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so violently that such as were loose have been shaken out; his knees knock together; his hair bristles slightly, from the contracted state of the integuments of the scalp; his cheeks, lips, ears, and nails turn blue; rings which before fitted closely to his fingers become loose; his respiration is quick and anxious; his pulse frequent sometimes, but feeble; and he complains of pain in his head, back, and loins. All the secretions are usually diminished; he may make water often, though generally he voids but little, and it is pale and aqueous; his bowels are confined, and his tongue is dry and white.

Blueness of the skin.

More or less hurry and difficulty of breathing, with a short dry cough. Great diminution of the volume and force of the pulse.

More or less suppression of bile and urine.

A peculiar feebleness of the voice.

Coldness of the tongue and breath.

Sensation of burning heat in the epigastric region. Great thirst.

Vomiting and purging of a rice-water fluid.

Torpor and drowsiness in a variable degree, but without delirium.

Cramps in the muscles.

After all differences have been allowed for, it would still be a just thought if, on looking at a case of choleraic collapse, we said, "This patient is in the cold stage of a malignant intermittent, with certain peculiar symptoms."

If we proceeded to open a vein, our diagnosis would be confirmed. "The black, thick, treacly appearance of the blood is not peculiar to the collapse of cholera. It has this character during the cold stage of a severe ague-fit. Dr. Macintosh and others, who have bled patients during the cold stage of ague, describe the blood as flowing from the arm at first in a slowly trickling stream, being of a dark colour, and not coagulable." (Johnson). Still more convinced should we be of the correctness of our opinion if the patient rallied; for in the "consecutive fever" of cholera, we should recognise the hot stage of our intermittent. Finally, if we inquired as to the original home of this fell disorder, we should find it to be the marshy tracts formed by the Delta of the Ganges; in fact, that it was a result of malaria.

We do not desire to press too far this striking analogy between ague and cholera. The use we would make of it is to show how unnecessary is the hypothesis of "spasm of the pulmonary arteries" to account for the phenomena of collapse. The same essential phenomena, in a less violent degree, the arterial emptiness, the venous plethora, the treacly blood, meet us in the cold stage of ague; and no one supposes them to depend upon "spasm of the pulmonary arteries" there. Indeed, the tendency of modern pathology is to look upon the nervous system, and especially its sympathetic portion, as the starting-point of the series of chill, heat, and sweat, however varied their individual and relative character.

We have left ourselves little space to speak of the treatment recommended by Dr. Johnson, on the strength of his novel theory. He begins with a sneer at the only direction where a gleam of hope appears. "I have not the faintest hope or expectation that a specific remedy for such a disease as cholera will ever be discovered. The number of really specific remedies which we possess for any disease is, unfortunately, very small. Those who believe in specifics are, in general, ignorant of the nature of disease, and of the true methods of cure; and this ignorance renders them quite incompetent to estimate the influence of treatment."

The inconsequence of the thinking here would be amusing if it were not painful. We then find that the celebrated castor-oil is supposed to act simply as an aperient; e.g., "not to increase excretion from the blood into the stomach and bowels, but to assist in the expulsion of the morbid secretions from the digestive canal." If this is all that medical science can do to help a patient attacked by cholera, the presence of the physician at the sick-bed is a mere form. However, in severe collapse Dr. Johnson recommends venesection to be tried. He condemns brandy and alcoholic stimulants, thinks ammonia sometimes useful, points out well the absurdity and injury of trying to feed a collapsed patient, has little opinion of warm or hot-air baths, and of course objects to ice or iced water, since they check the vomiting, which upon his theory is eliminative.

If, then, Dr. Johnson be right, the great bulk of cholera treatment hitherto practised in Europe has been not only not curative, but positively injurious. It has been so, because based upon a false theory of the nature of the disease; and the only chance of improvement for the future is to discover the true theory, and to base our treatment upon it. It is not surprising that we turn from such a picture to the contrast presented by our own beloved system, which needs no theory of disease, but from the symptoms themselves is guided by an infallible rule to the discovery of the specific remedies.

