A TREATISE ON CHOLERA, English and Asiatic. WITH DIRECTIONS FOE THE HOMCEOPATHIC TREATMENT. aSM BY P. P. CURIE, M.D. 3f > Prophylactic Treatment 28 Treatment of General Sufferings ftiom thi: Epidemic Influence . 30 Treatment of Choleisine 32 Treatment of Cholera of Middle Intensity . . . 3.3 Treatment of Very Severe Cholera .... 34 Treatment of the Febrile Stage 35 Cases of Asiatic Cholera 37 Allopathic Treatment contrasted with the Homeopathic 42 THE CHOLERA. ENGLISH CHOLERA. The Cholera may be described under two divisions ; Ist, as it appears in temperate and in tropical countries ; 2nd, as an epidemic affection, spreading from warm countries to our latitudes. The first is the ordinary Cholera, or bowel-complaint of hot seasons in temperate countries. In this country it is generally designated by the title of English Cholera. The symptoms of the Sporadic Cholera, in general, declare themselves suddenly and particularly at night. Sometimes it is preceded by general uneasiness, sensitiveness of the abdomen, attended with thirst, want of appetite, flatulence ; soon the patient is seized with vomiting and purging, more or less painful and frequent. At first the vomitings are chiefly composed of undigested food, then afterwards of a liquid, either watery, or glary, or bilious, or finally of pure bile ; they are rarely sanguinolent. The vomitings are acid, and frequently burn the throat in passing. The motions are painful, frequently difficult, and are accompanied with a burning sensation, or sense of erosion, or of tearing pain in the umbilicus. The vomiting takes place at the same time with the stools, or alternately with them. The stools are mucous, or blackish, or yellow, or green, seldom bloody ; they are very offensive, the motions are preceded or attended with tenesmus, and cause burning pain at the lower part of the rectum. The abdomen is sometimes retracted, in other instances it is distended. The pains are sometimes very severe and increased by the slightest touch. In the intervals of vomiting the patient suffers from nausea by hiccough, by eructations, by straining. The thirst is intense ; the throat burning, with great anxiety. The features are deeply b 2 4 altered. The extremities cold, bluish like, whilst the abdomen is burning. The pulse is frequent and small, sometimes nearly suppressed. In many cases the patients experience cramps in the calves of the legs, in the thighs, in the forearms, fingers, and toes. The urine is generally scanty, in some cases it is suppressed ; in some cases painful palpitations are experienced ; in other cases the patients are quite faint, and sometimes are convulsed. In those severe cases the face assumes the character termed hippocratic ; in those cases the body is bathed with viscous sweat, the voice is extinct, the vomiting has ceased, and the patient soon dies. The progress of the disease is rapid, it soon acquires a high degree of intensity, and in a few days the disease terminates, in most cases favourably ; the convalescence is rapid, and in a short time the digestive functions are completely restored. When the reverse takes place, either the patient has been treated injudiciously, or he was previously affected with a chronic disease of the digestive organs. When the disease terminates fatally, the death is attributed to the exhaustion produced by the excessive evacuation, or by the intense sufferings of the patient. Prognosis. — The Cholera is always a serious affection, especially in old age, and in young infants, and persons affected with chronic diseases of the digestive organs, or in persons debilitated by chronic illness. The coldness of the body, the suppression of the pulse, and the great debility, are the signs with the aphonia, which indicate most danger. The causes which appear to have most influence upon the development of the affection is the end of the summer and humid heat ; the disease prevails chiefly at the end of August and September. Irregularity of diet, food of bad quality, new wine, fruit, &c, have also great influence upon its development. Cold drinks whilst the body is heated, or the impression of cold nights after warm days, the inhalation of impure air, such as crowded rooms, or the inhabitation in narrow crowded streets, and bad drainage, have been frequently the causes of Cholera. This affection may attack individuals here and there when it is said to be Sporadic ; but generally it rages epidemically, and many persons are affected at the same period. Moral depression, grief, fear, and anxiety, have great influence also on its development. Treatment. — The treatment of the English or European 5 Cholera should be purely Homoeopathic, as experience amply demonstrates its complete success when properly and timely applied. Chamomilla is one of the best remedies ; it is especially applicable when the vomiting and purging are of bilious and mucous character, and chiefly when the purging predominates, and the stools are preceded by griping, and also when the attack has been brought on by a fit of passion. A drop of the third dynamisation is dissolved in four teaspoonfuls of water, a teaspoonful every hour ; at longer intervals, two, three, four hours, when the symptoms are not very urgent ; in very bad cases, a dose may be given every quarter or half hour. Ipecacuanha, of the third dynamisation is the most applicable remedy when the predominant symptom is bilious vomiting. It is given till the form of the affection changes and requires another remedy, such as chamomilla, as we have just explained. A. drop of Ipecacuanha is mixed in four teaspoonfuls of water, a teaspoonful to be given every quarter of an hour, or every half-hour, or at longer intervals if the symptoms are ameliorated. When the stools are attended with great prostration of strength, and coldness of the body, and when they are of rather a rice-water character, when the patient is tormented not only by pain in the abdomen, but also by cramps in the extremities, Veratrum becomes the best remedy. A drop of the third dilution is dissolved in four teaspoonfuls of water, a teaspoonful every quarter, half, one, two, or three hours, is given according to the rapidity of the progress of the disease ; therefore the more the symptoms are pressing, the more frequently the medicine should be repeated, and vice versa. Arsenic may be of service in extreme cases, when we observe a complete coldness of the body, great prostration of strength, hippocratic face, suppression of the pulse, and great thirst. A drop of the third dynamisation is dissolved in four teaspoonfuls of water, a teaspoonful every quarter or half an hour, or at longer intervals, if the symptoms improve. It is hardly necessary to add, that when the solution of a remedy is finished, another drop should be dissolved, and given in the same manner, if no change in the symptoms indicates another medicine. The dose for young infants should be of course not so much as for young people or adults. One drop in eight teaspoonfuls of water would be quite sufficient ; in 6 children of two or three years, one drop in six teaspoonfuls would be the right quantity. Cupextm is seldom applicable in the treatment of Sporadic Cholera, but still its use may be necessary in cases when convulsions develop themselves. In such case, this remedy should be given alone, or alternated with Veratrum, or Chamomilla, according to the indication pointed out for those two remedies. The dose of Cuprum would be a drop of the fifth dynamisation in four teaspoonfuls of water, a teaspoonful every quarter or half an hour as required, or at longer intervals. To make the treatment more fully understood, we think we cannot do better than relate cases treated by the mode of practice we have just explained. CASES. Mks. S , aged forty-nine. She has been affected several years with a chronic bronchitis, asthma, and at times with gastritis, and ulceration of the leg. During the treatment of her complicated affections, she was seized all at once without any apparent or known cause with severe pain in the abdomen. The 13th of September, 1848, she complained of burning pain at the epigastrium, and of great sinking and lowness of spirits ; her breathing was oppressed ; she had pinching in the abdomen, thirst, and loss of appetite ; there were efforts to vomit, and frequent watery motions. Prescription. — Two drops of the third dilution of Veratrum at a few hours interval. Soon after the first dose all the symptoms changed for the better, and after the second the patient was in her usual state. C , aged above forty, affected with chronic syphilis, disease of several bones, sternum, tibia, &c. During the treatment of his chronic affection, he has been several times attacked all at once with cholerine. On September, 1848, he came to the dispensary and complained of frequent watery motions, not much pain in the abdomen. Prescription. — Verat. two drops of the third dilution in ten teaspoonfuls of water, a teaspoonful every three hours. After the first dose he was already much better, and soon got quite well. On several occasions Veratrum has been completely successful, the symptoms being the same. In other instances C. has been seized with sudden 7 relaxation, watery stools, no pain whatever, but great prostration of strength, pulse very weak, almost suppressed, thirst ; he had a similar attack the 31st of August, 1846. Two drops of the tincture of Secale of the third dilution, in ten teaspoonfuls of water, were prescribed, one teaspoonful every four hours. After a few doses he began to rally, and was soon convalescent. Total abstinence of food was prescribed. The 3rd of September he felt a little weakness, and had a pap-like stool in the morning. China, one globule of the thirtieth dilution was prescribed, and he became quite well afterwards. The 6th of November he was attacked again ; he had a motion every half-hour, he had no pain, but was quite prostrated. Prescription. — Secale, two drops of the third dilution in twelve teaspoonfuls of water, one teaspoonful every two hours. The next day he was much better; the motions still being relaxed. Secale was repeated, one dose every four hours ; he soon got well. On the 14th the patient had another relapse, he complained of griping in the bowels before the watery motions. Veratrum, one drop of the third dilution in five teaspoonfuls of water, one teaspoonful every two hours. On the 17th, the motions were watery; he had no pain, but the stools w r ere almost constant ; there was great weakness ; he had taken only a little arroAV-root. Prescription. — Secale, two drops of the third dilution in twelve teaspoonfuls of water, one teaspoonful every two hours. Since he began the Secale till next day, the 18th of November, he had only five motions ; he took beef tea, and became very restless and thirsty afterwards; the tongue was furred, though the appetite was returning. Pulsatilla one drop of the third dilution in six teaspoonfuls of water, one teaspoonful every four hours ; he was again soon well. The 25th of August, 1 848, during the prevalence of English Cholera in London, he was seized, without any well defined cause, with violent vomiting and relaxed motions, altogether watery, with much pain in the abdomen. He felt quite cold all over, great prostration, cold perspiration. He felt as if life was leaving him ; could hardly move in his bed, pulse almost extinguished ; face sunken. Prescription. — No food whatever, water for beverage. Veratrum, one drop of the third dilution in five teaspooniuls of water, one teaspoonful every three hours. After the first dose, 8 the sickness and diarrhoea ceased, and in the evening all the unpleasant symptoms were removed. The patient remained two days after without any motion ; he got rapidly well. Mrs. E , aged about thirty-six, was under treatment for chronic metritis, and suddenly suffered from relaxation of the bowels, without any known cause, except it were atmospheric influence ; the motions were very watery, and there was a good deal of rumbling in the abdomen ; forcing pain after the motions, with great soreness in the anus ; she also complained of a burning heat in the uterus. Prescription. — Veratrum, one drop of the third dilution in five teaspoonfuls of water, one teaspoonful every four hours. As soon as she began to take Veratrum she became better, and soon got well. Richard H , of about forty, under treatment at the institution for a chronic irritation of the mucous membrane of the digestive organs, and chronic opthalmia ; strong constitution. In August, 1845, without any cause known, excepting the atmospheric influence, the weather being damp, dull, and hot, he was seized with spasmodic pain in the stomach, flatulence, belching, with a very offensive smell, tongue coated, relaxed Avatery motions, spasmodic pain, prostration, pulse weak, irregular. Prescription — Complete abstinence from food ; Veratrum, one drop of the third dilution in five teaspoonfuls of water, a teaspoonful about every three hours. The patient soon felt better, and after the first drop of Veratrum, he was quite well. The medicine had began its beneficial action almost instantly. Miss P 