tlie more thorough elimination of the products o'f nitrogewaste from the blood. He maintained that independently of any of the variable or adventitious chemical constituents of the blood, muscles more freely supplied with that fluid act better than those less freely supplied, and pointed out that as the blood pressure in the vessels of the heart is greater than that in the vessels of more remote organs, the former can naturally do more muscular work than muscles more distant from the centre of circulation. He moreover referred to the reduced and intermittent pulse of uraimia as urea is a cardiac stimulant. contradicting the view that " Dr. O'Connell enquired in cases of death from low bodily temperature, what is the cause of the cardiac paralysis ? May it not be due to the absence of urea from the blood?" He also suggested that the increased action of the heart and respiratory organs during exercise, might be due to the increased tissue waste, and consequent accumulation of urea in the blood. With reference to his last suggestion Dr. Wood referred to the experiments of the late Dr. Partes, which proved that during the period of exercise there is a diminution in the excretion of urea ; while during the rest which followed, exercise, an increase in the excretion took place. The meeting soon after dispersed. nous
PROCEEDINGS OF
THE
MEDICAL
GWALIOR
DISTRICT
SOCIETY.
Fifteenth Meeting, held in Morar, *lth January 1882. Surgeon-Major F. R. Hogg, A. M. D-a (President) in chair. Surgeon O. Or. Wood, A. M. D., read paper on the subject of Micro-Organisms in Disease." The President in opening the discussion referred to the interest of the subject, and asked Dr. Wood to send his paper in extenso to the Indian Medical Gazette for publication. Surgeon-Major Buchanan, A. M. D., held that the subject of Micro-organisms as causes of disease was still subjudice, and contended that as many competent authorities still refuse to accept the germ theory, we ought not hastily to draw conclusions from observations which, however interesting, are as yet insufficiently supported by evidence. Surgeon Ryan, A. M. D., confirmed a remark made by the author on the experiments made by him (Dr. Ryan) on the treatment of malarial fevers by creasote, which as an antiperiodic he found to be second only to quinine. He agreed with Dr. Buchanan as to the unsatisfactoriness of the evidence
Seventeenth Meeting, held
"
we at present possess of the germ origin of certain diseases ; but with regard to malaria, gave it as his opinion that the clinical symptoms of the diseases produced by this miasm favoured the doctrine of some such origin. He believed that heredity was a powerful agent in modifying types of disease, but pointed out how little influence it had in protecting natives of this country from malarial affections. Regarding the question of the influence of diet, he thought that there were great opportunities in India for the relative susceptibility to certain diseases, such as malarial fevers, cholera, &c., of the flesh-eating Mhssalman and the almost vegetarian Hindoo. Touching the subject of interment, he maintained that there was no direct proof of the unhealthine^s of cemeteries. Surgeon-Major Hogg concurred with Drs. Buchanan and Ryan in holding that it was by no means well ascertained thfat the germs, fungi, &c., found in the blood and tissues of patients suffering from certain infectious diseases were the cause of those diseases. He however bore testimony to the good results of antiseptic remedies in some of those diseases, particularly instancing the use of inhalations of Carbolic acid in whooping-cough, which he said he had seen productive of most beneficial results. A somewhat desultory discussion turning chiefly on cholera then ensued, in which most of the members present took part, after which the meeting adjourned.
observing
Sixteenth Meeting, hald in Morar, l?th January. The President in the chair. " Surgeon O'Connell, A. M. D., read a paper On the Uses of Nitrogenous Waste in the Blood," in which he maintained, from various
anatomical,
and clinical considerphysiological, in the
of urea blood was a physi(This paper was sent for publication to the Indian Medical Gazette). Dr. Ryan contended that clinical experience was totally opposed to Dr. O'Connell's theory. The tendency of urea in the blood was, so far from stimulating, to paralyze the circulatory and respiratory centres ; and he held that the complicated construction of the renal tubules had for its object
ations, that a certain
amount
ological necessity.
_
on
the 21s?
January.
