XII. TREATMENT OF CHOLERA AT LEEDS.

This is described in a letter from Mr. Birtwhistle in the Lancet for Aug. 25. Mr. B. states that saline injections have been tried, found to fail, and abandoned. Mr. Morley, resident surgeon of the Hospital in Marsh-lane, Leeds, used the salines, after Stevens' fashion, but had not seen enough to determine their value. "This was prior to the exposure of the cases in Cold-bath-fields prison." The treatment actually pursued was nearly the same in Leeds and York.

"When a patient was admitted in the collapsed stage, tins containing hot water, and suitably shaped, were applied to the abdomen, back, and feet, the body being previously surrounded with a blanket. These retain the heat for a long time, and had been found to answer better than any kind of bath in restoring the natural temperature. Should the prostration of strength be extreme, reaction was assisted by the internal administration of strong stimulants, consisting chiefly of ammonia and camphor. A scruple of calomel, uncombined with any other medicine, was then given every hour, until the severity of the symptoms had abated. The quantity was then lessened, and the interval between each dose increased. Six or eight doses had been generally sufficient to arrest the vomiting and purging, and to excite the biliary secretion. It had rarely been necessary to push the mercury to salivation, although I think it would be advisable gently to touch the mouth, with the view of lessening the consecutive fever."

At the York cholera hospital re-action was promoted by the enema of spirits of turpentine, in a mucilaginous mixture, six ounces being thrown up in extreme cases. We have seen one patient recover from the stage of collapse who took turpentine per os et per anum. Drs. Goldie and Anderson speak favourably of the medicine. Mr. Teale avoids much opium on account of the secondary affection of the head. The majority of the medical men in Leeds and York are non-contagionists.

XIII. CHOLERA CURED BY CALOMEL AND OPIUM.

Mr. Dobson, a very intelligent surgeon of Pimlico, has related a case of this description. The patient was almost in extremis when he saw her. Heat was applied to the surface and the whole body rubbed constantly with warm turpentine. Large quantities of brandy were given, and cal. i. with opii, gr. ij. every half hour. Besides this an enema of starch and tinct opii, 3ss. was administered. As the patient rallied the doses of calomel and opium were diminished. She recovered perfectly.

XIV. A LOGICAL DEDUCTION.

Dr. Weatherill, of Liverpool, injected into the veins of a man labouring under cholera, four hundred and eighty ounces of saline fluid. Strange to say, the man recovered. However, Dr. Weatherill declares that his own opinion of saline injections, from this single case, "is exalted, and he should not think he did his duty if ever again he suffered a patient to die of cholera, without using it." He sums up thus ;-" any medical man who does not (use injections) will excuse me for passing severe judgment on his conduct." This is modest with a vengeance. So every medical man is to prostrate his judgement, his reason, his experience before Dr. Weatherill, or excuse him for censuring him severely, if he does not. It matters not that others may reason differently, or have a larger experience in this mode of treatment; they must employ injections at the pain of Dr. Weatherill's displeasure.

XV. COLD WATER IN CHOLERA.

This, at the time we are writing, Sept. 10th, is the last plan recommended for the treatment of cholera. It is contained in a communication from Dr. Hardwicke Shute to the Board of Health, and has been transmitted by the Board to the Lancet and Medical Gazette. The quantity of cold water taken "in the most marked cases of

recovery," was as much as some gallons in a few hours. Dr. Shute adds to this the abstraction of all kinds of stimulus external and internal, even to the exclusion of friction or of the application of heat in any form. Dr. Shute does not shuffle-he says broadly and boldly that the treatment is to apply to the second and particularly to the third stage of cholera, "when the pulse at the wrist has ceased, or become nearly imperceptible." This is manly and honourable. Dr. Shute does not say, like Dr. Stevens, that the premonitory diarrhoea is not curable by ordinary means, and then laud his method for curing it. All is fair and above-board with Dr. Shute ;-" if my remedy does not succeed in the really bad cases, reject it." Dr. Shute not only applies cold internally but to a certain degree externally also. The following is this able and benevolent physician's practice.