1, came under treatment for a chronic affection of the digestive organs, and soon began to improve in health. She was of a nervous temperament, spare habit, irritable disposition. She had been previously attacked with English Cholera, which was treated successfully with two drops of Veratrum in eight teaspoonfuls of water, a teaspoonful every two or three hours. The chief symptoms were watery motions, cramps in the abdomen, sickness. The 20th of September of 1848, she came to the institution, feeling herself very ill, she could hardly reach the place. She was looking pale, was cold, pulse very small, not very quick. She complained of much sickness, and violent vomiting of bile and watery fluid ; she experienced severe crampy pain in the abdomen, and soreness ; the abdomen was full, distended ; frequent 9 watery motions, soreness at the anus, prostration of strength, cramps in the legs, and despair of recovery. Prescription. — Veratrum, two drops of the third dilution in eight teaspoonfuls of water, one teaspoonful every half-hour. The first dose was given at the institution, and she found speedy relief. She took a second dose, and afterwards was able to return home with comparative ease. She was nearly well the next day. Having eaten something that disagreed with her, she was not so well the 22nd. She had many loose watery motions again without any pain, but great prostration of strength. Prescription. — Secale cornutum, two drops of the third dilution in ten teaspoonfuls of water, a teaspoonful every three hours. The following day the diarrhoea was completely removed, but she did not feel well ; she felt sick occasionally, and grasping pain in the abdomen, the head felt as if it were in a vice ; she experienced a kind of stupor ; was thirsty ; there was a burning sensation of the tongue ; at one time coldness, and then again sense of burning at the epigastrium. She felt very weak, looked very ill, delicate, and thin. She was nervous and irritable. Prescription — Arsenicum, two globules of the twelfth dilution in ten teaspoonfuls of water, a teaspoonful every six hours. She gradually mended under the action of Arsenic, and a few days after we could not find any trace of her acute attacks. Mrs. M , aged fifty, under treatment for chronic affection of the digestive organs and kidneys. In September, 1843, without known cause, she was sick, and vomited bile, and her bowels were much relaxed. After three days' illness, she sent for medical aid ; the motions were frequent, liquid, dark, and attended with much pain in the abdomen, which was distended. She passed much flatus ; she had intense headache ; the circulation was languid, the pulse Aveak, and there was great general debility. Prescription. — Veratrum, a drop in six teaspoonfuls of water, a teaspoonful every three hours. The medicine soon removed the relaxation, and the chronic treatment was resumed. Ann P , under treatment for chronic affection of the spine, and stomach. She was suddenly seized, 6th of August, 1844, with cephalalgia, sickness, vomiting of a bilious nature, loss of appetite, pinching in the abdomen, watery motions. She was low spirited, and felt much debility, great irritability. Prescription. — Abstinence from food ; Veratrum, one drop of the third dilution 10 in five teaspoonfuls of water, a teaspoonful every four hours. The 7th, she had still the headache and sickness, but no more vomiting, the pinching pain in the abdomen, and the relaxation continued, but the motions were less frequent, only two on that day. The relaxation of the bowels ceased under the action of another drop of Veratrum given in the same way; The 10th, she complained of soreness of the throat, and difficulty of swallowing. She seemed very hot ; the skin was dry, especially over the abdomen, much pain across the loins. Prescription. — Belladonna, a drop of the third dilution in four teaspoonfuls of water, a teaspoonful every four hours. After a few days the treatment of her chronic affection was resumed. Mrs. W , aged about sixty, had been under Homoeopathic treatment for chronic eczema, and also for a severe carbuncle. Though on the whole much better, she was very susceptible of cold, which generally shewed itself by coryza and cough. On the 7th of August, 1844, during rainy weather, temperature sixty degrees, she was seized with coryza, with thick greenish discharge from the left nostril, and the bowels became relaxed, the motions were watery, and preceded by griping pain in the umbilical region. These symptoms were severe, accompanied with cramping pain in the legs and fingers. The patient felt generally uncomfortable, with more or less prostration of strength. Prescription. — Total abstinence from food. Veratrum, one drop of the third dilution in five teaspoonfuls of water, a teaspoonful every four hours. Bth. The relaxation continued, but to a less degree, only seven stools since she began taking the Veratrum, the griping also diminished; disagreeable taste in the mouth, tongue coated yellow. Repetition of the Veratrum : she had nine motions in the twenty-four hours. On the 9th, though there was still some gnawing in the lower part of the abdomen, she had only one motion ; and the next day was convalescent. Miss P , aged five, under treatment for chronic enteritis. She is of a delicate constitution, pallid, irritable. The end of October, 1848, she was better of a cold and cough, that she had had for sometime before. Without known cause, excepting the state of the atmospheric constitution, she became affected with relaxation of the bowels, motions very frequent, at first slimy, then very loose, and dark greenish. The tongue was a little furred, the motions were preceded by griping pains : she was thirsty. Prescription 11 — Abstinence from food. Chamomilla, two drops of the third dilution in ten teaspoonfuls of water, a teaspoonful every four hours. The Ist of November : she was better in health, but the bowels continued too loose, the evacuations watery, with griping pain. Prescription. — Veratrum, two drops of the third dilution in ten teaspoonfuls of water, a teaspoonful every three hours. Nov. 3 : she was much better, only one motion. The colour was dark-brown, and it was fetid ; she was still low-spirited, and the tongue still a little furred. Prescription. — Pulsatilla, one drop of the third dilution in six teaspoonfuls of water, one teaspoonful every four hours. The 4th, she was quite well. Prescription. — Pulsatilla, two globules of the thirtieth dilution ; quite well afterwards of the accidental affection. The digestion was immediately restored after the last medicine, which was also given to cure the last symptom of cold in the head, but Veratrum was the remedy which cured the choleric affection. ASIATIC CHOLERA. OF THE CAUSES OF THE DISEASE. Nothing positive has as yet been ascertained as to the causes of Cholera. It is probable that electricity and mineral magnetism have much to do with its production, but this has not been proved, nor the modus operandi at all explained. Long discussions have taken place, and arguments been advanced in support of the theory of transmission of the disease by immediate contagion or by infection. The question is far from solved ; it seems pretty clear however, by the advance of the disease, that its march cannot be at all explained by transmission from one individual to another. When the Cholera prevailed in England, in 1832, the most stringent measures of sanitary quarantine were immediately adopted in France ; the disease did not break out on the coast, as at Calais, but suddenly declared itself in Paris, taking a leap, as it were, over all obstacles offered to its extension into that country. Although we are ignorant of the cause or causes, which give birth to Cholera, we are perfectly cognisant of the conditions, which favour its development and render it more fatal. 12 These conditions are, more especially, the aggregation of people in close places, ill ventilated and badly drained, such as the courts, lanes, and alleys of towns, or the immediate vicinities of rivers, where a humid atmosphere, tainted with bad odours, constantly exists. Food insufficient in quantity or bad in quality, the use of unripe fruit or vegetables, or the abuse of food even of good quality, and the abuse of stimulating drinks, may undoubtedly be reckoned among the causes. The ill condition of health of persons, predisposes to attacks of cholera, especially when the seat of their affection is in the digestive organs. Fear is also a predisposing cause; we should endeavour therefore to calm the anxiety of the population, and the most effectual means of doing this, is to prove to them, that we have powerful means of subduing the disease. I^S SYMPTOMS. The epidemic, termed Asiatic Cholera, presents the following characteristic symptoms: — Vomiting and stools of an aqueous nature, whitish, resembling rice-water, with suppression of the secretion of urine. The pulse is nearly suppressed or altogether absent, blueish colour of the skin, rapid emaciation, cramps in the limbs, frequently great oppression at the chest, and rapid exhaustion of strength. The description we are about to give here of the Cholera, we have obtained from authors who have observed the disease, and from our own observation ; we are especially indebted for this part of our little treatise to the " Cyclopaedia of Medicine," also to Dr. Cruveilhier, and all the Indian authors ; in fact, the description given by them is so perfect and complete, that subsequent writers have only confirmed their account. The disease exhibits great variety in its intensity, and presents itself under various forms. All the affections belonging to Cholera, may be arranged under three principal heads ; First, Cholerine or slight Cholera ; Second, Cholera of middle intensity; Third, Cholera of great intensity. We might add a fourth division, comprising the different morbid phenomena observed in a great many individuals who have escaped the Cholera, though they have suffered somewhat from the epidemic. 13 We shall begin with this last division. The influence of the epidemic has manifested itself, sometimes, by nervous symptoms, such as giddiness, lassitude, numbness, tingling, inability for mental or bodily exercise, sometimes by a febrile attack of twenty-four or forty-eight hours duration, or a continued fever without any well marked local symptoms, followed by uneasiness and want of appetite, which have yielded only to the most strict diet. Most frequently the digestive functions are deranged ; at no other time have so great a number of gastric derangements been witnessed; spasms of the oesophagus, anorexia, vomiting, bilious diarrhoea, nausea, borborygmi, colic, have been experienced, mild purgatives producing violent purging. In a great number of cases, gastritic or enteritic affections, apparently little serious, have been remarkable for their obstinacy, by their tendency to reappear after the least error in diet. Dr. Cruveilhier has published all these remarks in his valuable work on morbid anatomy; he has observed many individuals with or without frequency of pulse, complaining either of a burning sensation, or increased sensibility, or uneasiness at the epigastrium, increased by moderate inspiration, not being able generally to take a full breath ; they also complain of heat, pain, or uneasiness along the oesophagus and pharynx, a desire for cold and acid drinks ; the ingestion of the smallest quantity of liquid produced a sensation resembling a piece of lead in the stomach, lasting for several hours ; at the same time, there are constipation, nausea, and ineffectual efforts to vomit, a little mucus merely being ejected. In many cases the tongue was intensely red on its edges, and coated with a thick fur, becoming clean by desquamation ; convalescence has been long and difficult. In another form where the gastric irritation is more intense, continual anxiety is observed, caused by a peculiar sensation in the centre of the epigastrium, sometimes extending along the oesophagus, and sometimes along the base of the thorax; vomiting being excited by the slightest movement, or the smallest ingestion of liquid. Sometimes the small intestines are the organs chiefly affected ; colic at the umbilicus, or at the hypogastrium. These pains are more or less intense, continuous or intermitting, repugnance for food ; or where the appetite is still possessed there is loss of flesh, with sadness and lassitude ; there may be constipation, or the stools may be natural, with slight nocturnal fever if any be present. 