245

THE LANCET.

LONDON: SATURDAY, MARCH 3, 1855.

THE ARMY MEDICAL DEPARTMENT.

IN September last the allied armies landed in the Crimea:the French equipped with their tents, their kits, and every-thing fit to preserve the men in health, and provided withambulances and all needful surgical and medical appliances tosuccour the sick and wounded; the English disembarkeddestitute of the means of shelter, and having abandoned thegreat bulk of their medical stores at Varna. Did Lord RAGLAN

expect to achieve a conquest as rapid as that commemoratedby CÆSAR; that to see was to conquer ; and that his victorioussoldiers, after bivouacking for two or three autumn nights,would find luxurious repose and abundance in Sebastopol?Not even a hope so rash would have justified him in thwartingthe Surgeon-in-Chief in his preparations for the care of thewounded. We are daily depreciating our Army Medical

Department by humiliating comparisons with the superiororder and effectiveness of the French, and not without justice;but was there ever before such a reckless abandonment and

disregard of the most obvious duty of a commander-the careof his men ? We are but too well informed as to the defects

both of organization and in the capacity of some of the staff,not to know that the matériel of our medical staff and its

government admit of very great improvement; but calmlylooking back at the history of this disastrous campaign, wecannot avoid the conclusion that, had our Medical Departmentbeen perfect in every conceivable respect, it must have been

useless and inert under the ban of a leader who thought it

good strategy to plunge his men into the havoc of battle with-out a care for the succour of those who might fall.The Medical Department is blamed, but the Medical

Department cannot act. Nine-tenths of the diseases that

,desolate our camp are emphatically of the preventible class.

Scurvy, diarrhœa, and dysentery are more easy to preventthan to cure; but the Medical Department has not had it in itspower to do either. With whom is the blame ? It was not

after consulting the Medical Department that it was decidedto expose the men for weeks to all the changes of the weather,without shelter, and for many subsequent weeks to the in-clemencies of a Russian winter, under Ordnance tents: it was

not upon medical advice that the men have been fed with green

coffee, hard biscuit, and raw pork. The causes of the sickness

must to a large extent be shared between the Commander-in-Chief, the Commissariat, and the War Office at home. But

disease reigning in the camp, the surgeons are called upon tocure. Where are the means ? The correspondents of the press,and private letters without end, tell the same tales of medicinesexhausted, or never supplied. Whose fault is this ? Let

those answer who can tell. But we will answer thus far-Itdoes not rest with the Medical Department. Again, the’regimental surgeons see no hope of rescuing their patientsfrom death, but by removing them from a spot where

everything that engenders and foments disease is rife-

where nothing that can quell it is at hand. What is the

result? Let the following true history teil:—A sick officer

was recommended, as his only chance, to leave the camp.

Before this could be permitted, it was necessary for him,

although his life hung upon the passing moment, to procurethe signatures of five different officials. It so happened thatthis consumed five days, and when the indispensable signatureswere obtained, the document that was to be his saving passportwas lost ! Another five days’ delay, expended in the repetitionof the same routine, had not expired, before the wretched manhad died. Is the fault of all this, too, to lie with the Medical

Department ?Ever since the first exposures of the mal-administration of

everything that relates to the sanitary condition of the armywe have been promised speedy and effectual amendment. Acommission was sent out: we foretold its failure. It has done

nothing. A succession of small measures have been tried;and still the latest accounts are as bad as ever. What next is

to be done? It appears that Government now propose to seek

a remedy for a deep-rooted evil that pervades the whole sys-tem of our army administration, by the notable expedient of

sending out London physicians and surgeons to take the

management of new civil hospitals in aid of the military ones.That these men may be of some individual service is possible;that their presence in the East will effect the smallest step in

extricating the profession of medicine from that condition ofdegradation and contempt in which it is held by the chief

military authorities, and which is the true reason why it hasbeen so feeble in action, and why the honour of the Britishariub has been tarnished through. the loas of their physicalpowers, we dare not hope.We even feel ourselves called upon to censure the mode in