"The windows of the apartments, at the Cholera Hospital in Gloucester, are large and numerous in proportion to the size of the room, and the door which opens immediately into the garden, is seldom shut. The windows are open day and night, so that the patient may be considered as living in the open air, and the fire is kept so low as not to influence the temperature of the room. The covering of the patient is confined to a light blanket or rug; and it seldom happens that some part of the patient, particularly the breast and shoulders, is not constantly exposed. Under these circumstances, a pint of cold water is offered to the patient, and very frequently two-thirds of this are taken at a draught. In what I consider the most favourable cases, vomiting is almost immediately produced, and the patient in two or three minutes again calls for and eagerly drinks the same quantity, with the same results. This is often continued for hours, until gallons of water have been taken, and the greatest proportion, but I conceive not all, is rejected. In other cases the patient is too insensible to ask for water; and under these circumstances, it is offered every ten minutes or quarter of an hour, and most commonly drunk with avidity.

If gruel or tea be offered, the patient most frequently refuses it; and, generally speaking, no kind of nutriment is taken in any form until the period of convalescence. In the first six or eight hours no amendment can be observed. In the next six or eight hours there is some diminution of intensity in the purple hue of the extremities. In the next six or eight hours there is a manifest improvement in the countenance of the patient, and increased disposition to sleep. In some cases the pulse has not been perceptible for twenty-four or thirty-six hours. From this period the pulse, the animal heat, and the secretions, are very gradually restored; and at the end of forty-eight hours, on the third day from the commencement of the plan of treatment proposed, the patient is convalescent; and in all cases without consecutive fever. I mention these circumstances particularly, in order that the practitioner may not be impatient: he should make not the least alteration in the plan laid down, as long as the patient is merely not getting worse."

Dr. Shute observes that he has tried this plan in twelve consecutive cases with success. It is not consistent with our plan to indulge in elaborate criticisms in these excerpta. Our object is rather to collect facts. When we look back at the various methods that have been proposed, considered by their proposers successful, and on trial abandoned, can our readers blame us at expressing scepticism; will they not become sceptics themselves? When we see the most clashing theories and most opposite plans of treatment equally enthusiastically advocated, we cannot but suspect, that all are equally or nearly equally inefficacious. Amidst all this glitter of success the general lists shew no diminution of relative mortality, on the contrary they exhibit an increase. When the epidemic first appeared in this country, one method of treament was pretty generally pursued. Latterly we have had experiment on experiment hot water and cold water-bleeding and

stimulants-calomel and opium and salines frictions and no frictionsdrink ad libitum, and no drink at all.

Here is confusion worse confounded, and we scarcely hesitate to say, that in point of principles of treatment and practice, we are worse off now than we were twelve months ago. The cold water treatment is the last, and sanguine persons may believe that it is the best: unfortunately we are not sanguine.

In a disease like the present we would not discountenance rational and cautious experiments, far from it. But we would discountenance and reprobate most strongly premature declarations of success, and dogmatic abuse of all who do not yield implicit faith to what is written or said. Look, for instance, at the manner in which many of the advocates of the saline treatment have attacked and are attacking those who have opposed or have not assented to their views. Can any thing be more disgraceful? It is certain that truth will in the end prevail, and fallacy be as signally exposed. Dr. Shute behaves like a man of science and candour; all he expects his statements to lead to, is "a more extensive trial of the plan proposed." This is as it should be.