(President) in the chair. Surgeon-Major The President opened a Discussion on Erysipelas in India. He referred to a slight but apparently causeless outbreak of in Hogg-
Morar amongst the men Erysipelas which recently occurred and commented on the European Infantry regiment, immunity of the men of the Artillery. He stated moreover of the
that some cases had occurred simultaneously in the Fortress Dr. Hogg then proceeded to discuss the subject Gwalior. generally, referring to Bryden's statistics, and to the very slight pre valence of the disease in Indian jails. It was his opinion that there is a connection between Dengue and Erysipelas, epidemics of the former often preceding outbreaks of the latter disease. The subjects usualty attacked are not the young soldiers ; it is the older and perhaps somewhat broken-down men who are the principal sufferers. Dr. Hogg said that his experience was that Erysipelas in India is by no means so fatal a disease as it is in England. Regarding treatment, he was of opinion that Aconite, with the view of best the to be remedy employed reducing temperature, is in the early stage of the disease, but he also cc>nsidered the and iron internally to be of diet of employment supporting as a topical application great importance. Tincture of steel he objected to, and always employed cotton wool or flour. He further urged the importance of careful disinfection and that the disease does isolation of patient, though he not spread so readily in this country as it does in England. He would avoid incisions in the treatment of erysipelas unless absolutely necessary, as he believed that the patient could ill flows freely from such incisions. spare the blood which often Surgeon Armstrong, A. M. D., who was attending the eryin the York and Lancaster resipelas cases that had occurredmen attacked were middle-aged giment, said th at most of the in India. Two of them men, who had served about 10 years had suffered from Dengue a few years ago, one of them was of traumatic origin having followed the application of been applied to relieve the a blister to the temples which had of fever. persistent headache of an attack I. malarial Brigade Surgeon Sutherland, M. D., remarked that he had seldom met with Erysipelas in the native army. He would always ascribe an outbreak of idiopathic Erysipelas to the presence of some insanitary condition in the station. He disapproved of making sewage farms close to cantonments. His experience of Morar was that all wouu,ds heal very slowly in this station. Surgeon Byan, A. M. D., said he had treated several cases of epidemic idiopathic Erysipelas in the I'eshawar Yalley in the spring of 18S0, at which time the disease was very prevalent throughout the Punjaub generally. It appeared among3t men who had suffered much from malarial fever during the preceding hot weather. In some of the cases it In this epidemic Dr. was undoubtedly due to contagion. Ryan noticed that the Erysipelas behaved like one of the exanthemata, two or three days of initiatory fever invariably occurring before the cutaneous condition developed itself. He noticed the same in the cases now under treatment in *
_
believed^
'
THE INDIAN MEDICAL GAZETTE.
108
[April 3,
1882.
with his shoulder exposed to a draught The result was pain down the course of the nerve (neuritis ?) and then paralysis of hand displayed, v showing hourly records of temperature.) As to musculo-spiralwhich was soon after followed by atrophy of treatment, he found Quinine in large dose3 the most effica- (wrist-drop)of the affected side. When exhibited the patient cious ; but could find no benefit from the use of iron inter- the deltoid had recovered some of his power, only the extensors and nally. The cases were usually of a mild nature, and no inciThe treatment had consupinators remaining paralysed. Tincture sions had been necessary. of Iodine along in blistering and applying Dr. Armstrong, in connection with Dr. Ryan's remarks sisted of the musculo-spiral nerve, and later on the use about erysipelas prevailing among men who had suffered the course doses of the Internallv fall Triple syrup had much from ague, said he had seen several cases of ague in of electricity. exhibited. In the discussion which ensued the case of Morar which had been followed by glandular enlargements been local paralysis was first considered. and phlegmonous inflammations. An officer of the Indian Medical Department said he had Dr. Ryan, in continuation of his previous remarks, said Pathans suffering from an exactly similar form of that he held the fever of erysipelas to be essential, and not seen two disease with the same history. Both the cases had comcases in many merely symptomatic, being totally disproportime. pletely recovered in course of tionate to the amount of local (cutaneous) disturbance. Dr Hogg thought an ophthalmoscopic history of the case Dr. Hogg drew attention to the frequent prevalence of He was inclined to regard the prognosis as dengue and erythema in stations which were soon after was wanted. He believed the best treatment would be, a change of attacked by cholera, and asked " Is this outbreak of erysi- bad arrival there, a steady course climate to England, and after pelas merely a precursor of cholera?" and Iodide of Potassium. Before closing the meeting the President applied to each of Mercurials Dr Buchanan, A. M. D., considered that larger doses of member individually for his opinion on the cause of Eryi strychnia ought to be administered ; and suggested blistering sipelas, and the best precautions to be taken against its aloncr the course of the nerve, arid the application to the occurrence or spread in a station, and summed up in the surface of an ointment containing strychnia. blistered following conclusions : That the causes of Erysipelas are a mechanical Dr Ryan described an apparatus forming external (atmospheric) acting on deteriorated constitutions. the supinator and extensor muscles. for substitute to be adopted are :? That the best prophylactic measures Regardins the case of chorea,? out that the Plenty of out-door exercise during the cool season ; patient reof Surgeon-Major Buchanan pointed The better ventilation and cleansing canteens, &c.; and uneasiness to the occipital region, from the ferred pain when floors The avoidance of flushing washing them, and the disease as being of which ho was disposed to regard the use of proper cement between the flags. blistering and It was sugested that sand or sawdust should be sprinkled cerebral origin, to the Surgeon-Major Hogg referred it from non-progressive over canteen floors to facilitate thorough cleansing. locomotor ataxia the case as distinguisnmg The pruning of trees to at least 16 feet above the ground historv of upwards. As to its-origin, he to permit of a free circulation of air was also urged as an which gradually progresses many cases of pericarditis, &c., believed that in the service important sanitary measure. Among musicians especially chest escape observation. from strain on the heart diseases are very common, possibly from the exposure to caught from rheumatism else and lungs, at Mess, balls, &c., are subject. Eighteenth Meeting, held on the 26th January. which bandsmen playing an embolus and so lead to President in the chair. Endocarditis might produce this case would do well on was of opinion that He chorea Surgeon Hudson, I. M. D., related some cases which had Betting to England. He did not think the climate of the of syphilis complicated with recently occurred in his practice such cases. He defined chorea to be with pericarditis. hills to be suitable to synovitis of various joints, and ultimately of cerebral origin. of fatal epilepsy a spinal had In one of these cases, which termination, mercury Jackson s view, viz., Sureeon Ryan quoted Dr. Hughlings had been rather freely employed to the detriment of his is due to embolism of cerebral arteries. He chorea that constitution. of hemi-chorea as indicating a pointed to the prevalence A discussion followed, in the course of which several pprpbi'Oil origin. in of the use mercury more India, members deprecated parthe meeting terminated. After a few more remarks believed ticularly in the treatment of natives. tha,t the, only safe and reliable way of administering mercury held 23rd February. either to Europeans or Natives was by means of inunction Twenty-first Meetiny, or the vapour bath. The President in the chair. Morar.
The
of fever was
fallen double have
type being peculiar, air. daily .exacerbations marked by rise of temperature, &c. (charts of cold there
asleep
suggested
.
The^President
j
At the Nineteenth
Meeting, held "
on
9th
February.
An interesting communication on Ulcer of the leg amon" ? native soldiers in Morar" was contributed to the Society. " Its probable relation to Delhi Boil," "Bagdad Button," &c.,
was
read a paper on cholera. He and pathology of the disease. briefly described the symptoms and sporadic cholera were He was of opinion that epidemic He did not believe the disease essentially different diseases. in the ordinary acceptation of to be infectious or contagions be portable. He considered the those terms, but held it to a miasm travelling with the disease to be propagated by he attached chief importance atmosphere. As to prophylaxis, and to the improvement of to careful sanitary precautions On the outbreak of an the general health of the troops. instant removal of troops from epidemic he would urge the from his own experience the station ; he, however, quoted As several instances where this measure failed of success. to check the premonitory to treatment it was all had he found opium given very diarrhoea. For this purpose If rejected he would repeat freely yield the best results. should it be a second time the dose immediately, and it the rectum. In the first rejected he would administer by and would on no account stage he would also give stimulants, of bed even to go to stool. If permit the patient to get out second stage, he would employ the disease proceeded to the He had found excellent results opium with great caution. He was in the habit of a^mimsfrom Warburg's fever drops. He usually found that the terin"" this medicine in 3 doses. doses ; but he still persevered* patient rejected the first few the dose was finally retained every fifteen minutes until than from He had seen better results from Warburg's Tincture tried. any o ther drug he had-ever \
discussed.
Twentieth Meeting, held 17th February. Dr. Hogg in the chair. Surgeon Ryan, A.M.D., exhibited two patients, one suffering
from chorea following fever ; the other from local paralysis with a similar previous history. The case of chorea occurred in the person of the Band Serjeant of an Infantry (British) Regiment. He had suffered very much from malarial fever and had felt himself gradually failing during the last two years., A few weeks ago he was attacked with severe ,chorea chiefly affecting the lower extremities, and strongly simulating Locomotor ataxy. There was, however, no real loss of co-ordinating power, the ataxic appearances being due to the choreic movements of the limbs which rendered his gait and indeed every combined or complex movement uncertain. Under treatment (Arsenic, Bromide of Potassium, and general tonics) he had improved greatly, and was now able to walk fairly well with a little aid from a stick. The case of local paralysis occurred in a man convalescent from a severe attack of malarial fever. He appears to
'
Brigade-Surgeon Sutherland
important
,
(
April 1,
REVIEWS.
