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If I did not so thoroughly dislike disputes about priority, Imight perhaps easily explain how it came to pass, that an oldthing has been sent to us from America as a new one.To conclude, I may as well mention that some years ago,

French, German, and English newspapers treated in rather avague and somewhat exaggerated manner of a discovery ofmine, which to them was no less than a remedy good almostfor everything, especially for healing quickly all sorts ofwounds. There was some truth in that report, for it referredto the experiments made by Swiss surgeons on Ether Glue,but I did not like to say anything publicly about the subject,for reasons which may be easily imagined.Basle, January, 1849.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.FEB. 23, 1849.—J. M. ARNOTT, ESQ., F.R.S., PRESIDENT.

REPORTS AND STATISTICAL TABLES OF THE CASES AT THE

CHOLERA HOSPITAL OF ST. GILES’S IN THE FIELDS, IN 1832.By the late RICHARD PINCKARD, M.D., Physician to theBloomsbury Dispensary, and Fellow of this Society.

(Communicated, with Explanatory Remarks, by J. S. STREETER,Fellow of the Society.)

CASES of Asiatic cholera appeared in the parish of St. Giles’sin the Fields in the commencement of 1832. A cholera hos-pital was established for their reception, and placed under thesuperintendence of the late Dr. Pinckard and Mr. Walker.Between the 15th of February and the 29th of Alay, a periodof fifteen weeks, 131 patients were received into the hospital,or treated at their own habitations. The first table gives thenumber of cases admitted, and the number of deaths in eachof these fifteen weeks. The average number of cases per weekwas about nine; the number of deaths about 4.5. The totalnumber of cases was 131, and of deaths, 69. No cases wereadmitted between the 29th of May and the 26th of June, whenthe disease re-appeared. During the succeeding sixteen weeks,(from the 29th of June to the 16th of October,) as is shown inthe second table, 394 cases were admitted, and 182 deaths oc-curred ; the average of cases per week being twenty-six, andof deaths, twelve. The third table gives the duration of thecases, whether fatal or not fatal. The fourth table gives thenumbers of deaths and recoveries amongst patients of differentages, and of either sex respectively. The proportion of reco-veries was in both sexes the same, but varied much accordingto the age of the patients, being highest between the ages often and twenty; lowest in the most advanced periods of life.In the fifth table, the cases preceded by diarrhoea are distin-guished from those not preceded by that symptom, and theproportion of recoveries is shown to have been much greateramongst the cases of the former class. In the sixth table, 124cases observed during the spring months are divided into thoseadmitted "in the stage of impending collapse," and those ad-mitted " in the stage of actual collapse," and the proportion ofdeaths and recoveries in each of these classes of cases is shown;the numbers of the patients recovering " with fever" and"without fever," as well as the numbers dying "in collapse,"" in reaction," and " in fever," being likewise specified. Theseventh table gives the same facts with respect to 381 caseswhich occurred in the autumn; and the eighth table is a sum-mary of the same facts with respect to the whole number of505 cases. It is shown, that of 237 admitted in the state of"impending" collapse, only thirty-four died, (twenty-one incollapse, seven in reaction, six in fever,) while 203 recovered,(175 without fever, twenty-eight with fever;) and that of 268admitted in the state of actual collapse, 219 died, (195 in col-lapse, fifteen in reaction, and nine in fever,) while only forty-nine recovered, (twenty-seven without fever, and twenty-twowith fever.)Mr. STREETER stated that the fellows of the Society who

wished to know the manner in which Dr. Hichard Pinckardhad noted the individual cases from which these tables hadbeen constructed, would find the first four (as officiallyreported by himself to the Council of Health) recorded in theCholera Gazette, No. IV., page 142. He believed no othersexisted, but they sufficed to show the care and range of hisinquiries. With respect to one fact connected with cholera,and so clearly determined by the tables, lie himself thoughtit had never received that attention from the profession whichits great importance merited,-viz., the large proportion ofseizures in which the symptoms of collapse were not precededby diarrhoea. According to his own experience, collapse oc-

