Here we may ask, will opium aid or give the relief so urgently demanded? However serviceable as an astringent and anodyne in the premonitory stage of the disease, it cannot be exhibited in the second stage to so good an advantage, as, its direct influence is, to aid and promote congestions in those cases, where a tendency of this kind is already in existence.

Again, Dr. Hartshorn on cholera, page 65, says: "Unhesitatingly, I should hold the opinion that calomel is of no earthly use in cholera. The clinical experience, quoted for its success, is accounted for by the addition to it, almost always of opium in the prescription. Nor is the amount of success, with it, even then, great.

You observe that I have quoted three medical writers of quite recent times, who indeed are entirely averse to the treatment of cholera by calomel, with or without the addition of opium, for given reasons. Before I shall, however, proceed to say something as respects observations and facts relative to the employment of just these agents, I desire to lay before you the most positive convictions of no less high authorities, such as I consider rather advocates of this treatment.

Thus Prof. A. B. Palmer, who, according to his statements, had during three seasons, about two thousand cases under carefu observation and management in Chicago, in his remarks on Epidemic Cholera, page 19, says: "I am by no means insensible to the injurious effects, both proximate and remote, which the free use of mercury, under many circumstances produces. I have no sympathy with that class of practitioners, for ever seeing some 'liver complaint or bilious obstruction,' and hurling heroic doses of calomel or everlasting blue pills at these, so often imaginary difficulties. But mercury is a medicine of power, and has its uses, and cholera is one of the diseases where its remedial virtues are greatest. In this disease it seldom produces salivation, or other remote injurious consequences, and even if it did much more frequently, considering the extreme danger of the patient and the good effect it produces, we should be justified in its use. The use of this article (calomel) I consider of exceeding importance. My observations upon it have been careful and abundant, and I think I cannot be mistaken. The discharges may often be checked without its use, but unless the secretion of the liver is excited,

(and calomel when properly given and retained, tends powerfully and far more than any other article to excite that secretion,) the cholera discharges will again return and severe consequences follow. When mercurials, however, are used with opium, such returns of the symptoms are exceedingly rare.

He also says, page 32: "Some of the most remarkable recoveries of this kind, viz: the fully collapsed state, which I have witnessed, have been after large and repeated doses of calomel."

Further: Dr. N. L. North, on Epidemic Cholera, p. 24, remarks: "The calomel treatment, according to the reports of those who have used it, whether in larger or smaller doses, has produced better results than almost any other treatment, and it is said the patients are not apt to have consecutive fever, and that they are generally well in from three to five days."

Prof. Thos. F. Rochester, of this city, in a very ingenious and well-digested article, entitled "A few remarks on Cholera, (Buffalo Medical & Surgical Journal, vol. vi, Aug. 1866,) in respect to the treatment of calomel, page 4, expresses himself thus: “If the writer indicates a plan of treatment to be generally followed, he does so in no spirit of egotism, and with all respect to the opinion of those entertaining different views. It is the result of extended personal observation and experience; he has tried and has seen tried very many methods of treatment, and while he candidly admits that nothing is very reliable or satisfactory, his decided preference is as follows," etc.

And further, he adds: “It has been argued that calomel should not be given in the manner advocated on account of the great liability of salivation. It will salivate but very few, but if it is potent in permanently arresting the serous diarrhœa, and also in arresting some of the choleraic sequelæ, salivation is of minor importance."

What, however, has by distinguished modern observers been said, either to favor or condemn the use of calomel in this disease, the same applies also to the employment of opium.

Prof. Maclean, cited by Drs. E. and A. B. Whitney, in their treatise on Asiatic Cholera, page 66, remarks: “Opium in cholera should be given only in the premonitory diarrhoea. At this stage in combination with a stimulant, it is of the highest value. If persevered in, particularly in the strong doses, it is a dangerous

remedy, inducing fatal narcotism, at least, interfering with the functions of the kidneys, and so leading directly to uræmic poisoning."

Dr. Nelson, whilst he, as we have seen, in the strongest terms condemns the use of calomel in cholera, seems to be an enthusiast, however, as regards opium. In his monograph, page 188, he says: "Throughout the whole reign of cholera, opium has been had recourse to, with benefit, when judiciously employed, but which, alas, has seldom been the case, for there are only a few practitioners who are deeply versed in the recondite action of this heroic remedy, while the great majority see in it only an every day drug, and are totally ignorant of its mysterious power; a larger dose than one grain might so paralyze the stomach as to arrest its power of ejecting what ought to be discharged and lock it in, to the injury of the patient "

Again, page 190, he observes: "When opium is administered at the proper time and in proper quantities, it will not only allay a state of vomiting, which is not longer needed, but it will also sooth the whole economy in a notable degree and pave the way to a recovery."

