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TREATMENT OF CHOLERA WITH SUGAR.

BY SAMUEL WOLFF, ESQ.THE number of THE LANCET for April 8th contains an article of

intense interest, by Dr. J. I. Mackintosh, of Edinburgh, on the"Treatment of Cholera with Sugar;" yet the caption is suchthat it might not be generally read, and were it not for thename of the author would excite ridicule before perusal, ifperused at all. " What nonsense next? They have triedmustard and salt, and here is somebody trying sugar forcholera !" Such was the remark that drew my attention tothe article.

I am not about to write a criticism on Dr. Mackintosh’s views.I neither intend to praise nor to criticise, but simply to givefour cases which came under my treatment last month in aGerman family, and the treatment of which has much to dowith that article. Dr. Mackintosh will see that he was notthe only person using sugar in cholera. The result of the casesI am satisfied will be interesting to Dr. Mackintosh, whilst themanner in which I was forced to use sugar will contrast but ina very sorry manner with the doctor’s scientific reasons fordoing so. ’

On the 18th of June cholera broke out in this city with fear-ful violence; none that were attacked with it for the first twodays recovered; the average duration of the disease was abouteight hours. On the 23rd of June, I was called to a German,who had been in this country only a short time. On themorning of the 23rd he had driven a cow some distance fromthe country, and whilst hot drank large quantities of coldwater. In the middle of the day he was seized with symptomsof cholera, which increased until I saw him, (about three o’clockWhen I found him vomiting and purging rice-water,almost pulseless, cold, and covered with a clammy sweat,slightly collapsed, but cramping fearfully. I used the cus-tomary remedies-small doses of calomel frequently repeated,and mustard plasters to the ankles, wrists, and abdomen; Igave him also small quantities of pounded ice and brandy.His wife was very desirous to give him sugar and water, asshe said it was the usual drink in Germany, and he would likeit better than anything else. I protested against its use, uponthe score that it would be apt to make him vomit more, andcould not be persuaded to let him drink any of it, although Iwas solicited repeatedly by his wife and sister-in-law to give itto him. The man sank gradually until he died, about sixo’clock P.M. On the following morning about seven o’clock hewas buried.About ten o’clock on the morning of the burial of the de-

ceased, I received a summons to repair to the same house as in ithe previous case, that the German’s daughter had the cholera. ’,I went with all speed, and found a little girl, about sevenyears of age, deeply collapsed, purging and vomiting rice-water every three or four minutes, cold and clammy, with veryslight pulse, hands shrivelled, and eyes sunken. They hadgiven her several draughts of sugar and water before I arrived,and, as I found all the cases terminating so unfavourably, Ire-

solved to let them use the sugar and water, and followed myusual course of treatment. The child sank gradually until sheappeared to be just dying, in which condition she lay for somehalf hour or so, (I being called away to the case I shall givenext,) when her pulse began gradually to rise, which it con.tinued to do, and she recovered.As 1 stated just above, 1 was called away whilst attending

the little girl to see her aunt, who had been waiting upon thechild during the time she was sick, and finding there waslittle hope of her niece recovering, she became desponding,felt (as she says since) herself getting weaker, until she couldno longer stand. She staggered and fell upon the floor; theycarried her to a bed, and I was requested to go to her room.When I saw her I could detect no pulse; body cold; a clammysweat commencing to break out; cramps very severe in thearms and legs; rice-water discharge pouring away from her,which she was not conscious of, and, with the exception ofwhen the cramps were on her, she showed little signs of life.She would swallow anything that was put in her mouth; hersister-in-law was very attentive in giving the sugar and water.I pursued the course as usual, with the exception of putting ablister over the right side, she having had some signs of con-gestion a few days before. She is now well and hearty, havingmade an excellent recovery. As in the previous case, shesank as low as it was possible to do, and remained so for sometime, when a change took place; the pulse could be perceived;the urinated freely, and reaction came up until it rose to highfever, from which she suffered for two days.On the 25th the last woman’s husband was taken ill. The

cholera ran its course in spite of all the medicine. He lay asdead for some three hours, at the expiration of which time hecommenced to recover, and is now well, but his constitution isgreatly shattered. In this case I ordered the sugar and waterto be given freely, which was done without much persuasion.