curred not in one uniform manner in all cases, but in variousways. First, there was a class of cases in which the collapseresulted from the direct influence of the poison. Whetherthis poison was of malarious or human origin, as he did notthen wish to raise the question of contagion, he should not

now consider; but such cases of direct poison collapse mightbe attended by no vomiting or purging, or by next to none,and such attacks he believed would prove rapidly and univer-sally fatal. In another class the collapse was produced by thepoison, and attended, but not preceded by vomiting and purg-ing, while in a third class the collapse was preceded by diar-rhcea of several hours’ or even days’ continuance, and mightfairly be attributed, in part to exhaustion from previous diar-rhoea, and in part., but not wholly, as in the former classes, tothe direct influence of the cholera poison itself. These varie-ties of collapse should not be lost sight of in conducting thetreatment. With regard to the state of the blood, lie was notaware that chemistry had yet shown much more than whatDr. O’Shaughnessy had determined in the epidemic of 1832-viz., the loss of water and of normal salts from the serum, andthe presence of these in the evacuations. The specific gravityof the serum is therefore increased. In studying the treat-ment, he had himself tried to find out the mode in whichNature brought about reaction, and observation at the bed-side had convinced him that reaction from collapse never tookplace naturally or from treatment, without the occurrence offull vomiting. The history of successful cases fully corro-borates this view. Visit after visit the unconscious narratorcomplains of its continuance, and says, Better, except thevomiting, which still continues." Various emetics have beenemployed. At one time mustard was most in fashion, butthere are objections to its general use. Salt was extensivelyemployed, and among the ignorant and prejudiced has themerit of being considered a harmless and not a poisonousremedy. Tartar-emetic had its advocates, and various otheragents. Even cold water acts in this way, and where it suf-fices to keep up the vomiting produced by a salt emetic, heshould be disposed to regard it as the best remedy. In manycases, either with or without small doses of salines, as the car-bonate of soda, and the muriates of soda or potass, its employ-ment will keep up vomiting at such intervals as are necessaryto bring about and sustain reaction. He witnessed an instanceof recovery, where seventy single pints were taken, and forthe most part rejected within the twenty-four hours. Therewere, however, a few cases in which, after vomiting hadceased before reaction was established by cold water, wherethe vomiting was reproduced and sustained by the addition ofstimulants, the carbonate of ammonia and liquor ammoniafortissimns, in twentyand thirty drop doses; but such instanceswere certainly very few.

Dr. WEBSTER said, from all he could understand, the mor-tality met with at the St. Giles’s Cholera Hospital appearedmuch greater than the ratio throughout England. In the

spring epidemic, detailed in the paper, the deaths were nearlytwo in every three cases; whilst during the autumn, thegreatest number of fatal cases took place amongst old peopleand females. Hence, the mortality in the St. Giles’s districtseems to have been as high in 1832, as it proved in Scotland,where more than half the patients attacked with choleradied; but in England the proportion was one death in threeand a half patients affected. The severity of cholera in St.Giles’s might be easily accounted for by the character of thepopulation, and by the filth and insalubrity of that locality.He (Dr. Webster) had visited this hospital in 1832, as alsothe neighbourhood; and was by no means surprised at thehigh mortality now reported. Although no notice was takenin the paper, respecting the general mortality of London,when epidemic cholera formerly prevailed; he (Dr. Webster)would remind the Society that it had materially decreased.This fact was well known, and had been remarked at thetime. It was therefore interesting to know that a similar re-sult, with regard to the actual mortality, had recently takenplace, not only in the metropolis, but throughout England. Inproof of this opinion, he (Dr. Webster) would mention that,during twenty weeks, ending the 17th of February, inst., thetotal deaths from all diseases in London, amounted to 23,415;whereas, during the same number of twenty weeks, endingthe 19th of February, 1848, the aggregate deaths were 29,220;being an increase of 5805 cases ending fatally, or 24.79 percent. in favour of the present season; notwithstanding theremarkable fatality of scarlatina, to which he (Dr. Webster)had alluded at the last meeting of the Society; besides theexisting cholera. But the recent diminished rate of mor-tality in London, was chiefly remarkable in diseases of therespiratory organs, including influenza, which generally prove