14 In some cases, after several weeks suffering and repeated relapses, the stomach and large intestines, which appeared to be unaffected, evidenced their participation in the affection by vomitings, hiccough, anxiety, or by diarrhoea, the pulse became frequent, concentrated, and the patients have died. This affection is very dangerous ; the irritation of the large intestines with or without colic, has also been frequent, and has manifested itself by bilious diarrhoea. A great number of individuals previously affected with chronic gastro-enteritis, have experienced an aggravation of their symptoms, most likely in consequence of changes made in their mode of living, and not solely from the influence of the epidemic. OF CHOLERINE OR SLIGHT FORM OF CHOLERA. The patient complains of uneasiness and colicky pains in the abdomen, followed by diarrhoea, the stools consisting, first, of feculent matter or undigested food, and subsequently of a bilious character ; a little later the stools assume the choleric character, resembling whey not clarified, or like rice-water, in which broken fragments float ; in some cases the biliary function is increased. The choleric stools are sometimes very abundant, and may be compared to an intestinal perspiration ; the stools sometimes escape like enemata ; these evacuations may be attended or not with colic and straining. Sometimes after the choleric stools, mucous stools are observed, or sanguineous evacuations with straining as in dysentery. The filaments which are found in the fluid stools, either floating or sinking to the bottom of the vessel, are composed of mucus in an altered condition, resembling those observed in some dysenteric stools. The liquid which forms nearly the whole quantity discharged, presents all the physical and chemical characters of serum of the blood. Sometimes cholerine may become very severe without assuming the form of Cholera ; in such cases the evacuations are abundant, Avith intense thirst, prostration of strength, numbness of the limbs, slight cramps and syncope. The choleric stools 15 are sometimes followed by bilious evacuations, these being succeeded by inflammation of the mouth and formation of false membrane. Cholerine may be fatal in becoming chronic, and degenerating into enteritis or even cholera ; generally, however, the affection terminates favourably, if properly treated at its commencement. CHOLERA OF MODERATE SEVERITY. Cholera does not, fortunately, present in every case that degree of severity which attacks immediately the powers of life. We meet with cases which are marked by less formidable symptoms, resembling our Sporadic Cholera; of these cases some yield readily to appropriate treatment, whilst others evidently form the early stages of Cholera of great severity. Cholera of moderate severity, generally commences with symptoms of cholerine, the duration of which varies in time and degree, but becomes at once serious, when the patient is badly fed, and neglects hygienic rules. The transition from cholerine to Cholera, is manifested by vomitings, painful cramps in the extremities, intense thirst, epigastric anxiety, great alteration of features, the eyes sunk deep in the orbits, weakness of voice, tendency to coldness, and sinking of the pulse. The nervous centres are all affected at the same time, and deeply so. The symptoms just enumerated do not show themselves in the same degree of intensity, one or other symptom generally predominates ; sometimes several are absent altogether. The thirst, epigastric anxiety, distortion of the features, the eyes circled and deeply sunk in their orbits, the smallness of pulse, weakness of voice, suppression of urine, and tendency to coldness, are the more constant symptoms. In some cases the stools, vomiting, and cramps are wanting. The stools are seldom absent, and when they are so, it is a bad sign ; their absence does not indicate a lack of secretion, but that the secretions are retained in the body. The abdomen on percussion gives sounds which evidence the predominance of liquid over gaseous contents. The vomiting with efforts more or less violent, and continued nausea, are sometimes the predominant symptoms; they are seldom absent, the matter vomited has not that constant character which 16 is exhibited in the stools ; frequently the liquid is green, seldom resembling rice-water ; sometimes they merely consist of mucus, but are more frequently liquid of a yellow colour, the vomitings alternate generally with the hiccough. Suppression of urine is a constant symptom of Cholera; in many cases retention of urine follows its suppression; frequently urging to micturition precedes several hours, or even a whole day, or more, the excretion of urine. Cramps are perhaps the symptoms least constant in Cholera; when these predominate they constitute the essential character of Spasmodic Cholera ; the cramps generally begin in the muscles of the feet, and extend more or less rapidly to the muscles of the legs and thighs, the upper extremities, the abdominal walls, chest, and muscles of the jaws ; they are extremely painful, and more or less permanent, tonic and clonic at the same time occurring at various intervals, persisting sometimes to the last moment, and sometimes giving place to the state of collapse. The epigastric anxiety is one of the most constant symptoms. If patients are asked to describe this pain, they point to the epigastrium or sternum, and complain of an indescribable sensation of oppression, sickness, prostration, and sometimes burning heat. This anxiety is frequently more difficult to endure than the cramps, and gives rise to restlessness and sighing, with a total indifference to their state, and frequently a feeling of approaching death, with desire for that change. The countenance of a Cholera patient is so characteristic, that this alone suffices to establish the diagnosis in most cases ; the eyes are deeply sunk in their orbits, the face of an earthy or leaden hue, sometimes purple, the cheeks and lips have a tendency to blueness, the features are painfully contracted, attended with rapid emaciation. The voice is much altered and weakened ; it is hoarse, hollow, and broken, announcing a great alteration in the powers of life ; the pulse sinks, and more accurately than any other symptom, indicates the degree of danger of the patient; when the pulse is absent for any considerable time, the danger is very great. The cramps and vomitings may suppress it for a moment, but it rises again on their cessation. It is on the sinking of the pulse the concentration commences, and on its reappearance the reaction begins. The breathing does not exhibit a constant character, it is normal or accelerated, but always incomplete, and does not serve to completely vivify the blood. The coldness is a consequence of 17 the concentration of the organic action towards the interior ; in no other disease is it of the same degree ; it is generally attended with copious perspiration and blueness of the body ; this symptom, coldness, is only complete in extreme cases, and bears a proportion to the severity of the case. Cholera of middle intensity, when not degenerating into the state of asphyxia, presents two marked periods, viz., first, period of concentration ; second, period of reaction ; the latter is always in proportion to the former as to its severity. The reaction may be incomplete or only temporary, and the case may terminate fatally. Frequently the typhoid form supersedes the choleric state, and may follow any form of Cholera, from the slightest to the most dangerous. It is especially fatal in old age, in sickly persons, and those previously affected with chronic gastritis or enteritis. SEVERE CHOLERA. The most dangerous kind of Cholera is in reality the same as that last described, only more intense. It presents itself under two forms well defined ; sometimes the patients are blue as in asphyxia, and sometimes this appearance is absent. The first has been designated by the name of " blue Cholera," or asphyxia, or " algid," on account of the coldness of the body ; the second may be called the non-asphyxiated form ; in this form the circulation and the chemical process of respiration are not quite suspended. The insensibility of the surface of the body, and the state of its circulation are well indicated by several circumstances. Leeches will not draw blood, blisters and mineral acids, and boiling water applied to the skin, have no effect, nor is the patient sensible of their application. Hiccough, jactitation, and a sensation of heat, impelling the patient to throw off the bed clothes, notwithstanding the actual coldness of the surface. Generally the invasion of this form of Cholera has been preceded by some indisposition that can be traced, if we examine with care the previous state of health of the patient. The invasion of the state of asphyxia is in most cases sudden ; the patient is seized with violent vomitings and purging ; it seems that the whole contents of the stomach r: 18 and intestines are evacuated immediately; the vomitings and purgings of rice-water-like fluid follow as heretofore described. The patient is tormented with severe and painful cramps ; at the same time, or soon after, he is seized with intense coldness, and viscous sweat and blueness of the skin, especially of the face and extremities, the pulse is nearly or entirely suspended, the patient appears in a state of passiveness, interrupted by screaming on account of the violent cramps, or sighing on account of the epigastric anxiety, which is extreme ; the face is distorted in a frightful manner, the features are drawn, the eyes sunk in their orbits ; the voice is hollow, weak, almost extinct; it is with the greatest effort that the patient can articulate a few faint words. The voice is designated by the term " sepulchral" which is characteristic of Cholera. The patient is tormented by intense thirst for cold drinks, although the tongue is moist. The tongue is also icy cold, characteristic of the disease, which symptom is met with in no other disease to the same extent. The patient is in a dreadful state of anguish ; he has great pain at the epigastrium and sternum, cannot bear the clothes. The breathing is variable, sometimes quick, and at other times slow ; sometimes it appears normal, the air expired is quite cold. The stools are either abundant, suppressed, or involuntary. The urine is suppressed, the veins are empty, the circulation appears to be limited to the region of the heart. At the height of the disease the patient presents the appearance of a corpse, the eyes half open appear decomposed, the humour partly absorbed, or has evaporated. The sclerotic coat is dried up under the lower lid, and at the points in contact with the air. The patient lies motionless, and appears to be kept alive only by the little remaining circulation and respiration. The livid skin has lost all its tonicity ; when pinched it retains the impression of the ringers like a corpse. Notwithstanding these cadaverous appearances, the vitality is not destroyed, but merely oppressed. The patient still hears, the intellect is complete, and when the patient is roused, the ideas are perfectly clear. Muscular power is only oppressed, for if tormented with cramps or anguish, he moves sometimes violently, or if seized with a violent inclination to stool, he leaps from his bed with an energy which could not be anticipated. This apparent state of death may last several hours, or even a day or two, in some cases. The patient generally 19 dies in this state ; sometimes the reaction is salutary, and restores him to life again. In a great many cases the reaction only commences, the state of asphyxia soon predominating. In many cases, the reaction saves the patients from immediate death ; but they die in a typhoid state, which supervenes. Frequently when the patient is restored, he is afflicted with chronic gastro-enteritis, most difficult to eradicate. The varieties presented by the patient are very numerous, but the characteristics of the disease remain the same. Sometimes vomiting predominates, sometimes the purging, and at other times the epigastric anguish, and nausea, without vomiting, a sensation of suffocation, with either a sensation of a bar across the chest, or tearing pain at the same region. Sometimes the cramps are the principal symptoms ; painful contractions are excited on the slightest movement, or sometimes without, not only in the muscles of the limbs, but also of the trunk, the abdomen and diaphragm, and the muscles of the chest, neck, and jaws ; the patient cannot help screaming with pain, the cramps fly from one part to another, and death sometimes occurs during one of these contractions. In some cases these dreadful cramps are the only symptoms presented. The most fatal variety is the following : the patient is seized all at once with icy coldness, he feels no pain, has no vomiting, one or two liquid motions occur, and death follows without the least sign of reaction. Algid Cholera, without asphyxia symptoms. This form offers more chance of success than the preceding one. The symptoms occur successively, not simultaneously as in Cholera asphyxia, the blueness of the body is absent, all the other symptoms are similar, but the circulation is not entirely suppressed, as in asphyxia. Reaction, although difficult to obtain, is not so rare as in the preceding form. Symptoms of the Febrile Stage. — The preceding stage, in most instances, makes a very gradual transition into the present one. After the patient has remained in the collapsed state, probably for a considerably longer time than the medical attendant expected, some degree of warmth will be found returning to the surface, and the pulse is