Section Iii.--Different Modes of Treatment.

After speaking of the various expedients resorted to for the cure of cholera, says Dr. Watson: "I believe that each, in some cases, did good, or seemed to do so; but I cannot doubt that some of them did sometimes do harm. I had not more than six severe cases under my own charge, and I congratulated myself that the mortality among them was not greater than the average mortality. Three died, and three, I will not say were cured, but recovered, * * * under large and repeated doses of calomel. Yet, as I said before, I do not venture to affirm that the calomel cured them." It seems that Dr. Latham commenced the treatment and Dr. Watson followed it up, repeating the half-drachm doses of calomel many times, as the patients seemed to rally after its administration. Again, he observes: "It was remarked of those who recovered, that some got well rapidly and at once, while others fell into a state of continued fever, which frequently proved fatal, some time after the violent and peculiar symptoms ceased. Some, after the vomiting and purging and cramps had departed, died comatose--over-drugged--sometimes, it is to be feared, by opium. The rude discipline to which they were subjected might account for some of the cases of fever." * * * "Never, certainly, was the artillery of medicine more vigorously plied, never were her troops, regular and volunteer, more meritoriously active. To many patients, no doubt, this busy interference made all the difference between life and death. But if the balance could be fairly struck and the exact truth ascertained, I question whether we should find that the aggregate mortality from cholera in this country was any way disturbed by our craft."

In a report by the acting physician to the Bellevue Hospital, made to then "Special Medical Council," August 2d, 1832, while the Epidemic Cholera was still prevailing there and in the city, the physician says: "The treatment I have divided into two kinds--the pathological and the mixed. The first having been determined on, after the careful examination of twenty-three persons dead of cholera; since then, ten more have been examined, which serve to confirm the conclusions first formed.

PATHOLOGICAL TREATMENT--First Stage.--This consisted in the administration of blue pill and opium with absolute diet. If pain was present, leeches to the epigastrium and arms, and when these could not be procured, cups to the epigastrium. This plan never failed to arrest the disease in the hands of those who diligently pursued it, where the mucous membrane of the gastrointestinal canal was not previously diseased.

Second Stage.--First, Blood-letting; second, diligent frictions with the ointment alluded to above, when persons could be procured to perform the duty; third, ice to allay the thirst; fourth, small doses of brandy and laudanum, if the vomiting continues; fifth, cups to the epigastrium, if there was pain and the brandy omitted.

Third Stage.--First, ice to allay the thirst, which is now, indeed, unquenchable; second, external heat; third, a continuation of the frictions; fourth, no opium, and, frequently, no brandy, especially among the children.

MIXED TREATMENT--First Stage.--Besides the above treatment, calomel and Dover's powders was a very frequent prescription; also scruple doses of calomel, and calomel and opium in small doses, and all with success. Nevertheless, I believe they occasionally did harm.

Second Stage.--First, blood-letting less frequent than above; second, calomel and Dover's powders continued; third, calomel and opium; fourth, calomel, capsicum and opium; fifth, soda powders; sixth, scruple doses of calomel every half hour; seventh, ice.

Third Stage.--Calomel and Dover's powder; calomel and opium; calomel, capsicum and opium; carbonate of ammonia and capsicum; scruple doses of calomel every half hour. External heat in various ways; ice, etc. Severe shocks of electricity along the course of the muscles to allay the cramps; also, the burning of alcohol on the skin. The first was the practice of Dr. Devan, the second, that of Dr. Gardner, and both lay claims to having been the first to use these means."

The ointment alluded to above is composed of mercurial ointment, one pound, camphor finely pulverized, seven ounces, and the same quantity of capsicum. With this, the patient was rubbed briskly from head to foot and repeated at short intervals. The result was, that mercury generally showed its specific effects upon the gums in from five to ten hours from the commencement of reaction. The success of this external application of mercury, conjoined with its internal administration and frequent blood-letting, may be learned from the cholera statistics of this and other institutions.

Dr. Pereira employed sixty-grain doses of calomel, it is said, with success, and Dr. Barton of New Orleans, in 1849, gave in ten cases from 120 to 150 and even to 180 grains of calomel at a dose, and, in one case, gave 220 grains, intending, it is said, to have weight sufficient to keep it down. This brave and heroic practice did not afford relief in a single instance; the cramps, and vomiting, and purging continued, and a few hours closed the scene--all died.