I shall not make any remarks upon these cases, but leavethem, trusting that if there are any other practitioners who haveused the sugar they will make the result publicly known, as itis important all such cases should be recorded.Independence, Missouri, United States, July, 1854.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborumet dissectionum historias, tam aliorum proprias, collectas habere et interse comparare.—MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

CHARING-CROSS HOSPITAL.

HYDROPHOBIA; DEATH; AUTOPSY.

(Under the care of Dr. ROWLAND.)(Concluded from page 214.)

State on admission, at twelve A.M., on Monday, July 3rd.-Expression of countenance, anxious and watchful, more like-dread of something going to appear; face pale and intelligent.The patient is of spare habit; hair light-brown, fine and long;has been brought up at a Sunday-school; talks distinctly, andhas full use of mental powers. Pulse natural; tongue steadyand clean; bowels open yesterday morning; pupils dilated;skin hot, dry. Mr. Diamond, the house-surgeon, poured out alittle of the tonic mixture kept ready; but when offered to hershe refused to taste either this or water. She had at the sametime spasmodic action of the muscles of the trunk and upperand lower extremities, accompanied with sobbing and sighing,as when a person unaccustomed to douching has a bucket ofcold water thrown over him. Blowing on the face producedthe same effects as the showing of water. When the patientwas gazed at for some time the anxious look would go away,and break into a smile. The mental powers were preter-naturally heightened.A draught, composed of fifteen minims of chloroform, ten of

laudanum, in an ounce of water, was now offered, but thesight of it caused the convulsions to come on again. The

house-surgeon at last succeeded, by getting her to close hereyes, open her mouth, and at the same time gently expiring.He placed the fluid suddenly into the mouth with a spoon; butdirectly it was in the cavity the convulsions came on againmore severe than before.

Half-past twelve A.M.-Dr. Rowland saw her, and orderedfifteen minims of chloroform, to be taken every third hour, andat half-past one o’clock he prescribed a small dose of calomel,to be followed by an enema of turpentine and castor oil. Theback was also to be rubbed with equal parts of chloroform andtincture of aconite.

Great difficulty was experienced in giving her the calomel.It was tried mixed up with a little sugar in a teaspoon; shetook it into her own hand, but when she got it close to hermouth the spasmodic convulsion came on. It was at last tried,at Dr. Chowne’s suggestion, placed between bread and butter,and was thus ingested. When she had eaten it all, she askedfor more, and thought she could drink a little warm water,but she could not take it when presented. It was tried througha silver tube, but without success, and the attempt to give anenema also failed. The application down the spine directlybrought on convulsions, and at the first application she threwherself on all fours, like an animal.

Half-past two r. M. —Prefers sitting up, the thighs flexed, withthe elbows resting on the knees, the hands being placed ateach side of the head. When requested to lie down, she saysshe feels easier when in the position just described, and that ifshe attempted to recline the cold would hurt her back. To

remedy this, the sheet was warmed, and with a little persuasionshe gently overcame the difficulty, as she is very willing, andattempts to do anything you propose to her. Immediately on

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lying down she has, however, an attack, though enjoying the unable to complete a sentence, being interrupted by the fits;full use of her senses. complains of great heat--wants her clothes and bedclothes

Pupil dilated; tongue whitish; skin hotter, dry; pulse taken on; distressing anxiety for fear her mother should leave equick, 140. her, turning every instant to see if she was still present.