which the selection of civil practitioners has been made. The

selection has been made, we understand, almost exclusivelyfrom the London hospitals. Office in a London hospital has beenaccepted as the guarantee for superior efficiency. Has any care

been taken to learn whether election to the London hospitals-is achieved by merit, or by intrigue? By this restriction, orthis preference, an injustice has been done to many men notholding hospital appointments, but not less able than thosewho do, and also to the many more who have seen everyvariety of practice in the country.At the very commencement of the campaign, and long before

the expedition to the Crimea-namely, in May last-westrongly animadverted upon the insufficiency of the medicalstaff of the army. We then pointed out the expediency of

encouraging surgeons in civil practice to attach themselves assupernumeraries to different regiments and hospitals. But our

recommendation, dictated solely by the desire to supply themuch-wanted medical aid to our sick and wounded soldiers,and that medicine and humanity should extract good out ofevil, and profit by the opportunity of promoting sanitaryscience, involved no infraction of the first principle of govern-ment-that of unity and responsibility in administration.

The plan we suggested would have entailed no violent inter-ference with the organization of the Army Medical Depart-ment. Under that plan, civil surgeons would have given in-valuable aid, without, we think, creating jealousy, or disturb-ing the proper order of the Department.Now, under accumulated pressure, the aid of civil surgeons

has become a necessity: and how does the Government availitself of that aid? By destroying the unity of the MedicalDepartment,-by creating a separate staff that owns no alle-

giance to the head of that department, and is consequentlyirresponsible-by a solecism in Government, that must give

246 THE ANNUAL MEETING OF THE NEW EQUITABLE ASSURANCE COMPANY.

just offence to the army surgeons who have borne the brunt offices of undoubted respectability. We are glad to say thatand hardships of the campaign. the great mass of this business is due to the good opinion of

It is not our wish now to deprecate the establishment of medical men, and has been recommended by individual prac-new hospitals to be tended by civil surgeons, whether at titioners in every part of the kingdom. A large number of

Smyrna, Rhodes, or elsewhere. Past mismanagement, long medical men are insured in the office, and a great proportionneglect of all the laws of sanitary science, contempt for the of the shares are held by members of the profession.warning voice of medicine, and the consequent terrible and It cannot be said that the NEW EQUITABLE has not deserved

ever-increasing accumulation of sickness, have made this viola- well of the faculty. It was the first office which recognisedtion of decency and of sound government an unavoidable the medical attendant of the parties proposing to insure as innecessity. But since Ministers have gone so far in rising all cases the medical referee of the Company. The directors,above the trammels of office-routine as to supersede an entire seeing that the full fee of the physician or surgeon in ordinarydepartment of the military service by invoking independent consultation in dangerous cases amongst the wealthy has beencivil aid, let us hope they will not stop here. The medical fixed by custom and usage at Two GUINEAS, determined toservice has broken down, not through its own fault, but be- make that sum the fee payable to the medical attendant incause of the imbecility of those departments which had the cases of life assurance proposals of a certain amount; that is,control of its every action. The Commissariat, the Staff, the they determined to raise the medical consultation and opinionWar-office, and other purely military departments, have in the serious and formal act of life assurance-an act performedbrought ruin on the army, and disgrace on the British name, often but once in a life-time-to a level with professional consul-by their own inherent vices and incapacity. Let foreign aid tations in cases of serious disease. They were moved to this bybe called in here ! Let incapable generals be replaced by a sense of the injustice the medical profession had long sufferedmen of vigour and skill in their profession, no matter where from life assurance offices; by the importance of the act ofthey may be found. Let our Indian officers be sent out, not giving a medical certificate for such a purpose, intrinsically con-to drill Turkish contingents, but to teach the art of war to sidered; and by the circumstance that in giving these certificatesthe "regular" troops. Let Lord PANMUBE try this reform; a medical practitioner may be obliged in some cases to men-and if he have the courage to rescue a plebeian army by tion facts adverse to the interests of his patients. The directors

showing his contempt for the traditional authority of its aris- of the NEW EQUITABLE have every reason to congratulatetoe-i-afie lenders, he will soon be taught to appreciate the themselves and the profession upon the success of the plan tojustice of the course pursued towards the Medical Depart- which, in the face of much opposition and misrepresentation,ment. they have resolutely adhered. Without a single exception,