The treatment recommended in the American Practice of Medicine, by Dr. W. Beach, which was fully tested by the author himself while in discharge of his official duties as physician of the Tenth Ward, city of New York, during the prevalence of cholera in 1832, is worthy of consideration on account of its simplicity, its great efficiency and wonderful success. "Among all the medicines," says the author, "ever given or proposed in the incipient or premonitory stage, none will be found so efficacious as our neutralizing mixture, made of genuine materials and given very strong. Occasionally, it may be proper to add fifteen or twenty drops of laudanum; this, however, is very seldom necessary. A vast number of medicines are recommended in this stage of cholera, but there are none, I am convinced, so efficacious as the above."

In the second, or confirmed stage, the same medicine was continued in larger and more frequent doses, with hot fomentations to the abdomen, stimulating lotions, sinapisms and injections. The cholera drops were also administered, composed according to the following formula:

Rx. Tincture of Capsicum, Tincture of Opium, Spirits of Camphor, Essence of Peppermint. Equal parts--mix.

Give a tea-spoonful every hour or half hour, according to the severity of the symptoms.

In the third, or collapsed stage, he directed a tea-spoonful of pulverized black pepper to be mixed and given in a tumblerful of hot gin-sling; also, the same to be prepared and applied hot to the bowels and extremities. Also, to two tea-spoonfuls of either pulverized red or black pepper, pour on a sufficient quantity of hot water, let it stand till nearly cold; strain and inject the whole up the bowel. This would often arouse the patient in the collapsed stage when there was little or no hope of recovery. Such are in brief the remedies which were used so successfully in the Tenth Ward of this city, in 1832. Here it will be noticed that the general principal evolved in this treatment consists in its prompt and diffusive stimulant, its antispasmodic and corrective power so combined as to act gently and kindly, yet promptly and successfully, as the records show, to which we shall refer in the sequel.

Another mode worthy of a passing notice is one analogous to this, adopted and recommended by the eminent Dr. G. S. Hawthorne, of Liverpool, England, who observes: "Of the medicinal remedies, the chief is opium. This, I have explained, should be given in combination with medicines of a cordial, stimulating and antispasmodic character, of which the most efficient are camphor, capsicum, ether and aromatic spirits of ammonia. The following formulæ present the combination of the medicines which I would prefer:"

Rx. Powdered Opium, gr. xij. Camphor, gr. xxx. Capsicum, gr. ix.

Spirits of wine and conserve of roses Q. S.--mix--divide into twelve pills. Each of these pills, it will be observed, contains one grain of powdered opium. These are accompanied with the following:

Rx. Chloric Æther, Aromatic Spirits Ammonia, Camphorated Spirits, Tincture of Capsicum. Of each, one drachm. Cinnamon water, two ounces--mix.

"Cholera," observes Dr. H., "presents itself in four distinct degrees of malignity. All the modifications of the disease require to be treated on the same principles, the only difference being that, in the detail, the milder forms require less powerful doses of the medicines. The mode of treating the most malignant form of the disease, will serve as a model on which all the others are to be treated. This most malignant form has, by all writers on the subject hitherto, been pronounced incurable. They say it never was cured in a single instance, and never can be cured by the power of medicine. I shall, however, point out a mode of treating it which will prove itself infallibly successful where my directions are followed with sufficient promptness, boldness and skill." In detailing the mode of procedure, the doctor observes: "Place the patient immediately in the horizontal posture in bed, and give him on the instant, as this is an extreme case, ten of the antispasmodic pills, and two ounces of the antispasmodic mixture, and wash the whole down with a glass of undiluted brandy or whisky, flavored strongly with cloves, essence of ginger, or some such warm aromatic spice. In the mean time, have him covered with an additional blanket, and let the usual means of communicating heat, such as jars or bottles of hot water, bags of hot salt or sand, hot bricks, or whatever can be most readily procured, be applied without delay to the feet and different parts of the body, so as to restore the temperature and produce perspiration as quickly as possible. As soon as the perspiration has begun to flow freely, superadded to the medicines and cordials already administered, a glass of brandy-punch should be given, the punch to be made strong and to be swallowed hot as possible. After this, no drink should be given until the perspiration has flowed freely for a few minutes. The stomach will then retain it, and the patient should be indulged freely with copious draughts of rennet whey, warm toast-water, flavored with some agreeable spice, mint, or balm-tea, or any such mild beverage. The necessity of attending to this is most important. When the discharges from the bowels cease, and when the pulse becomes full and bounding, the body is covered with a copious, warm perspiration, which will not fail to be the case under such treatment; the danger is over. The perspiration, if the patient can bear it, should be kept up for twelve hours, and may, with advantage, be continued moderately even longer. Its duration, however, must be regulated according to the strength of the patient and the state of the pulse. After the first four or six hours, more heat need not be applied than is perfectly agreeable to the feelings of the patient. It is remarkable how suddenly the precordial oppression, etc., are relieved on the breaking out of a free perspiration, and, what is of greater importance still, the vomiting, where it exists, immediately ceases." In short, all the urgent symptoms soon subside, and the patient becomes convalescent.