It is needless to recapitulate the victories gained by homœopathy over cholera. In Russia and Germany in 1831-2, in Liverpool and Edinburgh in 1849, in the Golden Square Hospital in 1854, the disease was studied, encountered, and to a large extent vanquished. We probably formed our theories about the nature of the disease, as did our allopathic brethren; but we never allowed them to influence our treatment. We met cholera, as all other diseases, by remedies selected according to the law of similars. Hahnemann gave us Camphor, Veratrum, and Cuprum; to these later students of the Materia Medica have added Arsenicum and Secale; and these are the remedies which every one of us uses against cholera. Such

unanimity is rare, even amongst homoeopaths. And what is the result? Can we honestly say, like Dr. Johnson, that "there is no remedy which has the slightest pretensions to be considered a cure for cholera; no drug or agent which, so far as we know, will neutralise the poison or lessen its virulence"? We certainly cannot. On the contrary, we can all echo Dr. Russell's confession of faith made in 1849. "It is our firm belief, from all that we have seen and heard, that Camphor is an almost infallible remedy for cholera, if given at the very outset of the attack." Later experience, as we shall see directly, has even extended this statement, and declared that there are no bounds to which we must limit the power of Camphor to rescue the cholera-patient from death. We cannot, indeed, use equally strong language about Veratrum, Arsenicum, and other medicines. But no one who has used them in suitable cases of cholera can doubt that they exert a decided modifying influence over the symptoms, and often conduct the most unpromising cases to recovery.

So far, then, we have every reason, as regards cholera, to be gratified at the success of our system in the past, and to be hopeful for the future. But we should be wrong to think that we have attained perfection in this matter. We boast of only losing our 26 per cent. of cases of cholera; but this is a frightful mortality positively, whatever it may be comparatively. It is our bounden duty, as each epidemic of cholera threatens us, to review our means of offence and defence; and while we burnish and sharpen our old weapons, to see if we cannot add yet more effective instruments of warfare to our armoury. There are two proposals now before our body which have for their object the diminution of our mortality from cholera.

It is advised that we should rely more exclusively upon Camphor in our treatment-that it should be given in full doses and frequent repetition in all forms and stages of the disease. This proposal comes from our esteemed Italian colleague Dr. Rubini, to whom we owe the Cactus grandiflorus. It is supported by alleged success of the most unique character, some 592 cases having been treated by this

method without a single death. One is of course disposed to think at the first blush that very few of these cases could have been real cholera; they must surely have been diarrhoea, more or less choleraic in character, occurring during the raging of the epidemic. No doubt many of the cases were of this kind, but it is extremely improbable that all were so. For instance, in one of the certificates appended to Dr. Rubini's pamphlet,* the colonel of a Swiss regiment states that he had 183 of his soldiers attacked with cholera; that seventeen were sent into the Military Hospital, of whom fifteen died; that the remaining cases were kept in the infirmary of the corps, and submitted to Dr. Rubini's treatment, and all recovered. If the impression we receive from this certificate be correct-that the first seventeen cases which occurred were sent to the hospital, and all subsequent ones placed under Dr. Rubini, the inference is plain that he must have had his proportion of severe cases. Another certificate seems to imply that out of 200 cases treated fifteen were in collapse. Even apart from direct statement it is incredible that out of so many cases coming before a single physician (Dr. Rubini himself treated 377 in the epidemic of 1854) a fair proportion should not have been severe; and the unqualified success is most striking and satisfactory. It will, at any rate, strengthen and extend our confidence in this great remedy, Camphor. We have always believed it the specific for the stage of invasion; but if Dr. Rubini be right, we should not leave off its use because the disease makes progress, or choose another medicine because we encounter it in a more advanced stage. Wherever cholera is, he says, there let Camphor, and Camphor only, contend with it, and the victory is sure.

It must be confessed that this has not been the experience of British homœopathists hitherto. Dr. Rubini says, however, that we do not give our Camphor in sufficiently strong doses. If we are to test his method, it seems we must redistil our spirits of wine until they are so much over proof as to dissolve their own weight of Camphor. Of this

*We take the account of it given by Dr. Bayes in the June number of the Monthly Homeopathic Review.

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