82

if collapse is threatened, a very powerfulstimulant (to be more particularly spokenof in the next stage) is applied to the arms,legs, and pit of the stomach. Opiateenemas have also been used with advantage.The evacuations have invariably been cha-racterised by a total absence of bile.

On the Stage of Collapse.

Having lost the first case seen in the stageof collapse (the patient not having beenbled), I determined on giving bleeding afair trial. Six cases were bled in succes-sion, andin some the pulse was perceptible, inothers not so, yet blood flowed in all ; and intwo or three to the extent of 12 ounces, butwithout the least benefit, and even appear-ing to hasten death, in more than one in-stance. Calomel was also given, togetherwith ammonia, and other stimulants, inter-nally, and mustard cataplasms were appliedto the feet and pit of the stomach; the

bleeding in no case restored the pulse ; allthe cases proved fatal.

I am very doubtful as to the propriety ofbleeding where the patient is much ex-

hausted by the discharge, and the sur-face is cold, although there is a pulse. Ihave myself latterly trusted entirely tocalomel and opium, and to stimulants,giving the aromatic spirit of ammonia freelyinternally, and using an application of

boiling turpentine externally; linen clothsdipped in it being securely wrapped aroundthe legs, and arms; the pit of the stomachbeing also covered in the same manner. Iattribute most of the cures obtained in the

stage of collapse, to the frequent applica-tion of this powerful stimulant, reaction be-ing often speedily produced even whereno pulse could be felt, and where in similarcases all other remedies had previouslyfailed. The turpentine is renewed everyhour, or even oftener, until reaction is in-duced ; in this way several pints have beenused in a single case, with the best effect.In many cases where a collapse has threat-ened, the application of turpentine in themanner above-mentioned has arrested it, iand raised the temperature of the slciii abovethe natural standard ; notwithstanding theliberal manner in which it has been used, Ido not remember a single instance of trou-blesome vesication. Reaction having takenplace, I continue the calomel, and also usemercurial frictions until salivation is pro-duced, or the natural secretions are restored.I do not think calomel possesses any powerto produce reaction, but that we must relyon stimulants, particularly external ones,to produce that effect, giving calomel, as inthe other stage, to restore the secretions.

Of the 21 deaths, 15 were first seen in astate of extreme collapse, of whom

7 were bled immediately;2 were bled in the stage of reaction;6 were not bled at all.

6 were seen before the stage of collapse.t3 of them were bled;3 were not bled.

151 were seen previous to the stage ocollapse.

31 were seen first in the stage of col.lapse.

I have delayed sending the above for afew days, waiting the result of a case ofcholera in the collapsed stage, occurring ina child three years old, in which cold wa.ter was given in large quantities with de-cided advantage ; the patient refused everyother kind of liquid, but drank the waterwith avidity. Calomel was also givenfreely, and the turpentine applied to theextremities, all internal stimulants wereforbidden. The patient, I am happy to say,is now quite recovered. I have the honourto remain, Sir, your obedient servant,

W. WOODMAN,St. Thomas, near Exeter,

Oct. 5th. 1832.

W. WOODMAN.

EXTRACTS

FROM PAPERS ON THE

MALIGNANT CHOLERA,

RECEIVED FROM THE CENTRAL BOARD

OF HEALTH.

CAWOOD NEAR SELBY.

Cases from 5th June to Sept. 9th inclusive.Total cases, 87 ; deaths, 17 ; recovered,

70.1st stage. Pulv. ipecac. comp. in large

doses, combined with absorbents, astrin-gents, anodyne injections, frequently re-

peated.2nd stage. An emetic ; sudorifics and in-

jections as above ; calomel in small doses,combined with carb. calcis ppt., everv tenor fifteen minutes : soda water ; solutionof soda ; effervescing medicines ; sina-

pisms ; bottles of hot water to be appliedto the feet, 6:c.; frictiou. Warm-bath forchildren.

3rd stage. A powerful sudorific ; ca.

lomel with carb. oalcis ppt. or pulv. anti-mon. as above ; sulphate of quinine ; musk,and camphor in large doses ; soda water;solution of soda, and effervescing draughts ;sinapisms ; bottles of hot water to be ap-plied ; friction. The patient to be kept aswarm as possible in every stage.

JouN WIGHTMAN, Surgeon.WILLIAM CLARK, Surgeon.

Cawood, near Selby,5th October, 1832.