Such is Dr. Hawthorne's treatment, which is affirmed to have been invariably successful. It is based on the same general principle as the preceding--a prompt and diffusive stimulant. Here we might ask, What constitutes the chief reliance in the formulæ? Was it the opium that so promptly met and arrested the disease? or the combination of the other powerful stimulants with which it was united? Dr. H. places his main reliance on this drug, and yet affirms that it produced no narcotism or other sensible effect whatever, except as a diaphoretic, and even in this its influence may be questioned. The prognosis becomes favorable from the fact of a sudden rise in the temperature of the body, for the icy-coldness disappeared, the heat of the surface returned, the circulation was equalized and a profuse perspiration set in, and, as these conditions appeared, the urgent symptoms subsided. Not the excessive doses of opium, but the remedies in combination as a whole, produced by its prompt stimulating power these results, and the patient was thus relieved.

Mr. Forward, while superintending some of the public works in the State of Kentucky, in 1832, had in his employ more than two hundred laborers, among whom the Cholera Epidemic of that year appeared about a week before its irruption in Louisville. The first case was that of a young, sober, industrious white laborer, who was at the time vigorous and apparently healthy. It was a sudden and severe case and occurred about eleven o'clock at night. The physicians who usually attended these men were at a distance, and could not be obtained without considerable delay. Under these circumstances, Mr. Forward, after visiting the patient, becoming acquainted with the symptoms, and believing it a genuine case of cholera, commenced treatment at once, fearing, as he states, the patient could not live till a physician could be obtained. It was, indeed, a desperate case; violent spasms, with constant vomiting and severe purging, attended with that livid appearance and peculiar coldness so characteristic of the disease. "Of the treatment," says Mr. Forward, "I gave him first a quick, stimulating emetic prepared from the lobelia seed, which checked the vomiting and purging, but had little effect upon the spasms. I then applied the steam bath, having his feet and legs at the same time immersed in water as warm as he could bear, which was made strong with salt and wood ashes. I then sweetened a tumbler of warm water and put into it a tea-spoonful of "number six," and about the fourth part of a tea-spoonful of Cayenne pepper, and gave him one-third of it when I commenced sweating him, and the balance at intervals while he was sweating. By the time he had been sweated ten minutes, he was free from spasms and pain, but I continued the sweating ten or fifteen minutes longer, then wiped dry, after which the patient laid down and went to sleep--being thus relieved and cured."

Another case of a colored man who was strictly temperate and healthful occurred an hour or two later the same night. His attack, too, was sudden, and still more severe; cramps very violent, vomiting and purging equally as severe, though he had not been awakened from his slumbers more than fifteen minutes. This case was treated the same as the former, with the emetic, sweating, and when the sweating had subsided, administered a table-spoonful of spirits of turpentine, which relieved him entirely, and he soon went to sleep. The next morning both were comfortable, and went to work and remained well. During the prevalence of cholera at that time, Mr. Forward had thirteen cases in his own family, and, on one day when the epidemic was at its height, seven cases among the laborers. All these and many others that occurred were treated in the same manner, with the same undeviating success. Not a single instance of death from cholera in his own family, or among the hands on the road. When the epidemic cholera reappeared in 1835, the same course of treatment was pursued, with the same uniform success. Such results, considering the malignant character of the disease, are truly astonishing. Whatever may be said of the general principle of practice in these cases, its success must be admitted as equaling, if not surpassing, the treatment of any equal number of cases on record. Though conducted by an unpretending and unprofessional gentleman, yet, out of the whole number attacked during the continuance of the epidemic, not a single case was lost.

