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Correspondence."Audi alteram partem."

ON THE TREATMENT OF BLENORHRAGIAIN THE FEMALE.

To the Editor of THE LANCET. I

SIR,—A new disputant having entered the lists, in the per-son of Dr. Victor de Meric, as champion for M. Ricord, ofwhose admirable lectures, in your columns, he is translator,it is necessary to notice, separately, this gentleman’s remarks,in order to preserve what differences of opinion exist betweenDr. Egan and me from confusion.Dr. Victor de Meric claims for M. Ricord " that he has for

years expressed the opinion, that blenorrhagia not only ex-tends to the uterus, but may travel along the Fallopian tubesas far as the ovaries." (See THE LANCET, Feb. 5,1848, p. 144.)This statement may be perfectly true, but the publication, inTuv LANCET nf fbp twelfth lecture " delivered in fhP enmmnr

of 1847," upon the 5th of February last, or precisely sixmonths anterior to my first paper, must be held to be the realdate of his opinion above quoted becoming known to the pro-fession in England. I have examined the passage, and havesimply to say, that though a subscriber to THE LANCET forfifteen years, I read that passage for the first time, and, asI gladly gave the credit to Dr. Egan of anticipating me in thepublication of the fact of the involution of the uterus in manyintractable cases of this disease, so I most willingly admit thatM. Ricord has been before us both in its publication. Butwhether the priority in conception of the idea itself, or

of acting upon it in practice, belongs to M. Ricord, Dr. Egan,or myself-who can tell ?Dr. Victor de Meric mistakes if he supposes my paper

was written for the purpose of wresting from M. Ricordthe merit of any discovery he may have made, a matter ofmuch less importance than that of turning such a discovery togood account for the cure of disease. On the contrary, I setout by stating that" for some years my attention has beenattracted to the subject," and specially alluded to two caseswhich occurred in my practice in 1846; I then gave my ownimpressions, long existing, merely as incidental to the propersubject of my paper-namely, the treatment of gonorhroeain the female," and expressed satisfaction " that similar viewshave been entertained, and that I have been anticipated intheir publication by Dr. Egan, of Dublin, so far as the in.volution of the uterus in this disease is concerned."

Dr. Victor de M6rie’s remarks upon the difference inopinion between Dr. Egan and me I need not here notice, asthey will be found to be fully met in my second paper, inreply to Dr. Egan, which was placed in your hands before Dr.Victor de M6rie’s letter appeared. But when the lattergentleman ventures to prejudge me, and to pronounce a con-demnatory opinion that " further experience will very pro-bably settle the question" of the utility of copaibal injections"in favour of Dr. Egan"-an opinion founded on no knowledgeor experience of his own, I must tell him that his obtrusivemeddling was uncalled for and most ungracious. It may bethat M. Ricord "has never succeeded" in curing by applyingthe balsam directly upon the diseased membrane, and alsothat M. Piorry has tried the injection with no satisfactoryresults. I knew nothing of these circumstances when quietlyfollowing the bent of my own judgment, long before M.Ricord’s translated opinions (as shown by Dr. V. de Meric)were published in England, or made known in his lectures inFrance. But even if they had been familiarly known, I donot think thev would have deterred me then. as thev shallnot be allowed to turn me now, from prosecuting my own Iviews, and judging for myself. NL Ricord’s champion, likeother high-mounted champions, has shown too great for-wardness to exhibit the ornamental trappings of his newly-donned character, and gone somewhat beyond what wasnecessary for the proper assertion of his master’s rights; hehas indulged "something too much" in the coM)’6eMe andcabriolc. He demands more than the high-talented M. Ricordwould himself exact-a slavish concession to his opinion asthe unalterable decree of an oracle. M. Ricord, whose tactand judgment his champion himself cannot respect more thanI do, may yet see fit to change his ideas upon this, or uponany other point of his investigations; and as I know he wouldnot shrink from a candid avowal of the fact, so I believe hewill scarcely thank Dr. Victor de Meric for preposterouslyassuming their infallibility.As to the convenient theory of copaiba acquiring new pro-