It is our firm conviction-a conviction based upon full infor- every office started since the foundation of the NEW EQUITABLEmation and anxious reflection-that there is no department of has professed the principle of paying medical fees. Many ofthe service that has so well performed its duty, fettered as it the old-established offices have reformed their conduct so as to

has been by absurd obstructions, as the Medical Department, make the same declaration. We may mention with peculiarWe again, in the full confidence that we are uttering the pleasure that, of the two other offices specially addressing them-earnest wish of our brethren in the army, challenge and call selves to the medical profession, one has raised its tariff of

for a searching public inquiry into the. conduct of the Medical medical fees, and the other, which had long refused to payDepartment, and the conduct of those who have had a superior medical fees, has seen the wisdom of conceding their paymentauthority in the sanitary arrangements of the army. to some extent.

It will be well for Ministers, well for the Horse Guards, It cannot be doubted that the NEW EQUITABLE will continuewell for the Commander-in-Chief, well for the Commissariat its prosperous career. But as it has deserved and received, soand the other "aristocratic" departments, if they shall respect- it will require, the continued and increasing support of the

ively come out of the ordeal of public inquiry with honour medical profession. If the NEW EQUITABLE had proved aequal to that which has been earned by, if not yet awarded to, failure, medical men may depend upon it the battle for

our Army Medical Staff! medical fees for reports in cases of life assurance would havebeen certainly and irretrievably lost. To assure the victory atthe present time, renewed efforts on the part of the profession

FROM the Report of the Annual Meeting of the NEW are imperatively called for. We regret to say it, but ourEQUITABLE LIFE ASSURANCE COMPANY, held at the chief offices corresponding columns bear witness to its truth, that manyof the Company, on Thursday, Feb. 22nd, it will be seen, that offices, professing to pay medical fees, attempt, in practice, tothis office from its commencement to the present time has evade them to a very great extent. Some altogether avoidmet with a large measure of success. The office was founded sending to the medical attendants of the parties proposing toin January, 1851-a period of four years. During this time assure. Upon this point, it may be mentioned, that one life1636 proposals for life assurance have been received by the office which gloried in acting thus, has fallen into almost

directors, for assuring the sum of £649,972. Of these pro- irreparable ruin, from insuring unsafe lives. Other offices pay

posals 1282 have been accepted and completed, the annual such insignificant fees, that they are not worth the acceptancepremiums on them amounting to £18,750 13s. 3d. The of medical men, or on a variety of pleas, first get the reports,remaining 354 proposals, for assuring £149,807, have either and then refuse payment. It is well known that the Medical

been declined by the directors, or have not been completed. Visiting List has for many years contained a list of the offices

These figures challenge comparison with the amount of professing to pay medical fees, for the guidance of medicalbusiness done by the most successful offices during the earlier men; but this year the compilers have omitted the list

years of their existence; it is, in fact, equal in amount to altogether, observing :-double the business done in the same space of time by many It is useless to publish a list q .fii2au2-ance offices zehic7a only

247THE ASSISTANT-SURGEONS OF THE NAVY.

