ease.

symptoms-the cramps-and remedies all the worst features of the disIt is, however, no new and hitherto untried remedy, for it was long ago recommended by M. Abeille, who states that it modifies advantageously and rapidly the phenomena of cholera by its influence on the sensitive nerves. In the algide stage it excited reaction nineteen times out of twenty-three cases, and there were ten recoveries.

Though long lost sight of in this country, strychnine was employed with marked success during a comparatively recent outbreak of cholera in Japan by Assist. Surgeon W. Hensman, of the second battalion of the 20th Regt.; and the attention of my brother, John Balfour, I.G., having been directed to it, he resolved to give it a fair trial in an outbreak of cholera at Leven, Fifeshire, where he is now in charge. He writes me that he has seen nothing which so speedily relieves the urgent symptoms, or gives such hope of snatching many a serious case from the verge of the grave. The cramps soon cease, the purging and vomiting are mitigated, and in those cases in which the pulse has been imperceptible for hours, it is again felt at the wrist, while the complexion changes from the horrible dull-blue tint to the natural healthy colour, the urine being also generally secreted at once. The urgent symptoms are, in fact, immediately relieved, and though it does not cure every case, this treatment holds out a fair prospect of more favourable returns under circumstances more propitious than could be supplied in a small country town of 2,700 inhabitants, with one medical practitioner to attend upon all the cholera patients, no hospital, and a defective supply of nurses. As it is, 15 out of 24 well-marked cases thus treated have died; but many of them would have succumbed under all circumstances, even to a disease less formidable than cholera, as three were between seventy and eighty years of age, two more above sixty, another had long-standing disease both of the chest and womb, and several others were greatly deficient in bodily strength and stamina.

The general plan of treatment adopted is to place hot bottles round the patient and cover him with an ample supply of blankets: a large sinapism is then applied over the whole abdomen, and, in adults, left on for an hour. If the disease be not too far advanced, a drachm of laudanum is then administered (chlorodyne was employed at first, but was found too irritating to the stomach), ice to suck is allowed ad libitum, and small quantities of soda water if desired. Should this treatment have a good effect, the patient is conducted to recovery in the ordinary way; but should vomiting recur, or collapse come on, strychnine is had recourse to, a solution being employed containing one grain to the ounce, and of this a drachm and a half to two drachms is given to an adult for

the first dose, and subsequently a drachm every hour and a half or two hours, until the physiological effects of the drug (twitching of the muscles) manifest themselves; these are always accompanied by marked amendment. The subsequent treatment hitherto adopted has been the administration of quinine and nourishing soups in small but increasing quantities. It is believed, however, that the continuance of the strychnine in smaller doses and at longer intervals would be more beneficial in the more dangerous and severe cases. As it is, complete recovery has taken place in many patients in whom the symptoms had been of the most deadly character, the pulse having been in some of them more than four hours absent from the wrist; and in them no stimulants were administered, at least until convalescence had fairly set in.

The type of the disease at Leven has been of the very worst character attended by comparatively little vomiting and purging; as a rule, the cramps not severe; but the patient struck down and sinking as from some overwhelming dose of poison.

The treatment of cholera by strychnine, then, seems to hold out a fairer prospect of success than anything hitherto tried, while it promises two great and eminent advantages: 1st, even where it does not cure, it always relieves the symptoms; and, 2nd, though useful even in the most advanced stages of the disease, its action is not interfered with, but rather assisted, by the previous administration of opium, which the united experience of, I believe, almost all those medical men who have had any experience of the disease has shown to be the most useful remedy in the earlier stages of cholera; for the researches of Brown Séquard, Bonnefin, and others have shown that morphia and opium act on the spinal cord precisely as strychnine does, and, when administered together, one-half of the ordinary dose of strychnine is sufficient to produce the same effects as double the quantity administered without opium. Were I to hazard a theory as to the modus operandi of strychnine in cholera, it should be based on this correlation subsisting between it and opium, and I would say that as all the symptoms of cholera collapse point to a cessation of all the acts of vital nutrition, and consequently of the circulation, throughout the frame, wholly independent of drainage by evacu1tion, and often most marked where there are no evacuations, depending apparently in such cases upon the charge of poison being sufficient at once to overwhelm the nervous system, and thus prevent that reflex action of the sympathetic and cerebro-spinal systems on each other upon which, according to all our present knowledge, these vital acts seem to depend, so then our best hope of cure would appear to lie in some drug which should so stimulate the cerebro-spinal system as to enable it to respond to

the feeble efforts which the sympathetic must continue to exert while life remains. In the earlier stages of cholera, and in less severe cases, opium from its stimulant action on the cerebro-spinal system, is well calculated to attain this end, while its astringent action is rather an advantage in those cases in which the drainage from evacuation tends to be excessive; the hypothetical benefits of elimination being at variance with our practical knowledge of this disease, and manifestly inconsistent with the theory of zymosis and with all that we know of the history of diseases of this class. In more advanced or more severe cases, strychnine, the most powerful cerebro-spinal stimulant known, seems theoretically that agent most likely to be useful, and I think that the facts I have just related warrant my recommending it to my professional brethren as likely under favourable circumstances even to exceed their highest expectations. -Lancet.

ON THE TREATMENT OF HEMOPTYSIS WITH INHALATIONS OF LIQUOR FERRI SESQUICHLORATI [SESQUICHLORIDI].

BY DR. P. Q. BRONDGEEST.

Translated from the Nederlandsch Archief voor Genes-en Natuurkunde, Deel ii 2e by WM. DANIEL MOORE, M.D., Dub. et Cantab., M.R.I.A.

