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Notwithstanding the frigorific in the above instance wasmuch above the temperature that was desirable, I still wouldtrust more to this imperfect measure than to any other meansas yet employed in cholera. So long as we continue ignorantof the cause or nature of this disease, or of the means of de-stroying or expelling the morbid poison, if such exists, the i

main indication must be, to obviate or remove the dangerousirritations and profuse discharges produced by it. Nothinghitherto proposed for this object appears theoretically compar-able to great or benumbing cold, or is so much recommendedby analogy; but the true value of this agent can only be deter-mined by numerous trials.

I am uncertain whether the local depressing effect of severecold applied as above, would be increased by the exterior ap-plication of it over the region of the stomach. Pounded icehas often, with this view, been so applied; and if it be grantedthat the indication can be fulfilled to any extent, by compara-tively so mild a refrigeration, much greater benefit wouldnecessarily result from one so much more severe. After re-peatedly witnessing the little annoyance that proceeds fromthe slight congestion that follows a long-continued congela-tion of the animal tissues, when a frigorific at zero of Fahr.has, in the treatment of meningitis and neuralgia, been keptin contact with the scalp or side for a period of five or tenminutes, I should have no fear of a different result in the caseunder consideration.Brighton, August, 1849.P.S.-A week’s delay in the publication of the foregoing

remarks enables me to add a few particulars of another caseof cholera, in which the same powerful and prompt remedy wasused with striking success.

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The patient, an old man, of very infirm’habit, ’and whohad - been affected with diarrhoea for several days,’ wasseized with severe vomiting and purging, about twelve hourspreviously to my seeing him. He was in great pain fromcramp of the legs; and had received no relief from the opiatesthat had been administered. The matter vomited and ex-creted from the intestines was very copious, but had not yet

acquired the serous or rice-water character.Four draughts of the thick jelly ice described above, eachof about eight ounces, were exhibited in the course of abouthalf an hour; but two of these, which contained a largerquantity of salt than the others, (the taste of this being coveredin a great degree by lemon-juice,) were not long retained bythe stomach. After the last draught, there was no return ofvomiting, and calomel-and-opium pills were then administereduntil every dangerous symptom had disappeared.I may have been in error in designating the measure

employed in these two cases as a very imperfect measure incomparison with the exhibition of mixtures of much lowertemperature. A quick succession of copious draughts containingmuch ice may, provided their temperature be sufficiently lowto benumb, be equivalent to smaller or fewer draughts ofgreater power. Though this expedient is especially adaptedto the advanced stage of cholera, attended with profuse dis-charges from the digestive tube, it would probably, in minordoses, be of much value in other stages of the disease, and incombination with other remedies. In various diseases of adifferent character, such as gastric fever, a similar plan wouldalso promise great advantage.

ON THE

CROWING INSPIRATION OF CHILDREN ; ITSTREATMENT WITH CHLOROFORM, &c.

BY WILLIAM J. COX, ESQ., M.R.C.S., &c., London.

THE excellent practical remarks on this disease recentlypublished in THE LANCET, by Dr. Fairbrother, induce me alsoto offer a few observations on the causes and treatment of thismalady, of which I have had considerable experience. Thatlaryngismus stridulus, or child-crowing, is essentially a diseaseof irritation, and not of inflammation, is a fact long since satis-factorily established. It is not, however, merely by keepingthis abstract general principle in view, and acting thereon,that we are to expect a successful treatment. It will benecessary to consider the several sources of morbid irritability,and to determine, if possible, which, in each instance, is theorigo mali. We must bear in mind that it is a disorder of thetrue spinal system-in fact, nothing more than a derangedcondition, a morbid exaltation of the reflex function. Withthe brain it has nothing to do, and if, in a severe attack, therearise symptoms of cerebral disturbance, convulsions, paralysis,semi-coma, &c., these are to be looked on as entirely secondary,attributable to congestion from suspended respiration.