83

DONCASTER.

THE malignant cholera made its appear-ance in a suburb of Doncaster, on the 2ndof June 1832; and up to the 9th of Junethere were 14 cases, of which 9 died. Thetreatment was then changed, and from the9th of June to the 3rd of September therewere 98 more cases, of which 17 only died.The treatment up to the 9th of June was bystimulants, both internally and externally." The venous transfusion of an artificial

serum was tried in four cases, and for atime offered the most flattering results ;but collapse shortly returned, and they alldied. It is but justice to the originator ofthat practice to observe, that we were

all novices, and but ill informed of themethod of conducting the manipulations,of the quantity of fluid to be thrown intothe veins, and of the time such transfusionshould occupy.11 We also tried the saline plan, as re-

commended by Dr. Stevens, without anyof the favourable results anticipated ; andin some cases occasional small doses of ca- Ilomel were given."These measures having failed, they were

abandoned, and before collapse came on,mustard emetics and bleeding, with calomelin sufficient doses to change the secre-

tions, and opium, were successfully tried,followed by small doses of castor oil. Ascerebral congestion and irrepressible nauseawere found to follow repeated doses of

opium, its use was rarely repeated.(Signed) J/BRAt;soN, M.D.

Chairman of the Med. Bd. of H. Doncaster.Doncaster, Oct. 4th.

MUSSELBURGH.

DR. ALEXANDER STEPHEN, one of themedical practitioners at Musselburgh dur-ing the prevalence of the epidemic, ob-serves that, in the first stage, lie invariablyfound, when blood could be drawn, that itwas always followed by good effects withan anodyne of from 25 to 35 drops of lauda-num given immediately after the bleeding,and, subsequently, a dose of castor oil, thecompound powder or’the tinct. of rhubarb.In the second stage, when the patient wasyoung and of a tolerably good constitution,he found port-wine injections, with 30 grs.of the sulph. of quinine, or of starch withopium, or the tinct. of kino or catechu, withsmall and often-repeated anodynes by themouth, succeeded by wine-and-water, whenthe irritability of the stomach was subdued,of great benefit in restoring the pulse andstrength. In the third stage any treatmentwas generally unavailing. i

Sept.1832, ’,

CHOLERA HOSPITAL, I’ORTOBELLO.

ADMITTED from 12th of Feb. to 21st ofJune 1832, 40 cases; died 24; recovered 16.On the first breaking out of the cholera at

Portobello, the stimulating practice-viz.large and frequent doses of brandy, opium,ether, with dry heat and sinapisms, wereemployed, but abandoned as universallyunsuccessful, Large doses of calomel andcolocynth pill, occasionally substituting ext.h)osciam. in place of opium, were then r(3-sorted to instead. Venesection, warm-bath,enemas, external stimulants of mustard andpotassa along the spine, were also em.

ployed.In two cases of collapse, inhalation of

nitrous oxide gas was tried, and from theflushed state of the countenance, and in-crease of the pulse, it was thought well of,but want of sufficient means prevented acontinuance of the remedy and the pa-tients sank. T))e medical officers observe," We nevertheless felt convinced that a

perseverance in this practice would havebeen attended with the most beneficial re-

sult, and we can conceive no remedy solikely to resuscitate the patient from thecollapse stage."

(Signed) W. VALLANGE, M.D.,Hosp. Superintend.

C. ANDERSON, Surg.Sept. 29.

CHOLERA HOSPITAL, WHITECIIAPEL.

6’VE have found a purgative of calomeland rhubarb in the bilious diarrhoea, fol-lowed by the chalk mixture, combined withlaudanum, generally successful. Latterly,in the stage of collapse, two scruples ofcalomel given directly, followed by ten

grains every hour till the mouth becomesaffected, combined with carb. soda3 in thestate of effervescence, we have found suc-cessful. Of ten cases thus treated, sevenhave recovered, one only being followed byconsecutive fever.

R. L. REED, Surg.J. FAIRBANK, Surg.R. T. WooDHOUSE, M.D.

Sept. 22nd, 1832.

SOUTHWARK.

