in abeyance until the cough disappears. In three different attacks Causticum, 1st dec. dil., has given very marked and speedy relief; a few doses arresting a cough which otherwise would last two to three weeks. I have met with another case where a violent and fatiguing cough, attended with more or less expectoration, excited this escape of urine. The pulse was quick, and there was subacute bronchitis, and irritation of the digestive organs. Here the administration of Caust. 1st centesimal dil. was followed by speedy relief. In a case where a convulsive cough had existed for three weeks, and for the relief of which the patient was advised to try change of air to Clifton, symptoms of acute inflammation of the larynx and trachea set in, owing to getting drenched in rain. The cough was incessant, hoarse, and ringing, causing great pain in the windpipe. With the cough there was escape of urine, which was pale and very copious. Caust. 1st dec. dil., was given every hour until symptoms were less, and then it was administered every three or four hours. In twenty-four hours there was considerable relief, and the third day the pain and tenderness of the windpipe, with most of the cough, had disappeared, and with this the escape of urine. After about thirty hours' comparative quiet, a violent convulsive cough, with nausea and vomiting, set in; this proved to be whooping cough, and the enuresis returned. In the proving of Causticum, S. 476, there is involuntary emission of urine in coughing and sneezing, and Hahnemann in his introductory notes records this as one of the indications for Causticum. I do not report instances where Causticum has failed, and where it was apparently well indicated; the cases now given are more to illustrate its sphere of action, and fully bearing in mind the circumstance of occasional failure, I regard this medicine as one of our most important in such ailments. Of its efficacy in other ailments, as, for instance, rheumatic and arthritic affections, I have not had sufficient experience to enable me to express a decided opinion. 477 REVIEWS. On Cholera. An Historical Sketch with a practical application. By J. RUTHERFURD RUSSELL, M.D. Ross. Leath and Cholera Prospects: compiled from personal observations in THE above are three of the latest and most notable publications which the threatened return of the cholera to these shores has evoked. Dr. Russell's lecture has been read by most of us in the Annals of the Homœopathic Society and Hospital, whence it is reprinted. It is an able résumé of former epidemics, contrasting allopathic blunders and failure with the large amount of success which has resulted from the application of the law of similars to the treatment of this pestilence. The pamphlet of Dr. Tilbury Fox derives its value from containing many observations made personally during the last year's epidemic of cholera in the East. These observations go to show, in his own words, " (a) how unreasonable is the theory of spontaneous development; (b) that the source of cholera poison is India; (c) the influence and great power of the transporting agencies,-man, ships, and currents of air; (d) the line of investigation required by the International Sanitary Commission; (e) the action of good food as a preventive-a word for the poor, and a warning to ourselves; and lastly (f) the plan of prevention and treatment found to be the most successful of late." Of these points, the first and the last are of most interest The argument drawn from the outbreak of cholera to us. among the Mecca pilgrims in favour of its capability of spontaneous generation is satisfactorily disposed of. The channel of communication by which the disease travelled from India to Arabia is shown to be very obvious; and we are left confirmed in our previous belief that the only fountain of cholera is India. The sketch of treatment is preceded by a sentence which is very gratifying to our ears. "Diarrhoea is a symptom of many diseases, and amongst others, of cholera; but I would here insist upon that which has been amply proved by Indian physicians, and by the large experience of the recent outbreak, that diarrhœa is not by any means necessarily an early stage of cholera." In the East, Dr. Fox states, "there appeared to be no scientific principle guiding the therapeutical plans." The only novelty consists in the free use of Nux vomica and Strychnine. "There is a large amount of experience to show that in cases of collapse and frequent spasm the best possible results are to be obtained from the use of Strychnine." From one twelfth to one fourth of a grain is to be given frequently. Again, "in Egypt Nux vomica was freely exhibited to control the sickness, as well as to check the spasms. So great was the demand in Alexandria, that one chemist alone dispensed his six months' stock of extract in less than a fortnight." The homoeopathicity of Nux vomica to certain forms of cholera, especially where spasms predominate, is too obvious to require