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so fatal in cold and winter weather. For instance, during tained viscid bile. The severe cases of disease among thethe twenty weeks terminating the 17th of February inst., as children were so rapid in their progress, that it was of greatalready quoted, the deaths in London, by that class of diseases, importance to ascertain the period of first accession of thewere only 3869; whereas, during the parallel twenty weeks, symptoms; and with this intention frequent examinationsending the 19th of February, 1848, the deaths from the same were made. The cases which were seen at their commence-causes amounted to 8267, being an increase of 4398, or 113’67 ment in no instance passed into the stage of collapse. In thepercent. in the previous, more than the current season, which algide cases, the greatest reliance was placed upon the appli-shows, although since the lst of October last upwards of 500 cation of heat and moisture to the surface. The patientspersons have died from cholera, and 2253 by scarlatina, the were wrapped in blankets wrung out of hot water, and onpresent year has not been, on the whole, insalubrious. Not- which turpentine was sprinkled; hot bottles were then placedwithstanding the author does not allude to two important in different parts, and the child was again wrapped in drypoints connected with the present epidemic-viz., whether blankets. They were then allowed to drink freely of coldcholera is contagious, or is an entirely new disease, lie (Dr. water, generally containing a small quantity of brandy.Webster) would nevertheless reiterate the opinions he had Stimulating and anodyne liniments and sinapisms were alsomaintained in 1832, when cholera prevailed :-lst. That the employed. In one case galvanism was applied, and with thecomplaint was well known to ancient as also modern authors, most beneficial effect. A little girl of eight years old wasboth English and foreign; and, 2ndly, cholera is not con- apparently dying: she lay with her eyes closed, and insensibletagious. The last point is certainly still a vexata quce-3tio with to what was passing around her; her breathing was very im-some physicians who believe in its contagious character, or, perfect, and the pulse imperceptible at the wrist; and a ther-like Dr. Peacock, had changed their opinion; but he (Dr. mometer under the tongue indicated only a temperature ofWebster) was more than ever confirmed in his previous con- 88°. Slight shocks were passed, at short intervals, for aboutvictions. On these questions it was most gratifying to observe, a quarter of an hour, from the side of the neck to the epi-by the lectures just published of one of their most distin- gastrium, with the view of stimulating the diaphragm throughguished fellows, and a recent president of the Society-namely, the medium of the phrenic nerve. Immediately on the appli.Dr. Chambers, that the same views were entertained by so cation being commenced she opened her eyes, and complainedexperienced a practitioner. As no allusion had been made of the pain, she breathed more fully, the pulse again becamein the paper to the treatment of cholera, he (Dr. Webster) perceptible, and the temperature rose to 92°. From this timewould not enter upon such topics, but before sitting down, she gradually rallied, and was well in a few days. In thismust, however, repeat, that there existed no doubt in his mind case the child’s life was to all appearance saved by the appli-respecting the epidemic cholera, now prevalent, being neither cation of the galvanism; but in another case in which he hada new disease nor contagious. tried it, while some benefit resulted, the improvement was

