black and thick state of the blood, and the presence of venous coloured blood in the left auricle and ventricle, and in some of the arteries, 3dly. The singular vermilion tinge upon the upper part of the small intestines; and the dark venous vascularity of the lower part of the ileum. 4thly. The peculiar viscid, tenacious, cream-coloured secretion and accumulation in the intestinal tube, which sometimes not only filled it, but actually glued it together. 5thly. The change of the colour of the blood, from black to red, while flowing from the arm; and the success of venesection in checking the disease, indicated by this change. 6thly. The favourable change which always followed dark, grey-coloured, and viscid dejections. 7thly. Dark green motions, succeeding to the abovecharacterised motions, and the indication which the former furnished, viz. an approaching return to healthy function. 8thly. Collapsed state of the bladder, and want of secretion of urine, and its secretion and appearance always proving favourable.

These were the circumstances of the disease I always kept in view in treating cholera, and I never lost sight of them throughout the cure. My object was to remove congestive symptoms, and to effect the discharge of the viscid matter from the bowels. Bleeding, both general and local, antispasmodics, æther, ammonia, and camphor, with stimulating external applications, effected the first; and calomel, with aloes, the latter. I have often thought that much benefit was derived from the drogue amère already alluded to; and the warm gums composing it certainly appeared to be useful in aiding the calomel in removing this matter from the intestines; and therefore I often gave it with calomel, in doses from half an ounce to one ounce mixed with the camphor draught, and I was confirmed in the opinion, by appearances and by examinations after death; where I observed, in some cases, that the viscid matter had been carried half down the ileum, leaving the upper part of the canal completely free from it. The vast accumulation of this matter, and its uniform presence in all cases of cholera, in addition to the difficulty of removing it, led me to believe that relapse was frequently occasioned by its continuance in the bowels, even after the circulation had been restored; and therefore I considered its removal as a primary object, because it must be evident, that where the intestine is lined with such viscid matter, there must be a constant irritation kept up, and the action of medicines upon the living fibre interrupted.

Observing, even after the congestive symptoms were overcome, that little progress was made in the cure, till blackish grey, and,

subsequently, dark green, viscid dejections were procured, I was anxious to see what effects could be produced upon the secretions of the stomach and intestines, by bringing in contact the various medicines used in cholera with the secreted matter. With this view I removed a considerable quantity of this matter from the intestines of a fatal case of cholera, where it was found in considerable quantity, and made a deliberate and patient trial in the presence of several medical men, who were doing duty with me in the hospital. The following were the results :

1. The secretion itself was concentrated, cream-coloured, or greyish yellow, like healthy pus. When mixed with alcohol, it formed a number of discrete coagula, minutely divided; colour unchanged or ochry.

2. Ammonia, æther, and camphor produced no alteration whatever upon it.

3. Diluted nitric acid, precipitated it in small flocculi; tartaric acid in solution, and in considerable quantity, completely dissolved it, and rendered it perfectly fluid.

4. Cystic bile dissolved it sensibly, the mixture being intermediate in colour between the two.

5. Calomel mixed with it in small quantity, formed a dark greenish grey, precisely similar to the dark grey dejections already mentioned, and appeared to dissolve it.

6. Calomel and cystic bile, combined, rendered it more fluid, and produced a dark green colour.

These experiments were repeated as often as opportunities occurred, but without removing the secreted matter from the intestines, snd the results were invariably the same; the conclusion, therefore, which I draw from the foregoing facts are

1. That tartaric acid is the most useful drink, from its dissolving the matter.

2. That calomel unites with, and separates this viscid matter, and produces those black, grey dejections which precede recovery, and which are unaided by, and unmixed with bile.

3. That the green dejections which succeed to the former, arise from cystic bile and calomel, in combination with this matter.

These experiments have thrown a new light upon the treatment of cholera; and in all cases which came under my care afterwards, the principles indicated by them were observed and followed. Lemonade was given as common drink, which was always peculiarly agreeable to the patient; calomel, in full or scruple doses, with drogue amère, was repeated boldly and with confidence: and when

the congestive symptoms were once overcome, and the circulation restored, the subsequent treatment became simple and certain.

When I saw dark grey dejections, I considered that the calomel was doing its duty; and when I found them change to green, I felt satisfied that the biliary ducts were emulged, that bile had commenced to flow, and that all was safe.