In a report of a case of cholera treated successfully by rectified oil of turpentine, administered internally as a specific, by Richard Brown, Esq., Surgeon, Cobham, Surrey, November, 1848, it is stated that the patient, "aged fourteen, having suffered from severe bowel complaint, presented all the symptoms of cholera in the stage of collapse. The bowels acted incessantly, and anything taken into the stomach was immediately rejected; the pain around the umbilicus was intense, attended with severe cramps of the legs; the pulse exceedingly small, and scarcely perceptible; tongue coated in the centre, and flabby; the surface of the body much below the natural standard; the countenance of a blue cast, and expressive of the greatest anxiety. So decided, indeed, was the symptom that the case was considered almost without hope." "But I had determined," says the physician "to treat the first case of cholera that occurred in my practice with rectified oil of turpentine, given internally, the active principle of which, camphogen, possesses stimulating, diuretic, diaphoretic, sedative, antispasmodic, antiputrescent properties. I administered immediately one drachm of it combined with mucilage and aromatics, directing it to be repeated every two hours, the patient to be kept warm and to take meal broth with excess of salt."

Now mark the result of this simple, uncombined remedy. In the evening of the same day all the urgent symptoms were assuaged, the purging and vomiting had ceased, the pulse was raised, the surface of the body had become warm and moist with perspiration, the pain around the umbilicus diminished, and the cramps less violent, but the countenance still bore the appearance of great anxiety. Such were the immediate results of the administration of this remedy, which appear, from the subsequent history of the case, to have been permanent and unattended with any constitutional derangement, or other serious and unpleasant effect. On the morning of the next day the patient was steadily improving; much of the anxiety of countenance had vanished, but the pain in the belly and cramps of the legs still remained, though much relieved. On the second morning after the attack the patient was very much better; no pain in the belly, and does not feel sick from the turpentine. On the third morning the patient was up, and, though exceedingly weak, there was no trace of any alarming symptom remaining. The bowels had moved from the effects of a previous dose of calomel (two grains) given the next morning after the attack, and the evacuation was much more healthful. A mild tonic and alterative plan of treatment was all that was necessary to restore the patient to her usual health, and she is now well. The remedy was given at first every two hours, then every four, and lastly every six hours. This treatment commenced on the 26th and terminated on the morning of the 29th. Its duration about sixty hours, when the patient is declared convalescent and comparatively well. Here we might ask, What experiment with any single remedy has been more important and satisfactory in indicating and directly pointing out a general principle of practice for the successful treatment and cure of this formidable disease? We say single remedy, for it is doubtful whether the two grains of calomel exercised any curative influence whatever, or in any way varied the result. It is, therefore, to the use of the rectified oil of turpentine that the favorable termination and cure of the disease is to be attributed.

There is another mode of practice which has been exhibited to some extent in almost every part of the world, claiming to be more efficacious and successful than any other in the cure of epidemic cholera. It is the general principle which is the great and important consideration with which we are concerned in presenting it among the various modes adopted for the cure of this disease. This is found clearly defined and ably presented by Dr. Joslin in his lecture on cholera, in which, after exhibiting the views and doctrines governing the practice, and contrasting its results with those of other modes, he observes, in relation to the treatment of cholera in its early stages, that "whatever may be the form of attack, give one drop of the tincture of camphor dropped on a lump of sugar, and then dissolved in a table-spoonful of cold water. Repeat this every five minutes until there is a decided mitigation of the symptoms. This will usually be after five or six doses. If the disease be taken in time, ten or twelve doses are ordinarily sufficient. There is abundant testimony of the efficacy of this camphor treatment from all parts of Europe." Again, speaking of the first variety, in which the most prominent symptom is diarrhoea, the Dr. observes, "If camphor does not soon give relief, we are to resort to phosphorus, or to phosphoric acid. Dr. Quinn has employed both with equal success. Phosphoric acid is to be preferred when there is a gluey matter on the tongue. In some cases, veratrum, chamomilla, mercurius, or secale may be indicated. However, phosphorus and phosphoric acid rarely fail to cure; and some high authorities are in favor of giving one of them at first, in preference to the administration of camphor in this form of cholera."