Dr. PEACOCK had recently had his attention attracted to only temporary. Dr. Peacock said, in conclusion, he couldthe subject under discussion, in consequence of the children not dismiss the subject without alluding to the question ofof the Holborn Union, removed from Tooting, having been contagion. Before his recent experience he had been inclinedsent into the Royal Free Hospital. In all, 155 children were to the view that cholera was never contagious; but he wasreceived into the hospital; and of these, eighty-four were now compelled to believe, that however it might ordinarilymore or less seriously indisposed. Nine only, however, pre- spread, it was capable of being, under unfavourable circum-sented decided symptoms of cholera; thirty others had severe stances, propagated by contagion. The children from Tootingdiarrhoea, vomiting, and prostration; and the remainder had were sent into the hospital on the 5th of January; and ononly diarrhoea. The attack was not preceded by any marked that evening, and on the 6th, 7th, and 8th, about fourteenpremonitory symptoms, and was ordinarily sudden. The women, and four male attendants, were sent to take chargechildren were observed to droop, and after one or more of the of them; the number of persons who, during the first fort-usual rice-water evacuations, and some vomiting or retching, night, were directly in communication with the children,they went rapidly into the stage of collapse. In one case the being probably about twenty-five or thirty. On the 13th, asymptoms were most marked in less than half an hour after man who had been sleeping in the boys’ ward was seized withthe seizure of the child. In all the cases, however, there symptoms of cholera, and died of the disease in the Holbornmust have been an entire emptying of the contents of the Union; and from this time to the 21st, eleven other male oralimentary canal before the serious symptoms supervened; female attendants were attacked by the epidemic; and ofand this seemed generally to have taken place during the these, one died with all the symptoms of algide cholera. Ofnight, while the vomiting, and other urgent symptoms, did these cases, all were of a serious description; and of thenot occur till the morning. Of the cases characterized by other regular attendants on the children, one only, so far assevere vomiting and diarrhoea, two only subsequently passed I am aware, escaped entirely all symptoms of the disease.into the algide stage. Though from the youth of the patients During the same period that, as now stated, twelve out ofit was difficult to speak positively on this point, the urine was eighteen or twenty of the regular attendants on the childrenbelieved to have been entirely suppressed, in all the fatal were thus suffering in the part of the building appropriatedcases, for some time before death. Cramps occurred in only to them, there were at least fifty or sixty other persons intwo cases. The disease proved fatal in four cases, death oc- wards not many yards removed from the others, but whichcurring, in these, in five, six, eight, and sixteen and a half had little or no communication with them, who had nohours from the accession of the serious symptoms. On post- symptoms whatsoever of the disease. The case Dr. Peacockmortem examination the appearances detected were those regarded as strongly supporting the view of cholera beingwhich ordinarily characterize cholera. The brain and its capable, under certain circumstances, of being diffused bymembranes were extremely congested. The lungs were im- contagion, or, more properly speaking, by infection. But theperfectly expanded, and in the cases which proved fatal at case was yet stronger than this: from the first that the chil-the earliest periods, were unusually bloodless; while their dren were in the hospital, free intercourse existed betweenlarger vessels, and those of the body generally, were engorged the Holborn Union house and the wards. Several nurses,with blood of the semi-coagulated or tarry character usually after being a few days in the hospital, returned to the union;described. There was much blood, some of it feebly coagu- and men who slept at night in the union were all day in thelated and decolorized on the right side, but mostly semi iluid; boys’ ward. On the 13th-on the same day that the manand there was also some in the left ventricle. The mucous before referred to was seized-another man was taken inmembrane of the stomach and intestines was generally pale the union with cholera, and died; and from this time Dr.and thickened, though not altered in consistence. The various Peacock understood that many deaths from cholera hadmucous glands, and especially those of Brunner in the duo- occurred in the establishment.denum, were very large. This enlargement was most marked Dr. BALY alluded to the relation subsisting between thein the cases which proved fatal at the earliest period, and in diarrhoea which precedes the collapse state of cholera andthose which were examined soonest after death. In cases of the cholera itself. Is this " precursory" diarrhoea really acholera in older persons, the enlargement of the glands is not part of the disease-in fact, its premonitory stage ? or is it agenerally found; and it does not exist in those which survived distinct affection, which merely predisposes the patient to befor several days; so that it could not be regarded as essentially attacked by that formidable malady ? The former view ofa morbid state. He had recently examined the body of a boy the question is the one almost universally adopted. It seemswho died shortly after having sustained severe injuries, and to be further generally admitted, that the full development offound, in his case, the glands as large as in any of the cases the cholera attack may be easily prevented by administeringof cholera. The alimentary canal contained more or less of a the ordinary remedies for diarrhoea--opiates and astringents,pliltaceous material,which,on microscopic examination, proved especially opium with lead-in this premonitory stage. Histo consist of epithelium. The urinary bladder was contracted, (Dr. Baly’s) own experience of the disease, as it had shown it-the ducts of the liver were empty, and the gall-bladder con- self in Milbank Prison, did not satisfy him of the correctness

