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analogy of puerperal fever may with bene-fit be consulted.

I am acquainted with an extensive parishwithin the bills of mortality, whose surgeonhas adopted one little varied plan of treat-ment from the beginning of the epidemic.For a few weeks nearly all his cases re-

covered ; and then again, without any alts-ration of system, he finds that nearly allhis cases for the few next weeks die. Thishas occurred more than once, without his

being able to refer it to any tangible cause.Cholera has for this fortnight past been

raging at Dumfries with excessive vio-lence, having almost depopulated the town.It is at present prevailing at Edinburgh toan extent which has never been known be-fore, and with marked fatality. The wea- 1ther during the above period has beenthick, rainy, and excessively warm for themonth of October, in Scotland, marked bythe luxuriance of the vegetable world, thewild strawberry being actually loaded withflowers and fruit, and the buttercup in fullflower. This increase of temperature, andthe peculiar state of the atmosphere thathas existed for some time past, which Idare not attempt to describe, is supposedto be the cause of the increased fatality ofthe cholera here at present.Edinburgh, Nov. 1832.

OBSERVATIONS ON

ASIATIC CHOLERA.

By Dr. VERING, Chevalier de la Légiond’Honneur, &c., Vienna.

MONSIEUR,-Je prends la liberté de vous envoyer quelques mots sur le choleramorbus, en vous priant de les faire insurerdans LE LANCET. It est mieux pour ge-neraliser le bien qui pourrait en r6sulter

pour l’humanité de les faire publier dansla langue Anglaise. Veuillez compter,Mon-sieur, sur mon empressement de vous servir,si un jour l’occasion s’ell presente. J’ai1’honneur d’etre, Monsieur, votre serviteur,

D. VERING.Vienne, en Autriche,

Dec. 9, 1831.

TnE disease called " Asiatic cholera"

Iis produced by certain terrestrial and at- Imospheric causes, which chiefly affect theabdominal nerves, when their energy isdiminished by bad diet, the action of cold,or the decline of vital power itself. Thismorbid influence again produces des j’essene-ments of the bowels, in consequence of whichthe mouths of the exhalent vessels, or thesurface of the intestinal canal, continue to

pour forth into their cavity the serous por-tion of the blood, until the vital fluid gra-dually becomes less fluid, and ceases to

circulate through the extreme portions ofthe body ; hence the animal heat dimi-nishes by degrees, and there arises a stateof spasm, extending from the extremities

I

to organs most essential to life, and termi-nating in tetanus, and a complete paraliza-tion of every function.Numerous dissections, in which the

mouths of the exhalent vessels are alwaysseen open, and projecting, the remarkablewant of fluidity in the blood, and the sen-sations which I have experienced myselfduring an attack of this disease, have con-firmed me in this view of the subject. Ourfirst indication naturally is to destroy asquickly as possible the deleterious cause

of the disease, by combating the effectsproduced on the abdominal nerves by theatmospheric and terrene causes before al-luded to. With this view we order uatientsof a good constitution to drink, during theearly period of the disease, large quantitiesof warm water, tea, &c., and endeavour atthe same to bring about copious perspirationby warm applications externally. This

cutaneous transpiration, often produced bynature herself, is frequently followed by aquick restoration to health, on which ac-count the use of ice,-in favour of which norational argument can be adduced,-shouldbe avoided during this period. In commoncases we employ with the same object ofrestoring the cutaneous circulation, power-ful doses of ipecacuanha: this has beenattended with great success, and we wererarely compelled to have recourse to generalbleeding. When it was necessary to abstractblood, this was done by the application ofleeches to the temples, or, more commonly,to the scrobiculus cordis ; but in all cases itwas found expedient to second the action ofthe emetic by large warm sinapisms appliedin succession to different surfaces ot theskin. Ipecacuanha has no beneficial effectwhatever in the second stage of the disease,characterised by coldness of the skin, &c.Here we may expect a favourable result, bvacting powerfully on all the surfaces, bothexternal and internal, by means of camphorand cold.As nature frequently produces the same

(’Sects by various means, so in medicine thesame result may be obtained from the mostopposite agents ; hence we can readily un-derstand how cholera may have been curedin different cases by very different modes oftreatment; but as 1 have been able to save58 out of 40 persons attached by the abovetreatment (varying it only as the tempera-ment, &c., of each patient required), I havethought it may be useful to make knownsuch a fortunate result.