1882.]
The President in opening the discussion thanked Dr. Sutherland for his interesting paper. Surgeon-Major Buchanan, A. M. D., described an outbreak of cholera which he had treated in Lucknow. It originated with a native. This man was seized with cholera, and was ordered off to the Epidemic Hospital. By mistake, however,
he was taken to the 11. A. Hospital and left outside one of the wards, until the error was discovered and remedied. In the patient spite of careful disinfection of the place where had been laid, a short time afterwards, after a shower of ward outside which he rain a case of cholera occurred in the had been lying, and this was soon followed by a second and a third case. Then the epidemic became general. Dr. Buchanan had treated the first few cases with chlorals but withthe funeral of one of out success. About two days after these cases, an officer who had accompanied the funeral party In this case Dr. Buchawas himself attacked with cholera. tried Ipecac, nan, acting on a suggestion of Dr. Manley's, in large doses, and the patient recovered. After that he treated all his cases in a similar way ; and_ though some of them of recoveries. The died, there was a very large proportion disease at which he had found the ipecac, the of period treatment yield the best results was just as the first stage The theory on was passing into the second (collapse.) is that of relaxation of which this treatment was founded of the circulation. For the vessels and re-establishment would recommend the use of prophylactic purposes he already referred to, sulphuric acid. During the i ?f dilute sulphuric acid Dr. Buchanan had administered 3 the field battery daily to each man of the It. H. A., but gave nothing. After commencing its use no further cases of hut one appeared in the cholera occurred in the R. H. A., field battery. The sulphuric acid was then administered to them also, and no more cases occurred. Dr. Buchanan entirely concurred with Dr. Sutherland on the importance of immediately arresting all diarrhoea during a cholera epidemic, and described how he had got sentries placed over .the latrines, so that any man going twice within a limited a time, was at once taken away to receive dose of astringent
cholera laria.
109 poison
was
merely
.mixture.
appeared
very
malignant
form of ma-
Surgeon-Major Hogg related some experiments of applying water to every part of the surface of the body with the view of replacing the lost fluid of the blood by absorption through the skin ; but failure in every instance was the
result. He believed in the relation between malaria and the cholera poison.
Surgeon Wood was opposed to the view that cholera and malaria are identical, and pointed to other malarious countries such as America, where cholera is not endemic. Dr. Sutherland believed in the efficacy of atmospheric disinfection, by burning sulphur, &c., in an infected station. Dr. Hogg showed that in Morar, cholera had always followed the course of the Biswas Nullah, usually attacking the best barracks. It constantly kept occurring in the same barrack blocks. He thought that much of the mortality in time past had been due to the delay in getting transport of tents from Agra. Dr. Sutherland was of opinion that it would be desirable to have permanent huts built on the ridges selected as sites for cholera camps ; so that in the event of a cholera outbreak troops might be moved without any delay. The meeting soon after broke up. Oswald Wood,
Surgeon,
epidemic
of the treatment of Surgeon Armstrong's experience to be of any avail ?cholera was that no remedy when once the disease was fully developed. Surgeon-Major O'Reilly, A. M. D., related some of his experiences during an epidemic "of cholera in Allahabad in 1860. He believed the symptoms of cholera to be due to arterial spasm ; thus the blood is thrown into the veins, the and the veins of the portal system becomes congested, stomach and intestines relieve themselves by exudation, and In the same so the rice-water evacuations are produced. account for the suppresway spasm of the renal artery may sion of urine. This theory would explain the success which has occasionally attended such remedies as blood-letting, and Tartar emetic. Dr. O'Reilly had tried Chloroform, either as Spirits of Chloroform or as the pure article suspended in mucilage, with fair success ; his treatment being based on the arterial spasm theory. Of late Dr- Butler had employed Boracic acid with success. A member present thought that arterial spasm would priand not exudation. marily cause congestion of the lung, jExudation would follow dilatation of the arteries , as proved by the experiment of dividing theSplanchic nerve. Surgeon Wood, A. M. D., said he had heard Dr. O'Reilly'a ?theory expressed in other words, viz., that cholera is analogous to Tetanus, the one being an affection of the motor the other of the sympathetic nervous centres. The failure of Nitrite of Amyl would not overthrow the arterial spasm theory, as that might be due to the evanescent nature of the results of the drug. He thought the success of Boracic .acid referred to by Dr. O'Reilly very encouraging, as pointing to a germ origin of the disease, to be combated by the -early, use of antiseptics. Dr. Buchanan said he was in the habit of combining the Chloral with Ipecac, -treatment. He .found that the Ipecac, caused immediate emesis, but appeared to check the vomiting of the disease. For nourishment he would avoid Beef-tea and fluid foods of all sorts, giving instead blancmange, and other easily digested farinaceous food. Drs. O'Reilly and Sutherland had both seen several cases which proved fatal from collapse, but who never had any purging or vomiting. Dr. ..Sutherland believed ttufct the
a
A. M. D.,
Ilonrj. Secy. Morar,
8th
March,
1882.
