of ice being added. Did the stomach eject the medicine immediately, or a few moments afterwards, the same dose was re-adminis tered. Ice was ordered to be taken into the mouth ad libitum, in preference to drinking much water, which usually was thrown off as soon as it reached the stomach. At reasonable intervals a teaspoonful of brandy also, with the addition of ice was given to the patient, until contra-indicated. After the lapse of two hours a second powder was exhibited.

I shall state as a fact that in the majority of cases in which the first dose of the comp. calomel powder had been retained for about fifteen minutes, the vomiting, as a rule, ceased, the profuse rice-water evacuations gradually diminished in copiousness and frequency, until after the lapse of several hours a less exhausting bile-colored diarrhoea became established, which finally disappeared under the further use of a few fractional doses of powdered opium and ipecac, of a grain of each. In exceptional cases of a very grave character, more than two, compound calomel powders were found necessary, the addition of opium to calomel of the composition mentioned, must be called a mere medium dose. In such a combination opium, to which ipecac is added, will produce no deleterious effect on the brain, while it will suffice to act satisfactorily as an anodyne and sedative, to allay the great irritation of the stomach and intestinal tube.

I should here mention that in a number of instances the gums of the patient after the expiration of ten to twelve or more bours, appeared to be more or less swollen and somewhat painful; in some cases salivation was produced, which, however, yielded in the course of a week to very small doses of iodine combined with iodide of potassa, and a gargle containing a small amount of diluted hydro chloric acid. Warm stimulating poultices were placed around the limbs suffering from cramps, and also over the bowels, which seemed to add at least to the relief of the pain more than sinapisms or repeated rough frictions made by the bystanders, which under the circumstances even did harm. As soon as the vomiting ceased the patients were supported by proper nutriment in small quantities, spoonful by spoonful, at reasonable intervals, as chicken-broth, beef-tea, or also milk with a little soda water, etc. This principally constituted the medication in the second stage of cholera. If the patient was seen in the condition

of impending collapse, and the dejections were still continuing, the same treatment was pursued, together with the occasional employment of spirits of camphor, tinct. of capsium, etc., and also aided by the application of artificial warmth to the surface until re-action became established, if possible. In complete collapse the patient was rather left to the efforts of nature, than of being subjected to active treatment. Good results have followed some times by the continued use of small pieces of ice and beef-tea.

What by the lamented Dr. Newman in his able paper (published 1854) had been termed "congestion of the brain," and spoken of as a stage of cholera, dependent upon irritation of this organ, excited in the course of the disease, and which to others and my own experience, will be observed in one epidemic more than another, or also may fail to make its appearance, has been treated by me by ordering cold application to the scalp, one wet cup behind each ear, (in two instances,) one grain of calomel to be given every two hours, and as much ice placed on the tongue as the patient desired, until all dangerous and distressing symptoms seemed to subside.

I must, however, mention that of the cases which came under my observation, (five in number,) three had been under the care of Eclectics, having been treated chiefly with tablespoon doses of powdered ginger, but which were always ejected from the stomach; while the remaining cases had received no medical attendance previous to my being called. All these patients, among whom was a woman who shortly before had given birth to twins, and having had no medical aid during her suffering from cholera, soon did well. In the treatment of these cases as an average, six grains of calomel together with the applications mentioned, was usually sufficient to relieve the congested state of the brain.

After having described the mode of treatment I have pursued, especially during the two latter cholera epidemics, I shall now attempt to point out the probable action of the remedies under consideration. Calomel combined Calomel combined with opium in proportions already mentioned, appears to act first as a sedative, and second to produce a certain alterative effect on the system in general, but not as has been assumed, to act as a chologogue, a mere restorer of biliary secretion, since the gall-bladder has been found filled VOL. 7 NO. 9-43

with bile after death. The combination of calomel and opium seems rather to restrain and effectually check not only vomiting, especially with the frequent administration of small quantities of ice, but also to arrest more or less rapidly the profuse, so-called rice-water dejections, and finally change them into healthy stools. Even when a certain collapsed state has taken place, re-action has by the judicious use of calomel sometimes been established, however hopeless the condition of the patient did appear. In such cases animal heat will gradually re-appear, the general surface lose its death-like feeling, the circulation be restored and become more and more equalized; a warm moisture will take the place of the cold condition of the skin, and with the resumption of the pulmonary function of æration, the restlessness will vanish, and the voice, before husky or nearly extinct, gradually becomes natural, the sensation of oppression of the precordia, the insatiable thirst, the sharp and contracted state of the features will disappear; also the lost nerve power, the secretions, especially that of urine be restored, etc.

