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whilst the losses sustained by others were to the number of956; and that out of this latter number there were 170 fromdiarrhoea; while the deaths with us in that disease were onlysix. In fact, whilst the numbers of our patients were at least,it may be conjectured, two-thirds greater, the deaths with uswere nearly two-thirds less than those of others, whose rule itwas not to adopt our treatment.Upon these facts, which it is in every one’s power to verify,

I shall offer no further comment; and in hastening to closethis report, I must beg to add my testimony to the zeal andintelligence with which my colleagues fearlessly performedtheir duties in their laborious attendance upon the sick.

I have the honour to subscribe myself, gentlemen,Your obliged and obedient servant,

JOSEPH AYRE,Medical Superintendent under the

General Board of Health.

[LETTER FROM DR. CARTER.]To the Editor of THE LANCET.

STR,—Considerable experience in the nature of choleraduring the recent visitation, and the most gratifying andmarked success in its treatment by the use of calomel in smalland frequently repeated doses, joined to a wish to acknow-ledge the source to which is due all my success,-Dr. Ayre, towit,-induce me to send you the following strictures upon someportions of a letter by Dr. Sandwith, in last week’s LANCET.If my remarks contain no other merit, they do at least addone more to the swelling number of ardent and disinterestedadmirers of Dr. Ayre’s conduct, and believers in the efficacyof his treatment; and as the doctor is an entire stranger tome, with whose existence I was unacquainted a few weekssince, it is happily impossible that my disinterestedness canbe called into question.And first, let us analyze those conclusive "series of facts,"

which, with sledge-hammer-like force, settle at once, and forever, the infectious nature’of cholera, greatly to the discom-fiture of that " spurious philanthropy which has prompted menof amiable sentiments to promulgate the opposite opinion," notbecause, remember, they conceived, however erroneously, theywere upholding truth, but because (mark the compliment)they would rather do evil that good might result-they wouldrather uphold what is false than suffer patients to go un-attended-or else, because "from a mercenary desire, menwished to prevent a panic !’’A man catches the cholera in London, brings it to Hull,

comes into contact with six individuals, and they all catch itfrom him; this appears startling and convincing at first sight,but a second survey detects that three of these cases were butslight diarrhoea, and this reduces the number to the followingfour:-1, Mr. Hayzen ; 2, his mother; 3, a friend in the samestreet, and much in the same house; 4, a neighbour.

Let us for a moment admit, for the sake of argument, thecholera to have arisen epidemically, and to have confineditself to this street, it becomes at once manifest that each ofthe sufferers might have taken it from the same source. Thequestion then resolves into this,-did they catch the diseasefrom Mr. Hayzen, and from each other, or did they get itfrom a source other than human infection, operating in thesame manner by repetition in each successive case ?

It appears to me, that the integrity of the whole series offacts depends upon one link, the fact of Mr. Hayzen havingtaken the disease in London at all, and not in the same streetas the others; even if he did, this might, of course, but be acoincidence; one fact, however well recorded or favourable,cannot establish a theory; whereas, if he did not, the wholetrain of argument tumbles to the ground ! And how looselyand carelessly given is the history of the first case. I quotethe words of the letter:" The cholera was understood to ragein London:-did it or did it not do so ?" Curiously enough,the only authority cited by the author to prove that it musthave done so is Dr. Watson, who, in a lecture published fif-teen years after, believes it appeared in London in the summerof 1834.

Again, Mr. Hayzen fell into cholera on board the steamer.Did his medical attendant see him on board, or immediatelyupon his arrival? because if he did not, the testimony of the patienthimself is valueless. Your correspondent proceeds to state thatif the disease had been epidemic merely, we had a right toexpect the occurrence of other cases, where contact had nothappened. In reply to this, I will first quote Dr. Ayre’s ex-perience at Hull as contra-distinguished to this. He says, atpage 15 of his work on Cholera, " of all the persons in thistown (Hull) who were in communication with the sick, notone instance fell within my knowledge of the disease being