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of these views in all respects. He had observed three classes vated the distress of the patient, and appeared to produce noof eases which differed from each other in respect of the good result: it heated the body, but did not effectually rousestate of the bowels previous to the full development of the its vital powers. The free administration of cold water wascholera attack. First, there are those most severe, and gene- indicated not only by the thirst suffered by the patient, butrally fatal, cases of the disease, where, in the course of two, also by the known state of the blood; for this fluid is drainedthree, or more hours, the canal empties itself by two or three of its watery part, and till water is supplied to it, cannotfree faeculent evacuations, and then the stage of complete serve its all-important purposes in the body, and can, indeed,collapse suddenly supervenes. In a second class of cases, the scarcely circulate. He gives water, then, with the hope thatdevelopment of the disease is more gradual. For one, two, or a part may enter the bloodvessels, and not with the object ofthree days before collapse is established, there is diarrhoea, exciting vomiting. As a mere palliative of symptoms, chloro.the evacuations being at first fseculent, then gradually more form had been most serviceable. Administered by inhalation,and more serous in their character, and deficient in bile, till it immediately relieved all pain and spasm, and sometimes forat length they are white or colourless; and this diarrhoea has a time checked the vomiting. The comfort it in some casesgenerally been attended with increasing scantiness of urine, afforded the patient was most remarkable. These were.theoccasional vomiting, and sometimes very slight cramps. Now, only measures of which the uses seemed (to Dr. Baly) indu-in both these classes of cases the diarrhoea clearly belongs to bitable. A small portion of port wine was generally added tothe cholera as much as do the symptoms that mark the stage a part of the water his patients had given them to drink, butof collapse. But no fact that had come under his observation whether it exerted any influence for good or evil was doubtful.led him to believe that the remedies which check ordinary In some of the milder cases, a large blister had been applieddiarrhoea, arising from irritation or slight inflammation of the over the abdomen, and this measure appeared in some in-mucous membrane of the intestines, exert any well-marked stances to cause an early restoration of the urinary secretion.influence over this true premonitory diarrhoea, of cholera. In Dr. Baly subsequently stated that he had employed the injec-a third class of cases, looseness of the bowels more or less tion of saline fluids into the veins in six cases, but in no casesevere, presenting nothing unusual in its characters, and from with the result of saving the patient. The first effect was intime to time checked by remedies, has existed for some days, some instances as remarkable as in the cases treated in Edin-perhaps weeks, and then a change in the symptoms has taken burgh, in 1832. The breathing, which had become spasmodicplace; the evacuations have become serous; sometimes and interrupted, became regular and free; the pulse returned;vomiting has occurred; the skin has become lax, the the natural colour and warmth of the surface were restored,countenance depressed, and in a few hours, or in a day &c.; but in a short time the collapse returned, and although aor two, the cholera collapse has followed. Now, in these fresh revival of the system was produced by the injection of acases, it has seemed to him, (Dr. Baly,) that the first fresh quantity of saline fluid, the patient ultimately sank anddiarrhoea, which existed so long, and showed itself amenable died. The salts used were in some cases the chloride ofto ordinary remedial agents, was to be regarded, not as part sodium, with carbonate of soda; in others, the chloride ofof the cholera, but as a distinct affection, which had rendered sodium, with phosphate of soda. It might be that this methodthe patient susceptible, or more susceptible, of the cholera of treatment would be improved, and eventually prove highlypoison. If ordinary diarrhoea has this predisposing influence, useful, but the results of experience were at present decidedly(and that it has he did not doubt,) the importance of checking unfavourable to it. Ile might mention that he had tried thethe complaint as early as - possible could not be denied. In administration of large doses of calomel, and in one case -gavethis way cholera may be,-and (Dr. Baly believed) has been five doses of ten grains in each, and five doses of a scruple inprevented. But still the cases of this kind are not, according each, but no perceptible effect on the course of the diseaseto his observation, sufficiently numerous to explain the fact, was produced. After death, the greater part of the calomelthat the prevalence of cholera in a particular locality has was found enveloped in mucus in the stomach: a small por-sometimes undergone a great and almost immediate diminu- tion only had passed into the duodenum.tion, on measures being taken to discover every case of diar- Dr. COPLAND, in 1831, had paid much attention to the ques-rhoea amongst the population, and to administer to the persons tion as to whether cholera was an infectious disease. He hadthus affected, opiate, aromatic, and astringent remedies-a at that time free access to the reports on the disease, sent byfact of which several instances have been published. It is, he surgeons in India to the directors in London, from the yearthought, not yet proved, that a real relation of cause and 1817 to 1828. The perusal of these documents had convincedeffect, or any other relation than that of mere coincidence, has him that the disease was an infectious one. Whatever ,thesubsisted in these instances, between the adoption of pre- conclusions arrived at by the various authors of these reports,ventive measures and the sudden decline of the epidemic; for the facts were undoubtedly in favour of infection. With re-the history of the disease teaches us that its prevalence in a spect to this point, Dr. Copland referred to the labours of Sirparticular locality is often not only of very short duration, but William Pym, and his recommendation to the Board of Healthts also frequently as sudden in its cessation as in its rise. With in 1832, of isolating the infected persons. Dr. Copland be-reference to the treatment of cholera when fully developed, lieved that this proceeding was the cause of the comparativehe could not boast of greater success than others who had had small mortality which had taken place. He referred to theto deal with this formidable malady. The system is poisoned, great noise which at present prevailed about the removal ofand till we discover a specific which shall neutralize the noxious exhalations which might affect persons with cholera;morbid poison, we must treat the effects it produces in the he believed that more good was to be done by not allowingbody, just as in typhus fever we treat merely the effects of the the sick to infect the healthy. When the disease did spreadtyphus poison. But in the treatment of cholera, we are at a it was from overcrowding, and the visiting of the sick by theirgreater disadvantage than in the treatment of typhus, in as- neighbours. It was found, in the Irish and Scotch fishingmuch as the effects of the typhus poison are in great part local villages, that the disease had spread in a direct ratio to theinflammations, which may be moderated by means of remedies communication between the sick and the healthy. With regardwith which we are familiar. The powers of the system in to the treatment, he had in 1832 recommended the applica-typhus, though depressed, answers more or less readily to the tion of hot wet blankets sprinkled over with turpentine. Thisinfluence of stimulants, and nourishment can be introduced plan he still recommended in infants and young persons, butinto the bloodvessels; while in cholera the local effects are in the stage of collapse in old persons it had not been foundsuch as we know not how to control, the strongest stimulants of much service. From the few trials he had made of Stevens’shave comparatively little influence in rousing the system from plan of treatment by salines, he was convinced that it meritedits state of depression, and the natural process by which nutri- a more extensive employment.ment is conveyed into the blood is interrupted. He (Dr. Baly) Mr. BUsK had not seen much of the disease since October,had tried the various known remedies and plans of treatment when about forty persons affected with it were admitted onthat had been recommended, but with results so little satisfac- board the Dreadnought. Of these, twenty-one died. The dis-tory that he was almost disposed to say, (though it must be ease had been remarkably fatal, seeing, that with the excep-understood with some limitation,) "the less that is done for the tion of six persons, all the patients had been strong, healthypatient, the better his chance of recovery." At all events, he men, living on wholesome food, and not subject to privations.was satisfied that some of the more energetic methods of treat- The six alluded to had been in the hospital-ship for six monthsment tended to hasten the fatal termination of the case. Much previously. He had seen much of the disease in 1832 in thegood, however, was to be done by milder measures. Warmth, same class of men. The present disease was of a differentexternally applied, since it is favourable or necessary to the type to that, for in the present epidemic the greater number,organic chemical functions naturally going on in the body, is, indeed all but six, had died, not iii the stage of collapse, buthe believes, an important part of the treatment, aiding the of some consecutive affection-not fever, but a kind of oppres-system to resist and throw off the poison. But the degree of sion and coma which presented themselves after the patientsheat should be moderate, for too much heat greatly aggra- appeared convalescent. These symptoms were almost inyari..