, pretend to pay fees. IVe are in possession of prospectuses fi-o2n more especially in its junior branches, by men of comparativelynearly all these offices, settingfort7t their readiness to pay, and, mean education and slender professional attainments. The0!t the other hand, of as many letters from correspondents, com- continuance of the war, and the consequent necessity of main-plaining that the majority of them, when brought to book, do taining a large fleet at sea, so thoroughly drained the supplyNOTpay. We tootsA our hands ofthent, and strongly recommend of naval medical men, that the Government were obliged toow’ sacbscribens to bring the matter to issue by taking no notice be little fastidious in their choice of candidates for the situ-whatever of the letters they send out. ation of surgeons’-mates. Hence it was by no means unusual

, . for the ranks of this class of officers to be recruited, on an

We can appeal to our readers, whether this is not a true emergency, from students only partially educated at the

statement respecting the payment of medical fees by a number medical schools, from lads serving behind the counters of theapothecaries; and, on the occasion of a great strait, by givingof offices professing to pay them ? the appointment to one of the sick-berth attendants, or ’ lob-

The NEW EQUITABLE has honomably fulfilled its engage- lolly boys,’ as they were then called in the service."ments with the profession. It has, from its commencement to

" To men obtained from such sources, rank and social station.. ’

.

were matters of very secondary importance. It may readilythe present time, paid the sum of X2218 to medical men as be imagined, that in the great majority of cases it was littlefees-a larger sum, we do not hesitate to say, than has ever cared in what degree, either the one or the other, was assigned, .-, , ,if,. . them. Little addicted to study, it signified not much whe-been paid by any other life assurance office whatever, The ther they whiled away the hour in the sick bay, the cockpit,remedy, then, for the evils now complained of is in the hands or amidst the boisterous mirth of the midshipmen’s mess.of the profession. They have only to show, by their support Under such guardianship, it is to be feared the sick often fared’ ; -’ badly in more ways than one.t The seaman, ever sensible ofof the NEW EQUITABLE, that an office acting honestly and acts of kindness, is keenly alive to the slightest manifestationliberally towards themselves shall succeed in the highest de- of incapacity or neglect on the part of those who minister to

gree, and the recusant offices will soon be brought to act with his wants during sickness. It was one of the subjects of peti-

gree, and the recusant offices will soon be brought to act with tion by the seamen, during the mutiny of 1797, that theyjustice to our profession. Every policy recommended to the should have better attendance when sick and wounded in

NEW EQUITABLE by medical men is an effective protest in action.’ Dr. Lind, and the other illustrious men whose names..

have been already mentioned, struggled hard about this timefavour of the payment of medical fees. The more rapid and to effect some improvements in the Medical Department of theextensive the success of the NEW EQUITABLE becomes, the navy, and they were not wholly unsuccessful. 1: Still so late

more certain is it that the offices professing to pay will be kept as 1798, we find the celebrated surgeon John Bell, in a Memoirmore certain is it that the offices professing to pay will be kept addressed to Earl Spencer, then First Lord of the Admiralty,

up to the mark, and the more hope there will be that offices deploring ’ the very inadequate encouragement held out to

now refusing all payment will give way upon the subject the navy surgeons of that day, and the consequent difficulty- ,, . - of obtaining men of competent education for this branch ofThe NEW EQUITABLE is an organized lever or wedge, by which of public service. § competent education for this branch ofNEW organized wedge, by the public service.§ He says, 1erhapn in a whole fleet therethe profession can make their power felt more by the assurance are few surgeqns’-mates, not one may be, who are able to per-companies than by any other mode of proceeding whatever. form the greater operations of surgery. It has happened,

’’ after the most earnest entreaties of the officers, of the surgeon,We heartily commend these considerations to the interests and of every one concerned, a ship of the line has gone into

and reasoning faculties of our readers and the profession at battle without one assistant on board : no, not one to screw a

large. tourniquet, to tie an artery, to hold a shattered stump, to putlarge. a piece of lint on a bleeding wound.’∥" It was not until the year 1805 that the Board of Admi-