produced by infection. The medical attendants, the visitors,the clergy, and the nurses out of the cholera districts, withthe persons conveying the sick to the hospitals, or bearing thedead to their graves, all have been alike exempt, and withthem likewise those of their families and friends, and con-nexions of every kind, forming altogether a great multitudeof persons." But, secondly, I may reply, with equal and neu-tralizing force, that if the disease had been infectious at all,we had a right to expect the occurrence of cases away fromthe same street, for it is remarkable that so many cases shouldhave been confined to the street ! Surely among seven casesthere must have been contact with many individuals livingelsewhere; and why did they not take it ? why did the diseaseappear to oppose its own law, the law of infectious diseases, notbeing confined to one locality, but spreading continuously ?But to turn to another point, wherein I will avail myself of

some arguments adduced before the London Medical Societyby Mr. Headland, at their last meeting. If calomel be notthe remedy for cholera, because it will not cure cases of themost intense severity as some of those at Hull, alluded to byDr. Sandwith, what remedy have we for any disease exceptsulphur for itch? Do we possess a remedy for scarletfever, for small-pox, or for any one disease ? Our igno-rance of the nature of the poison in cholera is not moredecided than it is of the poison of other diseases; in oneand all of them we see only the results, and if the personaffected is not strong enough to resist the poison, he dies, andthis in spite of all and any medical treatment; but we do nottherefore neglect to treat and cure the milder cases; neitherdo we say, because we cannot cure the severe, we know nothow to manage the mild. Is it any sort of slur upon thecalomel treatment that it can do no more for the most severecases than medicine can do for other most severe diseases ?

I will not enter into that wide field for discussion, thepathology of cholera, but I will humbly confess, that if calomelbe proved to cure cholera almost wholly and solely, as I thinkit has been, I shall rest satisfied to employ it, in the teeth of themost opposing theory. Only let me ask in this place, wheredid Dr. Sandwith glean his information that Dr. Ayre calcu-lated on a visitation of only medium severity" ? Was hetaken by surprise, and found unprepared ? The books of theRegistry office must show, by and by, whether or no his suc-cess in the treatment of even the very worst cases has notbeen incomparably greater than that of his opponents. Thevery least the writer of so bold an assertion could have donewas to back it up with proof.

Finally, I deny that Dr. Ayre can be taxed with wishing,arbitrarily, to exclude all remedies but calomel. He merelyclaims for calomel that important and almost exclusive usewhich is accorded to mercury in lues, to quinine in ague. Inneither of these diseases do we banish opium, stimulants, vene-section, blisters, leeches, &c.;j and yet, who will say that ineach mercury or quinine is not specific-is not the remedy-the sheet-anchor ? Not a jot more knowing are we as to theway in which quinine cures ague than we should be of the wayin which calomel cures cholera.To carry out his own views. Dr. Humphry Sandwith should

leave a case of ague uncured by virtual empiricism, lest heshould supplant rational medicine, for surely quinine is givenempirically. Surely he forgot, when he penned the con-clusion of his letter, that in a recent communication to THELANCET Dr. Ayre proposed to cup over the region of thekidney, in addition to giving calomel.

T am Sir vour obedient servant

H. F. CARTER, M.D., M.R.C.S., & L.A.C.

A SUDDEN DEATH, AND NO INQUEST.To the Editor of THE LANCET.

SIR,—A poor man named Mitchell, an omnibus driver, whoresided in Hunslet-Iane here, had an attack of delirium tre-mens, and was under the care of a surgeon. Towards theevening of the 25th inst., by some imprudent neglect, he wasallowed to dress himself and walk out, strong and vigorous,but in a very excited state of mind. By flattery and persua-sion, he was induced to return within an hour, accompaniedby two policemen, who, on a favourable opportunity occnrring,tied him down on the bed, and applied handcuffs. A secondsurgeon was sent for, on whose arrival the patient, it is said,was made to inhale something, and " in less than five minutes"was a corpse. No inquest took place, and the interment wascarried through early on the 27th.The circumstances are peculiar, and the absence of all legal

inquiry is remarkable. Is it not due to the friends, to the

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public, and to these medical gentlemen themselves, that anexplanation be given by the latter, of the cause of death ?Was it ether, or chloroform, or what else was it ? Surely thequestion as to the propriety of adopting or rejecting the inha-lation theory, so much vaunted, and the reverse, ought to beenlightened by the detailed results of such a case. Why wasthere no inquest, and why such haste to bury ?