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ably attended by suppression of urine. The coma was, doubt-less, the result of the presence of urea in the blood. He hadalso observed that the stage of collapse varied from that ofthe former visitation; the cramps were not so severe, andthough the surface was very blue, it was not so cold. Theheat of the body was also easily restored, by the applicationof warm blankets, &c., to a temperature of 90°, whilsta thermometer placed under the tongue did not rise beyond780. In the late cases, perspiration had been entirelyabsent, whilst in 1831-32 it had been enormous; therewas also less shrinking and collapse of the features. Theduration of the disease was longer in this than the last. Withrespect to the treatment, he could add nothing to what had beenadvanced by Dr. Baly. From his own experience he shouldsay, that in neither epidemics had medicine had any controlover the disease; and in no case that he had seen did it appearto him that any good had been done by the means employed.The only exception to this was, that chloroform certainly did,whether applied externally or given internally, have a mostbeneficial effect in relieving the spasms and cramps, but it hadno control over the course of the disease. It had seemed tohim that the principal force of the disease had fallen on thekidney, and the restoration of the secretion of this organwould prevent a fatal result, but then, no remedies applied forthis purpose had been of any avail. It was observed in hiscases, that after the urine had been suppressed, the first waterpassed afterwards was always albuminous, and accompaniedby casts of the tubuli uriniferi, showing that the epitheliumlining them had been thrown off. On this occasion he shouldsay that the disease was one of the kidneys as much as of anyorgan. With respect to the pathology of the disease, theglands of the small intestines had been found, when thepatients died in the stage of- collapse, to be very much en-Iarged, with signs of great congestion of the mucous mem-brane. He had also noticed another symptom in the lateepidemic, which when present had invariably proved fatal;this was, a discharge of blood from. the intestines. Afterdeath, in these cases, considerable patches of ecchymosis werediscovered in the large and small intestines, accompanied bycoagula. In these cases the mucous membrane, after a time,became gangrenous. He showed some morbid specimens of4’ht l1i",,,,,,,,,,,,,,.

