disease, advises (with but two exceptions that I am aware of), the earliest and most earnest efforts to restrain the precursory diarrhoea, so marked and constant as to be known by the title of cholerine. This is often an easy task. It suffices generally to put the patient to bed, and administer a full dose of opium in some form.

But of late, Dr. G. Johnson, an English physician, recommends a course directly opposite. He purges with castor oil freely, giving half an ounce every half-hour in water, and allowing cold water to be drank ad libitum. He thus saved, as he affirms, twelve out of fifteen attacked. The plan has been unsuccessful in other hands. A medical commission reports, after fair trial of it, sixty-eight deaths out of eighty-nine persons so treated. Dr. Stark had previously eulogized the cathartic practice still more heroically carried out; having selected croton oil and colocynth as the proper articles, giving a drop of the former with a moderate amount of the latter every hour, until a bilious evacuation is procured. Diluted sulphuric acid is meanwhile given to check the vomiting.

In certain prolonged cases, when a species of inflammatory affection of the stomach and bowels is developed, the milder articles of this class are occasionally beneficial. If calomel does not suffice, castor oil, magnesia, or rhubarb may be added in moderate doses. Of stimulants, properly so called, I should wish to avoid, if possible, the administra tion. If they become absolutely necessary, beyond opium, which is, incidentally, the best of them, I would use capsicum, camphor, and ammonia, in quantities proportional to the urgency of the case.

Heat is almost uniformly applied to the surface, though disputes have run high whether it ought to be in moist or dry form. Hot, dry air is extolled by one; vapor baths or hot water by another; and by still another, the body is directed to be enveloped in poultices, of as great warmth as can be borne. If the skin is relaxed, I prefer the dry form, and lay about my patient bags of hot salt, hot bran, etc. Mustard may be advantageously applied, in poultices or by dry friction, to irritate the surface. Nitric acid and capsicum, and a great variety of irritants, are used also as ointments and embrocations. In protracted cases, epispastics are of unquestionable service, both as stimulants and revulsives. Some practitioners, finding that these heating formulæ are so often complained of by patients as adding to their sufferings, have gone to an opposite extreme, and have advised cold affusions, and even friction with ice, upon the blue or bronzed skin, covered as it is with a chill and clammy perspiration.

Camphor has been proposed by Hahneman, upon homoeopathic principles, as "the true and only remedy for cholera," and he ventures to assure any one, who will "take it in sufficient quantity, and with proper zeal and perseverance, that he will not die." The remedy has gained great celebrity in our own country, and is much employed everywhere as prophylactic. Large draughts of tepid water have been recommended, on the one hand, and on the other, a Dr. Hardwicke Shute has reported a prodigious success from the drinking of indefinite quantities of cold water exclusively. Broussais gives pellets of ice; Magendie, hot punch; Baird, of Newcastle, relaxes with the

tobacco enema; Fyfe (of same place), stimulates with glysters of mustard and brandy. Sulph. quinine, nux vomica, galvanism, electricity, and acupuncture, have their advocates. Sir James Murray suggests the placing of the body in an exhausted receiver, to determine to the surface in collapse. The idea is plausible and ingenious; it is dry cupping on a large scale.

The blackness of choleric blood has induced the exhibition of oxygen and its mixtures, as nitrous oxyde, etc.; but the reports of the results of the experiments are not encouraging. Dr. Latta and others have injected into the veins warm water in large quantities, holding in solution the salts drawn off in the serous discharges peculiar to this disease. The attempt is a total failure. Dr. Stevens, who entertains peculiar views of the chemical changes of the fluids in disease, and of the paramount importance of saline remedies in fevers, has extended his treatment also to cholera; and the reports of the success of his plan in the management of the epidemic in the Coldbath Fields prison, London, were highly favourable. They have not, however, received any further confirmation from any quarter.

The highest degree of success, in the encounter with this terrible malady, that has yet been attained in this or any other country, is claimed for Dr. Cartwright, of Louisiana. His plan consists in the free exhibition of calomel, capsicum, and camphor.

It may be observed, generally, that in the doubtful and tentative management of this terrible pestilence, to which even the most sagacious and scientific physicians were driven, those prescriptions have obtained most reputation that contained all or some of the articles thus mentioned. Of these, perhaps, the capsicum was, at least, in the southern and southwestern parts of our own country, the most relied on, and has been combined with morphine, quinine, ether, etc. I was much pleased with a formula which I frequently exhibited, differing chiefly from Cartwright's in the addition of opium or morphine. The quantities of camphor, calomel, capsicum, and morphine, were carefully adapted to the age of the patient, and the apparent urgency of the case. If any symptoms of narcotism presented themselves, I omitted the opiate, and substituted ammonia.