I am, Sir, your obedient servant,Leeds, Oct. 29, 1849. INVESTIGATOR.

** It is not too late for an inquest in this case, and it willbe a disgrace to the authorities of the town if a judicial inquirybe not instituted. It is a case in which the coroner, if he re-ceive proper notice of the circumstances from the inhabitants,and a demand for an inquest, could not refuse to hold one,without rendering himself liable to removal from his officeby the Court of Queen’s Bench. We sincerely hope thatthe demand for an investigation will be duly made, as a moreproper case for an inquiry never occurred.

THE CHOLERA SUB-COMMITTEE OF THE COL-LEGE OF PHYSICIANS, ON THE CHOLERAFUNGI.

THE following are the principal conclusions and resultsarrived at by this committee on the nature and import of cer-tain bodies examined microscopically in relation to cholera.

" 1. Bodies presenting the characteristic forms of the so-called cholera fungi are not to be detected in the air, and, asfar as our experiments have gone, not in the drinking-water ofinfected places.

"2. It is established that, under the term annular bodies’and cholera cells, or fungi,’ there have been confoundedmany objects of various and totally distinct natures.

" 3. A large number of these have been traced to substancestaken as food or medicine.

" 4. The origin of others is still doubtful, but these areclearly not fungi." 5. All the more remarkable forms are to be detected in

the intestinal evacuations of persons labouring under diseasestotally different in their nature from cholera."Lastly. We draw from these premises the general con-

clusion that the bodies found and described by Messrs. Brittan Iand Swayne are not the cause of cholera, and have no exclu-sive connexion with that disease; or, in other words, that thewhole theory of the disease which has recently been pro-pounded, is erroneous, as far as it is based on the existence ofthe bodies in question.

WILLIAM BALY, M.D. Cholera Sub-WILLIAM W. GULL, M.D. Committee.

Medical News.

HOMOEOPATHY AND hIPUTED MANSLAUGHTER.—The trial ofCharles Thomas Pearce, who had been committed to Newgateby the Deputy-Coroner for Middlesex, on a charge of themanslaughter of Richard David Pearce, took place at the OldBailey, on Saturday last, before Mr. Justice Maule. Theprisoner was arraigned on the coroner’s inquisition, andspeedily acquitted. There are circumstances connected withthe proceedings of this trial which call for searching inquiry.PAYMENT OF MEDICAL REFEREES AT ASSURANCE OFFICES.-

We are glad to observe, from an advertisement in anothercolumn, that the Royal Insurance Company has adopted thecourse of remunerating those members of the medical pro-fession who may be referred to by persons desirous of insuringtheir lives. This is another step in the right direction, an’lwe trust that the example set by so respectable and pros-perous an association, may be extensively followed by otheroffices. The principle of payment being acknowledged by thisinsurance office, we cannot doubt that, on reconsidering thematter, the directors will see the propriety of converting thefee they have named into the customary fee of one guinea. Itshould be recollected by directors, that in replying to thequestions, the amount of the insurance is not the measure ofthe labour and trouble which is entailed on the medical prac-titioner. His replies are the same, whether the insurance isfor .E100, or for £5000.The Royal Exchange Life Office, also, one of the oldest

and most respectable in London, has resolved to pay medicalpractitioners a just remuneration for the information they

contribute. Amongst the old -established-offices of high-standing,this one, we believe, took the lead in the good work. Whilethis is passing with establishments of just repute and solidity,.is it not strange that we have still to record the fact that thedirectors of the Clerical, "Medical," and General AssuranceCompany still resist the practice of remunerating medicalpractitioners for the valuable information they contributerelative to the health of persons who seek to insure their livesat that institution ? At no very distant day we shall publish,.in juxtaposition, a bright list of the paying offices, and a.black list of the defaulting ones.THE LONDON MUTUAL LIFE AND GUARANTEE SOCIETY.—We