perties by its elaboration in the kidneys, it is all very fine,and may be correct; but where is the tittle of evidence that itis so Dr. Victor de Meric goes on with his quotation thus:-" This principle, the result of the renal elaboration, is con-tained in the urine, and it is by means of this peculiar elementthat the affected surfaces become modified;"’ and he concludeswith his own prudent conditional—" If this view of the actionof copaiba be admitted, injections with this substance are ofcourse out of the question." Fiddle-de-dee ! What prin-ciple ?-what result of renal elaboration ? - what peculiarelement :-ana all aepenumg upon one portentous IJ : J.

do not admit this view, because it has nothing but guess-workfor its foundation, and is opposed to positive facts in my ownexperience. For several years I have used no other treat-ment than copaiba injections in simple gonorhroeal orblenorhragic vaginitis among my hospital patients ; and evenunder all the unfavourable circumstances of its application,numbers have given me assurances of a perfect freedom fromthe foul discharge, &c., by their use. And although, for thereasons stated in my first paper, I lay no stress on hospitalpractice, yet in a question of cure, evidence derived from itmight well be received. I can speak confidently, however, of £experience to the same effect in private practice, and amwarranted in doing so by the declaration of the sufferersthemselves, whose testimony I consider the best in such cases.in the two instances noticed in my second paper, of the childwho had gonorhroeal ophthalmy and gonorhroeal vaginitis,and the Irish labourer whose eyes were similarly but stillmore severely affected, the first was perfectly and indisputably" cured by applying the balsam directly upon the affectedmucous membrane," no other treatment having been used for

, either species of the disease ; the second was also cured by, the same direct application of the balsam to the mucous or

conjunctival membrane of the eyes. Here, at least,-and these’ are but two out of many cases, recurred to only becausel they have been already adduced in my first paper ;-here, atF least, there was, there could be, no " renal elaboration,"-no)

" principle" resulting therefrom, as the curative agent,-nott the shadow of a " peculiar element,"-nothing whatever buti the copaiba directly applied in solution to the mucous mem-s branes, as an iniection and as a lotion, or collyrium.

While such indubitable results have attended my ownpractice, am I wrong in repeating that I resolved to test thesoundness of my conclusions on my hospital patients beforeventuring to promulgate dogmata at variance with existingtheory and practice" ? or, in the relative statement, that " Ihave found the disease obedient to the use of these injectionsmore than of any other kind" ? Ought I to have suppressedthe results because ignorant of their having been sanctionedby M. Ricord, or the reverse ? or ought I now to suppress thembecause Dr. Victor de Nleric is pleased to prophesy that" further experiments will, however, very probably settle thequestion in favour of Dr. Egan ;" and graciously adds, that heis inclined to think so from the trials made at Paris, whichhave " signally failed" ?-I am, Sir your obedient servant,

R. G. MAYNE.R. G. MAYNE.

THE OPERATION FOR STRANGULATED HERNIAAT UNIVERSITY COLLEGE HOSPITAL.

To the Editor of THE LANCET.

SIR,—I cannot but take up my pen in defence of one whohas received such harsh treatment from men who profess andconsider that it is a breach of medical etiquette to speakagainst another practitioner publicly, even if his treatmenthas not been correct; but when it has not only been proper,but completely successful, in a very difficult and dangerousoperation, it is a most uncalled-for and ungentlemanly attack,and worthy only of emanating from the pen of a disappointedcandidate, or his immediate friends. It is true that the ope-ration did occupy more than one hour, but Mr. Marshall toldme afterwards, when speaking on the subject, that he wassurprised to hear that he had been so long, but that he haddetermined, previous to entering the room, that as it was hisfirst operation, he would not hurry through it, but see whathe was cutting and doing. I am aware that the operationcan be done in a few minutes, of which we have lately hadseveral examples, two shortly before, and three since Mr.