Dr. Nelson here doubtless means the use of opium in small or medium doses in the second stage of cholera.

Drs. A. and E. B. Whitney, although according to page 112 of their treatise, they really appear as sharply opposed to the employment of opium in the second stage of the disease, as you will please to recollect, nevertheless they at p. 191, strangely enough, advise the temporary addition of tinct. opii to certain injections into the bowels in cases in which on account of the great irritability of the stomach, their favorite combination of chloroform cannot be retained.

Prof. Palmer, in his remarks on Epidemic Cholera, p. 17, says: "Opium in proper doses and combination in certain stages of cholera, before the vital powers are much exhausted, and while irritation of the stomach and bowels is the most prominent symptom, is the great remedy in the disease, or at least one of the prominent and essential items of a correct treatment. It is by far the most potent remedy we possess for allaying that irritation, arresting the flow of fluids to the mucous surface and controlling the debilitating discharges, and when from its use these effects are

produced, the system by other proper aids, is generally enabled to rally and struggle successfully against the morbid influences." He also says: "No language can be too strong in condemning the use in larger quantities in the advanced stages of the disease." Dr. Blacklock regards the exhibition of opium as a poison in

cholera.

Dr. Cox, quoted by Dr. Peters in his treatise, p. 153, remarks: "It is quite powerless to check the vomiting or purging, or to relieve the cramps, and is totally inadmissible in any stage or any dose."

Dr. Warring says: "Dr. Cox's opinion is perhaps too sweeping, but that it is injurious in large and frequent doses, either alone, or in combination, is a fact that few will be inclined to doubt."

I could quote a great many more medical writers, either advo cates or opponents to the employment of opium alone or combined; for my present purpose, however, the number cited above seems to be quite sufficient. One could believe that physicians might be rendered skeptical in medical science by such conflicting statements and opinions, but it strikes me the profession will, on the contrary, but improve in this respect. We learn thereby a great truth, that opium in cholera has been abused, that it had been given in too large doses, or when in small quantities, its use too long persevered in and administered even frequently in impending and complete collapse; in short, that it had often been given without a clear view of the indications which this medicine fulfills. Exhibited in such improper doses and at improper times, opium has doubtless proved to be a very dangerous agent, and must have fearfully added to the bill of mortality in most of the irruptions of a disease which of itself appears so appalling and destructive in its effects. On the other hand we find the great practical utility of this remedy well established and recommended in cholera by such medical men, who have always made a wise and careful use of it in proper quantities and at proper stages of disease, closely watching its effects on the system.

We finally observe with some surprise and satisfaction, that even such authors as in principle as well as practice, are opposed to its employment in cholera, under certain circumstances, however, seem to be forced to its use and advise it in such cases in spite of all their a priori reasoning.

Mr. President and gentlemen of the Association:—After having tried various plans of treatment during the last three epidemics of cholera in our city, I feel it my duty to state, that none has given me such entire satisfaction as what has been termed the treatment of cholera by calomel and opium conjointly with stimulants; and this evening I feel indeed happy when I am enabled to recount to you the history of Mr. P. B., whose life had three times been in extreme danger in the cholera epidemic of 1854, but who fortunately escaped each time by being subjected to this mode of treatment. These three severe attacks succeeded one another with fourteen days' interval of apparently restored health. The two latter attacks taking place soon after great imprudence in diet, as I learned from his wife. In the attacks in which I have seen him, strange as it may appear, always in a more or less collapsed state, his pulse and heart sounds were then almost imperceptible, respiration greatly oppressed, his voice in the second and third attack nearly extinct, vox cholerica, his tongue and general surface icy cold, the latter in the third attack covered with clammy perspiration, shriveled and corrugated, and at the extremities already cyanosed. His features had become ghastly. He likewise presented in each of these states, alternately, a picture of great restlessness, or of entire apathy and indifference, only craving for drinks; in fact, a series of phenomena were exhibited which could only be the result of the powerful action of the cholera poison, due to the great loss of fluids from the system by the incessant and profuse vomiting and purging and the severe cramps he had to endure. This patient afterwards enjoyed a full, vigorous health up to this present day. Indeed he represents a true type of the Teutonic race. I could also report the cases of two married ladies who were twice and other patients who were once in such a dangerous condition during the two latter epidemics in this city, having recovered under the adopted plan of treatment.

I shall proceed now to describe in detail the method I have pursued, and which in good constitutions afforded encouraging results. For instance, I visited an adult person in the second stage, greatly suffering from copious vomiting and so-called ricewater discharges, cramps of the extremities, etc., I gave my patient a powder composed of calomel 20 grains, opium 1 grain, ipecac à grain, in a teaspoonful of sweetened water, a small piece