Three P.M.-Has pain at the top of the head. Is lying Half-past three _A.M.-About this time again passed a smalldown with her hands pressed at the sides and at the back quantity of black offensive faeces, and started up suddenly, justpart of the cranium; says she is easier so. Complains very as previously ; is inclined to be sick; pain in the epigastriummuch of a painful stiffness at the back part of the neck. Con- and throat increased; says she feels hot and bad; pulse small,vulsions, which occurred about once every half-hour, are more occasionally intermits; skin moist.frequent and severe. Expression more wild and anxious. Four A.M.--After a retching attack, the patient spat out aWhen asked to glance at a looking-glass, she complied, and thick white viscid saliva, which hung like a drop tenaciouslydirectly she caught sight of herself the fit was brought on; to the lower lip; this continues frequently, and is always pre-soon after this she passed a little pale urine. ceded by retching; convulsive paroxysms more severe and fre-

Half-past four P.M.—Asleep; looks very wild and anxious; quent. The child’s body performs violent writhing movements;breathing in a sobbing manner. the head is thrown back, and the extremities are in violent

Five P.M.-Her father is with her; she looks much altered; motion; she occasionally catches hold of the bedclothes, andconvulsions brought on by the slightest breath; is very pleased fondles them tightly; has left off the sitting up in bed; whento see her mother; holds her hands, and does not want her to this occurred, she always threw herself back with a violentleave her. effort, she could not do so quietly.

Half-past five P.M.-Has eaten some bread and butter; Ten minutes past four.-Retching and convulsions morefeels very thirsty, but she says it is no use trying to drink, as it severe; saliva increased; looks at times very wild and vicious;will choke her. A window open at the end of the ward the mother has started back two or three times, afraid of her;causes too much atmospheric disturbance for her. Cold applied delirium increased; calls the house-surgeon "Henry;" says awithout wind does not produce much effect. She is much strange dark man is coming up-stairs; wants the street-doorworse, the attacks being more frequent. shut. The retching for the last five minutes was continuous,

Half-past six P.M.—Fits much stronger and more frequent, and is s’) now, beginning with a peculiar eructating noise ; hasbeing four or five in the quarter of an hour, and causing some just had a kind of suffocative attack, lasting for nearly half adifficulty to the nurse to keep her in bed. She is asking ’if the minute, which seems to have prostrated her much. Sincedog has been 7cilled yet. then the paroxysms are weaker; delirium increased.Seven P.M.-Is now in a very strong convulsion. She is Twenty minutes past four.-Looks more wild; says she is

given to inhale, on a piece of lint, about one drachm of chloro- mad because the dog bit her; complains of great pain in theform, and after a little trouble and persuasion, she took the throat; eyes sunken; expels her breath through her nostrilslint into her own hand and held it under her nose. This with a snort, but takes it in through her mouth; the inspira-soothed her considerably, so much so, indeed, that when it had tion is short, expiration quick and forced; has had no retchingall evaporated she asked for more. Mr. Diamond kept on for the last five minutes till just now, and has vomited up awith this continuously till- little matter like thin gruel. Says, "Let’s cut our throats I"

Eight P.M., when Dr. Rowland came again to see her. The and is now saying the Lord’s prayer.latter tried to put her completely under the influence of the Half-past four.-Has been for the last ten minutes con-anæsthetic agent, but failed, as had happened to the house- tinuously delirious; talks most about blood, and articles ofsurgeon previously. At this time it was difficult to apply the dress being red; says " We all look red," and then " We areaconite to the back, for when she sat up, which was the only all white;" no retching; spits a little saliva occasionally; theway to accomplish the frictions, the convulsions came on again, peculiar eructating noise is still present; recites verses.as severe as they had done before the chloroform was inhaled, Half-past five.-The convulsive paroxysms, which are nearlydirectly an attempt at rubbing was made. She violently consecutive, consist mostly in rigidity of the back, neck, andthrew herself back, and said, " Don’t do it any more-I siiall inferior extremities, which latter are sometimes kicked up andbe better presently." Ice was also given her by her mother, down; the arms are moving continuously across the chest; sick-but she would not take it on any inducement, giving as a ness has become more frequent; she is much weaker after severalreason that her brother used frequently to give her ice after of the suffocative attacks; the breath smells earthy; deliriumhe had had it in his mouth, and she had therefore taken a dis- nearly continuous; talks much of fire, blood, dress, and riches;like to it. hands and feet cold and purple-coloured.Nine r.:vz.-She complains of a severe pain, referred to the Quarter to six.-Sickness, which had stopped for about a

epigastrium and throat; convulsions worse during the last quarter of an hour, has come on again; the matters vomitedhalf-hour, occurring violently every two or three minutes. are greenish, watery, and frothy; the convulsions are more

