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This case has been followed by sixteen nearly similar cases,treated in the same way, and with the same result. The firstfour- of these were attended by Mr. Toogood and myself, threeI saw with Mr. Pollard, and the rest were under the care ofMr. Toogood, with the exception of the case of one woman,whom I was requested to see by Mr. Paul, and who diedcomatose some days afterwards, apparently from the retentionof urea in the blood.The increased development of the intestinal glands and

follicles, and inordinate action of the gastro-intestinal secer-nents and exhalents, the greatly diminished proportion of theserum of the blood, and the increased density and venouscharacter of the blood retained, are all plain and ascertainedfacts, and lead to a reasonable hope that remedies directed tothe arresting and removing these morbid conditions may pre-vent their going on to a fatal termination. The cases adduced,though perhaps too few to be conclusive, assuredly very muchencourage this hope. The treatment adopted is the same incharacter as that suggested by Dr. Graves, and so successfullycarried out by Mr. Beckett, of Hull. The gallic or tannicacid may have the advantage over the acetate of lead in notbeing sedative in their action; and there can be no doubt thatthe use of these remedies by injection into the rectum is avaluable modification of this practice. The good thus effectedis probably chiefly owing to the extent and great rapiditywith which exhalation and absorption go on in the largeintestines, but something, I am disposed to think, is also dueto an astringent and tonic effect on the sphincter muscles. Inone case, during the administration of an enema, the sphincterwas seen to be completely paralyzed, the anus being open,and the contents of the rectum trickling away as from adrain. This state ceased after the injection.The carelessness of nurses renders it desirable to remark,

that no good can be expected from the use of these injectionsif they are not carefully given-if too much fluid or air be in-jected into the bowels.

Torquay, Oct. 1849. ___________

PRACTICAL NOTES ON THE TREATMENT OFCHOLERA.

BY DAVID DAVIES, ESQ., M.R.C.S. &c., Bristol.

BILIOUS diarrhoea in infected districts may, as a general rule;be considered the effect of the epidemic influence, as, if letalone, it generally terminates in cholera; it is less likely to doso when accompanied with pain than when not; is very sus-ceptible of treatment, and is generally checked by three orfour doses of the compound powder of chalk, and opium, of ascruple each, repeated after every motion; or the chalk mix-ture, with tincture of catechu and laudanum. If at all severe,the patient ought to be put in a warm bed, and a mustardpoultice applied to the abdomen. If this do not succeed ina given time, some other astringent should be substituted, asone will often answer where another has failed. The bestsubstitute is the acetate of lead, in from three to five graindoses, conjoined with an opiate proportioned to the age, andrepeated every hour, or according to circumstances.

Rice-water diarrhoea is very successfully treated with theacetate of lead’and opium. I think one large dose of calomelat first acts beneficially; hot water to the feet, and a mustardpoultice to the abdomen, should never be neglected. In fivecases where the purging was severe, and the patients ap-proaching a state of collapse, I gave a drachm of laudanum,and ordered hot fomentation to the bowels, &c.; four of themrecovered. I have never given opium when there was anyapparent venous congestion.

C7iolera with collapse.-Calomel given in scruple doses everyhour, in two grain doses every quarter of an hour, and in five-grain doses every half hour, seemed to have no effect at all.The trisnitrate of bismuth was given in ten-grain doses everytwenty minutes to twelve patients; eight of them died, andfour recovered; it seemed to have no effect at all. The ace-tate of lead will often stop the discharge from the bowels,but the collapse continues, and the patients sink. We have Igiven it alternately willi diffusible stimuli, but with the sameresult. Hot turpentine fomentations relieve the cramps inthe greater number of cases in a very short time, and a mus-tard-poultice over the stomach will often relieve the vomit-ing; but nothing is of avail to ward off the fatal terminationof the disease, except a peculiar constitutional tenacity oflife, to which probably the recoveries from a collapsed stateof cholera are chiefly owing. The most agreeable drink in astate of collapse is a mouthful of toast-and-water, or simplewater; when reaction has taken place, mutton-broth wil

generally stay on the stomach better than anything else. Teais the most certain provocative of vomiting.Mercury is not preventive of the disease.-I have seen several

children, from six to twelve years old, attacked with cholera,although they happened at the time to be in a state of saliva-tion. These cases were equally fatal with the rest.

7s the cholera infectious ?-From several instances which oc-curred, I believe that the poison of cholera may be carriedfrom one place to another, and that so carried it will takeeffect, the required conditions being present.