THE imperative necessity which exists for the better accom- ralty, then under the presidency of the late Viscount Mel-necessity which exists for the better ville, feeling it impossible, under the system then pursued, to

modation of the assistant-surgeons in the navy is a sufficient obtain the services of a sufficient number of medical officersreason why we should return to this important subject. This of any kind, called upon the Sick and Hurt Board, to make

such a proposal to them as would induce properly qualifiedis the more urgent at the present moment, because a regulation such enter the to them as service. The rperly was, thatmen to enter the naval medical service. The result was, thatis now under contemplation by the Board of Admiralty, and we an Order in Council was passed to the effect, ’ that the navalhave reason to believe that it contains no provision for the service having sunercd materially in the present war from the..

want of surgeons and surgeons’-mates, and the difficulty ofbetter accommodation of that most important class of our procuring properly qualified persons being in a great measurebrethren. We are informed, that some modifications are to be attributed to the more liberal provision made for the same

made in reference to the pay, and other inducements are to be description of officers in his Majesty’s land forces, regimental-made in reference to the pay, and other inducements are to be description of officers in his rank with land forces, their assia-surgeons being allowed to rank with captains, and their assis-held out for assistant-surgeons to enter the navy. It may tants with subaltern officers,’ it was therefore resolved, ’ as anbe as well to state, that, fully acquainted as we are with adoption of great advantage to his majesty’s naval service,

, that the said naval medical officers should have the same rankthe wishes of these gentlemen, nothing short of their better with the officers of the same class in his Majesty’s landaccommodation on board ship will have any influence upon forces.’¶them. It may be of service at this moment to extract a

passage from a pamphlet, published three or four years since, * " While truth compels us to make this humiliating statement, it alsopassage from a enables us to record, with some pride, the fact, that amongst those who enteredby Dr. M’WILLIAM, on this subject, as that will abundantly the service at this period, there were many brilliant exceptions to the class of

. men we have here described. Some of them who still live have shed lustre

show that no faith has been kept with them by any Govern- over the department and the profession."t " ’I remember whensurgeons’-asslstants were wholly uneducated, andment which has existed for the last half century. The great the men’s lives in danger from their ignorance; it is only now you have a

and meiitorious services rendered to his country by Dr. superior class of men in that line, and you certainly have a very superiorana meritorious sei vices renaerea to his country by class:—Evidence of Admiral Sir Edward Codrington before Commissioners,M’WILLIAM, and his long and arduous services in the navy, 18lù. Minutes of Evidence, &c., p. 137."’ °

_ /’ i ‘ Some time after Lord Howes action of the 1st of June, 1791, the haif-stamp his statements with an authority which no special pay of the surgeons was increased, as was also the full-pay of the sura’eons’-

, ... mates; if the first mate was in possession of a case of instruments, he waspleading can, in the slightest degree, invalidate. It will be decreed to receive .05 per month.’—TROTTER’S Medicina Nautica, p. 17.’’

seen that, for upwards of fifty years, an Order in Council has § " outlines of Military Surgery, by Sir George llalliilgall, p. 24."seen that, for upwards of fifty years, an Order in Council has " Bell, althought not a naval surgeon, had ample opportunities of know-existed, and to the shame of those in authority, has never ing the actual condition of the naval medical staff. He says in his Memoir.

, I have studied naval surgery with particular care. I have bestowed upon itbeen acted upon. The interests of the country demand that of money, of time, of labour, more than I am entitled to bestow. I have fol-

. ,. lowed vour victorious fleet, and attended your pensioners and your wounded,

there shall be no further obstruction of justice :- as if I had been attached to Government by old serviees and high rewards: -Letter to Lord Spencer."

’’ Looking no further back than to the end of the last cen- 11 I myself having been in action several times with only one assistant in a

tury, we find the Naval Medical Department, although adorned line-of-battle ship, and he not a very well qualified one.’—sir IV. Burnett-. a

. before Commissioners, 1840. §§ 2571-2625."by the great names of Lind, Blane, and Trotter, occupied, ’Ii " order in Council, dated 23rd August, 1805."