The mention of water, or the disturbance of air caused by the like a very exaggerated fit of shivering, excepting the rotatoryclothes of the attendants, bring on a paroxysm immediately. motion of the arm; the back is quite stiff.

Half-past ten P.M.-Convulsions worse; has once or twice Ten minutes past six.-Pupils widely dilated; is in a profusestarted up in bed suddenly in the standing position, and then sweat; extremities are hot again; vomiting, which had stoppedthrown herself again forcibly on her back. for a few minutes, has come on again, and is yellow and

Half-past eleven P.M.-Passed about a pint of limpid urine; watery. Pulse 140. Surface of the body moist; is much moreis much quieter; has begun again with the inhalation of exhausted; sighing has come on nearly continuously; is

chloroform; pulse small and quick; suddenly sits up in bed, talking of heaven; and connects words in rhymes.and then throws herself back; cannot bear her mother to Half-past six.-Is much worse; paroxysms weaker; deliriumleave her or let go her hands; complains greatly of the pain in nearly continuous; tries to scratch; says she must catch thethe back of the neck and epigastrium; skin hot and moist. bystanders, but is unable to move out of the flat position she

Second day, one A.M.-The paroxysms during the last hour is in.have become less frequent, -only three or four times, except Ten minutes to seven.-Sickness and convulsions con.

when she is excited by the sound or mention of water. The tinuous; delirium more of a muttering character. Pulse verychloroform was again given her on lint to inhale, but, as she small and thick. The head is bathed in perspiration; thehad a repugnance to it, it was not pressed. The patient has hands and feet cold and dark-coloured; the right cheek has aevinced slight aberration, fancying herself at home. She has greenish look; the lips are dark; the eyes are fixed upon theshown an inclination for milk and an orange; but, although persons watching her; she vomits continuously.she attempted several times with her own hand to take it. each Quarter-past seven.-Pupils widely dilated; colder and moretime she placed it near to her mouth the violent spasm took purple; vomiting still continues, seems to choke her, notplace. having power to get the fluid out of her mouth; mutters more,.Two A.M.—Better; only one paroxysm during the hour; the so as not to be so easily understood.

impression of being at home increased; asked her mother to Quarter to eight.-Sobbing constantly; convulsions arebring out her bedclothes; has had a few minutes’ sleep. similar to severe shivering; is becoming comatose; cannotThree A. M.-Fits much more frequent; jumped up suddenly answer any questions; muttering delirium.

on her feet, and voided a small quantity of very offensive Quarter-past eight.-Is sinking fast; always sobbing; armsfasces; constantly asking her mother trivial questions about continue to move occasionally, with convulsive starts ofher toys, workbox, &c.; great dread of her parent leaving her body.side for an instant; constantly repeating her pleasure at the Nine.-Low muttering ; delirium ; foams at the mouth;dog being killed, (which círcmnstance had previously beea told pulse hardly perceptible at the wrist; slightly over cardiacher, though iracorrect, in order to quiet her;) complains of very regiun.great pain in the epigastric region; for several minutes is Half-past nine.-The sobbing continues; occasional convul-

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sive starts; is quite comatose; pupils widely dilated; foams atthe mouth; no pulse at wrist; extremities are warmer thanthe surface of the body; clammy perspiration.