Some authors have fallen into the error of attributing the cerebral torpor or comatose condition of the latter stages of cholera, to the previous use of narcotics. The fallacy of this notion is evident from the fact, that these tokens of sensorial disturbance have been most strikingly notable, and of most frequent occurrence, in those parts of the world where opiates were least confided in, as among the Broussaians of France, and the Homoeopaths of Germany. But it is easy to satisfy ourselves on the subject by experiment. I saw this condition exquisitely developed in several patients, who had taken no stimulant, and to whom I had suffered no anodyne to be administered.

I repeat that I regard this pathological state as a part of the full history of cholera-as one, indeed, of its characteristic stages. It is not shown, of course, when the patient dies in the first or congestive stadium, or sinks, under the exhausting discharge of fluids, into col

lapse, or promptly fatal prostration, or is suddenly put an end to by vehement and universal spasm. Nor do we meet with it when we have been successful in arresting the progress of the disease or substituting remedial and healthy reaction and excitement, for the series of irritating and inflammatory lesions and obstructions to which its current tends. So, to compare small things with great, we may put an end to a paroxysm of intermittent fever, in the cold stage-the stage of incubation which ushers it in, or in the hot stage; by bringing on, in the first, a recuperative reaction, and, in the second a remedial instead of the impending morbid cutaneous determination and

relaxation.

A western physician, Leczynski, recommends (in the Western Journal, Nov. 1852), chloric ether, in the dose of 3ss to 3j every half-hour; and chloroform, which he administers in milk, 70 to 100 drops every quarter or half hour. He tells us that 200 drops have been given at once, and successfully. It is adapted to prostration and collapse. "It stimulates, exhilarates, coagulates protein bodies, promotes the excretion of bile, soothes and produces a temporary anesthesia of the voluntary apparatus, but an increased action of the ganglionic nerves, and the organs they enter." Being "energetically antispasmodic, it is indicated whenever a stimulant antispasmodic is wanted; it is contraindicated in plethoric and cachectic subjects. In the first it may cause apoplexy; in the second, it may decompose the already diseased blood to such a degree, as to make it entirely unfit for nutrition."

Strychnine was mentioned above among the remedies employed in cholera. Abeille regards it as "certain a specific here, as quinine in ague." He gave one-third of a grain in two ounces of water, four times in twenty four hours. In combination it formed the favorite. prescription of Professor Edwards and Dr. Howes in the epidemic of Cincinnati, in 1851. They exhibited "with remarkable success in the very worst forms of cholera, and even sometimes in profound collapse, the following formula: B.-Strychniæ, gr. ss; ol. terebinth. 3ij; mucil. gum acacia, 3viij. M. S. One tablespoonful every half-hour until the discharges ceased, and the reaction occurred. In some of the worst cases, the dose was repeated every fifteen minutes. In one case, the above prescription was renewed seven times, and 3 grains of strychnine given in forty-eight hours. In one case only was its poisonous effect noticed; in this 1 grain had been given in sixteen hours." (Trans. Am. Assoc., vol. v.)

Dr. Fuller considers sulphuric acid to be a specific in cholera. "One ounce of the 'dilute acid' of the Pharmacopoeia is mixed with eleven ounces of water; of which one ounce and a half is given every twenty or thirty minutes, according to the severity of the case, until six or seven doses are given."

DIARRHEA.

That disorder of the bowels which has received this significant title, is so frequent an attendant upon other diseases, that many writers,

with the great Cullen at their head, have expressed considerable reluctance to give it place as a distinct malady in systems of nosology. I have not hesitated a moment on this point. Diseases are not palpable to us, unless as a series of cognizable symptoms, effects of certain definite causes; and it is in this combination of cause with regular and uniform effect, that each disease practically considered, must be allowed to consist. In the case now before us, there is doubtless present some peculiar and characteristic condition of the mucous membrane lining the intestinal tube, as exhibited by the increased secretion from its exhalant vessels, and the consequent or symptomatic increase of peristaltic action of the muscular tunic of the same tube.

Diarrhoea, then, may be defined to consist in morbid frequency, fluidity and vehemence of the alvine evacuations. These circumstances are usually connected with pain and griping preceding each motion, and more or less relieved by it. For the most part, there is loss of appetite and gastric uneasiness, amounting occasionally to nausea and vomiting. The tongue is furred and whitish: the pulse small and rather frequent, but free from febrile irritation; there is early loss of strength, and when the discharges are abundant, or the attack is protracted, emaciation goes on to a striking degree.