Marshall’s, which were performed with becoming celerity, butit is a melancholy fact, that Mr. Marshall’s is the only sur-viving patient out of the six. This does not, I know, dependon the rapidity of the operation, but still I think it is quiteproper for a man to take his time in a first case, especiallywhen the "unfortunate patient" is unconscious of pain, andthe " unhappy operator" but a young surgeon. If Mr. Mar-

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shall has been appointed somewhat earlier than usual, he willonly have gained so much the more experience by the timehe arrives at the ordinary age of full surgeons. Very few areaware of the extent of Mr. Marshall’s investigations andwritings; but if they were more generally known, his appoint-ment would be less cavilled at.

I am not at all acquainted with Mr. Marshall in private,therefore I cannot be said to be interested on the topic anyfurther than to see justice done to a man who will, I feel con-fident, turn out one of the best that ever emanated fromUniversity College.-I beg leave to sign myself,

Your obedient servant,October 16,1848. A THIRD YEAR’S MAN.

ON SMOKING TOBACCO, AS INDUCING OR PRE-VENTING CHOLERA.

To the Editor of THE LANCET.

SIR,—I observed in the Times of Monday last, Oct. 9th, anarticle headed, "The Cholera at Woolwich, Oct. 8th," in whichit is stated that a medical consultation had been held, and that" the convicts on board the Justitia, at the Royal Arsenal,have been permitted to have tobacco and pipes to smoke."The public from this may be led to infer, that smokingtobacco is considered by the profession a means of guardingagainst cholera. I would therefore ask how the cholera islikely to be prevented by the exhibition of a poison, whichproduces debility, and disarrangement of many importantfunctions, particularly those of the brain, stomach, and heart,for we know that the effects of tobacco are severe sickness,headach, faintness, cold sweats, extreme prostration, and, insome cases, convulsions, and even collapse and death. Per-sons accustomed to smoke may be stimulated at the moment,but these feelings are always succeeded by depression of asingularly lasting character, and a state very ill adapted torepel disease. With the impending danger of cholera, whenthe digestive functions should be kept in as good a conditionas possible, the peculiar dvspeptic symptoms produced bytobacco are much to be dreaded. Dr. Prout, in his excellentwork, on " Stomach and Renal Diseases," speaking of tobacco,says,

" Although confessedly one of the most virulent poisonsin nature, yet such is the fascinating influence of this noxiousweed, that mankind resort to it in every mode they candevise, to ensure its stupifying and pernicious agency."

I am, Sir, your obedent servant,Sutton Coldfield, Oct. 11, 1848. RICHARD HORTON, M.R.C.S.E.RICHARD HORTON, M.R.C.S.E.

PUBLIC HEALTH.—CHOLERA.ABSTRACT OF A NOTIFICATION RESPECTING THE NUISANCES RE.

MOVAL AND DISEASES PREVENTION ACT WHICH APPEARED IN

THE GAZETTE OF OCTOBER 6TH.

General Board of Health, Gwydir House, Oct. 5th.The experience obtained of this disease during its former

invasions of this country, and during its recent progress,appears to afford ground for the correction of some viewsformerly entertained concerning it.Although it is so far true, that certain conditions may

favour its spread from person to person, as when greatnumbers of the sick are crowded together in close, unventi-lated apartments, yet this is not to be considered as affectingthe general principle of its non-contagious nature.The guardians of the poor and the parochial boards will

probably be required, either by themselves individually, orby persons to be employed or specially appointed by them forthe purpose, to make examinations from house to house oftheir several districts, and report to their boards upon thestate of each locality.