Quarter-past ten P.M.-Died suddenly; looks like a childwho has been suffocated. Pupils dilated; body much warmerthan it has been for the last three hours, and bathed inmoisture. Urine, under microscope, presented a great numberof blood-corpuscles, (specitic gravity 10’11;) pale.Post-morton Examination.-Membranes of the spinal cord

very vascular; spinal fluid very transparent; vascularity ofcord general. Brain: General venous congestion, substancesoft; nothing worthy of notice in the medulla oblongata. The

papillae of the tongue were much elevated and large, especiallyat the root of the organ; the mucous membranes of the pharynxand larynx, as far down as the oesophagus and glottis, were red,thin, and loose, and marked by a circumscribed transverseline about the base of the arytænoid cartilage. Most of the

organs of the chest and abdomen were healthy; the blood wasvery fluid and very dark coloured, the upper lip being lividand discoloured, as with persons who die from submersion.

We alluded above to the unlikelihood of inoculation takingplace, when the virulent fluid comes merely in contact withthe mucous membrane; and we may now add that the truth ofthis statement is confirmed by a circumstance mentioned inthis case. The report states that the owner of the dog, imme-diately he heard of the accident, sucked the wound inflictedupon the child; but although the latter died with undoubtedsymptoms of hydrophobia, this fearless man does not seem tohave suffered from the contact which must have taken placeduring the act of suction.

It will be observed that the first symptoms of the diseaseappeared just at the period mentioned by authors-viz., thirty-two days after the introduction of the virus into the system,the horror of water being the first sign of the impending affec-tion.A very peculiar feature of the case is the consciousness in the

young patient of the nature and cause of the fearful disease underwhich she sank. We are not aware that such knowledge isgenerally possessed by hydrophobic patients of so tender an age;and it will be noticed that in the case treated at King’s Col-lege Hospital the unfortunate man did not make any remarksas to the nature of the complaint under which he was labour-ing, nor on the destruction of the dog. The child, on thecontrary, repeatedly expressed great delight at hearing thatthe dog had been killed-a circumstance not in accordancewith facts, but which was mentioned to the poor child, as statedabove, to tranquilize her mind.

It will be observed that the patient could not be com-pletely narcotized with chloroform; the spinal marrow wasprobably in so irritated and excited a condition, that theanaesthetic agent, usually so powerful, was not sufficiently soto conquer the spinal excitement. The failure of chloroformin this instance is a fact which should be carefully noted.Nay, the presence of feculent matter in the rectum exercisedsuch an influence on the medulla, that each time an evacuationtook place the child was constrained to jump up, being forciblyimpelled by a violent spasmodic fit.Nor was the spinal marrow alone affected; for the irritation,

inflammation, or excitement, whichever it may be, soon tra-velled to the cerebrum; this circumstance giving rise to deli- rium, and the supposed existence of phantoms hovering before IIthe patient. But with all the wandering, there was upper- most in the child’s mind the remembrance of the bite, and theconsciousness of her state, the poor creature calling out "I ammad because the dog bit me." "

This idea of blood seems to have taken a firm hold of thepatient’s mind, for at one time she saw everything with a tingeof red; in fact she was constantly exclaiming that the bed-clothes, the walls, the dress of her mother, &c., were of a redcolour.Without giving any evident signs of violence, the child

evinced the desire to injure by scratching, and made severalattempts upon those nearest to her; still these :Cits were farless strong and marked than with Dr. Todd’s patient.We understand that the dog was not destroyed, because it

did not subsequently evince any morbid symptoms; and it isstated in the report that the animal bit many children besidesthe one who was attacked with hydrophobia.. No furthermisfortune seems, however, to have taken place; it may there-fore be conjectured that the bites alluded to had no virulentproperty. Are we then to suppose that a dog may, in a stateof excitement, without being actually rabid, inflict a woundwhich shall inoculate hydrophobia upon the injured person,