were much pleased in finding the following paragraph in theprospectus lately circulated by this Society.-" Ground for-complaint on the part of the medical profession-in referenceto the non-payment of a fee to the private medical attendantof the life proposed for insurance-having existed, the directorsof this institution have determined that in all cases the usualfee to the professional gentlemen referred to shall be paidwithout hesitation.A STEP TOWARDS THE CONCOURS.—We were much gratified

in perusing a notice posted up a few days ago, at King’sCollege Hospital. Students desirous of filling the offices ofhouse-surgeon, physician’s assistants, clinical clerks, anddressers, were therein requested to send in their namesprevious to the examinations which are to decide whichcandidates are best fitted for these various offices. By thesemeans there is no doubt that very efficient subjects will beselected, and it is surely not too much to entertain the hopethat the good effects of such elections will gradually lead to amore extended application of appointments by concours.

QUALIFICATION OF MEDICAL OFFICERS FOR PAROCHIAL Ap-POINTMENTS.—An interesting discussion took place in the St.Pancras vestry, on the appointment of a medical officer for oneof the districts of that extensive parish. The directors of thepoor having advertised for a medical officer for the north dis-trict, vacant by the resignation of Mr. Smith, three candi-dates presented themselves to the vestry. The first statedthat he was a member of the College of Surgeons of London;the next, that he was a member of the College and a licentiateof the Apothecaries’ Company; and the third, that he was amember of the College of Surgeons of Edinburgh. All werein actual practice in the district. In the discussion whichtook place, Mr. Harding, a medical member of the board,made some explanatory remarks on the present state of thelaw, the former custom of the vestry, and the merits of thequalifications produced. The vestry determined that a quali-fication in medicine and surgery be required of each candi-date. That as the College of Surgeons of Edinburgh and theCollege of Surgeons of Dublin educate and examine in inedi-cine, surgery, midwifery, and chemistry, the diploma of eitherof these colleges be considered a sufficient qualification. The-effect of this vote, as far as the parish of St. Pancras is con-cerned, was of course to exclude the member of the Collegeof Surgeons of London, on the ground that he had not, byexamination, proved his qualification to practise medicine,midwifery, and pharmacy.NEW COUNCILLORS OF THE COLLEGE OF SURGEONS.—At a nu-

merously attended meeting of Fellows on Thursday last,November 1, Mr. GEORGE PILCHER, and Mr. JoHN Brsaor, wereelected members of the Council, in the vacancies caused bythe death of Mr. C. Aston Key, and the resignation of Mr.Welbank. This result will have a material influence in for-warding the projected revision of the Charter of the College.MORTALITY OF THE METROPOLIS.—Deaths registered in

London, in the week ending October 20,1028; weekly average,1162; decrease on the average amounts, therefore, to 134deaths. This reduction of the mortality was greatest on thesouth side of the river, for the deaths of the week in this divi-sion were 276, whereas the average is 324. Mortality fromcholera had fallen from 110 in the previous week to 41 in thelast. In the whole metropolis, the daily number did not, inany instance, exceed nine. Deaths from diarrhoea and dysen-tery amounted in the week to 63; in the previous week theywere 105. Of the 14,538 persons who had died of cholera inLondon in 55 weeks, 6657, or nearly one-half, died after lessthan one day’s illness, (exclusive of the duration of premoni-tary diarrhoea.) and of the remainder, 2466 sank under thedisease before it had reached the second day. Small-pox andmeasles were much less fatal than usual; scarlatina was fatalin 41 cases, the average being 64; typhus in 63 cases, averagebeing 56. Barometer, mean of week, 29.89; mean daily tem-perature increased from 430 on Sunday to 59°7’ on Thursday,and continued at nearly this value during the rest of the week.Deaths registered in London, in the week ending Oct. 27,