PROCEEDINGS OF
THE
MEDICAL
GWALIOR
DISTRICT
SOCIETY.
Fifteenth Meeting, held in Morar, *lth January 1882. Surgeon-Major F. R. Hogg, A. M. D-a (President) in chair. Surgeon O. Or. Wood, A. M. D., read paper on the subject of Micro-Organisms in Disease." The President in opening the discussion referred to the interest of the subject, and asked Dr. Wood to send his paper in extenso to the Indian Medical Gazette for publication. Surgeon-Major Buchanan, A. M. D., held that the subject of Micro-organisms as causes of disease was still subjudice, and contended that as many competent authorities still refuse to accept the germ theory, we ought not hastily to draw conclusions from observations which, however interesting, are as yet insufficiently supported by evidence. Surgeon Ryan, A. M. D., confirmed a remark made by the author on the experiments made by him (Dr. Ryan) on the treatment of malarial fevers by creasote, which as an antiperiodic he found to be second only to quinine. He agreed with Dr. Buchanan as to the unsatisfactoriness of the evidence
Seventeenth Meeting, held
"
we at present possess of the germ origin of certain diseases ; but with regard to malaria, gave it as his opinion that the clinical symptoms of the diseases produced by this miasm favoured the doctrine of some such origin. He believed that heredity was a powerful agent in modifying types of disease, but pointed out how little influence it had in protecting natives of this country from malarial affections. Regarding the question of the influence of diet, he thought that there were great opportunities in India for the relative susceptibility to certain diseases, such as malarial fevers, cholera, &c., of the flesh-eating Mhssalman and the almost vegetarian Hindoo. Touching the subject of interment, he maintained that there was no direct proof of the unhealthine^s of cemeteries. Surgeon-Major Hogg concurred with Drs. Buchanan and Ryan in holding that it was by no means well ascertained thfat the germs, fungi, &c., found in the blood and tissues of patients suffering from certain infectious diseases were the cause of those diseases. He however bore testimony to the good results of antiseptic remedies in some of those diseases, particularly instancing the use of inhalations of Carbolic acid in whooping-cough, which he said he had seen productive of most beneficial results. A somewhat desultory discussion turning chiefly on cholera then ensued, in which most of the members present took part, after which the meeting adjourned.
observing
Sixteenth Meeting, hald in Morar, l?th January. The President in the chair. " Surgeon O'Connell, A. M. D., read a paper On the Uses of Nitrogenous Waste in the Blood," in which he maintained, from various
anatomical,
and clinical considerphysiological, in the
of urea blood was a physi(This paper was sent for publication to the Indian Medical Gazette). Dr. Ryan contended that clinical experience was totally opposed to Dr. O'Connell's theory. The tendency of urea in the blood was, so far from stimulating, to paralyze the circulatory and respiratory centres ; and he held that the complicated construction of the renal tubules had for its object
ations, that a certain
amount
ological necessity.
_
on
the 21s?
January.