Mr. STREETER had been present in two instances where theinjection of saline fluids into the vein of the arm was practisedin the St. Giles’s Hospital, but in. both cases without the:slightest alleviation. He had seen the warm bath, the hot-airand spirit-vapour bath, by means of the basket apparatusunder the bed-clothes, employed without producing theslightest reaction. He had employed mustard extensivelyover the skin of the abdomen, chest, and limbs, and althoughits specific action on the skin followed, it failed to arrest theprogress of the collapse; nothing but vomiting, recurring atintervals, retarded or removed that. He had seen phosphorusemployed, and in two instances had found the pills in thebodies after death. In one, a rapid case, they had not passedthe stomach. In the second, a protracted case, one of thepills was found, curiously enough, in the appendix vermiformis.He had been present at only a few post-mortem examinations,as he always believed cholera communicable, but the onlyConstant appearance that he could attribute to the diseasewas an increase of vascularity in the mucous membrane 01the intestines. The premonitory diarrhoea he had not foundto yield to simple and ordinary remedies. During the preva-lence of cholera, every bowel complaint should be regarded aspremonitory, and receive the most active treatment. Hisusual remedies were, superacetate of lead, powder of opium.calomel, and capsicum, of each one grain in a pill, to beadministered after each action of the bowels, with a dose ojacetate of ammonia and nitric ether. In conclusion, he wouldobserve that he felt assured of the infectious nature of choleraand believed that it was very frequently communicated b3the medium of clothes, as well as by personal exposure.

Dr. GARROD, on being called upon by the President to givfthe Society the results of his researches into the condition 01the blood in cholera, stated that in general they accorded ver3much with those of Dr. O’Shaughnessy, made during the epi.demic in 1832. Dr. Garrod had always found that the bloocin cholera exhibited characters different from those whiclpresented themselves in any other disease. In the first placethe specific gravity, both of the blood itself, and also of th<serum, was always found to be considerably increased; that othe blood from 1065 (the healthy average) to 1075 or 1080, an<that of the serum to about 1040, ten or twelve degrees abov4the normal average; hence its tar-like consistence. This stat4was exhibited in a patient’s blood that he had-very recently