Laryngismus stridulus may arise in two ways:-1. From irri- -tation of the incident nerves-viz., a, the trifacial, as in pain-ful dentition, exposure to draught, eczema, porrigo, &c.; b, thasuperior laryngeal, in scrofulous enlargement of the cervicalglands; c, gastric filaments of the par vagum in overloadedand deranged stomach; d, spinal efferent nerves in intestinalirritation from worms, &c., mesenteric disease. 2. Fromdisordered equilibrium of the spinal centre, explanatory of theinfluence of passion, rage, terror, crying, sleep; &c., in bringingon a paroxysm. In both cases, the morbid action is of course- .transmitted through the motor nerve of the larynx, the re-current. I believe the second cause far more active and.general than the first in inducing this disorder, acting as a.dormant predisposition, only waiting the presence of an ex-citant to call it forth into energy. I have met with manyhysterical and spasm-prone patients,

who told me they hadbeen in infancy subjects of this malady, showing the power-ful influence of an undue excitability of the spinal marrow.Now, as regards the treatment, it must vary with the cause-

But I have found two remedies, above all others I have em- .ployed, eminently successful-namely, chloroform and hydro-cyanic acid. And the success attending the exhibition ofthese remedies is perfectly coincident with the opinion I haveexpressed above, with regard to the source of the disease, as-both these agents act powerfully, and immediately, on .the.spinal centre. The first is to be employed during the paroxysm,the other during the intervals of attack. When the spasm ofthe glottis is passing into convulsion, the ingress of air nearlysuspended, the head thrown rigidly back, the veins of theneck turgid, the face livid, the hands clenched, the thumbsinserted’into the palms, &c., and when the usual remedieshave failed in producing relaxation, danger of suffocation being-imminent, a piece of lint dipped in chloroform should be ap-plied (in a handkerchief) over the sufferer’s mouth. In a fewseconds the muscles will be relaxed, the spasm will be over,and the poor little patient breathe freely. The sudden effectis often almost magical. The benefit of the second remedy,though more lasting, as striking directly at the root of theevil, is less obvious. It would be presumptuous on my part,,and an unwarrantable trespass on valuable space, to offer anysuggestions as to its dose or mode of administration.

Poplar, July, 1849.

COMMUNICATIONS ON THE TREATMENTOF CHOLERA.

Medicines at Long Intervals in Cholera.—Value of Calonel andCarbonic Acicl Gas at Short Intervals.

By P. NIDDRIE. M.D.

IT is melancholy that cholera continues to be treated bymeans which much experience has shown to be perfectly use-

less, and that even high authorities continue to recommendmeans that have not the least influence on this disease. Ihave notes of ninety-three cases that occurred, in the yeax1832, in the cholera hospital ship, Dover, thirty-three of whichterminated fatally; and from these and many subsequentcases I have fully ascertained, that brandy in any quantity,up to a bottle in twelve hours, does not at all stimulate, thatammonia is equally powerless, and that opium, chalk, heat,friction, and bleeding, are perfectly useless. So little effecthad these and other remedies, that I feel assured they didnot in the least retard the fatal termination of any of thesethirty-three fatal cases, and in one case the fatal terminationwas certainly accelerated by the abstraction of a few ouncesof blood. Calomel and soda-water, given every three or fourhours, were equally useless. Melancholy experience of theuselessness of such means has led some to believe that treat-ment is of no avail in cholera, and that most cases would doquite as well if left entirely to themselves. This is doubtlessthe case in severe cases of collapse, if medicines be administeredevery three or four hours; but what results from the treat-ments so zealously urged by Dr. Ayre ? In a former numberof THE LANCET, I gave details of one of the numerous casesthat have convinced me that cholera, even in the stage ofcollapse, is quite as manageable as any other severe disease.The mode I have followed differs little from what I find Dr.Ayre so zealously recommends, and consists in placing on thetongue two grains of calomel, mixed with a little sugar, to bewashed down by an effervescing draught. If rejected, thedose is repeated immediately; if not followed by vomiting,the dose is repeated in from five to ten minutes, till reactioncommences, when the period between each dose is gradually

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extended to an hour or longer. Calomel and carbonic acidgas seem to be as powerless as other means, unless thrownconstantly into the stomach; therefore this mode of givingthem must be followed, and the course of the disease being sovery rapid, the patient must not be left until collapse yieldsto the constant attacks of these remedies. I have had ampleexperience of the total uselessness, in cholera, of large dosesof medicines given at long intervals, and am fully convincedof the great value of calomel and carbonic acid gas, constantlyand perseveringly administered at short intervals. Underthis treatment purging ceases, or becomes less frequent, al-though vomiting may occasionally recur for some time; theexpression of the countenance gradually changes; the tempe-rature of the breath and tongue rises; the pulse gets strongerand the skin warmer; cramp becomes slight, and extremecollapse is followed by little or no febrile excitement; and thegums do not even swell if care be taken gradually to discontinuethe calomel by extending the period between each dose ascollapse disappears. I would earnestly urge this treatmenton those who have found the usual remedies fail, and amassured, that if this mode of administering calomel be strictlyfollowed, the result will be found to be as happily successfulas the usual large doses of medicines at long intervals arefound to be despondingly powerless.