It must be remembered, and I cannot repeat the caution too often, that in every instance the strictest vigilance is necessary; the medicines should never be discontinued, till healthy secretions are produced; and even after they have been produced, laxatives and alteratives should be taken daily, for at least a month after the patient is considered perfectly recovered.

The urine seldom flows freely till a day or two after these viscid, tenacious dejections have passed of: this is a symptom that should never be lost sight of, as the patient cannot be considered quite safe till this excretion is re-established.

The effects of calomel, lemonade, tartaric acid, and cystic bile, on the secretions of the intestines, seem to be deserving of attention in the treatment of fever, and many other diseases.

In common with most other medical men, I had a horror of this disease, from the various reports which I had received of it, and the unsatisfactory account given of its treatment. The instructions, too, derived from superior authority, were so vague, that it was impossible to draw any rational conclusion from them. Magnesia and milk, burnt cork and castor oil, were in their turn recommended as specifics. With such information I really felt at a loss how to treat the first case that came under my care; and my attention was consequently directed to the treatment of symptoms alone, till experience soon taught me, that to remove congestion, and restore the balance of circulation, were the first indications of cure; and that if these were attended to in the early stage of the disease, it became as manageable as most other acute diseases. I likewise soon discovered that many of the notions which had gone abroad, and which had been strongly inculcated, were erroneous: for instance, to drink any thing cold was supposed to be attended with direful consequences. This is the reason which induced me, at first, invariably to give warm brandy and water and rice-water, though actually loathed by the patient. This loathing of warm fluids on the part of the patient was such as could not have escaped the attention of the most common observer; for, although the patient appeared to be dreadfully distressed by thirst, and was always calling for cold

drink, yet, when any thing warm was presented, he put it from him with disgust.

To consult the dictates of nature in the treatment of disease, where there is no decided and manifest objection, can never be wrong; and, as I saw no good reason why warm drinks should be exclusively essential in this disease, more especially as there was so strong a predilection for cold drinks on the part of the patient, I resolved to step out of the beaten path, and gave my patients the nitric acid agreeably diluted. I was gratified to find that it had no bad consequences, but that it was a most pleasant beverage to the patient, relieving that most distressing and urgent symptom, the burning sensation at the stomach.

Fifty-nine cases of epidemic cholera were treated by me in the ' general hospital at Madras, from the 23d of May till the 23d of August, 1819; of which number fifteen died, nearly one in four, as the following statement will show :

In the cases where recovery took place, the disease was met at an early period; and in those which terminated fatally, four, five, and six hours had elapsed from the first attack, before medical assistance was had recourse to. From this fact it appears probable, that, if the disorder be taken at an early period, it would be as manageable as any other acute disease; but the rapidity with which it runs its course, requires the most active and energetic measures to check it, and the loss of an hour may cause the loss of a life!

BOOK V.

ON THE FEVERS OF INDIA.

FEVERS are the most prevalent diseases in warm climates, and, in many places the most destructive. In some parts of the East Indies, however, particularly in the districts under the Madras Presidency, the mortality amongst Europeans is much greater from dysentery than from fever; but the comparative prevalence of, and mortality from, fevers and dysentery, as respects the East generally, depend so much upon locality and various fortuitous circumstances, that no positive statement can be offered on the subject. Although results may vary in different places in India, the number of deaths from fever will at least equal, if not exceed, that from dysentery; whilst the proportion of deaths in those labouring under dysentery and fever respectively, will, in almost all situations, be greatest in the former disease, unless during the epidemic prevalence of fever of a very malignant type. In the western hemisphere, the much greater prevalence and fatality of fever than dysentery are extremely manifest.

The types or forms of fever which are met with amongst Europeans resident within the tropics are very various, either as they present themselves in the eastern or in the western hemisphere. But the varieties can scarcely be said to amount to specific differences; and, in respect of the eastern hemisphere especially, it may be affirmed that the differences which they present in their characters are entirely the result of the activity, intensity, and combination of their exciting causes, conjoined with the predispositions of those affected.

I have never remarked any appearance of fever from a specific or contagious source in India; and, although believing in the influence of infection as respects the continued adynamic fever of temperate climates, I have, during an experience of thirty-seven years in India, never observed fever to proceed from contagion in this part of the world. The fevers, therefore, of India, and I be