Again, in the second variety, cholera gastrica, Dr. Joslin observes, that "the remedies are generally ipecacuanha or veratrum, sometimes nux vomica. Camphor is to be given at the outset. Put two or three globules of the third of ipecac. in a little sugar of milk and place them on the tongue. This may be repeated, if necessary, in half an hour, an hour, or an hour and a half. But if the disease is not checked, give veratrum or other medicines according to the different indications." Again, in the third variety, cholera spasmodica, "the remedies are camphor, cuprum metallicum, and veratrum. If camphor has not relieved, give cuprum, and repeat it many times, at intervals of half an hour or an hour, if its salutary effect is not manifested. If necessary, then give veratrum in repeated doses, or other medicines, according to the different indications." In the fourth variety, cholera sicca, "there is no diarrhoea or vomiting; there is sudden prostration of the vital powers," etc. "The first remedy, as in other varieties, is camphor. If the patient is cold, blue, pulseless, that is, collapsed, carbo vegetabilis; some recommend hydrocyanic acid." In the fifth variety, cholera acuta, veratrum is named as the main remedy.

Such is, in brief, the treatment so highly extolled and recommended by some in the cure of cholera. It is, in substance, the same as was originally suggested when the disease first appeared in Europe, nearly half a century ago, and will probably continue unchanged for generations to come. Of its general principle and its adaptation to the pathology of the disease we shall speak more at length in the sequel.

After referring to the pathology of the epidemic cholera, showing its strong analogy to congestive fever, from the fact that in both diseases the blood recedes from the surface, and collects upon the internal organs, inducing a state of congestion, and showing the necessity of adopting prompt and efficient means to promote reaction, Dr. Massie observes, "I am not so bigoted, or so wedded to any system of medicine, as to be its champion to the exclusion of others. I consider I have a perfect right to investigate all of the different systems, and avail myself of any information which I may deem important and true, and I will premise by saying that the treatment I now adopt for cholera has been attended with more success than when I treated it under a different system."

"If I am called at an early period of the disease, even when there is nausea, vomiting, and diarrhoea, I commence the treatment by giving equal parts of rhubarb root pulverized, saleratus, and peppermint plant powdered; one pint of boiling water being added to half an ounce of this compound. After simmering it for half an hour, sweeten with loaf sugar and strain, and, when nearly cold, two or three table-spoonsful of good French brandy should be added. Give two table-spoonsful of this, taken warm, in connection with the following preparation, viz.: Rx. Pulverized cinnamon, cloves, and gum guaiacum, each one ounce, good brandy one quart, given in two tea-spoonsful to a table-spoonful every fifteen or twenty minutes to an adult."

"The patient should be well covered with warm clothing, and bottles of hot water, bricks and stones placed around his body. This course is almost sure to be followed by a moderate moisture of the skin, which should be kept up for eight or ten hours; to do which, I give ptisans of catnip or spearmint, and apply hot tincture of Cayenne by flannel cloths over the abdomen; if this fails to keep up the perspiration, I administer the following: Rx. Camphor, grs. x.; Ipecac., grs. v.; Opium, grs. ijss; Supercarbonate of soda, scruple ij. Mix, and divide into two, three, or more powders; give one every hour, or oftener."

"In very urgent cases, I have used tincture of camphor, ounce iv; essence of peppermint, ounce iv; syrup of ginger, ounce ss; tincture of Cayenne, dram j. A table-spoonful, from one to four in an hour. I have given the saturated tincture of prickly ash, with the compound tincture of guaiacum, with good effect, in doses from a tea-spoonful to a table-spoonful every fifteen or twenty minutes. When there is excessive irritability of the stomach, the following injection should be given after every discharge: Rx. Saturated tincture of prickly ash, ounce ss; water, ounce j; tincture opii, dram ss. Mix." Such are the views of Dr. Massie, as presented in his Treatise on the Eclectic Southern Practice of Medicine. They are confirmatory of the observations and experience of many other eminent practitioners, and strictly accord with his views of the pathology and essential phenomena of the disease.