Ptyalism and Cure of Cholera under large doses of Calomel.By HENRY DERMOTT, Esq., Surgeon, Pimlico.

"ALLOW me to draw your attention to the following case ofmalignant cholera, in which ptyalism was rapidly producedby the external as well as internal use of mercury.

" Mrs. G-, residing in Garden-street, Vauxhall Bridge-road, was seized with cholera, in its worst form, on her returnfrom the funeral of her husband, who died of that diseasein ten hours. !

" I immediately saw her, and administered one scruple ofcalomel, with two grains of opium, and put her under the in-fluence of chloroform, in order to check the violent sicknessand cramp, which it did effectually for the time. I alsoapplied mustard poultices to the abdomen, thighs, and legs,on removing which about an ounce of the strong mercurialointment was rubbed over the surface where each poultice ’,had been applied. The scruple doses of calomel were re-peated every half-hour, until one drachm and a half had beenadministered. On the day after, the patient complained ofthe mouth being sore; on the second day, ptyalism was pro-duced to a considerable extent, and the patient rapidly re-covered. There is very little doubt that a great deal canbe done by the external exhibition of mercurials in producingptyalism, which, once produced, your patient is safe to getwell; first stimulating the absorbent system by the applica-tion of mustard, or any other strong stimulant, and thenrubbing in the strong mercurial ointment ad libitum."

On the Employment of Embrocations and Injections of StrongLiquid Ammonia in the Collapse Stage of Cholera. ,

By DARWIN CHAWNER, M.D., Lincoln.DURING the year 1832, I saw a good deal of the cholera in

the north of England, and also at Newark-upon-Trent, Notts,where I then resided. The following plan of treatment, whichI adopted in the stage of collapse, was much more successfulthan any other I saw practised.

I directed two nurses, each having a thick woollen glove onher right hand, and in her left a bottle containing a liniment,consisting of six ounces of strong liquid ammonia, and twoounces of olive oil, to embrocate very actively the patient’sarms, chest, and upper part of the abdomen, for some minutes;this done, these parts were covered with a hot blanket, andthe legs, thighs, and lower part of the abdomen were treatedin like manner. The whole process required about ten or fif-teen minutes. The effects were, immediate relief from the

spasms, a considerable restoration of animal heat, and a generalimprovement in the state of the patient. In some cases therewas a complete establishment of reaction. When the reactionwas not so complete as I could wish, I directed an injectionto be given, consisting of ten or twelve ounces of very warmmilk, with as much of the liquid ammonia in it as I thoughtthe patient would require. As I have no note of the quantity,and as the strength of liquid ammonia varies, I must leavethis to the judgment of the medical attendant. When thisplan was well carried out, I do not recollect a case in whichwe failed to effect a reaction, and many patients recoveredwhen the degree of collapse was so great as to leave but little

hope in any kind of treatment. I may briefly state, that thegeneral treatment, in addition, consisted of moderate doses ofcalomel and opium.

Lincoln, August, 1849.

P.S.-I should suggest the use of a portion of mercurialointment instead of olive oil.

On the Use of Repeated -Doses of Calomel in Cholera.BY the courtesy of the Editor of THE LANCET, in inserting

my remarks on the Treatment of Cholera, in his journal ofthis day, I am induced again to trespass, and to beg space forsome further observations.

This number contains three other communications, in whichthe facts detailed claim for calomel the highest consideration;for, although Mr. Pery would seem in some degree to attri-bute his success to opium, I believe others in the habit ofseeing such cases will ascribe the altered character of theevacuation, and the secretion of urine, to twenty-four grainsof calomel, taken in fifty minutes, and followed by twelvegrains more; rather than to six grains of opium, or twenty-four of camphor, with capsicum, taken, combined, in the courseof twenty-four hours.

I am desirous of pointing out how far the cases publishedin the letters alluded to tend to prove the advantage of alarge dose over repeated small quantities of this medicine.