Householders of all classes should be warned, that theirfirst means of safety lies in the removal of dung-heaps andsolid and liquid filth of every description from beneath orabout their houses and premises.Next to the perfect cleansing of the premises, dryness ’,

ought to be carefully promoted, which will of course requirethe keeping up of sufficient fires, particularly in the damp andunhealthy districts.By the recent Act (11th and 12th Victoria, chap. 123, sec. 1)

it is provided, that upon notice in writing, signed by two ormore inhabitant householders, that any dwelling-house orbuilding is in a filthy and unwholesome condition, or thatthere are upon such premises any foul and offensive cesspool,drain, gutter, or ditch, or any accumulations of filth, or thatswine are so kept as to be a nuisance or injurious to health,

the authorities shall examine, or cause the premises to beexamined; and if upon examination, or upon a medical cer-tificate of two legally-qualified practitioners, it appears thatthe nuisance exists; the public authority shall make com-plaint before two justices, who are required to make orderfor the removal of such nuisance. The amended provisionscontained in this Act should be early considered, promulgated,and enforced.

In the meantime, if, notwithstanding every precautionarymeasure which can be taken, this disease should unhappilybreak out in any district, then it will be essential to thesafety of the inhabitants that they should be fully impressedwith the importance of paying instant attention to the pre-monitory symptom that announces the commencement of theattack." In most cases," writes the British consul respecting the

epidemic which has just broken out in Hamburgh, " the dis-ease has first manifested itself in a slight relaxation of thebowels, from which, if promptly attended to, the patientgenerally recovers; but if the symptoms are neglected, spas-modic attacks ensue, and death follows mostly in from fourto six hours."

It will be indispensable, therefore, on the first outbreak ofcholera, that the local authorities should immediately makearrangements for daily house to house inspections of thepoorer localities in their respective districts.Heads of families, masters of schools and workhouses, pro-

prietors of large establishments and works, such as factories,mines, warehouses, wharfs, and docks, should either be theirown inspectors, or employ some trustworthy agent to examinedaily every person in their employment, and to give at oncethe proper remedy, if the premonitory symptom should bepresent.Each member of the visiting committee should be provided

with proper remedies, prepared in appropriate doses for ad-ministration on the spot, in every instance in which the pre-monitory symptom is found to exist, and should report everyperson so treated as requiring the instant attention of themedical officer.

Dispensaries for bowel complaints should be establishedat convenient stations, at which the neighbouring inhabitantsmay apply for the proper remedies and advice the momentthey are attacked by the premonitory symptom.Experience having shown that the establishment of cholera

hospitals was not successful, the best provision practicable mustbe made for affording assistance to the individuals who mayneed it at their own houses; and one of the best modes ofeffecting this object will probably be the selection of properpersons, who may be instructed as nurses in the special ser-vices required on this occasion, and paid for devoting theirwhole time to attendance on the sick at their own habita-tions, under the direction of the medical officers.

It will be necessary to engage a sufficient number ofmedical officers at suitable remuneration, some to devotetheir whole time, by day and night, to the service of thedispensaries, and others to attend the sick at their own dwel-

lings. ,

Medical authorities are agreed that the remedies properfor the premonitory symptom are the same as those foundefficacious in common diarrhoea; and that the following, whichare within the reach and management of every one, may beregarded as among the most useful-namely, twenty grains ofopiate confection, mixed with two tablespoonfuls of pepper-mint water, or with a little weak brandy-and-water, and re-peated every three or four hours, or oftener, if the attack issevere, until the looseness of the bowels is stopped; or anounce of the compound chalk mixture, with ten or fifteengrains of the aromatic confection, and from five to ten dropsof laudanum, repeated in the same manner. From half adrachm to a drachm of tincture of catechu may be added tothis last if the attack is severe.Half these quantities should be given to young persons

under fifteen, and still smaller doses to infants.It is recommended to repeat these remedies night and

morning for some days after the looseness of the bowels hasbeen stopped.Every article of food which is known to favour a relaxed

state of the bowels should, as far as possible, be avoided-such as every variety of green vegetables, whether cooked ornot, as cabbage, cucumber, and salad. It will be important,also, to abstain from fruit of all kinds, though ripe, and evencooked, and whether dried or preserved. The most whole-some articles of vegetable diet are-well baked, but not newbread, rice, oatmeal, and good potatoes. Pickles should beavoided. Articles of food and drink which in ordinary