We find in a very valuable work, entitled the Eclectic Practice of Medicine, published at Cincinnati by Professors Powel and Newton, a full account of the mode of practice generally adopted and pursued by the great body of physicians in the West, the substance of which we are induced here to present, preserving, as far as practicable, the language of the authors. For our inquiries are, What are the modes of practice? and what modes, if any, are consistent with the pathology and the essential phenomena of the disease? Each mode, however prominent or however obscure, is entitled to a fair representation in our inquiries, and should be held responsible for its deviations from the strict and generally received principles of science, and the consequences arising from any such deviations, or departure therefrom.

"When called upon," say these eminent professors, "to treat a patient in the early stage of the disease, he should at once be placed in a recumbent position, and everything should be avoided which will have a tendency to disturb the mind, as well as the stomach and bowels. In the greater part of cases in this early stage, the administration of the compound pills of camphor, made according to the following formula, is sufficient to prevent a further development of the disease:

Rx. Camphor, } Opium, } [=a][=a]., gr. xxxv. Kino, } Capsicum, gr. v. Conserve of roses, Q. S.--Mix.

Divide into thirty pills, and give one after each discharge from the bowels, or oftener, if the urgency of the case requires it. Occasionally, however, there may be applied a large sinapism over the whole abdomen with advantage. Greenhow's aromatized brandy,[II.] the aromatic tincture of guaiacum,[III.] may sometimes be beneficially alternated with this pill. Should there be an overloaded condition of the alimentary canal, the fluid extract of rhubarb and potassa,[IV.] three parts, with saturated tincture of prickly-ash berries, one part, may be administered in table-spoonful doses every hour, and continued until the bowels are properly evacuated, after which the above astringents may be given; but where the diarrhoea is excessive, it would be imprudent to wait for catharsis, as the discharge should be checked as speedily as possible.

In the second stage, when nausea, vomiting, and cramps are present, more active means should be pursued. To overcome the nausea or vomiting, the preparation of Dr. O. E. Newton, termed in the American Dispensatory compound mixture of camphor,[V.] may be used with excellent effect; it is prepared as follows:

Rx. Camphor water, } Peppermint water, } [=a][=a]., f ounce j. Spearmint water, } Paregoric, f dram ij. Mix.

From a tea-spoonful to a table-spoonful may be given every five or ten minutes; and in cases where this does not act sufficiently prompt, the following may be administered:

Rx. Common salt, dram j. Black pepper, dram j. Vinegar, f dram v. Hot water, f ounce iv. Mix.

Of this a table-spoonful may be given every ten or twenty minutes, and continued until the nausea ceases.

To remove the cramps, hot bricks, or bottles of hot water, etc., should be kept applied to the feet, legs and arms, and cloths wet in water as hot as can be borne, must be applied over the abdomen and changed every few minutes; this should be perseveringly pursued until relief is obtained. Sometimes advantage will ensue from stimulant applications along the whole length of the spine. Cramps of the muscles of the limbs may be overcome by bathing with the compound cajeput mixture,[VI.] either alone or in combination with chloroform, and applying friction at the same time. This course usually checks the further progress of the disease, and the patient is saved; however, should it fail and the stage of collapse come on, in addition to the above treatment energetically pursued, the patient should be enveloped in blankets, wet with water as hot as can be borne, which should be renewed every ten or twenty minutes, and stimulants may likewise be given; the saturated tincture of prickly-ash berries will here be found beneficial, both by mouth and enema."

Dr. Morrow observes, that "to fulfill the most prominent indication, the production of an equilibrium in the circulation, and excitability, the compound tincture of guaiac[VII.] may be given." This is prepared by adding gum guaiacum, cinnamon and cloves--each, one ounce to a quart of best brandy, and is administered in tea-spoonful doses in hot, sweetened water and brandy, every fifteen or twenty minutes till relief is obtained. As a general remedy, its exhibition is most salutary. In some cases where excessive nausea is the most prominent symptom, it may be advisable to administer an emetic to relieve the gastric irritability, to equalize the circulation and check the spasms. For this purpose, the acetous tincture of lobelia and sanguinaria,[VIII.] with the addition of one-third spirituous tincture of aralia spinosa,[IX.] is preferred. This is given in doses from a tea-spoonful to a table-spoonful every ten minutes in warm catnip-tea, sweetened. In very urgent cases, it may be given in larger doses and frequently repeated.