Exciting causes.-Any sudden emotion of the mind willoften bring on an attack in an infected district; in this waythe death of one member of a family has often produced thedeath of several others. Those who are very much afraid ofthe epidemic seldom escape it, and seldom recover whenattacked.The best diet in a cholera district I believe is milk. At

Stapleton, where 140 died, and where the cholera sporules(if that theory be correct) must have been very thicklystrewn over the whole place, all the children in the cottageschool, amounting to about sixty in number, and rangingfrom three to six years old, escaped without a single case ofcholera or diarrhoea among them; and the infants, amountingto about thirty, also escaped.. Their diet is principally milk.Both these were situated in the middle of the Asylum, andwere surrounded with cholera and diarrhoea.Queen.square, Bristol, Oct. 1849.

REPORT OF A CASE OF

RUPTURE OF THE LONG HEAD OF THE BICEPSMUSCLE.

By JOHN PARKIN, M.R.C.S.L & L.A.C., Holmfirth.

JAMES P-, aged twenty-five, labourer, applied to me, onemorning, having received some injury to his shoulder-joint.He could not give any very accurate account as to the precisemanner in which it was done, or how he fell, (I surmise hewas rather the worse for liquor,) but states that he fell uponhis shoulder. On examination, I found it slightly tumefied,but its rotundity was not much impaired; there was a littleprominence anteriorly. He had perfect motion of the arm inevery direction, saving that he could not raise it up to hishead, or even draw it very far from his side, without causinghimself much pain; moving the arm backwards was sufficientto produce pain. Both limbs were of equal length; nor couldI detect the slightest crepitation. I bound the arm to thebody, put it up in a sling, enjoined perfect quiet, and orderedsome lotion to be applied to the shoulder, requesting him tocall upon me again in a week or so; but not having seen himsince, I suppose it must have been going on well.

Holmfirth, November, 1849.

ANALYSIS OF PAPERS ON THE TREATMENTAND PATHOLOGY OF CHOLERA.

So great has been the number of communications on the sub-ject of cholera, which have reached our ofl2ice within the lastfew weeks, that, desirous to afford some share of space in ourpages to all our correspondents in turn, we must from time totime present the observations of some of them in an abbrevi.

ated form, which, however, contains, as we believe, the principalpoints which they wish to urge on the attention of our readers.

Beri2arl-s on tlie Treatment of Cholera.By H. H. TATLOR, Esq., Surgeon, Sunderland.

" The first symptom in almost every case of cholera that hascome under my observation, has been a violent pain in the epi-gastric region, with a feeling of heat and ftilness; this hasgradually extended itself over the region of the liver andspleen, accompanied with violent retching or vomiting, fol-lowed by extreme faintness, and cold, creeping sensation overthe whole surface. Considering the disease at this stage oneof simple congestion of the stomach, liver, spleen, and probablythe pancreas, I recommend the immediate application ofleeches, (the number according to the urgency of the case;)afterwards a very large linseed, or bran, poultice. I ordermustard plasters to the feet, and give the following medicines:Carbonate of soda, thirty-six grains; dilute hydrocyanic acid,twelve minims; water, six ounces: mix. Two tablespoonfulsto be taken every three hours.

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" This treatment has invariably arrested the disease, andwere we more frequently called in at this period, the iiiflain-matory stage might be altogether prevented.

" Secondly, where we have vomiting, purging, and cramp,suspended action of the kidneys, &c., give the follow-ing:-Chloride of mercury, three grains; powdered opium,half a grain ; powdered capsicum, one grain ; conserve

sufficient to form a pill. One every hour or two hours,according to the urgency of the case. Carbonate of soda,two drachms; aromatic spirit of ammonia, two drachms;spirit of nitric ether, three drachms; water, five ounces and ahalf. Two tablespoonfuls every hour. Mustard plasters ap-plied to the calves of the leg, and one large one over the regionof the stomach. Bottles of hot water to the region of theheart, and to the feet. Should I not quickly succeed in gettingmy patient into a good heat, he is well rubbed down the spine,over the region of the heart and abdomen, with a linimentcomposed of spirits of camphor and tincture of saponis andopium, parts equal; afterwards, a broad flannel roller applied.The cramps in the legs and thighs are quickly removed by theuse of the liniment and bandaging.