(President) in the chair. Surgeon-Major The President opened a Discussion on Erysipelas in India. He referred to a slight but apparently causeless outbreak of in Hogg-
Morar amongst the men Erysipelas which recently occurred and commented on the European Infantry regiment, immunity of the men of the Artillery. He stated moreover of the
that some cases had occurred simultaneously in the Fortress Dr. Hogg then proceeded to discuss the subject Gwalior. generally, referring to Bryden's statistics, and to the very slight pre valence of the disease in Indian jails. It was his opinion that there is a connection between Dengue and Erysipelas, epidemics of the former often preceding outbreaks of the latter disease. The subjects usualty attacked are not the young soldiers ; it is the older and perhaps somewhat broken-down men who are the principal sufferers. Dr. Hogg said that his experience was that Erysipelas in India is by no means so fatal a disease as it is in England. Regarding treatment, he was of opinion that Aconite, with the view of best the to be remedy employed reducing temperature, is in the early stage of the disease, but he also cc>nsidered the and iron internally to be of diet of employment supporting as a topical application great importance. Tincture of steel he objected to, and always employed cotton wool or flour. He further urged the importance of careful disinfection and that the disease does isolation of patient, though he not spread so readily in this country as it does in England. He would avoid incisions in the treatment of erysipelas unless absolutely necessary, as he believed that the patient could ill flows freely from such incisions. spare the blood which often Surgeon Armstrong, A. M. D., who was attending the eryin the York and Lancaster resipelas cases that had occurredmen attacked were middle-aged giment, said th at most of the in India. Two of them men, who had served about 10 years had suffered from Dengue a few years ago, one of them was of traumatic origin having followed the application of been applied to relieve the a blister to the temples which had of fever. persistent headache of an attack I. malarial Brigade Surgeon Sutherland, M. D., remarked that he had seldom met with Erysipelas in the native army. He would always ascribe an outbreak of idiopathic Erysipelas to the presence of some insanitary condition in the station. He disapproved of making sewage farms close to cantonments. His experience of Morar was that all wouu,ds heal very slowly in this station. Surgeon Byan, A. M. D., said he had treated several cases of epidemic idiopathic Erysipelas in the I'eshawar Yalley in the spring of 18S0, at which time the disease was very prevalent throughout the Punjaub generally. It appeared among3t men who had suffered much from malarial fever during the preceding hot weather. In some of the cases it In this epidemic Dr. was undoubtedly due to contagion. Ryan noticed that the Erysipelas behaved like one of the exanthemata, two or three days of initiatory fever invariably occurring before the cutaneous condition developed itself. He noticed the same in the cases now under treatment in *
_
believed^
'
THE INDIAN MEDICAL GAZETTE.
108
[April 3,
1882.
with his shoulder exposed to a draught The result was pain down the course of the nerve (neuritis ?) and then paralysis of hand displayed, v showing hourly records of temperature.) As to musculo-spiralwhich was soon after followed by atrophy of treatment, he found Quinine in large dose3 the most effica- (wrist-drop)of the affected side. When exhibited the patient cious ; but could find no benefit from the use of iron inter- the deltoid had recovered some of his power, only the extensors and nally. The cases were usually of a mild nature, and no inciThe treatment had consupinators remaining paralysed. Tincture sions had been necessary. of Iodine along in blistering and applying Dr. Armstrong, in connection with Dr. Ryan's remarks sisted of the musculo-spiral nerve, and later on the use about erysipelas prevailing among men who had suffered the course doses of the Internallv fall Triple syrup had much from ague, said he had seen several cases of ague in of electricity. exhibited. In the discussion which ensued the case of Morar which had been followed by glandular enlargements been local paralysis was first considered. and phlegmonous inflammations. An officer of the Indian Medical Department said he had Dr. Ryan, in continuation of his previous remarks, said Pathans suffering from an exactly similar form of that he held the fever of erysipelas to be essential, and not seen two disease with the same history. Both the cases had comcases in many merely symptomatic, being totally disproportime. pletely recovered in course of tionate to the amount of local (cutaneous) disturbance. Dr Hogg thought an ophthalmoscopic history of the case Dr. Hogg drew attention to the frequent prevalence of He was inclined to regard the prognosis as dengue and erythema in stations which were soon after was wanted. He believed the best treatment would be, a change of attacked by cholera, and asked " Is this outbreak of erysi- bad arrival there, a steady course climate to England, and after pelas merely a precursor of cholera?" and Iodide of Potassium. Before closing the meeting the President applied to each of Mercurials Dr Buchanan, A. M. D., considered that larger doses of member individually for his opinion on the cause of Eryi strychnia ought to be administered ; and suggested blistering sipelas, and the best precautions to be taken against its aloncr the course of the nerve, arid the application to the occurrence or spread in a station, and summed up in the surface of an ointment containing strychnia. blistered following conclusions : That