MR. CHARLES GASELEE malces the fol-

lowing observations in the course of his

reply to the Board :-" I rely on opium asthe sheet-anchor by which the disease maynow be certainly staid. But opium, to beefficient, must be given largely, and re-peated according to the recurrence of thealvine discharges; and when this has beendone, far from having seen any ill conse-

84

quences, I feel happy in having so success-ful and harmless a remedy."Where the disease is well marked, but

much milder than in confirmed cases,Mr. Gaselee in such cases recommends a

warm bed, hot fomentations, soda water,small doses of calomel and opium, opiateenemata, occasional cordials, and goodspiced beef-tea, when the purging has beenrestrained by an anodyne injection. Inconfirmed collapse Mr. Gaselee says, "I I donot know on what to rely when it has comeon rapidly. If, however, patients be putinto a warm room, if hot brine fomentationsbe assiduously applied, if small but re-

peated doses of ammonia be given (pro-vided the stomach retain them), if mode-rate quantities of brandy, port-wine, or

gin-and-water, be allowed frequently, ifsmall opiate enemata be given to restrainthe purging, and toast, soda water, or coldwater, be permitted as a beverage, thoughnot largely, I believe that reaction willmore often follow such measures, than byadopting any of the other plans which havebeen lauded as so successful. Yet the un-certainty of a favourable result under everyplan which has been hitherto proposed, issufficient to justify the trial of new andreasonable measures."

211, High Street, Southwark, Sept. 26.

FLUIDS IV CHOLERA.—WARM SPOOGING.

MR. EDWARD GREENHOW, of SouthShields, who has treated his patients chieflywith calomel and opium, and speaks of in-ternal stimulants as highly pernicious incholera, deprecates the permission of muchfluid to the patient. He observes, that thepills are much more likely to be retainedand absorbed into the system bv restrictingthe patient in the quantity of liquid ; for 1have remarked, that when the patient hadbeen allowed to satisfy his intolerable thirst,the oppression about the pericardium hasbeen proportionately increased, only to be re-lieved by the rejection of the contents of thestomach." He also warmly recommendssponging the body with warm water in thedisease. Oct. 1st, 1832.

COLD WATER.

MR. R.L.DUDLEY says, 11 Oflate I havefound the most successful plan to be thatrecommended bv Ur. Shute. It has only inthree instances failed to produce a reaction ;and one of these was a child long collapsed;the second, an old woman; and the thu’d, avery intemperate man. It has Mmetimesbeen followed by death in the stage of re-action." Oct. 4th, 1832.

OPIUM, INJECTIONS, ETC.

DR. DONNELL, of Liverpool, writes, " Ibelieve that opium alone is all that is neces.sary for the cure of this disease in the firstform. In the second form, I am of opinionthat opium alone ought not to be trusted to.In the third stage, opium appears to me tobe injurious, inducing coma. 1 have seenthe venous injection tried, and it has alwaysfailed. In 1 cases, however, treated by afriend, 3 recovered ; 9 died. I do not thinkthat any plan of treatment we have hithertotried is of the least use in collapse. Some,it is true, recover under treatment; but asmany recover without any treatment what-ever. 1 have never tried Dr. Stevens’s plan;but I know it has repeatedly failed in the

. hands of others. Oct. 3d, 1832.

TREAT)IENT AT EAST RETFORD.

THE medical men in East Retford are notof opinion that their practice has been par-ticularly successful; but they are of opinionthat cholera requires plans of treatment asvarious as any complaint does to which the

, human subject is liable.Age, kind of constitution, habit of living,

and mode of attack, render the difference oftreatment necessary.To answer the three questions briefly and

generally ;-for the robust and healthy kindof constitutions met with in this neighbour-hood :-

t 1st. Bleeding; (children, by leeches;), ipecacuanha, as an emetic ; calomel and. castor oil as a purge ; calomel and opiumin small doses.

2d. The same treatment : but the great; object is to salivate, by letting the patientl suck a few grains of calomel with suar(which will not purge) every hour ; and byhaving the legs and thighs rubbed with blueointment and liq. ammonias [the person

rubbing wearing gloves].3d. Occasionally a small bleeding ; mus-

tard as an emetic, and in cataplasms roundthe feet; friction with sp. camphor gr. iii ;, sp. terebinh, gr. j; ammooia and brandy, being very wary about congestion.

We may add, that we found cramp bestrelieved by opium, mustard cataplasms, andturpentine friction ; ’vomiting, by soda pow-dera in a state of effervescence ; and thirst,by cold water, or soda water. All other

remedies, suitable to circumstances, weret resorted to, as in other kinds of sickness.