248 THE GRIEVANCES OF NAVAL ASSISTANT-SURGEONS.—TREATMENT OF CHOLERA.

" With the rank thus obtained it was expected, as a matterof course, that the concomitant advantages would follow. The

object of the Government was obtained, for from this time afar superior class of men entered the naval medical service..But it will hardly be credited, that up to the present hour thenaval assistant-surgeon, although nominally holding the rankof a lieutenant in the army, with an education, general andprofessional, the same as that of the army assistant-surgeon,ha.ving passed through a course of professional studies moreextensive than that required of candidates for diplomas bythe Royal Colleges of Surgeons of the United Kingdom, pro-bably possessing the degree of Doctor of Medicine,’ and con-versa,nt with natural history and other branches of science, isstill, as were the surgeons’-mates in their worst days, destinedto remain in the midshipmen’s berth."*

Correspondence.

THE GRIEVANCES OF NAVAL ASSISTANT-SURGEONS

HENRY F. HANXWELL,Hon. Sec.

" Aucli alteram partem."

MEETING OF THE STUDENTS OF GUY’S HOSPITAL.

To the Eclitog- of THE LANCET.

SIR,—In compliance with the proposition contained in thecircular issued by the students of Middlesex Hospital to themetropolitan and provincial hospitals of the United Kingdom, ia general meeting of the students of Guy’s Hospital was con- Ivened, for the purpose of appointing a committee of three to i

co-operate with the committees of other hospitals, and tosuggest such measures as are best calculated to promote theamelioration of the position of the naval assistant-surgeons.At the same meeting a subscription was entered into, in orderto defray expenses.

I am. Sir. vours obedientlv.Guy’s Hospital, Feb. 28th, 1855.

MEETING OF THE STUDENTS OF ST. BARTHOLOMEW’S HOSPITAL.To the Editor of THE LANCET.

SIR,—A meeting of the students of St. Bartholomew’s washeld at the Albion Hotel on Wednesday last, which was welland numerously attended. The propositions of the MiddlesexHospital were discussed and approved of. The movers and

seconders of the resolutions all expressed their disgust at thepresent treatment of naval assistant-surgeons by the Admiralty,and the necessity of maintaining the true position of the pro-fession. The recent proposition of the Admiralty for substi-tuting unqualified students for assistant-surgeons in the Balticand Black Sea fleets, by sending out dressers of a second yearto rank as assistant-surgeons, was universally condemned.The following resolutions were unanimously carried :-1. That the students of St. Bartholomew’s fully concur in

the object for which the meeting at the Middlesex Hospitalwas convened, and pledge themselves to use their utmostendeavours to carry out the resolutions there adopted.

2. That this meeting views with deep regret the want ofsufficient medical aid in the naval service; that, in the opinionof this meeting, such want is owing to the present Admiraltyregulations, so unjust to the assistant-surgeons, and so dero-gatory to the medical profession.

3. Though unwilling to throw any obstacle in the way ofsupplying that deficiency, this meeting resolves not to acceptemployment under the Admiralty while such regulations con-tinue in force.

4. That a subscription be at once entered upon to defray allnecessary expenses.

5. That a committee be formed, &c. &c.I am. Sir. vnur ohRrHent Rfrvn.nt.

JOSEPH ALLEN, Chairman.St. Bartholomew’s College,March 1st, 1858.

* " ’ On the first appointment of a medical officer he shall receive a com-

mission as acting assistant-surgeon, and shall remain as such during a pro-bation of twelve months; after which, if he produce the required certificates,he shall be contirmed as an assistant-surgeon from the date of his first appoint-ment."’ He shall, while serving in either of the before-mentioned capacities, onlybe entitled to mess with the mates and midshinmen in the gun-room, or, as

the case may be, according to the rating of the ship.’—Extract from Memo-randum, dated Admiralty, February 1st, 1849."

SINUSES OF THE HIP DEPENDING ONEXFOLIATIONS FROM THE PELVIS.

EDWARD M. HODDER, F.R.C.S.E., &c.