In the annexed summary of Mr. Cox’s cases, it will beseen that the quantity of calomel administered, and thenumber of hours elapsing before its effects were visible, arelarge, in direct proportion to the smallness of the doses given.The three most speedy recoveries were those in which fiveand three grains were taken every ten minutes; in one case,’every fifteen minutes; and in these the aggregate is infinitelyless than where one-grain or two-grain doses were preferred.Of the two deaths which occurred three or four days after re:action, one patient had taken 480 grains; the other, 384 grains,in two-grain doses. In Mr. Pery’s case, where twenty-fourgrains were given in the time that would only have afforded.eight grains, according to the two-grain system, the resultsappear much more marked and satisfactory; and I can assureyour readers that the certainty and rapidity of the effect is,incomparably greater where the full dose-twenty, or eventhirty grains-is given at once. In speaking of this patient,lie remarks, as others have done who have given large dosesof calomel, that " he felt very well, but exceedingly weak,"after a bilious motion was produced. I think there can be nohesitation in deciding by which method this effect will be mostspeedily obtained. To those who have a doubt, I beg to offermy experience, as most positively in favour of the largerquantity, which seldom requires to be repeated, and nevermore than once, or, at the most, twice; whilst it is shown that;in what appears to be the mildest treatment, the quantitytaken varies from two drachms to an ounce.As these gentlemen have not the fear of giving -calomel to.

an unusual extent, they cannot object (as many others do,who have not tried it) to administer the quantity I recom-mend, on account of its magnitude; and it must be evidentthat one such dose is better calculated to attain the objectaimed at-viz., "to act forcibly and speedily upon the sto-mach, liver, and kidneys, with as little risk as possible of im-pregnating the system with mercury." Upon the stomach, asI have mentioned in my last letter, a direct sedative effect isobtained, whilst the secretion of the liver and kidneys israpidly induced. There is this further advantage in the largedoses-the medical man can be assured of its being taken. Byalways having some with him, he can place it on the patientstongue; and if no vomiting occur within ten minutes, he mayrest pretty certain of the effects.

If vomiting should take place within that time, he maygive another dose, and leave his patient without anxiety, aseven should there be further irritability of the stomach,enough will be retained from the two administrations to checkit very speedily, and to produce the other results indicated.He has only to give directions for the auxiliary treatment,such as warmth, friction, effervescing drinks, and gentlestimulants; and remain confident that the calomel is enec-tually doing its duty, whilst he is attending to other cases.

I feel called upon to protest against the administration ofcalomel in small doses often repeated, from the assurancethat it will lead to disappointment, and probably induce theprofession to abandon its use, as was the case before; andhowever satisfactory it must be to find that it has been so

useful, I believe, as I have endeavoured to point out, thatthese very cases indicate the propriety and superiority of oneor two effective doses in the first instance, which seem to have

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the following advantages: first, more speedy and certainaction; secondly, the smaller amount necessary to be given,and consequently the less risk of injuriously affecting theconstitution; thirdly, the great advantage of knowing thatyour remedy is taken, and has a fair chance of doing itsduty.I am glad to confirm, by experience, the suggestion madeby OMpoc, of the probable efficacy of emetics; and I shouldobserve, that the cases in which I have found them mostuseful and generally employ them are those in which vomitingor nausea form a predominant symptom; or where there isgreat sense of oppression in the præcordial or epigastricregion; and in these cases the sedative effect of calomel isafterwards remarkably conspicuous.My card is entirely at your service; but I would prefer

again to subscribe myself, Sir, yours very obediently,August 25, 1849. A. B. M.

This correspondent appends the following

ANALYSES OF COMMUNICATIONS ON THETREATMENT OF CHOLERA.

A CORRESPONDENT, signing himself " R.," remarks, -"Amongst numerous remedies for the treatment of cholera,I see no notice taken of one, which in India has been foundof the utmost utility in checking an attack of the disease-viz.,quinine. It is there given along with calomel and opium,which two medicines have been for ever used in Indian prac-tice, for the purpose of restraining the violent action of theintestines, and allaying emesis. This combination of medi-cines has been found to check the diarrhoea, and at the sametime to rouse the depressed nervous system; and in the lowform (?) of cholera which is at present raging in London, itwould, I have no doubt, be found equally efficacious. It must,however, be given in the early stages of the disease, and inlarge doses."The writer furnishes us with an extract from a report on

cholera, by a gentleman of the greatest practical knowledgein the treatment of the disease.-" I cannot forbear recordingmy testimony to a combination of medicines, which, in wardingoff and checking an attack of cholera in numerous instances,both in Europeans and natives, has been followed with thehappiest results. The remedy consists of quinine, calomeland opium, in the quantities of six, four, and two grains re-spectively, followed by a wineglass of brandy diluted with alittle warm water. This given within the first hour or two ofseizure, will be found, in a large proportion of cases, to checkthe disease :’

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" EoMo" says----’ Amongst the many remedies for cholera,brandy is vaunted as useful and important."Have we hitherto learned that brandy’ has relieved orcured ? I think not. It is a ready and popular resource,which has been grasped or handled readily, in extremity, onthe do something’ principle.