-

" Where there is purging of bloody serum, or dysenteric mo-tions, sugar of lead and opium is the best remedy, togetherwith injections of catechu and opium, or still better, tanninand opium. I have tried gallic acid, but cannot, from my ex-perience, speak favourably of it.

" In the stage of complete collapse I have given small, butfrequently repeated doses of calomel, with great benefit.Allowed beef-tea, brandy, &c., and administered, in the shapeof mixture, five grains of sesquicarbonate of ammonia, everyhour or oftener. Had I a suitable apparatus, I should feelmuch inclined, in this stage, to try the means so highly recom-mended by the late Drs. Kelly and Mackintosh, of Edinburgh.They found, in the most unpromising cases, nothing succeedlike the saline injection thrown into the vein carefully.

CHIRURGICUS states that he has "Frequently employed calomel with unvarying success in

the premonitory diarrhoea and in the impending collapse ofcholera, but he has never administered it in an isolated form;the sequent benefit he cannot, therefore, justly ascribe to itsinfluence, -which might, and probably did, accrue from theaction of the agent with which it was combined. I have (hesays) invariably used it in combination with opium, and alwayswith beneficial results, but I have treated identical cases withopium, camphor, and the vegetable astringents, with equalsuccess; and moreover, I have, in several cases, without theaid of calomel or opium, suppressed the disease with largedoses of the vegetable astringents alone. Many good practi-tioners deprecate the employment of opium; perhaps theyconceive it has a tendency to perpetuate, or rather prolong,the suppression of bile; that impression is, however, destituteof foundation. The liver is quite a passive agent in the dis-ease, and will resume its functions, upon a restitution of thevital fluid, of which it is deprived through the morbid actionof the bowels. The alimentary canal is undoubtedly theprimordial seat of this disease."

M.R.C.S.E. says,- -

" From the phenomena of the suppression of the biliary andrenal secretions, of their gradual occurrence, and from theirhappening at a period more or less remote from the com-mencement of the diarrhoea, which is almost universallyadmitted to precede them, I am induced to consider that thefometic poison makes its primary impression upon the gan-glionic system, and through its influence the capillary vesselsof the alimentary canal are incited to all abnormal andexcessive action, which results in the rapid elimination of thesenna and salts from the fibrinous and globular portion of theblood. The effect of such abnormal action must soon be ex-perienced throughout the whole system, but will tell primarilyand specially upon the liver, that viscus deriving its secerningblood almost exclusively from the venous channels of thestomach and intestines.

" Granting this view to be correct, we should direct ourremedies primarily to the suppression of that enormous

exudation from the bowels which is rapidly laying prostratethe powers of life.

" Calomel is one of the most important and potent remedieswe can employ to aid us in the conquest of this disease, buthere I differ from Dr. Ayre, as to the niodus operaradi of theremedy. The action of calomel here I conceive to be sedative.It appears to me to exercise its beneficial agency by soothingthe ganglionic nerves, and robbing them of that preternatural

excitement which constitutes, in my opinion, the essence ofthe malady. That mission accomplished, the mucous mem-brane ceases its morbid function; the separation of the fluidfrom the solid constituents of the blood is in consequence nolonger enacted upon its surface; hence the liver regains itsnormal supply of portal blood; the biliary secretion, hithertosuppressed, from the absence of the material for its elabora-tion, is again resumed.W. C. B. says,-

-

" The general impression seems to be, that unless wecan find ’a specific’ for cholera, we can never cure it.’Supposing such to be the result of all the researches ofthe most eminent of the profession, the disease will still re-main as novel as it was in 1832. The cause of this dreadfulmalady, as well as of any other malignant epidemic, is stillunknown; but on that account is it yet to be said to be incur- ,

able? I think that none of your readers can say what is thecause of scarlet fever, small pox, typhus fever, &e. Has thereever been discovered ’ a specific’ for any of the above dis-eases? Why should we expect to find one for cholera ? 1

" We have the eruptions in small-pox and scarlet fever, andwe have the vomiting and purging in cholera,but these are onlyefforts of Nature to throw 06’the poison, and if the person soassailed has not strength to resist the effects of this poison, hedies. In all sorts of diseases, when the body receives a certainamount of poison, death is almost certain, and the medicaltreatment is of no use unless the vis medicatrix naturœ secondsour efforts."I have attended about 500 cases of epidemic cholera, and

innumerable cases of choleraic diarrhoea, since last March. Imay state that I have attended it in both low and lofty loca-lities, and have still found the disease as malignant and fatalin one as the other, and not confined to the poor, or those whohave not the means of procuring the common necessaries oflife.