the causes of Erysipelas are a mechanical Dr Ryan described an apparatus forming external (atmospheric) acting on deteriorated constitutions. the supinator and extensor muscles. for substitute to be adopted are :? That the best prophylactic measures Regardins the case of chorea,? out that the Plenty of out-door exercise during the cool season ; patient reof Surgeon-Major Buchanan pointed The better ventilation and cleansing canteens, &c.; and uneasiness to the occipital region, from the ferred pain when floors The avoidance of flushing washing them, and the disease as being of which ho was disposed to regard the use of proper cement between the flags. blistering and It was sugested that sand or sawdust should be sprinkled cerebral origin, to the Surgeon-Major Hogg referred it from non-progressive over canteen floors to facilitate thorough cleansing. locomotor ataxia the case as distinguisnmg The pruning of trees to at least 16 feet above the ground historv of upwards. As to its-origin, he to permit of a free circulation of air was also urged as an which gradually progresses many cases of pericarditis, &c., believed that in the service important sanitary measure. Among musicians especially chest escape observation. from strain on the heart diseases are very common, possibly from the exposure to caught from rheumatism else and lungs, at Mess, balls, &c., are subject. Eighteenth Meeting, held on the 26th January. which bandsmen playing an embolus and so lead to President in the chair. Endocarditis might produce this case would do well on was of opinion that He chorea Surgeon Hudson, I. M. D., related some cases which had Betting to England. He did not think the climate of the of syphilis complicated with recently occurred in his practice such cases. He defined chorea to be with pericarditis. hills to be suitable to synovitis of various joints, and ultimately of cerebral origin. of fatal epilepsy a spinal had In one of these cases, which termination, mercury Jackson s view, viz., Sureeon Ryan quoted Dr. Hughlings had been rather freely employed to the detriment of his is due to embolism of cerebral arteries. He chorea that constitution. of hemi-chorea as indicating a pointed to the prevalence A discussion followed, in the course of which several pprpbi'Oil origin. in of the use mercury more India, members deprecated parthe meeting terminated. After a few more remarks believed ticularly in the treatment of natives. tha,t the, only safe and reliable way of administering mercury held 23rd February. either to Europeans or Natives was by means of inunction Twenty-first Meetiny, or the vapour bath. The President in the chair. Morar.
The
of fever was
fallen double have
type being peculiar, air. daily .exacerbations marked by rise of temperature, &c. (charts of cold there
asleep
suggested
.
The^President
j
At the Nineteenth
Meeting, held "
on
9th
February.
An interesting communication on Ulcer of the leg amon" ? native soldiers in Morar" was contributed to the Society. " Its probable relation to Delhi Boil," "Bagdad Button," &c.,
was
read a paper on cholera. He and pathology of the disease. briefly described the symptoms and sporadic cholera were He was of opinion that epidemic He did not believe the disease essentially different diseases. in the ordinary acceptation of to be infectious or contagions be portable. He considered the those terms, but held it to a miasm travelling with the disease to be propagated by he attached chief importance atmosphere. As to prophylaxis, and to the improvement of to careful sanitary precautions On the outbreak of an the general health of the troops. instant removal of troops from epidemic he would urge the from his own experience the station ; he, however, quoted As several instances where this measure failed of success. to check the premonitory to treatment it was all had he found opium given very diarrhoea. For this purpose If rejected he would repeat freely yield the best results. should it be a second time the dose immediately, and it the rectum. In the first rejected he would administer by and would on no account stage he would also give stimulants, of bed even to go to stool. If permit the patient to get out second stage, he would employ the disease proceeded to the He had found excellent results opium with great caution. He was in the habit of a^mimsfrom Warburg's fever drops. He usually found that the terin"" this medicine in 3 doses. doses ; but he still persevered* patient rejected the first few the dose was finally retained every fifteen minutes until than from He had seen better results from Warburg's Tincture tried. any o ther drug he had-ever \
discussed.
Twentieth Meeting, held 17th February. Dr. Hogg in the chair. Surgeon Ryan, A.M.D., exhibited two patients, one suffering
from chorea following fever ; the other from local paralysis with a similar previous history. The case of chorea occurred in the person of the Band Serjeant of an Infantry (British) Regiment. He had suffered very much from malarial fever and had felt himself gradually failing during the last two years., A few weeks ago he was attacked with severe ,chorea chiefly affecting the lower extremities, and strongly simulating Locomotor ataxy. There was, however, no real loss of co-ordinating power, the ataxic appearances being due to the choreic movements of the limbs which rendered his gait and indeed every combined or complex movement uncertain. Under treatment (Arsenic, Bromide of Potassium, and general tonics) he had improved greatly, and was now able to walk fairly well with a little aid from a stick. The case of local paralysis occurred in a man convalescent from a severe attack of malarial fever. He appears to
'
Brigade-Surgeon Sutherland
important
,
(
April 1,
REVIEWS.
1882.]
