courage, and this unselfish devotion to the welfare of his fellow-creatures, he will honor his calling, and thereby, and thereby only, will his calling honor him.

If in the years to come we thus keep steadily in mind this noblest end of life and labor, we may hope to be always worthy members of an honorable profession, and through the gathering mists of declining years may look back with an honest pride to this hour of farewell.

Owing to the prevalence of this disease as an epidemic, it has attracted considerable attention the past winter, as constituting an important factor in modifying the general condition of public health in this city. It made its appearance about the last of November, and has continued with more or less violence from that time to the present; however, few fatal cases have occurred, death from this disease proving an exception rather than a rule under judicious management.

The extent to which it has prevailed has been somewhat magnified by both the medical profession and the press, one journal estimating that more than four per cent of the population have had it in some form.

Such exaggerated reports are easily accounted for upon the principle that new epidemics, like everything else that is taking, are liable to become suddenly fashionable; besides, undoubtedly numerous cases of diarrhoea, the result of exposure to cold or the eating of unwholesome fruits, as well as the beer and whisky fluxes so common in city practice, are frequently honored by the appellation of winter cholera.

At the present time, very little is positively known about the origin of this disease, consequently there are no fixed facts on which to base an opinion; therefore, further investigation will become necessary before any definite conclusion can be attained regarding its character, and such investigation must be confirmed by the scalpel, the microscope and chemical analysis

all views at present entertained as to its cause are, to a great extent, based upon mere conjecture. There is a wide difference of opinion among medical men regarding the cause of winter cholera. A few believe it to be a toxemic neurosis, and claim to recognize in it a modification of that dread pestilence, Asiatic cholera, while others concede it to be a form of gastroenteritis, following exposure to cold and wet. Another theory is that it is caused by the presence of oxalic acid in the blood, its advocates claiming the source of this acid to be the indiscriminate and universal use of canned fruits and vegetables as articles of diet. And finally, as a dernier resort, to sewer gas is ascribed the honor of giving birth to the new-comer. As cold, damp weather and sewer gas are forces that have been in constant operation in Chicago for many years, it is astonishing that they have had no influence in generating this epidemic until within the last four or fre months. In further refutation of the influence of sewer gas cause of this disease, it will suffice to state that numerous well-authenticated cases of winter cholers are reared as occurring at farm-houses in localities quite remote from the city, and in families, no memher of which has visted Chimage aring the prevalence of the epidemic. Regarding the theory of blood poisoning by oxalic acid, resulting from the use of canned fruits, it will be quite sufficient to mark that this theory had any foundaauthoions rdery tion in thof, we would have had waer cholera in every city, rown and village of the Und Sas ten years ago. That the eating of wake Šis a weather may pave the excing varatch and cholera mares we are there is no evides a dow dar der erste even as predisposing ple d'avender consideration. It does not scam possible ike any

exposure to cold, damp uses of gastro-hepatic a reasonably doubt; but

who has had any experience with mums viazd it with gastro

Yes this is frequently

catarrh is a bilious attack with stomachic inflammation, and may follow any of the causes of indigestion and exposure to cold. Cholera morbus is an idiopathic emeto-catharsis, neither brought on by an irritant poison nor epidemic influence, while winter cholera depends upon a special material or malarial cause yet unknown, except by its effects; is epidemic and without any limited localization. This special zymotic influence eventuates in a toxemic affection, in which the alterations in the blood are manifested by the vomiting and eliminative diarrhoea which characterize this disease.

In confirmation of the view that winter cholera is the result of a special zymotic toxemia, I beg to submit a brief outline of the symptoms, course, and particularly the treatment that has proved the most successful in the management of the disease, not only at my hands, but in the experience of others, whosefacilities for observing the action of remedial agents in this disease have been more extended than my own.

The premonitory symptoms of winter cholera are general malaise, chill, headache and some fever, varying in degree in different cases; after several hours a remission occurs; this may last six, twelve or twenty-four hours, when the patient's discomfort returns, accompanied by nausea, vomiting and diarrhoea. The nausea and vomiting are so slight in some cases as to cause no particular inconvenience, while in others it is an important feature of the disease, the stomach often becoming so irritable that it is impossible for the sufferer to retain any aliment, the most bland fluids being rejected as soon as swallowed.

The

The evacuations from both the stomach and bowels are serous in character, resembling the rice-water discharges of cholera, but unlike remittent fever, gastro-hepatic catarrh and cholera morbus, exhibiting no trace of bile. Absence of bile in the evacuations is pathognomonic of winter cholera. skin is jaundiced to some extent in all cases. secretion is scanty; thirst is moderate; respiration is slow, yet free. The alvine evacuations are very profuse, as many as thirty passages in three or four hours being a common occur

The urinary

16

diarrhoea abates more or less: but headache and shooting pains remain. and the puise does not regain its natural standard. The stomach is less disturbed, and thirst is not so intense. This period of remission lasts from six to twentyfour hours. Finay. the diarrhoea and other symptoms return with all their original violence. The progress of the disease er the second remission is somewhat varied. Its character, Ar, is periodical throughout its whole course. ans are irregular, and may occur at any time. These The As and remission may continue until the patient is gahausted, and if not relieved, prostration and coldness callapse identical with that of cholera, and death JNA Á xưa Favorable cases usually terminate in from - in an intermission, getting well even without mare violent cases, if badly managed, or in A & had constitutional habit, may last from senal & the symptoms being somewhat modified seldom occurs, the return of the diardermission, being frequently misThis can be readily verified by an stions, which are always tinged convalescence.

was together with the evident eamentary canal, liver and kidster death from winter cholera £rgans corresponding with

24 unlikely that we should find ader empty, or else its duct see and kidneys engorged with congested and swollen, with

salts; however, to future be left the task of determinterations that follow in the

iera, the first object must be er. This may be accomplished eter, resina podophylli. After perate, or as soon as the stools

exhibit the presence of bile, one of the following capsules may be administered after each movement of the bowels:

R. Tannate of quinia....
Pulv. opii.........

Di.

.....gri.

M. Et. ft. capsules No. X. The above is a popular prescription with several physicians of my acquaintance, who claim for it specific virtues. I have had quite as good success with the sulphate alone as when combined with opium and Quinia seems to be the one remedy in the disease that overshadows all others, and the sooner the constitutional impression or cinchonism is produced the sooner the patient recovers his normal tone and vigor.

My experience with bismuth, opium and tannic acid alone has proved anything but satisfactory. This, I believe, has been the experience of others; yet, combined with quinia, they become valuable auxiliaries in the treatment of winter cholera. Some cases of extreme prostration with threatened collapse may necessitate the use of brandy and whisky, and, in severe cases of vomiting, hypodermic injections of morphia over the stomach are admissible.

(III.]

ACUTE ALBUMINURIA.

BY PROF. JOHN TASCHER, M. D., OF CHICAGO, ILL.

This disease makes its appearance during any period of life, but usually it is the sequel of some eruptive disease, hence the greatest number of cases that we are called on to treat occur among children between the age of one and twelve years. Just why this disease should follow in the wake of the eruptive more than in other diseases is not very clear. It is a well-established fact that the skin, kidneys and lungs are vicarious organs; (in other words) one organ can perform the functions of the other for a short time. In all eruptive diseases there is an impaired action of the skin, thereby causing the lungs and the kidneys to do a greater amount of work than in their normal condition. After a longer or shorter time,