proportionably developed, being very perceptible at the wrist, about eighty, and soft ; the vessels of the conjunctiva gradually become distended with blood, or if those of the inferior hemisphere have been so c 2 20 during the stage of collapse, the distension now diffuses itself over the whole membrane ; the patient, who on his attention being roused, is perfectly sensible, complains of severe pain in the head, of a sense of giddiness, and that the light distresses his eyes. The tongue in this early stage is clean and moist ; the bowels are readily acted upon by medicine, and the discharges are feculent, and though somewhat clayey, contain a proportion of bile ; but the urinary secretion is sometimes either not restored, or is considerably deficient for a day or two after the establishment of fever. In the progress of fever, the tongue becomes black and sordes accumulates about the teeth ; the eyes become more and more injected, the intellect more and more torpid ; though the patient can be roused to answer questions, and even may make one or two sensible remarks on his condition; but the instant the conversation ceases, the eyes are turned up in the orbit, exposing through the half-closed eye-lids the red sclerotica, and the patient is in a state of profound stupor. The urinary secretion is now established, and the urine which at first was dark coloured and cloudy, is now limpid and pale ; the alvine discharges are darker than at first ; and throughout the disease there is a deficiency of vascular action and of temperature, which is not observed in any other kind of fever to the same extent. However flushed the countenance may appear, the temperature of the surface is below the standard, and the pulse is seldom above ninety. Typhoid is not an inappropriate designation of the condition just described, but the deficiency of vascular and caloric power, the peculiar vascularity of the eye ; the absence of subsultus, and of muttering delirium, and the condition of the intellect being throughout much more one of torpor than of irregularity, would be the marks by which that typhoid form differs from typhus fever. The duration of such a febrile stage is from a week to ten days. Its termination has been, in a considerable majority of instances, fatal. In another form, and one which supervenes in a minor degree of a collapse than the preceding, the symptoms do not differ from those described above, excepting that there are indications of greater excitement, more warmth of surface, and greater force and frequency of pulse. The mildest and most tractable type of the febrile stage was denoted by symptoms of general but moderate excitement, with 21 epigastric pain or pressure, headache and giddiness ; the tongue being at the same time either clean with a disposition to become dry and glazed, or slightly white and furred ; the skin warm ; the pulse free and forcible ; the urine high coloured, and the thirst considerable. In such a case there is little or no confusion of thought or delirium, and the eyes are not injected. MORBID ANATOMY. OF THE EXTERNAL PAKTS OF THE BODY The appearance of the bodies of those who have died in the blue stage, differs little from the description we have given of the state in life when the appearance so nearly resembles that of a corpse. The muscles are very rigid ; in some cases the fingers are separated, the upper and lower extremities are more or less bent. The appearance of Cholera continues to be visible after death. The globe of the eye is withered, as in bodies in which life has been extinct several days, the desiccation of the sclerotica continues, and affects all the portions in contact with the air. The blueness of the skin is less marked, and not so general as in life, the cyanotic appearance is confined to the face and extremities. The coldness of the skin is less intense after death than during life, owing to the absence of the clammy sweat. In several cases, eighteen hours after death, the heat of the body was still retained, as in death from asphyxia. The putrefactive process is slow, as in all subjects who have lost much blood ; the putrefaction of the digestive canal, however, is rapid, as in all cases of sanguineous congestion in the digestive organs. OF THE DIGESTIVE CANAL The mucous membrane of the mouth, pharynx and oesophagus is slightly blue, the follicles of the oesophagus are much developed. Peritoneum. — The surface of the peritoneum is dry, the liquid secreted is viscid. In a great number of cases the surface of the stomach and intestines exteriorly is remarkable for its colour. The peritoneum in a cyanotic state, as well as the skin, 22 frequently bands of injection, with small arbontations, are seen along the course of the intestines, as in peritonitis. Stomach. — This organ is sometimes contracted, the larger extremity almost as small as the rest ; in other cases, the contraction exists only at the pyloric extremity; sometimes the stomach presents the usual appearance. The liquid contained in the stomach varies in quantity and quality ; most frequently it is clear, yellowish, or greenish, mixed with albuminous particles ; in a contracted stomach not a drop of fluid was found, but its internal surface was lined with a thick coating of mucus, very adhesive ; the mucous membrane is not so frequently nor so deeply affected as the intestines, it was often found in a perfectly natural condition ; in other cases, the follicles were much developed, sometimes in the vicinity of the pylorus, at other times near the oesophagus, and occasionally on the whole surface of the stomach. The mucous membrane is occasionally found of a pale or a pink colour, uniformly injected ; in some cases the colour was found red with dots, and appearing in patches spots or bands along the folds of the mucous membrane. Sometimes there was ecchymosis, and occasionally the stomach was much inflamed. Small Intestines. — These were found contracted to a considerable extent, and here and there strangulated; in some cases the intestines were without any inflammation. In many cases where death had occurred in the blue stage, the intestines were found full, and even distended by an enormous quantity of choleric liquid ; several of these had been cases of what is termed the dry cholera. When the patient dies after the collapse stage, and after the reaction, no liquid is found, but a pultaceous mass, more or less abundant, of a greenish or yellowish colour. The mucous membrane of the small intestines presents very variable appearances. The development of follicles is not constant, in some cases the isolated follicles are alone developed. In some cases the conglominated follicles were alone affected, occasionally much inflamed, and even affected with gangrene. The colour of the mucous membrane presents every variety of shade, from pink to dark red. In some cases it is uniformly pink, as in persons Avho die during the process of digestion ; in others the colour is not uniform, and ecchymosis has been found to a more or less extent. It is chiefly near the ilio-coecal valve that the traces 23 of sanguineous congestion are most marked, the redness gradually diminishing in intensity from the valve to the other portions of the membrane, the more extensive the redness, the less intense it appears. Large Intestines. — These are most frequently and deeply affected ; their size varies much, sometimes they are much distended by liquids, and sometimes contracted in some portions and distended in others. The liquid resembles rice-water in those cases where the patient has died rapidly, and in large quantity only when the evacuations have been suppressed. When the disease has been of several days' duration, the liquid is less pure, and sometimes mucus only is found in the large intestines ; it presents different colours, and is sometimes sanguineous ; in those who died sometime after the period of reaction, a pulp was found of a greenish or yellowish tint, and in consistence similar to the meconium. The mucous memt -ane is variously coloured, sometimes it is natural in appearance, and at others presents the colour of the hortensis ; sometimes it is minutely injected with a fine arborescent appearance, with ecchymoses, more or less numerous. The coloured appearances may be found only near the ilio-ccecal valve, or it may extend over the greater part of the large intestines ; occasionally gangrenous spots of an elliptic form are observed. The follicles are frequently much developed, especially in the vicinity of the ilio-ccecal valve ; they are always perforated in the centre ; this is indicated by a small black dot. In some cases these follicles are surrounded by a red circle, which on examination, with the aid of a microscope, shows a fine injection of the vessels. The Spleen is small, denseless, more easily torn than in the natural condition ; it appears as if the blood had been squeezed out. The Liver is engorged with dark blood, but irregularly, and presents the marbled appearance. The gall bladder is found distended by a pitchy bile. The kidneys are sound. The bladder is contracted, and entirely empty in those who have died in the collapse state : some urine is found when death has occurred during the period of reaction. Organs of Circulation and Respiration. — The heart is in a state exactly similar to that when death has resulted from asphyxia. The right cavities, and the left auricle are distended 24 by a large quantity of blood ; the left ventricle is sometimes slightly dilated, but more frequently quite contracted, not a drop of blood being found in it. The large arteries are filled with fluid blood, the small arteries are found empty ; the venous system, particularly in the abdomen, is gorged with blood. The physical condition of the blood is very remarkable. The serum is absent, and its consistence is similar to currant jelly much boiled, and therefore less consistent than in its natural state. The blood, which is very dark, becomes less red on contact with the air, than generally in other diseases. The respiratory organs are found perfectly healthy, the lungs are dry, no crepitation is felt, and no serosity, as in cases of death in agony, and attended with rdle. The large vessels, both arteries and veins, are more or less engorged with black blood. The mucous membrane of the bronchia is of a blueish colour in those who die of Cholera asphyxia. NERVOUS SYSTEM. Luain. — The arteries and veins of the integuments covering the cranium, were distended with dark blood, which, in some instances, flowed like tar. In several cases the bloodvessels of the dura mater were tinged with this blood ; in other cases, serous effusion under the arachnoid membrane was found, frequently the pia mater was congested with bloodvessels. In some cases the cerebrum was highly vascular, and it has been found in a softened condition. Spinal Column. — Serous effusion was found between the theca vertebralis and arachnoid membrane ; in one case the fluid was bloody. In some cases the serous effusion was between the arachnoid and pia mater. In several cases the bloodvessels of the spinal cord were found highly injected with dark blood, and in one case, inflammation in the dorsal and lumbar regions. The spinal cord was tinged with dark blood. Ganglionic System. — The neurilema of the pneumogastric nerve was injected with bloodvessels. In one case the nerve was found enlarged ; in another case, thickened ; and in another, the neurilema was inflamed, with eeehymosed patches. The neurilema 25 of the splanchnic nerves was vascular, the ganglia at their origins were vividly injected ; one ganglion was ecchymosed : in a great number of cases, one or both of the semilumar ganglia were vascular, in one case it was inflamed ; in several, enlarged and infiltrated with blood or serum, and in two cases, softened. The solar plexus was highly vascular throughout, sometimes enlarged and infiltrated. In several cases the renal plexus was highly vascular, the cesophagial also ; in one instance the recurrent nerve of the pneumogastric was vascular. In several cases the cardiac plexus was enlarged and highly vascular. The researches of Professor Lizars agree perfectly with those of Delperch, Dr. Coste and Dr. Lowenttayn; it would be useless to repeat the result of these researches, being about the same as those of Professor Lizars. We refer the reader to the letter of Professor Delperch to Professor Lizars, which the latter has placed at the commencement of his interesting pamphlet on Cholera asphyxia. NATURE OF THE DISEASE. Before making any attempt to discover the nature of the disease called Cholera, it is necessary first to determine what we are to understand by the nature of disease in general ; it will be easy then to see whether the data thus obtained will apply to Cholera, or whether we should abandon, altogether, researches on the nature of the disease. The nature of disease is, according to our view, determined by a knowledge of the modifications of the organism and its functions, during the existence of the diseased condition. A knowledge of the cause, producing the diseased, state assists, by as much as it throws some light