Nosologists have made a variety of distinctions in diarrhoea, founded upon the causes by which it is brought on, and upon the nature of the fluids voided; thus we have mucous, serous, lienteric, bilious, and gypseous diarrhoeas. These phrases explain themselves with two exceptions. Lientery is an old word, referring to that looseness of the bowels connected with almost total defect of digestion of the food taken, which passes unchanged, or nearly so, though mixed with fluid. Gypseous diarrhoea is a phrase of Good, who takes for granted the calcareous nature of the white or chalky discharges sometimes passed. This assumption is, as far as we know, unfounded, for no chemical proof is offered, that a secretion so improbable and unnatural has taken place from the intestinal vessels; and the color may be owing to defect of bile, or the presence of much albumen. The same writer speaks also of a variety which he denominates tubular diarrhoeamembranous flakes, of different shape and size, coming away, some of them moulded upon the inner surface of the alimentary tube. This is a rare phenomenon. I have never met with it, unless following or connected with a high degree of inflammation of the membrane, as in enteritis proper and in dysentery. I cannot regard it either as correctly considered, a form of diarrhoea, or even as one of the symptoms of that affection. It is of diphtheritic character and origin.

The causes of diarrhoea are numerous and diversified. In a general way, we may affirm, that it is likely to follow the entrance into the bowels of anything which has bid defiance to the solvent and assimilating powers of the gastric fluids. Thus, the husks and seeds of fruits rarely fail to promote the alvine evacuations, and are used, figs for example, and unbruised mustard seed, as laxatives, by many invalids. Undigested food, under whatever circumstances, whether the failure be owing to weakness of the stomach, permanent or temporary, if not got rid of by vomiting, is apt to excite diarrhoea, and thus promote its own

expulsion. Not only the husks and seeds, but the juices of many fruits, and the substance of many vegetables, are irritating and laxative to those unaccustomed to their use as diet. Indian corn, cabbage, the sweet potato, the beet, apples, pears and berries, may be enumerated as showing this quality. The waters of many sections of country are purgative to strangers. I need not do more than allude to the long catalogue of cathartics to be found in treatises of Materia Medica.

It usually occurs that diarrhoea, excited by these modes of irritation, terminates promptly; the morbid causes having procured their own expulsion, by the peristaltic action which they have excited, the disturbance and ailment gradually subside, health being at once restored. On the principles of revulsive derivation, with which all are familiar, and which are readily applied here, many slight indispositions of which the patient had complained previously, are found to be thus relieved, and he enjoys better health than he did before the attack. Hence diarrhoea in its milder form, has come to be regarded as a salutary sort of malady, and its spontaneous appearance often looked upon as critical. It was easy, and not irrational, to reason a little farther, and infer that its artificial production by cathartics, was likely to prove beneficial in disease generally, and thus the extensive employment of this class of medicines is accounted for. Hence, also, the resort to cathartics, as preventive of certain ailments, and the habitual use of "spring physic" among other domestic prescriptions.

There are other causes of diarrhoea besides those which directly affect the alimentary tube. The ready reciprocity of action or impression which connects the cutaneous surface and the abdominal viscera, is a matter of familiar attention, and we are here presented with a striking example in illustration of it. The skin, when in a moist and perspirable state, being exposed to the influence of a damp or cold atmosphere, its vessels undergo a severe constriction, the fluid that filled them being expelled; the cutaneous transpiration is obstructed or checked, and often obviously vitiated in quality, and determination of blood necessarily takes place to the internal organs and surfaces. Particular predispositions, original and accidental, permanent and temporary, decide the current of these internal determinations. If the bowels receive the full shock of the morbid impression, we may have either enteritis or diarrhoea, or dysentery, or colic, according to the various modes of morbid action which may be excited. The irritation affecting the mucous surface expends itself sometimes on the secretory vessels, and there is an inordinate effusion of somewhat vitiated mucus, perhaps mingled with serum; this excites by its presence and distension, the peristaltic movement of the muscular structure of the tube. and is expelled. The discharge is often so acrid as to occasion a burning pain with tormina, as it passes along the alimentary canal, and give rise to annoying tenesmus. Nay, as the upper lip is inflamed by the coryza of catarrh, so the anus and neighboring surface may be inflamed by this discharge. From a supposed analogy referring to the similarity of cause, of surface affected, and of effused fluid, some have entitled this catarrhal or rheumatic diarrhoea.

Morbid impressions, made upon the liver, whether mediately or im