lived with the Innuits at Neitchille for some time, and then left them for the Kob-lu-nas country, probably with the hope of extricat ing themselves from this worse than Siberian prison. Crozier spoke of a fight which had taken place with a band of Indians, and Hall fairly conjectures that this inci-. dent must have occurred near the entrance of the Great Fish River, the remotest northern region which the Indians would be likely to penetrate. Again, there is a semblance of probability in this story; for the survivors would naturally make their way to the mouth of a great river which might possibly conduct them to one of the posts of the Hudson's Bay Company. Nor would it be surprising if they failed in their object and were compelled to turn their steps backwards. But all these are points upon which we hope so gallant and successful an explorer as Captain Hall will one day be able to give us further information.

(Standard, Oct. 14.)

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