on the subject, but is not essential to a knowledge of the disease itself. We believe, on the principle just enunciated, that a tolerably correct idea may be formed of the nature of the disease called Cholera, by observing the modifications in the organism presented to our view during the reign of the disease. The symptoms presented indicate the withdrawal of the vitality from all the more external parts : the circulation in the skin and subjacent tissues is 26 arrested, the temperature is so far reduced as to be almost annihilated ; the organic functions are suspended, more or less completely, according to the intensity of the disease ; in severe cases tonicity is altogether lost, folds may be formed in the skin, as in a lifeless body, those folds not disappearing. The surface is covered with cold perspiration, the fluid thus appearing is not produced by an activity of the secreting property of the skin, but is the result of mere mechanical transudation. As a proof of the want of vitality in the skin, (ordinarily an active secreting, and sentient organ,) it is insensible to corrossive liquids, as acids ; and to powerful irritants, as blisters, mustard poultices, &c. Boiling water, also, has little or no effect upon it ; such is now its insensibility. The face presents a death-like appearance ; life appears extinguished ; the eyes have lost their natural appearance, and seem withered ; the mouth is icy cold. Vitality seems, as with the skin, to have left more internal organs ; the circulation not only ceases at the exterior, but large vessels cease to receive their due supply of blood ; arteries of a considerable size have been cut, and no hemorrhage has resulted. The lungs continue to act mechanically, more or less ; but the most important function, the process of vivification of the blood, is remarkably diminished, and, in extreme cases, altogether suspended. Complete asphyxia results. This state explains the cyanotic condition of the skin and mucous membranes. The kidneys cease to perform their office ; hence there is no secretion of urine, the bladder is empty.. The brain itself, so far as the function of inervation is concerned, is almost arrested in its action on the external organs ; the act of inervation appears to be entirely performed through the sympathetic which animates the digestive organs ; in them the circulation is over active, all the blood being thrown upon them. The feeling of heat is extreme ; the patient complains frequently of an intense burning sensation, sensibility is increased to a high degree. It is not necessary to attempt to demonstrate the over-activity of the mucous membranes, this is sufficiently proved by the enormous quantity of choleric fluid secreted. The spinal cord, in order to furnish the nervous power incessantly demanded by the sympathetic system, has its circulation more active than in its ordinary physiological condition ; 27 we can readily understand from the over-activity of this organ why cramps and convulsions so frequently affect the muscles of the limbs and trunk. This activity of the spinal cord explains, also, how a patient in a state of apparent death, will suddenly rise from his bed, and go to the night-chair without assistance. Morbid anatomical appearances completely coincide with the foregoing description of the states of diseased organs during life. We need not re-examine separately each organ here, but refer the reader to the chapter on the subject. We will merely remark, " en passant," that the appearances presented in dissections after death from Cholera fully prove that there is a most copious concentration of fluids in and about the digestive organs, which explains what has been stated in reference to the phenomena of the disease. The conclusion arrived at is ; that in the disease called Cholera, there is a powerful concentration of the life power towards the digestive canal, in order to expel from the system the results of a morbific cause acting on the organism, which concentration may with propriety be styled nature's own effort. In the treatment, these efforts must be assisted, hence it will be easily understood how perfectly rational is the Homoeopathic treatment, in which the grand object is to support the organic action set up by nature to aid the invaded organism. In Cholera it is obvious, as we have just seen, that all the vital power is concentrated in the digestive organs ; therefore we must choose medicines which are calculated to assist these efforts of nature ; they are chosen from the class of medicaments which act powerfully on the digestive organs, such as arsenic, veratrum, cuprum, &c. PROGNOSIS. Cholera is one of the most dangerous diseases known. The records of every country bear testimony to the correctness of this opinion. Its ravages are awful, especially at the outbreak of the epidemic. The danger of the disease is to be estimated by the degree of collapse attending the cold stage. To be accurate in prognosis, 28 it is necessary to take into account the mode of treatment adopted for the disease. The Allopathic or ordinary treatment is, in the majority of cases not only unsuccessful, but absolutely dangerous — often fatal. Treatment of the most opposite kinds is recommended. Empiricism, the most deplorable is the guide of practitioners ; no positive rule, no real principle is acknowledged as a basis of treatment. The treatment is, alas ! left entirely to the caprice of the practitioner ; hence the immense danger of the disease. The Homoeopathic treatment is based on a fixed principle — a laic of nature, which can therefore never vary, never err. The disease, therefore, may be ranked among dangerous diseases, but by no means so fatal as might be expected from what is seen in every country where the Allopathic treatment is applied. Treated Homoeopathically •, and promptly so, the great majority of cases are curable. The sacred duty, therefore, of the profession, in the event of the Cholera breaking out in this country, is to apply Homoeopathy ; or if medical men, from prejudice, or other circumstances, obstinately refuse to put into practice the only safe treatment, we appeal to the public at large, whose interest it is to avert the fatal consequences of the epidemic, when abandoned to nature entirely, or treated by drugs, which are so uncertain in their result. Statistics have been officially furnished, which prove beyond all doubt the superior efficacy of Homoeopathic treatment in Cholera, as well as in every other known disease. PROPHYLACTIC TREATMENT. Experience has proved beyond all doubt the efficacy of Homoeopathic medicines administered as prophylactics. Few who have employed them with the view of preventing an attack, have failed. We must not, however, expect to prevent the disease in every case. Vaccination sometimes fails in preventing •the small pox, hence we must not be surprised if exceptions are met with in regard to Cholera. Veratrum and cuprum are the medicines which promise most 29 fully to prevent an attack. Two globules of the twelfth dilution of each medicine should be taken alternately every fourth day. When cholera prevails in the form of asphyxia, arsenicum should be taken alternately with the two preceding medicines, and at the same intervals and like doses. Should the medicines thus taken produce any marked phenomena, the interval between the doses should be increased a day or two. When persons are daily in attendance on cholera patients, it is advisable to rub the hands and face occasionally with camphorated alcohol, and to take, internally, one drop of the tincture when near the patient. This last advice is especially useful to persons who are much under the influence of fear and apprehension of taking the disease. During the prevalence of the disease, the regimen should be, in all things, moderate ; but it is important not to change too suddenly the habits of living, unless decidedly improper. It is advisable to abstain from stimulants, such as wine, brandy, beer, cyder, and acids, especially when persons are affected with chronic diseases of the digestive organs. Such persons should also abstain from veal, pork, geese, ducks, lobsters, &c. Fruits should be eaten very moderately, and if not in a ripened state, should be altogether discarded, especially by persons whose bowels are readily disordered. As a general rule, persons should be recommended to make choice of those aliments which they most easily digest. When under the influence of Homoeopathic medicines, spices, acids, tea and coffee, should be refrained from. Persons accustomed to take wine, should now take it in moderation. Warm clothing is essential ; and sudden transitions from heat to cold should be avoided as much as possible. By additional clothing we are guarded against suffering from sudden changes of temperature. Fatigue of body or mind should be avoided. Fear is pernicious ; the physician should endeavour to counteract its influence by inducing confidence in the minds of the people, which confidence is the more animating when founded on a solid basis — the success of Homoeopathic treatment. 30 TREATMENT. What has been advanced as to the nature of the affection is applicable to the treatment. If the reason why there is a cessation of the circulation and warmth of the surface be understood, we shall no longer depend on external applications for restoring these functions. We must have recourse to internal means which directly attack the cause of external coldness, that cause being removed, warmth reappears. A moderate heat should be maintained about the patient, in order to prevent his body becoming colder by contact with an atmosphere of a lower temperature. The same remark applies as to the inutility of irritating substances or frictions to the skin ; these are altogether impotent to influence the cause of the internal congestion, and therefore absolutely unable to restore vitality in the exterior. Food should be abstained from, not only because every thing taken would be either vomited or passed by stool, but because if retained it would be dangerous, inasmuch as the intestinal canal would be excited to an organic action, which would impede the pathological phenomena necessarily set up for the removal of the morbific cause. The patient should not be allowed even the smallest quantity of solid or liquid food, notwithstanding his exhausted condition ; a little fresh water alone should be allowed, and this in small quantity at a time. The patient should be kept in a room well aired and moderately lighted, and of a moderate temperature ; no fumigation of any kind should be allowed, being perfectly useless to the assistants, and obnoxious to Homoeopathic medicines. Particular attention should be paid to the selection of the remedy suitable to the stage of the disease, for success depends on the remedy being applied in due time. All the organic actions should be well remarked and followed with great care, as according to their nature or intensity, the medicine should be chosen. We are about to review the medicines which have hitherto been prescribed by Homoeopathic practitioners who have had the opportunity of treating this dangerous disease. The treatment 31 must be suited according to the divisions herein established in describing the disease. In the case of persons not suffering from an actual attack of Cholera, but who are influenced by the prevalence of the epidemic, nux vomica is suitable when the patient complains of giddiness, lassitude, tingling, cramps, and inability for mental or bodily exertion : two globules of the twelfth dilution should be given, and repeated if necessary in twenty-four or forty-eight hours afterwards. When the patient is attacked with fever, a drop of the tincture of aconite of the third dilution in four teaspoonfuls of water, a teaspoonful to be taken every three or four hours, according to the violence of the fever. If the gastric functions are deranged after aconite, two globules of pulsatilla of the twelfth dilution in water should be given in one dose if the patient complains of headache, loss of appetite, and tendency to relaxation of the bowels ; his tongue being furred, and his spirits depressed. If the bowels are relaxed, with bilious motions and colicky pain, chamomilla should have the preference ; one drop of the third dilution in four teaspoonfuls of water, one teaspoonful to be taken every three or four hours. When the patient complains of a burning sensation or over-sensitiveness in the epigastric region, nux vomica, two globules of the twelfth dilution should be given ; and if no good result is obtained, arsenic, two globules of the twelfth dilution should be given twenty-four hours after the nux vomica. The diet in such a case should be extremely moderate. When the tongue is very red, the thirst considerable, with nausea and costiveness, a drop of the tincture of nux vomica in four teaspoonfuls of water, one teaspoonful every four hours. When the gastric symptoms are more intense, with continual anxiety, vomiting excited by the slightest movement, or ingestion of liquid, arsenic should be administered ; a drop of the tincture of the third dilution in four