In most cases, the saturated tincture of xanthoxylum fraxinifolium bac. may be used with great advantage. It is a reliable, excellent and prompt remedy. When given in the early stages, it will frequently relieve in from ten to twenty minutes. In combination with the fluid extract of rhubarb and potassa,[X.] it has generally proved very prompt and efficient. In cases of partial collapse, when the patient is suffering from severe cramps, Hunn's Antispasmodic Mixture[XI.] is an excellent remedy. In cases of violent spasms, it has been administered every ten minutes in doses of from one to two tea-spoonsful in hot brandy-and-water sweetened, with great advantage, and it is peculiarly applicable in such cases where there is not too great irritability of the stomach. In many cases, camphor is very beneficially prepared, by adding one drachm of camphorated spirits to a half-pint of cold water and the mixture given in tea-spoonful doses every three or four minutes.

Dr. King states that in the early stage he has used very extensively the following preparation:

Rx. Ox Gall, ounce j. Capsicum, } Gum Guaiac, } [=a][=a]., scruple iv. Leptandrin, dram iv.--Mix.

This was given in doses of one grain, and repeated two or three times a day. He had also succeeded in some cases with a mixture composed as follows:

Rx. Sulphur Sub., grs. iv. Gum Guaiac, grs. ij. Charcoal, grs. ij. Camphor, gr. j. Opium, grs. ss.--Mix.

Dose, one to ten grains, repeated every ten minutes until relief is obtained. In some cases, however, this compound did not appear to exercise any beneficial influence. In cases of excessive irritability of the stomach, oat-meal cake coffee was given, for the purpose of allaying its irritability, with admirable effect. The saturated tincture of prickly-ash berries,[XII.] combined with tincture of opium, was used in some cases as an injection, with very good effect.

Dr. R. S. Newton observes that he had also used a preparation composed of equal parts tannin, capsicum, camphor and kino, with considerable success, to be given in doses of four grains, and repeated at short intervals until the discharges were checked.

He considered the saturated tincture of xanthoxylum fraxinifolium bac.[XIII.] the most valuable of all the remedies for the cholera which he had tested. When the stomach would not retain it, he gave it as an injection. It had a peculiar influence on the system, and having taken the remedy, he could speak from experience of its effects. When given as an injection, the effect produced was almost instantaneous; the sensation was as if he had received an electric shock; its use was very soon followed by a copious perspiration. He had more confidence in this than any other one remedy with which he was acquainted.

Dr. Wright observes that he had also used the neutralizing extract, saturated tinc. xanthox. fraxi. bac., and the compound tincture of guaiac.[XIV.] He had succeeded best with a mixture of equal parts tincture of prickly-ash berries and neutralizing extract.[XV.]

He had always found it necessary to attend strictly to the surface. The best external application he found was equal parts of capsicum, salt and mustard.

Dr. Chase states that, "in the early period of the disease, he had used the leptandrin, combined with neutralizing extract,[XVI.] very successfully. He thinks opium can be dispensed with in the treatment of cholera altogether. In typhoid cases, he pursued an entirely different course, and remarked that many cholera cases presented symptoms similar to those described in Wood's Practice, as belonging to pernicious fever, which must be treated according to their peculiar character."

Such, it is said, is the more general and successful practice in the Mississippi Valley, where the disease has several times prevailed in its most malignant form. For its curative efficiency much is claimed. Its utility, however, must be measured, as in all other cases, by the unerring rule, the actual results sustained by incontrovertible facts. The nearer any mode of practice accords with the general principle of pathology, the greater must necessarily be its success, for it is not in this disease, or in any other, that the bold, energetic and heroic practice, which is inconsistent and incompatible with this principle, cures, however extensively adopted and rigidly pursued. For this principle must direct and govern the practice, or else it becomes necessarily experimental or empirical, and must be inevitably attended with the most lamentable results.