comment. Dr. Johnson's lecture has excited, and well deserves, considerable attention. When cholera first appeared in Europe, the profuse vomiting and purging which generally characterise the disease naturally attracted most attention, When collapse supervened, it was readily set down to the drain of fluid which had been going on. Upon this theory two indications for treatment at once presented themselves. The first was to check the evacuations by astringents and sedatives; the second, to rouse the sinking vitality by stimulants. Opium and brandy accordingly were the types of cholera remedies in the epidemic of 1831-2. The mortality was frightful. In 1849 another invasion of the pestilence occurred. The evacuations still engrossed attention; and the pernicious doctrine was in the ascendant that cholera always had a preliminary stage of diarrhoea, and might be readily arrested in that stage by astringents and sedatives. If cases were wicked enough to go on to collapse, it was supposed to be in spite of the remedies employed. The epidemic of 1849, however, found the medical profession in Great Britain in a very different state from that in which it encountered the epidemic of 1832. We do not mean that in most of the large towns there were physicians practising homœopathically, though this has had an important influence on the theories about cholera. But a new generation of medical practitioners had grown up, with minds fashioned by the scientific culture, and quickened by the inquiring spirit of this age. They were little likely to rest in the rough and superficial doctrine about cholera which then obtained, and which did not even lead to successful practice. Many were the novel theories started, and the innovations introduced into the treatment of the disease. It would be useless to enumerate these; they have served their purpose in breaking up the ground, in dispelling a false satisfaction, and stimulating to farther inquiry. We are only at present concerned with the doctrine and practice of one of these physicians, Dr. George Johnson. In 1849 Dr. Johnson was a student at King's College. During the early part of the epidemic of that year all the cases of cholera admitted into the College Hospital were treated by liberal doses of brandy and opium. "Under this mode of treatment," Dr. Johnson writes, the mortality was very great. The treatment was then entirely changed; brandy and Opium were discontinued, and large quantities of salt and water were administered. The effect of this treatment was to excite frequent vomiting, and certainly not to check, but rather to increase, the purging; and the result was a much larger proportion of recoveries than under the previous mode of treatment. I was also deeply impressed by observing that, during that epidemic, the arrest of the purging by opiates was in several instances followed by the worst symptoms of collapse; and a painful question arose in my mind whether the collapse in such cases was not a direct result of the arrest of the purging." Such thoughts and observations as these seem to have led Dr. Johnson to the study of the disease in the writings of Indian practitioners, who see it in its original birthplace and highest intensity. Here he learnt to abandon altogether what may be called the European doctrine of cholera, and to mature a totally different mode of treatment. The epidemic of 1854 found him assistant-physician to the hospital; and, during the absence of the physicians in the autumn, in chief charge of the medical wards. It will be remembered how he astonished the profession and the public by announcing that he was treating all his cases, and with more than the average amount of success, by castor-oil. In a volume published subsequently, and now more concisely in the book before us, he states the grounds of his change of practice. In the first place he points out, as Dr. Russell in his treatise on Cholera had pointed out in 1849, that there is no relation whatever between the severity of the collapse and the copiousness of the evacuations of Cholera; that in the worst cases of collapse, indeed, there is little or no vomiting or purging at all. He concludes "that the evidence of there being an inverse rather than a direct ratio between the degree of collapse and the loss of liquid by vomiting and purging is fatal to the hypothesis, so generally received and acted upon, that choleraic collapse is caused by the drain of liquid from the blood." Next, he inquires "whether the symptoms of collapse are such as an excessive drain of fluid from the blood would be likely to produce?" This section is original, and very well worked out. He points out that the symptoms of loss of fluids are those of syncope, while the phenomena of choleraic collapse far more closely resemble asphyxia. The collapsed patient can stand and even walk; while for one exhausted by drain of liquid the very attempt would produce faintness. In the latter cases recovery is always gradual, in the former |