East Retford, Nottinghamshire, Oct. 3d,;1833.

a Mr. T. W. BARNETT, 75. Fore Street,s Limehousf, after detailing the general re-sults of his observation in upwards of %00

cases, says, "1 1 believe after, the collapse

85

has somewhat progressed, the system is

insusceptible of remedy (except the in-

jection into the veins). My reason forcoming to this conclusion is, that I have,in many instances, rubbed twelve ounces ofstrong mercurial ointment, combined withcamphor, and in other cases with mustardpowder, over the whole surface of the bodyin the space of forty hours; and given, atthe same time, five grains of calomel everyhalf hour, without the least soreness of themouth, or any sensible effect. The injec-tion into the veins has an evident effect onthe pulse, but is not lasting. I have notseen more recoveries by injection than othermeans. But of this remedy I think wewant more practice to know how to use itto advantage. Though I am of opinion thatmercury has no effect over the collapse,still, where the system sttuggles through,and mercury has been, and is continued tobe, used, the third or fever stage is morelikely to be recovered from ; but merelybecause this powerful therapeutic agent hasbeen used in the earliest susceptible stateof the constitution to medicinal influence.When the disease has passed through thecollapse, and the system perfectly reacts,it is again subject to curative means ; andthose remedies which are generally usedfor congestive fever of a typhoid type, be-come beneficial."

October 4th, 1832.

MR. Ric!!ARD KING, speaking of histreatment of the cholera at Darlaston, con-cludes his paper by saying, "I will justremark upon the different treatments thathave been from time to time adduced, andwhich I have fairly tried and found unsuc-cessful :—they are, laudanum, cajeput oil,croton oil, oxymuriate of potash, heat tothe surface of the body (feet excepted).friction, transfusion, and quantities of

brandy ;-these remedies decidedly hastendeath, and many of them considerably in-crease the pain of the sufferers. Calomelin scruple doses is the only remedy to bedepended upon. Affect the gums and thepatient is safe. Two recoveries out of abouttwenty, frcm the collapse stage of cholera,may perhaps suffice in proof of the efficacyof this treatment."Joseph Spencer, ætat. 40, residing at

Church-street, Darlaston, was 54 hourswithout any pulsation at wrist, 103 hourswithout passing any urine, and took 86

scruples of calomel in 26 successive hours.Widow Adams, mtat. 32, residing at

Cox-street, Dartaston,w:is 37 hours withoutany pulsation at wnit, 73 hours withoutpassing any urine, and took 9 scrnulos ofcalomel in 9 hours."The Towe!’, Oct. 3rd.

MR. GEORGE WIGGINS, of Watlington,Oxford, observes, that in the stage of col-lapse, the stimulant he places most confi-dence in is the carb. of ammonia in from 15to 20 grain doses every half hour, and assoon as any warmth returns, an ounce ofstrong warm brandy-and-water every ten orfifteen minutes, continuing to give calomeland use frictions. He recommends a spirit-bath, but has rather seen injury from thewarm-bath than benefit when the powers oflife are very low.

Sept. 1832.

Dr. S. CAIIBRIDGE, at the Cholera Hos-pital, St. Luke’s. City Road, abandoned theuse of calomel as an inefficient mode oftreatment, and adopted the saline treatmentof Dr. Stevens, and states that he is decid-edly of opinion, " that the saline remediesare not only the most rational, but decidedlythe most successful that have yet been tried,"and adds, " that from what he has seen oftheir effects, he is induced to believe thatthey demand the attentive consideration ofthe profession, in preference to remedieswhich have been extensively used with solittle advantage."

Oct. 5th, 1832.

"DIPLOMA" OF THE LONDON

UNIVERSITY.

TQ the Editorof TxF LANCET.SIR,—In running my eye over your very

useful notice of London schools publishedin last week’s number, I was much sur.

prised at a paragraph relating to the diplomaof the London University. It begins bycalling it a " student trap," and concludeswith, « It cannot be worth sixpence, andought not to influence the student in hisdetermination one iota."

If, Sir, you had exercised your accus-tomed penetration, or perhaps I shouldrather say, candour and fairness, in thismatter, it must have struck you that this"student trap" is part and parcel of thesystem of the university education ; that thesystem of emulation has throughout beenthe grand moving spring of the energies sboth of teacher and student, and that iftheir university can claim any superiorityover other schools it is owing to this and tothis alone.

If you will refer to the eariier pro-spectuses of this school, you will find thatthe council set out by proposing as an in.