Finally, since it cannot be denied that the deleterious effects of the cholera poison are decidedly manifested upon the great sympathetic and pneumo gastric nerves, in consequence of which their functions appear to be seriously disturbed or even suspended, and since also a great many good results have in epidemic cholera been observed from the employment of calomel and opium conjointly, I may perhaps be permitted to conclude that it possibly may exert a certain beneficial, although up to the present time but little understood influence over the organic nervous system, probably sedative and alterative in its effects, in consequence of which a salutary change of the disturbed functions of organic life and even of the deranged chemico-vital condition of the blood itself might be established, and thus pave the way to a final restoration of health. This must, however, be regarded as a mere hypothesis; indeed various articles of the materia medica employed in cholera, in very different ways and modes, have undoubtedly produced very happy results.

Mr. President and gentlemen of the Association:—When during the last three or four years I have read articles or treatises on epidemic cholera, I confess it has often been with mixed feelings of joyful surprise and also of sorrow, for very obvious reasons.

While we have not yet found the means of preventing entirely the spread and dreadful ravages of this deadly pestilence, yet more has been done in this direction by the medical profession during the just mentioned period than ever before.

As to the treatment of cholera, it must be admitted no remedy whatever seems to have fully satisfied the medical mind up to this very day. Of late several agents have strongly been recommended by some observers, especially for the purpose of a more speedy relief of the severe spasms and cramps in the second stage, as the employment of hypodermic injections of morphia, with or without the addition of atropia, or the internal use of chloroform; the latter in certain combinations is also said by some to rank first among means to meet powerfully and fulfill most promply the indications of any stage, and even that of the "algide con. dition," and to succeed in effecting a cure in nine-tenths of cases of those attacked.

Still I should mention that the same success in treating Asiatic cholera is claimed by Prof. Palmer of Chicago, an eloquent advocate of the calomel treatment, according to his own plan. It may however be truly said, that with but few exceptions, nearly every writer on the topic which is still involved in so much obscurity, prefers to recommend his own favorite mode of treatment, and takes pains to criticise all, or most others, or even ventures to condemn them more or less, not only as irrational and unsound in principle, but also as quite ineffectual in practice, which expressions cannot in fact always receive the sanction of a profession so enlightened and high-minded as the medical. Indeed, we as the friends of suffering humanity, must content ourselves with the consciousness of having done our full share of duty in having attempted to save lives in the darkest hours of peril, always to the best of our ability and conviction, in spite of the great discrepancy of opinions and theories. And should it seem to be proper to defend our modes of treatment, we should not hesitate, we must do so in honor to the profession at large and medical science.

The President, Dr. Eastman, having arrived, took the chair.

DR. MINER moved a vote of thanks to Dr. H. Nichell for his well-considered and able essay.

DR. EASTMAN suggested that the motion include the request of a copy of the essay for publication.

DR. MINER replied, that he preferred not to put the motion in that form; not however because he did not think the author deserving the compliment, but because it is entirely unnecessary, for the reason that all papers read before the Association, and worthy of publication, will be gladly published as proceedings of the Association without a special request. Voting to have them published could only add to the embarrassment of the editor of the Journal, who must exercise some discrimination in selecting the material composing the pages of the Journal. Papers and communications of interest locally, and not very objectionable when presented before the members of the Society only, were sometimes of no general interest to the profession, and when published, were not only of no value, but exposed the Society and author to derision and ridicule. Nothing was more unpleasant, than to reject such papers when designed for publication.

DR. EASTMAN replied at some length, sustaining Dr. Miner in his views, and justifying and approving his position, regarding it as not only proper but absolutely indispensable both for the credit of the Journal and the respectability of the Society that most careful supervision be exercised in this respect. The Secretary reports the proceedings, and cannot be expected to reject or change written papers presented by members. The editor of the Journal

must exercise this power, and should be sustained and aided in an effort so manifestly important, not only to the Journal, but to the credit of the Association and reputation of its members.

The motion of Dr. Miner was carried.

Scarlatina and diphtheria were reported as prevailing.
Adjourned.
T. M. JOHNSON, Sec'y.

Position in the Reduction of Inguinal Hernia.-Dr. Bond, of Nova Scotia, writes to the London Medical Times and Gazette, that he has never failed in the reduction of inguinal hernia when the patient stood erect, even after previous long continued, but unsuccessful attempts in a recumbent position. His attention was first called to this position by having a patient who was unable to reduce his own hernia except when standing. Dr. Bond offers no theory on the subject, but states that it is not on account of the erect position causing syncope.