The local treatment of morbid affections of the air passages, by the inhalation of fluids in the state of vapour, has lately been very extensively adopted. In no department can we, however, point to such excellent results as in the treatment of hemorrhage of the respiratory passages by means of styptic inhalations. The most important observations on this subject are undoubtedly those of Fieber, both on account of the fulness of detail with which they are communicated, and of the success with which the treatment was crowned. We fully endorse what Fieber says as to the value of this method: "If the mode of treatment by inhalation by means of pulverisers had," he says, "no other merit than that of rendering possible the direct application of hemostatics to the bleeding points or their immediate vicinity, this would suffice to ensure it an honorable place in therapeutics. Not only is one of the most dangerous symptoms often directly removed by the inhalation of styptics, but the dictates of humanity to free the patient from an affection which renders him most uneasy, and fearfully rouses phthisical patients in particular from the consoling illusion of improvement, which nature lends them to lighten their sickness, are most rapidly and effectually fulfilled."

Fieber's observations led me to form the resolution to adopt this mode of treatment when opportunity should present itself.

I shall now communicate the results obtained in three cases.

For pulverizing the fluid Bergson's well-known apparatus was employed, which on account of the facility of using it and its portability de serves to be preferred to any other.

Case 1.-On the 3rd Nov., 1861, I was called to see Heer de H., aged 57, the head of an extensive stonecutting establishment, who had for a year previously been under my care for pulmonary tuburculosis. The patient from time to time expectorated small calcareous concretions, and daily a large quantity of yellowish sputa, sometimes mixed with slight streaks of blood. From the physical examination of the chest, I inferred the existence in the apex of each lung of a cavity, according to my opinion in process of healing; in favour of which were the facts that the dulness on percussion was not extending; that the cavernous râles were very weak, sometimes not perceptible; and that, moreover, as has already been mentioned, calcareous concretions were expectorated, while the sputa appeared to me to be thick, and but slightly purulent. I found the patient lying in bed in a state of great anxiety and exhaustion. Those about him informed me that an hour and a half previously, while sitting in the watercloset and straining violently, he had suddenly thrown up an enormous quantity of blood, at the same time they showed me a spittoon half filled with bright red blood. Before my arrival the patient had been put to bed, and the discharge of blood had ceased, only some bloody phlegm was now brought up. The pulse was very small, and below the left clavicle strong râles were audible. I prescribed alum with laurel water internally, and cold compresses to the left side of the chest. In addition, I forbade his speaking, and recommended light diet, and that he should, as much as possible, avoid moving.

During the three following days his state was rather favourable; there was no fever, the sputa expectorated in the course of the third day were only very slightly tinged with blood.

In the night between Sunday and Monday I was called to him at halfpast two. The person who awoke me stated that spitting of blood had again taken place. I brought with me Bergson's Inhaler and a solution of one drachm of sesquichlorate [sesquichloride] of iron in eight ounces of distilled water, as I suspected that it would be necessary to make the patient inhale this fluid in the form of vapour. I found him coughing, and each time bringing up bright red blood, while a considerable quantity was already in the spittoon. With the greatest care he was lifted out of bed and placed in an easy position in a chair. The inhalation of the styptic was commenced, and was continued with many intermissions, until the patient expectorated only bloody phlegm. During the inhalation

he coughed but little, the hemoptysis was not for a moment aggravated by it. I left him, advising that every two hours he should very slowly make thirty inhalations. Next day I found that no further hemoptysis had taken place, only bloody sputa were expectorated, which continued for four days, while a solution of one drachm of crystallized sesquichlorate of iron in six ounces of distilled water was used for inhalation, a decoction of rhatany being at the same time prescribed for internal use. The patient's strength, however, diminished very much, so that on Friday morning that is the fifth day after the second attack of hemoptysis, I advised that the inhalations should be discontinued, the more so as they appeared not to be so necessary, the sputa having already begun to be less bloody. At two o'clock in the afternoon of the same day the patient suddenly raised himself upright in the bed, which was immediately followed by violent spitting of blood. When I visited him two hours later I found him in a sad state, very depressed, crying, exhausted, with a small pulse, complaining of oppression, with a glass half filled with blood at his side, and bringing up blood from time to time. In the left infraclavicular region very loud râles were again perceptible. As taking the patient out of bed was not to be thought of, I caused him to inhale for a considerable time, while in bed, the solution of one drachm of sesquichlorate of iron in six ounces of distilled water, until the spitting of blood had ceased, and to continue this every two hours. At half-past eleven in the evening I found him breathing very much oppressed, with loud râles, so that I thought I should not find him alive next morning. The inhalations were continued every two hours during the whole night. The following morning I was very much rejoiced to find that no more spitting of blood had occurred, and that after the inhalations only bloody phlegm was expectorated. The red colour of the sputa disappeared, the strength gradually increased, and now, after the lapse of six weeks, no hemoptysis has taken place. Although still keeping his room, the patient is already beginning to discharge some duties of an administrative nature, and is getting into a state similar to that he was in before the first hemoptysis occurred.

Case 2.-Miss M., aged 35, a native of Neufchatel, in Switzerland, governess in the family of F., at the Bilt, near Utrecht, came to consult me in the month of May for a laryngeal affection. She complained of sore throat, cough, shortness of breathing, and want of sleep. She had daily an attack of fever. She was very anxious about her state, as her father had died of laryngeal phthisis. On laryngoscopical examination I found that the signs of a chronic laryngeal catarrh, general redness, and slight mucus secretion were present; no ulcerations were perceptible