had an opportunity of examining, taken just as the stage ofcollapse was coming on, and he thought it would be a very in-teresting point to determine whether the collapse in all caseswas accompanied by this change, or whether it might arisesimply from a poisoned state of blood. Without such analtered physical condition, even in some cases where theevacuations had not been copious-that is, in cases somewhatsimilar to those named cholera sicca, he had found such analteration; whereas it had been ascertained, that in ordinarydiarrhaea, even when accompanied with profuse evacuationsfrom the stomach and bowels, the serum had been found of aspecific gravity not at all exceeding the healthy standard.With regard to the alterations in the fibrine, he thought thatit was more one of quality than of amount; for he had foundthat until it ceased to coagulate, it maintained about the-normal average, although when compared with fibrine fromhealthy blood, its elasticity and strength was much weakened,and, as the disease progressed, it soon lost altogether its powerof coagulation. The total amount of solids in the blood wasalways much increased, especially the organic portion, whicharose from the watery part passing off by the intestines, andtaking with it some of the salts of the serum, which last, com-pared with the organic portion, were consequently diminishedin amount, but not so much as stated by Dr. O’Shaughnessy.On this point, however, Dr. Garrod would not give a positiveopinion, as his analyses were not as yet complete. Dr.Garrod’had also examined the blood in several cases of cholera, forthe purpose of determining the amount of urea and uric acid"and the results of his experiments might be summed up in afew words-viz., that during the stage of collapse, the ureawas usually found in the blood in quantities greater than inhealth, but its amount was not large; that when partial reac-tion ensued, the urea was still further increased, but that in’the consecutive fever which sometimes succeeds the collapse,its quantity became excessive, and that probably some of thesymptoms then exhibited were due to this accumulation. Dr.Garrod considered that in the collapse there was an almosttotal arrest of formation of urea, as well as of the excretingpower of the kidneys, but that in the stage of reaction, theformation of the principle ensued, frequently without therestoration of the excreting function, and hence its aceumula.tion in the blood. The uric acid appeared to follow the samelaws as the urea. In one case Dr. Garrod found the serumslightly alkaline in the collapsed stage, but after partial reac-tion, it exhibited an acid state, which was not altered by theapplication of heat. The rice-water evacuations were alwaysalkaline in reaction, and contained a large amount of salinematters-viz., phosphate of soda and chloride of sodium, inproportions not unlike those found in the blood, the albumenin small quantities only. The vomited matters exhibited anacid reaction. The bile in one case had a specific gravity, 1044.The late hour of the evening prevented Dr. Garrod from en.tering into further detail.

"ROSO-GRASS OIL."

W. H. JUDD.

To the Editor of THE LANCET.SiR,&lstrok;Seeing a request for information in your No. of Feb.

3rd, as to the " Grass Oil," I write to say that I have used the" Roso-grass oil of Ceylon;" which believe to be the propername of the fluid referred to by your correspondent, at Chel-tenham. A sample, the remains of which I send you, wasobligingly given to me, at my solicitation, some time since, bythe Committee of the Royal Medico-Botanical Society, outof its Museum. I found this highly odoriferous oil to forman excellent embrocation in rheumatism and neuralgia. Ihave less knowledge of its internal use,having only tried afew drops occasionally as a dose. But I beg to refer you toEarl Stanhope, the president of the Society, who, with hisusual philanthropy, will, I am sure, cause a portion of thepaper that accompanied the oil, from India, to be forwardedto you as a guide as to dose and effects.

I was formerly senior honorary secretary to the above-named institution, and I assert, from the estimation in whichthat Society is held abroad, and from the many curiouspapers and numerous specimens annually sent to it from allparts of the world, that the association has not (in England)received the support and encouragement to which its foreigncommunications and the numerous scarce articles of materia.medica it possesses, fully entitle it.

I would on all occasions refer you to the Committee of theRoyal Medico-Botanical Society concerning rare vegetablesubstances, as yet known to but few persons, from beingseldom imnortpd- Paceeht for exnerument and inquire into:

their qualities and value.-I am, &c.