whilst the same dog may subsequently become perfectly harm-less ? Some authors incline to this opinion, and we find thatan Italian physician, M. Baruffi, has mentioned a case in pointin a late number of the "Annali Universali di Medicina." Thecase is headed thus : "Can the bite of an irritated, but notrabid, dog inoculate hydrophobia?" The question is answeredin the affirmative by the writer, the details of the case being ’as follows :-The patient was a woman, forty-four years of age, just re-

covering from illness, and still weak. She gave a kick to adog who came to seek for shade in her house, as she wanted-todrive the animal away from her children. The dog, irritated ’by the ill-usage, turned-round and bit her foot, and kept hold ’’of it until forcibly dragged away.The wounds on the foot healed in thirty days, and were not

at all indolent. Fifty days after the bite (October 20th, 1849,)the patient felt severe pain in the foot, shooting up to thetrochanter. The cicatrices swelled up, became surroundedwith a brown areola, and the muscles of the thigh wereattacked with spasms. In the night she had convulsive move-ments, and groaned much.On the next day the patient felt choked, and was thirsty,

but had an invincible horror of all fluids. When taken to the

hospital, she presented the same symptoms in an aggravateddegree; the pulse was flagging, there were convulsions, violentcoughing, and much spitting, to clear the throat.On the third day, the features were drawn, the strength

gone, delirium supervened, the muscular system was benumbed,and all voluntary movement was at an end, except that of’spitting violently; pulse feeble, respiration short and noisy,with mucous râles, and finally exhaustion and death.

’

Efforts were made to ascertain whether the dog which hadinflicted the wound was in a rabid state. The result of the

inquiry was, that the animal, just before it had bitten the,patient, was lying down and asleep, not the slightest signs ofdisease having been evinced, as was confidently stated by’persons who had seen it for several days up to the time of theaccident.M. Baruffi expresses his complete conviction that his patient

died of hydrophobia, and thinks that the virus may suddenlybe formed by the action of anger upon the nervous centres.He considers that examples of humoral alteration, under theinfluence of great nervous perturbation, are not rare, and citessudden icterus produced by terror, violent vomiting in hysteria,’faetid perspirations in convulsions and epilepsy, &c. Theauthor also mentions the experiments of M. Bernard, who, byirritating a limited portion of the medulla oblongata, could ina few moments increase the secretion of sugar by the liver. Itis also known that fear or a fit of anger have suddenly sodeteriorated the milk of wet nurses, that the suckling was-attacked with convulsions, or even perished, soon after drinkingthe altered milk.

It would therefore appear, according to M. Baruffi, that thesalivary fluid of the dog may, under the influence of anger, be-come suddenly impregnated with the hydrophobic virus. Theauthor tries to explain the non-appearance of rabid symptomsin the dog, after the patient had been bitten, by supposingthat the poison was dispelled by the action of biting, thedrinking of water, the chewing of grass in the fields, pick-.ing a bone, &c. &c., by which means he thinks the dog mayhave cleansed his mouth from any virulent saliva.Though these are all gratuitous suppositions, we are driven,

when considering the facts of the case treated at Charing-crossHospital, to adopt some hypothesis of the kind; for there can’be no doubt whatever that the child was bitten by a dog whichshowed no signs of rabidity, either before or after the accident;that the animal was not destroyed, and that it bit severalother children who have not presented any symptoms of hyclro-phobia. It will be of some use just to record these circum-stauces; the knowledge of them, along with the data whichmay yet be collected, will perhaps lead to the eventual solu-tion of this intricate question. We would, in the meanwhilebeg to close our report by stating that, in the Dublin MedicalPi-ess of the 9th of August, 1854, a case of hydrophobia willbe found, in -which many of the symptoms above describedhave been observed.

BOURNEMOUTH SANATORIUM.-The sanatorium erectedby a committee of subscribers at Bournemouth, Hants, is nownearly completed. It will accommodate forty-four patients,twenty-two of each sex. The upper story will be for males,and the lower story for females. Each floor will comprise twowards, the size of which will be forty feet by twenty, with acorridor, twelve feet wide, running the entire length of thebuilding, and adapted for exercise in unfavourable weather.