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All precautionary measures, such as qua-rantine, the seclusion of the sick, &c. havebeen proved actually injurious, and themalignity and rapid death which accom-panied the disease on its first appearance inthis country, diminished from the momentsuch means of precaution were abandoned.At Vienna, as in many other places, in- i

termittent fevers to a great extent precededthe cholera, and suddenly disappeared on I,the approach of this latter disease. At the I,time I write, when we have few if any

’

cases of cholera, intermittent fever under Ievery form is reappearing. The same orb-servations have been made by Dr. Wagnerat Odessa.* We have, therefore, reason tohope, from the return of the intermittentfever, that some favourable change hastaken place in the atmosphere, and that weshall finally be delivered from this destruc- I,tive plague.

’

SALINE VENOUS INJECTION

IN CASES OF

MALIGNANT CHOLERA,PERFORMED WHILE IN THE

VAPOUR-BATH.

By THOMAS LATTA, M.D., Leith.

To the Editor of THE LANCET.

SIR,-Last week I transmitted to you n.

short account of five cases of cholera treated

by suspending the body in a horizontalposition in warm vapour, and then inject-ing the veins with water charged with theprotoxide of nitrogen, and holding in solu-tion the salts natural to the blood ; this 1used at temperature 970 or 980. Aly re-port left the cases under treatment, and ac-cording to promise I now complete my task.The first case, Pat. Peddie, which was

a very hopeless one, and certainly beyondthe reach of any remedy except venous in-jection, was dismissed cured ; he neverhad oce untoward symptom after being in-jected.

The second case, Geo. Dunn, whose cir-cumstances were truly desperate, and whoserecovery goes far to recommend the treat-

ment, has also done well, which much ex-ceeds my expectations. Not only was theattack of cholera verv severe and far ad-vanced, but his constitution was under-mined by the pernicious effects of chronicdisease in his stomach and liver, of seven-teen years’ duration ; he has had phlebitis,but is now well, and declares lie is freer

* Hufeland Jour, des Prac. Hiel. 1831, p. 126.

from the symptoms of his old complaintsthan he has been for many years ; he hashad no consecutive fever, his spirits andappetite are good, and all his secretionsare natural.

The third case, a delicate female, sixty.five years of age, I reported dead in my last.The fourth case, Dan. Wilson, has been

convalescent, without consecutive fever,for some days.The fifth case, Cath. Bruce, terminated

fatally. Though this woman was a habi.tual drunkard, though subject to epilepsy,and for many months to an incontrollablediarrhœa—so much so, that she unavoid-ably became an offence even in the street;and though attacked with cholera in a verymalignant form, yet she improved so won-derfully under our treatment, that up to themorning of the fourth day I felt sanguine ofher recovery ; then, however, she had a

rigor, began to complain of pain in the regionof stomach, was sick and vomited, becamevery feverish, complained vehemently of

pain in the right arm at the extremity ofthe ulna (she was injected only in the leftarm, the wound in which was in good state,and quite free from uneasiness), which ac-quired a deep-purple hue, and spread overthe hand and up the arm. Shortly afterthis a similar appearance was visible inthe corresponding part of the left arm ; be-fore death her feet acquired the same hue ;she died on the evening of the sixth davthe sensorium was undisturbed to the last.Our post-mortem investigation discover-

ed nothing preternatural except in thecavities of the heart, which containedfibrinous depositions ; the liver and sto.

mach also were diseased ; the former en-

larged and indurated, feeling gritty underthe knife; the latter inflamed internally,its mucous coat being’ very thick and pulpy;other organs healthy.

Since treating the above cases, I havehad no opportunity of subjecting the planpursued to the test of further experiment,and therefore reserve my remarks till a

future period. Being entirely ignorant ofthe primum mobile of the disease, I have at-tempted to remove symptoms only, first byapplying external warmth in a way accept-able to the patients ; this not only perina-nently restored the natural temperature,but either moderated the discharges, or

removed them permanently ; then 1 inject-ed the veins, and so subdued these symp-toms which depended on the deterioratedstate of the blood ; the solution I used can.tained a third more saline matter than Iused in my first cases this change I deemednecessary, as less fluid is requisite to rousethe system when the vapour-bath is used.