XVI. M.M. FOVILLE AND PARCHAPPE

ON THE CHOLERA AT ROUEN. These gentlemen have written a sensible and interesting pamphlet. We cannot of course give even an abstract of it, but may mention one or two facts related by the authors. They had the charge of the cholera hospital at Rouen. The epidemic broke out in Rouen early in April, 1832, but owing to popular prejudices, no patients were received in the establishment until the 13th. This establishment appears to have been an asylum for the insane, situate on the left bank of the Seine in an apparently healthy situation. The total number of cholera patients was 78, of whom 38 died, 37 recovered, and three left the house before the issue was determined. There is another fact deserving of great attention, but too often lost sight of by those who treat, and those who weigh the value of the treatment of, cholera. The disease lasted 32 days in the asylum. In the first eight days there were

36 patients, and 23 deaths—in the succeeding 16 days there were 31 patients and 15 deaths-and in the last eight days 11 patients and no death. Here we see the rate of mortality progressively diminishing, from the first quarter of the epidemic's duration. Had Dr. Stevens arrived with his salines during the last quarter, when 11 cases occurred without a death, what a buz would have been made! The French reporters, however, are too candid and too sagacious not to see that the diminution of deaths was rather owing to the laws of the disease itself, than to the influence of treatment.

The reporters draw attention to another subject, the propagation of the disease within the asylum. The cholera wards were on the ground floor of the centre of the building; the upper stories being inhabited by the insane. Of the latter, 26 were attacked with cholera, 25 of whom inhabited the part of the building appropriated to the cholera patients. It was also found that most were seized in the dormitories nearest the cholera-wards, and, with one exception, the farther these were removed from each other the more rare were the attacks. Amongst the employés of the asylum only one was attacked the cook. He lived in the centre of the building. Of thirty-three religieuses who attended the sick, ten were attacked and three died.

From these considerations the reporters think they are justified in pronouncing, that " under the influence of the epidemic constitution that gives rise to cholera, persons inhabiting the vicinity of a collection of cholera patients are more likely to contract the disease than those removed from it."

We think this a fair expression of the facts of the individual case, and were the same thing generally noticed, it would also be a fair enunciation of a general law. But this has not been generally observed, at least there are very many recorded instances in which it was not; a circumstance which will tend to diminish the general applicability of the principle. At the same time we think that facts so well authenticated and so candidly stated should

make men hesitate before they subscribed to the doctrine of absolute noncontagion.

In their resumé the reporters observe that the cause of cholera is yet a problem that its seat is essentially in the digestive apparatus-that certain organic alterations constantly exist, and that their seat is in the same apparatus -that these alterations consist, first of a considerable defluxion towards the mucous membrane, and development of the glands of Brunner and Peyer, with extreme secretion of a particular fluid, followed by various degrees of inflammation of the membrane and of the follicles-that these alterations and the symptoms proceed pari passu-that in the absence of a specific, hitherto undiscovered, we must be guided by general principles and by the facts already mentioned-and that the true method of treatment should therefore be antiphlogistic, though not actively so.

We might proceed farther with these Excerpta, we might advert to contagion and to other topics, but we will desist. All parties should be anxious to apply the most successful treatment. We have therefore received with much pleasure the following circulars addressed by the Board of Health to all medical men who have the charge of patients affected with cholera.

(No. 1.)

Council Office, Whitehall, 3d Sept. 1832. SIR,-The Central Board of Health being anxious to obtain, from authentic practical Sources, short Outlines of the different Plans of Treatment in Cholera which may have been considered most successful; I am directed to request that you will have the kindness to submit the enclosed (No. 2.) to the Medical Members of your Board, and to any other Medical Gentlemen in the Neighbourhood who may have had extensive Practice in the Disease.

You will also request the Medical Gentlemen in charge of Cholera Hospital to fill up, and forward through you, a Return of the following Form, for each of these Establishments within the District under the Superintendence of your Board.

(No. 2.)

(Signed)

Council Office,

3d Sept. 1832. Medical Gentlemen, who have had Experience in the Treatment of Cholera, and are of opinion that they have been successful in their Practice, are requested to forward to the "Secretary of the Central Board of Health," under Cover to "The Clerk of the Council in waiting, Whitehall," a short Account of their respective Methods of Treatment of the Epidemic :

1st. When in the Form of Bilious Diarrhea.