" Suppose the malady were less active, how unwillinglyshould we administer a powerful stimulant where thereisirri-tation of the inner surface of the stomach or intestines ? Theratio is the same. Give brandy in cholera-you do 7tCM"!M. Howoften has diarrhoea been checked easily and safely after theassertion-’ Oh, Sir, I have taken some brandy, but I find my-self no better’ ?" In the latter stages the patients suffer great debility; their

powers are prostrated, from the vis Tnedicatrix naturce andfrom doses of chalk-and-apium; they are partly exhausted andpartly narcotised. As soon as the vomiting, purging, or pain,has ceased, let the patient remain quiet; do nothing for ten ortwelve hours medically, but see that the extremities are kept

warm; leave the patients alone, you cannot do them any good.After twelve hours has elapsed, maybe some reaction hastaken place. Then comes nursing. Avaunt with your physic!Give some strong beef-tea, arrowroot, or gruel, at intervals,for the next twenty-four hours, then a couple of rhubarb pillsat bed-time, and let the patient remain under the doctor’ssupervision for a week.

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Another correspondent, signing himself "RoBERTUs," re-

marks;" I am utterly at a loss to reconcile the various distinctions

which the Board of Health and other reporters of the diseasemake between the premonitory symptoms and the diseaseitself. - We have simple diarrhœa, rice-water purging, serousdiarrbcea, bilious diarrhoea, cholerine, and cholera. With re-

gard to the calomel treatment, I have made extensive inqui-ries, and with regard to the other plans of treatment, I havealso made extensive inquiries, and, without exception, I havefound in the modes of treatment of some dozen medical men,(none of which were wholly similar,) that opium is an ingre-dient of them all. With regard to the hopeless cases, oneperson has assured me that he has given four grains of opiumimmediately, and a grain every hour afterwards; and another,that he has given calomel in immense doses at short intervals,both without any ill effects. The inference that I draw fromthis is, that in this unfortunate stage nothing can do eitherhurt or good, and that such cases are not fit ones for theelucidation of the treatment of this mysterious disease. In thepractice with which I am connected, I have observed thatstimulants and opium, with the application of external heat,cataplasms to the epigastrium, (in case of sickness,) and hotfomentations to the abdomen, have been followed with themost unequivocal and beneficial effects; but in those caseswhich have displayed a more than ordinary virulence, or inwhich the premonitory symptoms have been neglected till a.

state of profound collapse has supervened, these remedieshave been wholly useless. Opium in all cases has been oursheet-anchor-in fact, the sine qua non of successful treat-ment:’

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A CORRESPONDENT writes,-" May I beg, Mr. Editor, that you will suggest the propriety

of all your correspondents who write about remedies in cholera,adopting the plan of recording the symptoms of their Asiaticcholera, and we may then know what conclusions to come torespecting the propriety of the treatment adopted, and itssuccess. I beg you will allow me to thank Mr. W. J. Coxfor his experience,.and to remain,

Sir. vour verv obedient servant,JACOBUS ANALYSIS, M.D.

Reviews.

Observations on Hospitol Gangrene. By JoiaN BOGGIE, M.D.,Surgeon to her Majesty’s Forces. Edinburgh: SutherlandSurgeon to her Majesty’s Forces. Edinburgh: Sutherland& Knox. London : Samuel Highley.

THE present work consists of an essay which was some yearsago read before the Medico-Chirurgical Society of Edinburgh,and afterwards printed in the Transactions of the Society; butthat work being no longer extant, the author has reproducedhis- essay before the profession in a separate form.The subject is one which does not now claim so much the

attention of medical men as it did when the author first pennedthese observations, for in the present day hospital gangreneis so rare, that it may almost with truth be said to be a diseaseof bygone days. Nevertheless it is occasionally met with evenin civil practice; and as the surgeons of the British army maybe again called upon to treat the same disorder upon a.largescale, it behoves them to make themselves well acquaintedwith the experience of those who have gone before them.The author was attached to the army in the Peninsula, and

in his professional capacity was called upon to take charge ofthe extensive hospital at Bilbao, where a great number ofwounded from the battle of Vittoria were collected together;there hospital gangrene was raging most furiously, conse-quently Dr. Boggie had ample scope for the investigation ofthis disease.The main object of the work is to show the efficacy of the