teaspoonfuls of water, one teaspoonful every two, three, or four hours, according to the urgency of the symptoms. When the small intestines appear affected, and the patient complains of colic, more or less intense, colocynthis is of great service, the fourth part of a drop in water every three or four hours ; but if the costiveness be obstinate, nux vomica should be preferred to colocynthis, given in the same way, the latter medicine being suitable if the stools are relaxed. When the patient is very low spirited, with loss of appetite and repugnance 32 for food, pulsatilla, two globules of the twelfth dilution is advisable, the dose repeated twenty-four or forty-eight hours after if required ; and if the symptoms are intense, a fourth of a drop of the tincture should be given in water every four hours. Bilious diarrhoea is treated with pulsatilla, a fourth of a drop in water every three or four hours. When the patient experiences much pinching and sometimes forcing pain, mercurius should be preferred in tincture in the way described for pulsatilla. Persons affected with chronic gastritis or enteritis, when their symptoms are aggravated, should strictly follow the regimen prescribed in case of prevalence of Cholera, and no time should be lost in applying to their medical attendant. When Cholera begins by what is termed cholerine, consisting of looseness of the bowels^ the stools being bilious, we should begin with pulsatilla ; one drop of the third dilution in four or six teaspoonfuls of water, according to the age of the patient, one spoonful given every two or three hours, guided by the frequency of the stools. When there is much griping, chamomilla of the third dilution should have the preference, doses as described for pulsatilla. As soon as the stools assume the serous character, phosphoric acid should be substituted for these remedies ; a drop of the third dilution in four or six teaspoonfuls of water, a teaspoonful given and repeated every one, two, or three hours, in proportion to the rapidity of the disease. When the pains are sharp, and the prostration already considerable, veratrum should be preferred, given in the same manner. Although the patient during this stage does not appear very ill, every kind of food, solid or liquid, should be denied ; a little water, or weak toast and water should alone be allowed. When the disease at its onset shows itself under a milder form with spasmodic colicky pains, biliary evacuations, with sour or bilious vomitings, the tongue more or less coated, with great thirst, chamomilla is the suitable remedy ; a drop of the third dilution in four teaspoonfuls of water, one teaspoonful given every half hour, hour, or at longer intervals, as the symptoms become less urgent. If the vomitings should predominate, ipecacuanha should be preferred. When the colic and diarrhoea are the most marked symptoms, chamomilla is the remedy. The last two medicines are given in the same way as directed before, but these are only applicable at the commencement of the disease, and in slight attacks. Sometimes after the 33 choleric stools, mucous or sanguineous evacuations are observed ; in that case, as well as in the cases where false membrane is formed in the mouth, mercurius is the best remedy ; a drop of the fifth dilution in four teaspoonfuls of water, one teaspoonful every two or three hours, or more frequently if symptoms are very urgent. In severe cases of cholerine, when the patient has copious liquid stools, with rapid prostration of strength, with cramps, numbness and convulsions in the limbs, secale cornutum is the best remedy ; one-fourth of a drop of the third dilution in water every half hour, or less frequently if the symptoms are not urgent, or diminish under the influence of the remedy. In cases of extreme prostration, it would be well to administer one globule of the thirtieth dilution of secale every two or three hours, and to continue the secale in tincture, omitting a dose of the latter occasionally to substitute the globule, resuming the tincture in half an hour or an hour afterwards, as the case may be. CHOLERA OF MIDDLE INTENSITY. We have seen in the foregoing description of Cholera, that the disease presents great variety in the mode of its attack, and in the symptoms during its progress. At the commencement of the disease we frequently find camphor very useful under the following circumstances : — The patient is attacked rather suddenly, feels icy cold all over, a state of stupor, with great anxiety, and a feeling of great oppression at the chest exists at the same time ; his strength is prostrated, his looks wandering, the eyes are hollow, he complains of burning sensation at the epigastrium extending to the throat, and cramps in the calves of the legs. The tincture of camphor should be administered immediately ; a drop every five or ten minutes, according to the rapidity of the symptoms. As soon as the characteristic evacuations appear, other remedies should be employed. If a medical man is present at the commencement, pulsatilla, one or two globules of the twelfth attenuation might be immediately given when the vomiting consists of food previously taken. As soon as the characteristic rice-water fluid is vomited, diarrhoea of a loose nature being present, and the cramps developed in different parts of the body, veratrum must be instantly resorted to ; a D 34 drop of the third dilution in four teaspoonfuls of water, one teaspoonful given every half hour or hour, or less frequently, if the symptoms are less urgent. Cup) urn is indicated after or before veratrum, when the patient has violent convulsions ; a drop of the fifth dilution in five teaspoonfuls of water, a teaspoonful every half hour, or less frequently as the symptoms diminish. Generally it will be necessary to give these two medicines alternately in similar doses, and at like intervals. Food and stimulants of every kind must be forbidden, only a little water may be given if the patient desire it, and this in very small quantity ; moderate warmth may be kept about the patient, and friction Avith the hand may be applied to the parts affected with cramps, these frictions ease the patient's sufferings a little, and give him more confidence to bear them. VERY SEVERE CHOLERA. In the most severe form of Cholera, veratrum should not be insisted on if it does not succeed rapidly, arsenic is now the chief remedy ; the fourth of a drop of the third dilution in water should be given about every half-hour, or oftener, if no change take place under its action ; in such cases, a globule of the thirtieth dilution of the same medicine should be given every two or three hours, choosing the intervals between the doses of tincture, its administration to be continued until signs of reaction take place. If arsenic does not produce any effect, and the patient continues to sink notwithstanding its use in asphyxia, carbo-vegetabilis should be given ; a drop of the fifth dilution in four teaspoonfuls of water, a teaspoonful every quarter or half hour, and after a few doses to alternate with a globule of the thirtieth dilution placed on the tongue. If the vomiting and diarrhoea have not ceased altogether, a spoonful of veratrum should be given about every hour also, choosing the suitable intervals between the doses of carbo-vegetabilis, which would be suspended only for awhile, to be resumed afterwards ; during this period nothing but cold water should be allowed to the patient, moderate warmth should be maintained about the patient, and the less he is moved the better. This remark applies to the other periods of the disease. Camphok, which we have seen, is the first remedy at the beginning 35 of the disease, is also an important one when the affection is attended not only with trismus, but general convulsions and cramps, tetanus, and loss of consciousness, coldness of the body, with bluish skin, pulse slow and hardly perceptible ; a drop of the mother tincture should be administered every five or ten minutes ; if the patient is unable to swallow, the drop should be placed between the lips and gums, or if possible on the tongue, when the patient is a little better of these formidable symptoms ; if trismus and spasms, with almost entire inability to swallow, continue, Belladonna should be resorted to ; a drop in four teaspoonfuls of water, one teaspoonful given every hour or two hours ; if this should fail, cantharis should be given in the same manner. If these symptoms should continue more or less, and the prostration of strength become more and more visible, lachesis should then be had recourse to ; a drop of the fifth dilution given at the same intervals as the other remedies. TREATMENT OF THE FEBRILE STAGE. The treatment here must follow the course of the symptoms, when congestion of the brain is indicated with eyes injected, giddiness, and some degree of stupor, belladonna is the chief remedy ; a drop of the third dilution in four teaspoonfuls of water, a teaspoonful to be given every two, three, or four hours according to the greater or less rapidity of the progress of the disease. When the symptoms of congestions are much marked, and the reaction powerful, the mother tincture should be preferred. In that case also, if the pulse become full and hard, a few doses of aconitum should be given either before or after the belladonna, when the symptoms indicate it, a drop of the third dilution in four teaspoonfuls of water, one teaspoonful every two or three hours. When, by the progress of the fever, the tongue becomes dry brown, or blackish, the gums and lips covered with sordes, and the stupor considerable, and if the pulse is full, but not very frequent, opium should be administered, a drop of the first or third dilution in four teaspoonfuls of water, a teaspoonful every two hours. If opium fails to relieve the cerebral congestion, if the skin does not get warm under its influence, and the sordes continue, Rhus toxicodendron should be substituted after twelve d 2 36 or twenty-four hours, and administered in the same manner- After rhus, if the same state continue, even in an aggravated form, arsenic should be given instead, in the same manner. When the febrile stage is marked by symptoms of reaction on the skin, and the pulse is strong, and more or less frequent, aconite should have the preference, a drop of the third dilution in four teaspoonfuls of water, a teaspoonful every two or three hours. After a few doses belladonna should be resorted to, and administered in the same manner, if symptoms of congestion of the brain should be present. When the congestion of the brain is not subdued by Belladonna, when that organ appears more and more deeply affected, and consequently the function of the nerves much impaired ; when the breathing becomes oppressed and difficult; the pulse feeble, irregular, intermitting, tremulous, or scarcely perceptible, the skin cold, clammy, &c, Lachesis must be resorted to ; a drop of the eighth dilution to be given in four teaspoonfuls of water, a teaspoonful every half-hour, or every hour, or at longer intervals — two, three, or four hours, if improvement takes place. In those cases where the vitality is being much diminished, and the strength is rapidly failing, Lachesis should be given, not only at a low dilution, but also at a higher dynamisation, in the following manner : a globule of Lachesis of the twelfth dilution, in a teaspoonful of water ; half an hour afterwards, a quarter of a drop of the fifth dilution, to be repeated every half-hour, two or three times, if no change takes place ; then one globule of Lachesis of the eighteenth dilution to be given in a little water ; half an hour or an hour afterwards, the tincture of Lachesis to be resumed again. After a few doses given as above prescribed, one globule of the thirtieth dilution should be administered. In that manner the medicine ought to be continued and varied, until some alteration in the condition of the patient seems to require a change of remedy. When the symptoms indicate that the stomach is the principal seat of reaction, nux vomica should be given in the same manner as the above medicines. We are guided in its choice by the state of the tongue, this organ being more or less furred, and red at the edges. For sensibility at the epigastrium, when existing in similar cases with red and glazed tongue, Lachesis should follow nux vomica, administered in the same way. 37 CASES OF ASIATIC CHOLERA. A. 8., a cook, aged thirty-three, of good constitution and general health, on the 24th of June, 1849, performed her usual duties, and dined moderately, but with a good appetite ; towards evening she felt uncomfortable; the abdomen was tense, the head giddy. Not knowing what else to do, she inhaled camphor, and soon after vomited her dinner undigested, and had also several loose motions. The vomiting and purging increased in severity, and about three o'clock in the morning, her fellowservant, thinking she was in a dying state, informed her master, who came immediately to call me to her aid. It was nearly four o'clock when I arrived. She was cold ; the countenance shrunk, the eyes sunken, the voice hollow, and almost inaudible ; she could with difficulty articulate but a few words : the pulse was scarcely perceptible. She complained of violent cramps in the legs and feet, and occasionally in the fingers ; severe pain in the epigastrium, and abdomen; she compared the sensation in the epigastrium to violent cutting or burning pain, alternated with feeling of intense coldness ; the whole abdominal and epigastric region was very sensitive to the touch. The fluid ejected from the stomach resembled whitish gruel, slightly tinged with blood. The stools liquid,, and resembling rice-water. Total suppression of urine. The tongue rather pale and dry, and quite cold to the touch. Great thirst. Great prostration of strength. She looked old and emaciated. Face pale and blueish. The hands cold and clammy. I immediately gave her Veratrum ; four drops of the third dilution being mingled with twelve teaspoonfuls of water ; a teaspoonful was directed to be administered every fifteen minutes ; and small quantities of pure water to assuage her thirst from time to time. The medicine soon acted favourably; the vomiting and purging becoming less frequent after a few doses, and nearly ceasing at the end of two hours. After seven o'clock in the morning, she had only two more evacuations from the bowels 38 during the day, with but little vomiting ; at that hour the pulse was much more marked ; the cramps and abdominal pain considerably diminished ; the tongue less cold ; and her voice had lost a good deal of its peculiar hollow, sepulchral tone. The use of Veratrum was continued as before during the whole of the forenoon. One, p.m. The patient improving in every respect, all the symptoms being much milder, and the vomiting quite suppressed. Seven, p.m. Nausea and purging entirely gone — abdominal pain much diminished ; but she could not bear any pressure on the epigastrium or abdomen ; and still suffered from cramps in the legs whenever she moved them. The tongue naturally warm. A dose of Veratrum was given every three hours during the night, and she continued to improve. In the morning there remained a little sensitiveness at the epigastrium, with a considerable degree of thirst, and the tongue was red at its edges. Tinct. Nux Vomica, one drop (third dilution) in four teaspoonfuls of water was prescribed, a teaspoonful to be taken every four hours. In the evening every untoward symptom had disappeared, and the appetite returning, a few spoonfuls of beef tea, in a cup of water, were allowed, which agreed very well with the stomach. On the following day, the patient being completely convalescent, she began to take some light food, and in a few days, when I saw her again, she was as well as she was before the attack. I was sent for to see a lady about forty years of age, who, for several hours, had been suffering under a severe attack of Cholera. When I arrived, I found her in great agony ; she had incessant vomiting and purging of colourless fluid, resembling ricewater, cramp-like pains, and violent burning throughout the whole abdomen, which was very sensitive to the touch ; severe cramps in the lower extremities, and at times in the fingers, countenance shrunk, eyes sunken, voice feeble, her skin was cold, and there were large blue patches on the face, chest, abdomen, and limbs. The pulse almost imperceptible, utter prostration of strength, sensation of great pressure in the chest, with anxiety, and apprehension of suffocation. I immediately prescribed four drops Tincture veratri (third dilution) mixed with two ounces of water, a teaspoonful to be given every quarter of an hour, and at longer intervals, should any improvement take place. This 39 medicine quickly produced a most beneficial result ; no sooner was the first dose administered than the patient became easier, and after she had taken a few spoonfuls, the vomiting and purging became much less frequent. In a few hours afterwards I saw her again ; the pulse was stronger, the skin becoming warm, the blueness (especially of the face) much diminished, and the voice more natural, but the sensation of pressure on the chest still continued very severe. I directed the Veratrum to be repeated every two or three hours during the night. The next morning the patient was entirely out of danger, the vomiting and purging had entirely ceased, the colour of the skin was perfectly natural, and she complained of nothing except general weakness, soreness of the abdomen, and a little oppression at the sternum. I prescribed Arsenic one drop of the third dilution in four teaspoonfuls of water ; the patient seemed to progress favourably until the evening, when I was hastily summoned, and found her in great distress again ; she had vomited, and was suffering from violent pressure at the sternum and epigastrium, with cramps in the hands, and extreme debility ; she thought she was dying. On inquiry, I learned that she had undergone a good deal of mental excitement during the day, and moreover, that she had taken some broth, after which, these unfavourable symptoms had returned. I gave her a drop of Pulsatilla in four teaspoonfuls of water ; after the first spoonful the symptoms seemed to be aggravated, the patient suddenly sat up in her bed, and pressing her cramped hands on her breast, she gasped the words, " I am dying." The pulse at this moment was certainly very weak, and the countenance anxious and sunken, but soon after this crisis the symptoms gradually became less alarming ; the vomiting ceased, and the great oppression diminished. Another spoonful of pulsatilla given ten minutes afterwards entirely changed the scene. At a late hour I again saw the patient, who was progressing most favourably ; the medicine was given at longer intervals. The night passed without farther accident, and after a day's abstinence, the patient being convalescent, she gradually resumed the use of her ordinary food. Mr. X , aged about forty, whilst under treatment for a chronic affection of the lungs, in December last, was seized on the 27th of that month, and without any cause he could assign, 40 with severe vomiting and purging; the material which he passed upwards and downwards was first of a green and then of a black colour ; it quickly became colourless. His strength was greatly prostrated, the skin cold, his pulse was nearly suppressed, and he had severe cramps in his legs, feet, and fingers ; the latter looked like those of a dead man, and the nails were quite black. Urine suppressed ; the abdomen was very tender to the touch. — Veratrum, two drops of the third dilution, in eight teaspoonfuls of water, one teaspoonful every half-hour or oftener, according to circumstances. After a few doses had been taken, the vomiting and dejections decreased rapidly, as well as. all the other symptoms. 28th December; the diarrhoea and vomiting have ceased ; he feels sick sometimes, and has much weakness and soreness about the epigastrium ; a clammy perspiration throughout the day. Urine continues suppressed, and his strength prostrated. — Arsenicum, two drops of the third dilution in four teaspoonfuls of water, one teaspoonful every third hour. 29th December ; is much better ; still complains much of weakness and of headache. — Pulsatilla, one drop of the third dilution, in four teaspoonfuls of water, one teaspoonful every fourth hour. 30th December ; much flatulence and general weakness. — China, two drops of the third dilution, in eight teaspoonfuls of water, one teaspoonful every fourth hour. The patient felt much better on the Ist of January, though distressed by a sinking at the epigastrium. — Oleand., two globules of the twelfth dilution, was prescribed, and on the next day that symptom had left him. He continued to improve, and had one or two more doses of China, and in a few days later I resumed the treatment of his chronic affection. That also is now much better, and he has never been troubled by any sequelae of the choleric attack. Mr. F. L , aged fifty-four, consulted me, in August, 1848, for a chronic bowel disorder ; he was passing loose motions of a bilious character. His disease had not been much lessened in January last, when he was attacked with cholerine. He had eaten cheese, and taken two glasses of port wine the day before. 9th January; he had first a natural motion, and soon after a dark one, then several sudden and quite watery stools, and some mucus escaped from the anus. He was very much exhausted. He took some Camphor. In the night he had a great deal of rumbling in the bowel?, rind several colourless discharges from 41 them ; perspired throughout the night ; he took some brandy ; he felt very weak. My prescription was, total abstinence from food, pure water as a beverage, and of Veratrum two drops of the third dilution, in eight teaspoonfuls of water, one teaspoonful every third hour. 10th January; he had many fluid, colourless stools yesterday, and has been very uneasy in his bowels. During the night he had several dejections of the description already given. After a dose of Veratrum, this morning, he had a darker motion, and passed some urine ; has felt darting pains in the region of the liver; continue the Veratrum. 11th January ; much better, though very weak. From this day he had no more loose colourless motions, and the treatment of the chronic diarrhoea was resumed. He has had no relapse of the cholerine, and is now enjoying very good health. 9th July, 1849. A fortnight since I was sent for in the middle of the night to see a lady, taken suddenly with cholera. She was in perfect health up to one o'clock a.m., when suddenly she felt giddy, great oppression and pain about epigastrium, and she was greatly prostrated, and soon began to vomit, first some undigested food and then a glairy fluid. Diarrhoea soon followed, the dejections perfectly liquid and very frequent. It was about half-past two a.m. when I saw her ; by that time she had had eight or ten vomitings, and as many motions. The cramps in the calves and in the feet were severe ; the pulse was slow and very weak ; the surface of the body was warm, I prescribed Pulsatilla, six globules of the nineteenth dilution, in twelve teaspoonfuls of water, one teaspoonful every fifteen minutes, the frequency of repetition to be diminished as improvement might take place. After a few doses had been taken, the vomiting moderated gradually, and ceased about eight a.m. The epigastrium and abdomen were very tender, but the pulse had then almost regained its normal state. The cramps had also moderated considerably ; the weakness and thirst were great. I prescribed Nux Vomica, two drops of the third dilution, in eight teaspoonfuls of water, one teaspoonful every second or third hour. In the course of the morning, the vomiting and purging returned ; the patient had immediate recourse, to the Pulsatilla, and experienced little benefit ; and when I visited her again the symptoms were less favourable, the pulse was weaker, the pain at epigastrium was increased, and the vomiting and purging were 42 again frequent, and of quite a watery nature. I immediately prescribed Veratrum, four drops of the third dilution, in twelve teaspoonfuls of water, one teaspoonful every hour, or at shorter or longer intervals, according to progress of symptoms. The patient soon felt better, and after five or six doses, had neither vomiting nor purging ; and in the evening all symptoms had moderated, and she was much improved. Nevertheless, the Veratrum was persevered in, though at longer intervals ; and in the morning the patient was convalescent. She remained one day more without food, and then gradually returned to her usual regimen. The treatment was commenced by Pulsatilla, because the disease had at first the appearance of a severe indigestion, originating in her taking a meal, though a moderate one, just after the occurrence of a mental disturbance. ALLOPATHIC TREATMENT OF CHOLERA. We have thought it advisable to give some account of the principal modes of treating Cholera, adopted by Allopathic practitioners ; this we shall follow with a few remarks, pointing out to those medical practitioners, to whom the care of the public health is entrusted, that if Cholera be so fatal in its result, that fatality is not to be attributed to the virulence of the disease itself merely, but to the want of a rational mode of treatment based on a positive law. We shall endeavour to show, at the same time, that a law has been discovered by the late renowned Hahnemann, and verified in practice by the experience of medical men in several countries of Europe, as well as in England. The " Cyclopedia of Medicine " contains an elaborate treatise on Cholera, in which we find that the same treatment is prescribed both in India and England ; from this, the Allopathists' high authority, we extract the following : — In the first period of the disease an emetic should be administere — mustard is chiefly recommended — the patient subsequently bled; a laxative is administered with rhubarb and 43 calomel, strict regimen is observed, diluents only being allowed, the patient should remain in the house, and be warmly clad. Cholerine is treated with opium, calomel, and aromatics, and, at a later period, castor