2d. In that of Rice-water Evacuations.

3d. In the Stage of Collapse.

We are convinced that if the Board follow up this plan-if they carefully procure and make known to the profession the results of treatment-if they issue short and simple directions to the public, especially the poor, as to what they should and what they should not avoid-if they calm terror and distrust by ceasing even to hint at restrictive measures which, if carried into effect, could do no good, but which really cannot be carried into effect at all-if they religiously abstain from violating the ties of kindred and feelings of affection by cruelly sanctioning the dragging away of the bodies of the dead, or by encouraging the mummery of separate burial places-if they rather invite than compel the transportation of the

sick to cholera hospitals-if they treat with urbanity the representation of those who differ from them in opinion, and do not dogmatise when they fail to convince-if they do this, we say, they will deserve and gain a popularity which they have not yet enjoyed, and will contribute to establish a kindlier feeling between the parties who have differed so widely and even so bitterly on cholera.

XLIX.

MENSTRUATION IN DIFFERENT COUN

TRIES.

IN Part X. of "The Principles and Practice of Obstetric Medicine," lately published, Dr. Davis considers the anatomy of the uterus and its appendages, and enters on the subject of menstruation. From the remarks on this function we are tempted to select those on the differences observed in different nations and climates. It is generally known that the period of puberty is earlier attained in the warm regions of the South, and in "the lands of the sun," than in the chilling North, or even than in temperate climes. But Dr. Davis has collected some facts and illustrations, not quite so familiar as -the general doctrine.

"In the more fervid climates of Asia and Africa, the women arrive at puberty at ten years of age, and not unfrequently at nine. Some years ago an English gentleman resident at Malta, who there occupied a distinguished post under the Government, favoured the author with the fact, that the native girls of that island sometimes marry before they attain even the latter age, and generally within a year or two afterwards. It is a matter of history, that the celebrated prophet of the Moslem faith consummated his marriage with one of his wives when she was full eight years old.' And now Khadija his wife being dead, after she had lived twenty-two years with him, to strengthen himself the more, he took two other wives in her stead, Ayesha the daughter of Abu Beker, and Sewda the daughter

of Zamá.’- Ayesha was then not six years old, and therefore he did not take her into his bed till two years after, when she was full eight years old. For it is usual in those hot countries as it is all India over, which is in the same clime with Arabia, for women to be ripe for marriage at that age, and also to bear children the year following.' Prideaux's Life of Mahomet, p. 30, 1718. We are on the other hand informed that in Sweden, Norway, and a great part of Russia, menstruation does not often take place till the more stayed ages of seventeen or eighteen. In reference to this latter fact it might seem open at least to a presumption that so much absence of alacrity to engage in a function so essential to reproduction, as in the sequel we shall find menstruation to be, might have an unfavourable effect upon the population of the countries of the north. The facts of history are, however, directly opposed to such a conclusion; and the explanation seems to be, that in those countries, the duration of the function comprehends a more extended series of years; that the women are strong and well constituted; and that they therefore are competent to menstruate more regularly and during a longer portion of their lives than the women of the south: whence it results that in the end they are found more prolific, and that under favourable circumstances as to the means of living, they become the parents of a healthier and more vigorous offspring. We are accordingly informed by Rudbeck and other writers, that the Swedes have usually families of ten or twelve children, AND NOT VERY RARELY a progeny equal to more than twice those numbers. It should not therefore seem surprising that the population of those countries, in other respects so unproductive, was become so superabundant during the Goth and Vandal times as to have been competent to furnish entire armies of adventurers, first to conquer and finally to colonise distant and more favoured regions. But let us reverse the picture. M. Virey, in his article on climate, in le Dict. des Sc. Medic. observes that the burning climates of the more southern countries of Europe