" I regret to see so many opposed to the calomel treatment,but I can only say I have used it in every case of cholera Ihave attended. In children there can be no doubt that it isthe best remedy, and the only one to be relied upon. Inalmost every case of cholera, the early exhibition of an emetic,(of sulphate of zinc,) followed by a scruple of calomel and onegrain of opium, will frequently arrest its progress. After-wards small and repeated doses of calomel, at intervals of tenminutes.

" Sinapisms placed upon the regions of the stomach, kidneys,spine, &c., and the external application of heat, contributegreatly to the relief of the more urgent symptoms. I veryseldom found any of my patients treated in this way muchaffected with the consecutive fever, which, in many instances,is almost as fatal as the disease itself. When I did, I seldomadministered any other remedy than the effervescing mixtureswith chloroform, and I have the greatest pleasure in statingthat I lost very few of my patients, if I saw them before theywere in a state of collapse. Even in this stage of the disease,when called, (I was most remarkably fortunate,) I eitherordered a mustard emetic,’ or large quantities of salt andwater’ to be taken: the beneficial effects of both I cannot findwords to express. The purging, which is so dangerous whencollapse is approaching, I have found to be best checked byone-drachm doses of the tincture of matico given in brandy.I have also used the starch-and-laudanum injection with thegreatest advantage. Finally, I feel it my duty to state that itis only by the closest attention’at the bedside of the sick, thatany patient can be restored to health, and that no man mustrely upon any prescribed mode of treatment, either in thisdisease or any other, but watch each change in his patient,and apply general principles to each symptom, as it assumesa different feature.

" Permit me to ask what is the cause of the respirationgoing on after the action of the heart ceases, and how to ac-count for the muscular twitchings which I have observed in

very many instances to occur after death, for various periods ?"

A YOUNG PRACTITIONER remarks,-" If any medical man entertain unbounded confidence in the

efficacy of any therapeutic agent in cholera, why should he,in urgent and well-marked cases, be guilty of such apostasyto his doctrine as to call in other additional remedial aids tohis assistance? Such, however, appears to have been the pro-ceeding of Mr. John Grove, with regard to a case which wasreported in THE LANCET of Oct. 20, and which was undoubtedlywritten in support of the utility of sulphur, of which he is soprominent an advocate.

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"After describing the condition in which he found the pa-tient, he proceeds to state that he administered the sulphurmixture, which, however, was not retained. He then adoptedmore active treatment, employing ether and opium. Findingthat the latter remedies remained upon the stomach, and thatthe sufferings of the patient were mitigated thereby, he im-mediately reverts to the sulphur; but for what purpose Icannot define. Finding, however, that no benefit resultedfrom its re-employment, which extended over a period of twodays, but that, on the contrary, the third day revealed anaggravation of the symptoms, notwithstanding its uninter-

irupted employment, he very judiciously suspended its ad-ministration, substituting the carbonate of ammonia. Againa sensible amelioration takes place in the patient’s sufferings,and again he reverts to his idolized sulphur, more cautiously,however, this time, and evidently with less faith in its specificutility, for he very sensibly uses it in conjunction with opiumand ammonia. This treatment is continued over the fourth,and on the fifth day, camphor, opium, and catechu are season-ably substituted, when a rapid amelioration ensues, and conva-lescence speedily results." Now, from what I have witnessed of this disease and its

treatment, I have no hesitation in asserting, that had thelatter remedies been employed at an earlier stage, muchgratuitous suffering and danger to the patient, and much un-necessary anxiety to the medical attendant, might have beenobviated.

"Chelsea, October, IS49." --

Mr. LITCHFIELD, of Twickenham, remarks,-"I have had under treatment, during August and September,

as the medical officer of the district, nearly 300 cases of severediarrhoea and vomiting, not falling into collapse; and I havefound calomel and opium, (solid,) in combination, the mostefficient cure. Mustard poultices have been very useful tothe epigastrium; and where the vomiting has not yielded tothe opium, ten drops of chloroform or chloric ether, every- quarter of an hour, (and two or three doses have usually suf-4iced ) have been valuable in checking it. Liquid medicinehas usually been thrown up almost as soon as taken."