oil ; a large blister is applied to the abdomen, the patient must remain in bed, a diluent diet allowed, and local and general blood-letting. Secondly. — The treatment of the cold stage varies ; a vein should be opened, if the patient is not in a state of collapse, after a large blister has been placed on the abdomen ; this to be followed by a dose of calomel and opium, twelve grains of calomel to one or two grains of opium. Should the circulation be weak, an emetic of mustard should be administered ; half an ounce in half a tumbler of water causes a full vomiting. Sinapisms to the abdomen, and along the spine, whilst the temperature is maintained by the use of warm bottles wrapped in flannel. Friction should be applied to the parts affected with spasms ; a pill of calomel, capsicum, and opium should be given as soon as the vomiting caused by the mustard has ceased. Some brandy and water should be given, if the prostration is great. The patient should have an emetic of mustard or common salt or a scruple of sulphate of zinc, and half a drachm of ipecacuanha, in a little brandy. After the mustard, several exciting remedies are recommended, as carbonate of ammonia, oil of turpentine, five or six grains of calomel every three or four hours. The inhalation of oxygen gas, enemata of tobacco, brandy and laudanum, or a lavement with mustard pulverized. Brandy is frequently repeated, and for diet diluents. Thirdly. — -In the period of reaction, local bleeding at the neck or abdomen, or when there is congestion in those regions, or in the head, blisters may be applied to the neck, the head shaved, and cold applications. Should vomiting exist with irritation of the stomach, leeches should be applied to the epigastrium. After castor oil and magnesia, calomel is the principal remedy. The patient should be kept in a warm place, and warmth applied to the surfaces when cold. In an advanced stage of the disease, wine and water may be given ; carbonate of ammonia, camphor, and quinine are also useful. The diet should consist of simple diluents, and after the febrile stage some wine and water may be given. When the bilious diarrhoea is a prominent symptom, leeches should be applied to the 44 abdomen, and mercurial preparations, such as " hydrarg. cum creta," " blue pills," and a small dose of opium given internally. Warm poultices should be placed on the abdomen, and a diluent diet observed. The foregoing is a description of the treatment pursued by Allopathic practitioners, both in India and in this country, in 1832. This irrational treatment has been little modified by time or experience ; the perusal of what is published under the auspices of the sanatory commission at the present moment will demonstrate this. A paper has been published by Dr. Crawford, on his return from India, in which similar uncertain treatment is prescribed. If symptoms of common diarrhoea be present simply, the evil must be averted immediately. A mixture should be procured at once, consisting of Chalk Mixture 6£ ounces. Tincture of Catechu £ ounce. Aromatic Confection 1£ drachms. Battley's Sedative Liquor 50 drops. Two tablespoonfuls of this mixture should be taken every four or six hours, until the diarrhoea is abated. Twenty-four grains of opiate confection may be employed instead of the mixture. Castor oil, with laudanum and peppermint water, may also be given. Two teaspoonfuls of the tincture of rhubarb, and from ten to twenty drops of laudanum is also prescribed. In the fibst stage, the patient should be placed in a warm bed or bath, or a hot air bath ; warm bottles should be applied to the cold surfaces, and frictions employed. Warm drinks may be given to mitigate the sufferings from straining. Weak mint tea, or a tablespoonful of peppermint water, in a cup of warm water, may be administered; or to cause vomiting, a cup of common salt and water may be given. If the vomitings and cramps are severe, a large poultice of mustard and vinegar should be applied to the region of the stomach, and from three to five grains of calomel, with stimulating antispasmodics may be given internally. Ijk Tiuctura Valerians Composite J " Athens Sulphuria 3 v * Oleum Menthiί piperitae J i 45 A teaspoonful in a wine glass of warm water or mint tea ; in case of severe cramps, ten or twenty drops may be added. Opium injection may also be given. Thirty or forty drops of opium and camphor in pills, in case of great irritability of the stomach, and a small quantity of brandy may be given. Bleeding should be seldom resorted to. Second Stage. — The Russians are partial to stimulating oil. Turpentine also is much used. The internal stimulants employed consisted of combinations of Valerian, sether, ammonia, and some of the essential oils, sometimes alternated with brandy, port or sherry wine, it being desirable that some light nourishment should be combined with the stimulants. Wine and brandy were sometimes administered, with arrow-root, sago, or good beef tea. On the first appearance of prostration, brandy, with cayenne pepper was given. The actual cautery was freely applied along the spine in cases of extreme prostration. Chloroform was also had recourse to, being injected into the rectum. The most diligent and careful use of all these means has, however, it must be confessed, proved wholly unavailing in a large number of cases, and produced apparently no more effect than if applied to a dead body. Arnica, Camphor, Infusion of Valerian, Sulphate of Quinine, dilute Nitric Acid in an Infusion of Athlsea and Laudanum, Oxymuriatic Acid, Naptha, small doses of Tartar Emetic, common Salt combined with Carbonate of Soda; all these have been recommended. Friction with ice, after which the patient is directed to be wrapped up in a sheet wrung out of salt water, then to be covered with blankets, and to take a solution of culinary Salt in water at short intervals. Common Salt is recommended as an emetic, and the sub-nitrate of Bismuth, to allay severe spasms, and check the copious serous evacuations. The reader may judge from the following brief summary, whether the French physicians were either rational or unanimous in their mode of treating this formidable disease. Dr. Magendie gave punch in an infusion of Chamomile. Dr. Recamier ordered effusions of cold water. Dr. Rostan pursued the opposite course, and employed the warm bath, followed by blood-letting, leeches applied to the epigastrium and infusions of Melissa, Mint, or Chamomile. M. Touset and M. 46 Coster advised a method of oxygenating the blood. Professor Andral prescribed a mixture composed of Ammonia, Sulphate of Quinine, Sulphuric Ether, and Camphor ; and directed the patient's limbs to be rubbed with Tincture of Cantharides. Dr. Gendrin ordered large doses of Opium, with cupping at the epigastrium. Dupuytren prescribed friction with flannel, decoction of Poppies, and fumigation. Baron Larrey prescribed cuppings, blisters of Cantharis and Camphor, dry friction with woollen material, and the use of aromatic oils. Dr. Wolowski divided Cholera into two classes, asthenic and inflammatory ; the first, or asthenic, he fought against with Aqua Mentha piperita, very hot ; Opium in large doses, and frictions with flannel, sinapisms, and dry cupping in the abdomen and the epigastrium. Against the second form, or inflammatory, he ordered bleeding, and a potion composed of Jalap, common water, and Aqua Laurocerasi, with cupping in the abdomen, chest, and along the spine. Dr. Broussais, having observed in most cases that the mucous membrane of the digestive canal presented marks of inflammation more or less extensive, prohibited at once the employment of hot and exciting beverages, or irritating medicines, explaining their danger, by increasing the existing mischief in the parts to which they were applied ; he preferred and resorted to the anti-phlogistic treatment, using counter irritants to the surface, in certain cases, as revulsives. We trust that the foregoing statement will satisfy the reader that the Allopathic school has no rational plan of treating Cholera ; but that according to their routine system, and preconceived notions, erroneous as they were in the majority of instances, each medical man adopted the most opposite treatment in the same affection. Thus proving that all is blind empiricism, it being impossible to discover any reason why one substance is chosen in preference to another, or any one course or method of treatment followed rather than another. Why should the " Punch" of Magendie be preferred to the " Brandy" of the English practitioner 1 Why should you, with Recamier, have recourse to the cold shower bath in preference to the warm bath of Rostan ? Why choose the calomel and opium of the Indian and English doctors, rather than the stimulating mixtures of Andral and others ? Which is the substance that 47 cures, or what is the rule for the composition of those compound formulae ? These questions have been asked in vain. The Times Newspaper has recently published a letter, in which " Asafoetida," " Opium," and Pepper have been put forth as infallible remedies against Cholera. The person who prescribes these remedies gives the most favourable account of their use in India, deploring at the same time the awful mortality under other modes of treatment ; but those who have prescribed Calomel and Opium have equally boasted of their success. Whose is the true mode of treatment ? To whom shall we listen ? Facts must be calmly interrogated, and the number of these is overwhelming in evidence that the treatment of the old school practitioners is worse than useless, and their promises are vain. Notwithstanding all their multifarious modes of treating Cholera, the disease, when at its height, destroys the half or more of those attacked. What, however, can be reasonably expected from this mass of confused modes of treatment 1 Any one endued with common sense and unbiassed by prejudice, can at once answer, seeing'that each method is contradictory to every other proposed, or adopted by these so-called rational physicians; statistical tables teach us the worthlessness of all these methods. To be just, we must acknowledge that the profession, especially those members of it who are above the petty feelings of self-seeking and self-love, do not hesitate to declare the utter inefficiency of the old system practice in the treatment of Cholera ; and we feel certain that the great majority of those practitioners, who have witnessed and treated the disease, hold an opinion little different to that expressed by Professor Buchanan in his recent pamphlet on Cholera, from which we quote the following concluding remarks : — " Tobacco, Strychnia, Prussic Acid, Galvanism, boiling water, firing the spine, or applying the cautery actual, or potential to any other part of the body, I never saw of any use, nor do I think the employment of them supported by any rational view of the nature of the disease. Large doses of Lead or of Calomel internally I never thought of use, and I have persuaded myself that I have found both detrimental. Nature seems to abhor all violent remedies in this disease. She herself effects a cure by slowly restoring the constitution of the liquids of the body, and 48 she will not admit of any practice but that founded on her own principles. ," We owe much to the old school for the knowledge they have given us of the disease ; we accept their labours with grateful feelings, and we only hope that, in their turn, the practitioners of the old school will admit the great truth discovered by Hahnemann. We have shown, as they must, and many of them do, acknowledge, that they have no fixed basis, no natural law, upon which their treatment rests. This want of a law is the true cause of all the deplorable uncertainty of their treatment of diseases, and consequent total failure in the treatment of cholera. Hahnemann has discovered a law of nature, a law of certainty which does govern the action of medicaments ; he has expressed it in the comprehensive sentence, " Similia Similibxjs Curantttb." This law we have verified practically, and we have seen its successful application in the treatment of disease. We appeal to the members of the profession to try what we have tried ourselves. We know from experience the value of our therapeutics and the certainty of our law of healing. Homoeopathy is far from having yet obtained its full development. Its success would be yet greater than it is, if its practitioners had a fuller knowledge of its varied and almost infinite resources. The limit to its success is the limit of our human faculties ; the happy issue of the treatment is in proportion to the knowledge, tact, readiness and experience of the practitioner. The failures in the treatment of curable cases, are due to his deficiencies. Even so, our statistics prove most satisfactorily the vast superiority of our method over that of the drug-givers. This little treatise on the Homoeopathic treatment of Cholera is to enable any man, possessing goodwill and a sound judgment, to attain to a safe practice in following the doctrine of Homoeopathy. FINIS. Thomas Habbild, Printer, Silver Street, Falcon Square, London.