To the Editor of THE LANCET.

SIR,—In a clinical lecture delivered by Mr. Syme, of Edin.burgh, on " Sinuses of the Hip depending upon Exfoliationsfrom the Pelvis," and published in THE LANCET on the 6th ofJanuary, 1855, Mr. Syme, in giving the history of the casebefore him, makes the following remarks :-

" This swelling remained in nearly the same state for twelvemonths, when, having attained the size of a hen’s egg, it wasopened by a surgeon, and discharged about a teacupful ofmatter. Three weeks afterward, another abscess, of largersize, formed nearer to the groin, and was followed by severalothers, of smaller extent, which were poulticed, and allowedto open spontaneously, while he lay in the hospital of Toronto,with apparently little prospect of recovery. Two medicalgentlemen who had been educated in Edinburgh," &c. &c.Now, Sir, the above quotation is incorrect from beginning to

end, and in justice to my colleagues and myself, as well as tothe hospital to which we are attached, I hope you will kindlygive insertion to this communication.The patient, T. C—, aged twenty-three, a blacksmith,

was admitted into the Toronto General Hospital, under mycare, on the 3rd of June last, with two sinuses, one in thegroin, the other at the upper and inner part of the thigh,through the latter of which a portion of necrosed bone couldbe distinctly felt. On going my rounds the following day, Imade a more careful examination of the case, and remarked tothe students, at the bed-sicle of the patient, "that the sinuseswere dependent upon a portion of dead bone, (ramus of ischiumand pubis,) which was still firmly attached, but which I shouldultimately have to remove." No abscess was opened, no

poultice applied, and nothing more was then done but the ap-plication of a piece of lint. On the morning of the 9th of June,he left the hospital of his own accord, and I neither saw norheard anything more of the case until my attention was drawnto it as published in THE LANCET. On inquiry, I find thatafter leaving the hospital, he placed himself under the care ofthe "two medical gentlemen who had been educated in Edan-burgh," and who contiaued their attendance upon him up tothe period of his leaving for Europe, in October last.In his lecture, Mr. Syme did not allude to the change which

Nature will accomplish by detaching the dead from the livingstructures in a period of six months. Such a separation mustbe to a certain extent effected before the surgeon is justified ininterfering.

T remain Sir your obedient servant

Toronto, Canada West, Jan. 29th, 1855.

ON THE TREATMENT OF CHOLERA.To the Editor of THE LANCET.

SIR,—At a time when cholera occupies so important a por-tion of both professional and public attention, it behoves us allto publish whatever we have found useful in its treatment.

I have only just received a bundle of THE LANCET, the lastfew numbers of which mark the curious contrariety of profes.sional opinion, in almost every fresh letter on the subject,Being anxious to save the mail (which is just leaving us), Iwill not dwell upon the several pathological reasons for reme.dies proposed-and adopted with, alas ! a very uncertain andunsatisfactory success—but simply suggest the trial of an" opiate and oleaginous" treatment in cholera.We have to deal with a membrane in (as has been very

rationally conjectured) a condition which, by its debility,admits of rapid exosmose of much of the fluid constituents ofthe blood, and which, by its extreme irritability, increasesperistaltic action and ivatery discharge. Opium quiets thislatter condition better than any drug we possess, and, uponthe authority of an eminent Italian physiologist, Matteucci,it checks exosmose also. Thus, it has a twofold value incholera. The properties of oil are well known. In India, ithas been common to combine laudanum with castor oil, andopium in the croton oil. From cases recorded, we may pre.sume that the purgative principle of this powerful aperient isquite subdued when largely given with opium in cholera ; forwe are told of thirty-three grains of the latter, and fifty-fivedrops (!) of the former having been given in a few hours; "and,so far from the oil acting as a purgative, it was necessary togive other aperients" cfter2narcls, as the case improved. Somuch opium, indeed, might well overpower any purgative.Olive oil (with opium, I believe, or laudanum) is an ordinary