The President in opening the discussion thanked Dr. Sutherland for his interesting paper. Surgeon-Major Buchanan, A. M. D., described an outbreak of cholera which he had treated in Lucknow. It originated with a native. This man was seized with cholera, and was ordered off to the Epidemic Hospital. By mistake, however,
he was taken to the 11. A. Hospital and left outside one of the wards, until the error was discovered and remedied. In the patient spite of careful disinfection of the place where had been laid, a short time afterwards, after a shower of ward outside which he rain a case of cholera occurred in the had been lying, and this was soon followed by a second and a third case. Then the epidemic became general. Dr. Buchanan had treated the first few cases with chlorals but withthe funeral of one of out success. About two days after these cases, an officer who had accompanied the funeral party In this case Dr. Buchawas himself attacked with cholera. tried Ipecac, nan, acting on a suggestion of Dr. Manley's, in large doses, and the patient recovered. After that he treated all his cases in a similar way ; and_ though some of them of recoveries. The died, there was a very large proportion disease at which he had found the ipecac, the of period treatment yield the best results was just as the first stage The theory on was passing into the second (collapse.) is that of relaxation of which this treatment was founded of the circulation. For the vessels and re-establishment would recommend the use of prophylactic purposes he already referred to, sulphuric acid. During the i ?f dilute sulphuric acid Dr. Buchanan had administered 3 the field battery daily to each man of the It. H. A., but gave nothing. After commencing its use no further cases of hut one appeared in the cholera occurred in the R. H. A., field battery. The sulphuric acid was then administered to them also, and no more cases occurred. Dr. Buchanan entirely concurred with Dr. Sutherland on the importance of immediately arresting all diarrhoea during a cholera epidemic, and described how he had got sentries placed over .the latrines, so that any man going twice within a limited a time, was at once taken away to receive dose of astringent
cholera laria.
109 poison
was
merely
.mixture.
appeared
very
malignant
form of ma-
Surgeon-Major Hogg related some experiments of applying water to every part of the surface of the body with the view of replacing the lost fluid of the blood by absorption through the skin ; but failure in every instance was the
result. He believed in the relation between malaria and the cholera poison.
Surgeon Wood was opposed to the view that cholera and malaria are identical, and pointed to other malarious countries such as America, where cholera is not endemic. Dr. Sutherland believed in the efficacy of atmospheric disinfection, by burning sulphur, &c., in an infected station. Dr. Hogg showed that in Morar, cholera had always followed the course of the Biswas Nullah, usually attacking the best barracks. It constantly kept occurring in the same barrack blocks. He thought that much of the mortality in time past had been due to the delay in getting transport of tents from Agra. Dr. Sutherland was of opinion that it would be desirable to have permanent huts built on the ridges selected as sites for cholera camps ; so that in the event of a cholera outbreak troops might be moved without any delay. The meeting soon after broke up. Oswald Wood,
Surgeon,
epidemic
of the treatment of Surgeon Armstrong's experience to be of any avail ?cholera was that no remedy when once the disease was fully developed. Surgeon-Major O'Reilly, A. M. D., related some of his experiences during an epidemic "of cholera in Allahabad in 1860. He believed the symptoms of cholera to be due to arterial spasm ; thus the blood is thrown into the veins, the and the veins of the portal system becomes congested, stomach and intestines relieve themselves by exudation, and In the same so the rice-water evacuations are produced. account for the suppresway spasm of the renal artery may sion of urine. This theory would explain the success which has occasionally attended such remedies as blood-letting, and Tartar emetic. Dr. O'Reilly had tried Chloroform, either as Spirits of Chloroform or as the pure article suspended in mucilage, with fair success ; his treatment being based on the arterial spasm theory. Of late Dr- Butler had employed Boracic acid with success. A member present thought that arterial spasm would priand not exudation. marily cause congestion of the lung, jExudation would follow dilatation of the arteries , as proved by the experiment of dividing theSplanchic nerve. Surgeon Wood, A. M. D., said he had heard Dr. O'Reilly'a ?theory expressed in other words, viz., that cholera is analogous to Tetanus, the one being an affection of the motor the other of the sympathetic nervous centres. The failure of Nitrite of Amyl would not overthrow the arterial spasm theory, as that might be due to the evanescent nature of the results of the drug. He thought the success of Boracic .acid referred to by Dr. O'Reilly very encouraging, as pointing to a germ origin of the disease, to be combated by the -early, use of antiseptics. Dr. Buchanan said he was in the habit of combining the Chloral with Ipecac, -treatment. He .found that the Ipecac, caused immediate emesis, but appeared to check the vomiting of the disease. For nourishment he would avoid Beef-tea and fluid foods of all sorts, giving instead blancmange, and other easily digested farinaceous food. Drs. O'Reilly and Sutherland had both seen several cases which proved fatal from collapse, but who never had any purging or vomiting. Dr. ..Sutherland believed ttufct the
a
A. M. D.,
Ilonrj. Secy. Morar,
8th
March,
1882.