°‘ Mr. HENRY TAYLOR, of Guildford, calls our attention to acurious fact in the- history of cholera given by Catlin, in hisaccount of the North American Indians—viz., the exemptionof those tribes that live exclusively on animal food. His obser-vations on the subject are so remarkable, that I venture (saysMr. Taylor) to quote them at length, under the impression thatthey have not been noticed by medical writers in this country.

"’ During the season of the ravages of the Asiatic cholerawhich swept over the greater part of the Western countryand the Indian frontier, I was a traveller through those re-gions, and was able to witness its effects; and I learned fromwhat I saw, as well as from what I have heard in other partssince that time, that it travelled to and fro across the frontiers,carrying dismay and death amongst the tribes on the borders’in many cases, so far as they had adopted the civilized modesof life, with its dissipations, using vegetable food and salt;but whenever it came to the tribes living exclusively on meat,and that without the use of salt, its progress was suddenlyestopped. I mention this as a subject which I looked upon asimportant to science; and, therefore, one on which I mademany careful inquiries; and so far as I have learned alongthat part of the frontier over which I have since passed, Ihave, to my satisfaction, ascertained that such became the ut-most limits of this fatal disease in its travel to the West, un-less where it might have followed some of the routes of thefur traders, who of course, have introduced the modes of-civilized life.’ "

" It may, perhaps, be objected that the primitive habits ofthese red men, more than their peculiar diet, rendered themsecure from the invasion of cholera; but if it were so, a likesecurity should have attended them from other epidemic dis-eases, one of which, the small-pox, committed such fearfulhavoc among them."A meat diet might be supposed to act as a preventive

against cholera on these grounds: that it maintains the vigourof the system in the highest possible degree, and that, fromits being so much more digestible than vegetable food, itdiminishes the activity of the intestinal functions, and sorenders these organs less susceptible of morbid influences; forit is assumed here, that the alimentary canal is the primary seatof the disease-an opinion which is evidently gaining ground.And I see no difficulty in understanding how an arial poisonshould find admission there, when its direct application might I

take place through the medium of the air, which passes hourlyinto the stomach, mixed with the salivary fluid.

Mr. H. L. STUART, of Douglas, Isle of Man, remarks :-"Having suggested carbon in the treatment of cholera in

the pages of THE LANCET, vol. i. 1848, p. 338, together withsulphur and nitre (potass. sulphuret) externally, and of gun-powder internally, on the same principle, vol. ii. p. 265, aswell as having privately proposed the latter for trial, but Ibelieve without persuasion, yet, as the benefits derivablefrom carbon, sulphur, and cold, separately, are abundantlyaffirmed, I presume may encourage some hope in the chemicalcombination of those elements, as they exist in gunpowder."Further, I presume that in the case of the young man at

Bristol, so tenacious of life, as detailed in the last number ofTnE LANCET, p. 439, if the body had been isolated, and elec-tricity drawn from the feet bv an electrical machine to anisolated rubber, and conducted by another chain to water ina metallic vessel on the ground, more satisfactory resultswould have ensued than from galvanism."

ANALYSIS OF MODERN INVENTIONS FORIMPROVING THE HUMAN FRAME.

The Elastic Chest Expander.MR. HENRY COST has sent forth to the public an ingenious

invention with the above title. It is an elastic band withhandles, which may be used as a backboard, or in any direc-tion ; and Mr. Cost has published directions for a set of ex-

ercises, illustrated by engravings, which we think cannot failto be useful, especially to females, whose mode of life too fre-quently admits of little muscular exercise. The implementis handsome, and so light that a mere infant can use it, and itis free from an objection which attaches to dumb-bells andsome other appliances, inasmuch as it can never exert anundue strain upon the muscles. The extent to which theexpander may be stretched, forms a very good index of actualmuscular power.

Mr. Cost’s book of Calisthenic Exercises contains recom-mendatory letters by Dr. Duesbury, Mr. Beaman, and othermedical practitioners, and also testimonials in favour of theexpander from the proprietors of many schools where it isused. We consider the invention meritorious, and deservingto be employed by young persons. An invention, similar inprinciple, and even still more valuable, is

The Baby-jumper,which has now become so naturalized in the country as to bepretty generally known. It is concisely described as follows :-" It consists essentially of a strap seat for the child, suspendedto four cords, which are kept asunder by passing over a hod-zontally-disposed hoop; this again being capable of beinghung from a ceiling by a strong India-rubber strap, highlyelastic. The infant placed in the seat, and suspended withhis toes just touching the floor, can, by a very slight move.ment and exercise of muscular force, cause himself to rise