conclusions were reached: first, that in whatever form or dose, whether continuous moderate doses of blue-pill, minute and frequent doses of calomel, or large doses of it, mercury utterly fails to stimulate the liver. The constitutional action of mercury excited both slowly and rapidly by corrosive sublimate produced the same results. In poisonous doses the bichloride produced a marked diminution in the flow of bile. Mercurial inunction was followed by negative results; and it was regarded as proved that, so far from increasing, mercury, by its general depressing action on the system, actually diminished the amount of bile.

Now we submit that, as depression does lessen the vigor of the secretive process, a much more potential cause for depression is to be found in the condition of the animal from his wounds and the presence of the canula, and from the actual wasting disease engendered by the deprivation of bile, than lies in the giving of a few doses of calomel, which at first, as we have seen, before the constitutional symptoms began, actually increased the flow; and the next conclusions of the report corroborate this idea, for it was found, secondly, that abstinence from or considerable diminution of food checked the secretion of bile; and, thirdly, in deprivation of bile, emaciation comes on, the appetite fails, the excretions assume a peculiarly foetid odor, and death occurs from inanition. Starvation diminishes the secretion, and nothing beyond giving food or supporting health increases it.

Whenever we hear of a new anaesthetic, we think of the time when the taking away of pain was to "harden society and rob God of the deep, earnest cries which arise in time of trouble for help," as the Scotch parsons told Sir James Simpson; and when even surgeons argued that "pain was a premonitory condition, no doubt fitting parts the subject of lesion to reparatory action," and that they would therefore "feel averse to its prevention"; when a famous living physician concluded a paper read before a London medical society, "Upon the Injurious Effects of Ether Inhalation," with queries as to "the desirability of removing pain"; when a great American surgeon declared, after some untoward details in giving ether, "that he would never again remain in a room where it was to be given."

After much experimentation for ether substitutes, a substance has been found which will actually manufacture chloroform in the blood, and, what is better, its invention is the result of purely a priori considerations. On the second day of June, 1869, Dr. Otto Liebreich, of the Pathological Institute of Berlin, introduced to the Medical Society of that capital what he defined as "a new hypnotic and anæsthetic agent"; this was the hydrate of chloral. Chloral itself was discovered some thirty years ago by Liebig as the product of anhydrous alcohol acted upon by dry chlorine gas, ultimating in a dense oily liquid, colorless, boiling at 210° with a sharp, pungent odor. Mixed with water this becomes the hydrate of chloral, and is converted into a white solid substance. The new agent became at once widely known, and in London Dr. B. W. Richardson, who is constantly experimenting with anæsthetics, was appointed to investigate it and report upon it.

The theory of its action, according to Liebreich, is that the hydrate of chloral, treated with an alkali, is resolved into chloroform, and into a formate which soon disappears; the blood is an alkaline fluid, therefore the hydrate, when it is absorbed, enters the blood, where its particles consume the surrounding alkali, and decomposition is effected after the required amount of alkali has been furnished by the blood. A minimum quantity of chloroform is then instantaneously formed, is set free in the tissues and passes to its first stage of action, the ganglia cells of the brain; as the chloroform increases in amount, its action extends to the spinal ganglia cells, and lastly to those of the heart corresponding with the slowest possible administration of chloroform, and passes out of the system as chloroform. From Liebreich's array of facts also was derived the necessary deduction that the agency at work was chloroform, chemically formed in the blood. There are few now who have not experienced or observed the profound and tranquil sleep produced by chloral; but it is the rival of opium rather than of ether, although it can be administered by inhalation. Besides producing sleep, it removes sensibility, reduces the animal temperature, causes extreme muscular relaxation, practically confirming the theory of its action as chloroform. Its physical action being clearly understood, its applications must be ex

tremely varied, and in fact it is now employed to relieve almost every known abnormal symptom or condition of body or mind. Dr. Richardson's report concludes with a warm tribute to the "genius and industry of the distinguished Professor of Berlin who has placed in our hands so admirable and scientific a remedy."

With regard to Cholera, the novelty is in the treatment alone; its nature is universally understood. A poison is absorbed into and infects the blood, spoiling certain of its constituents, which are ejected through the mucous membrane of the alimentary canal. A primary blood disease is thus produced, undergoing enormous multiplication in the body; and the direct results of the alteration are changes in the function of respiration, while the copious discharges are the efforts of nature to throw off the noxious material, as a necessary process to recovery. From no other cause than a virulent blood poison does a person in full health become in a few minutes, and utterly without warning, shrivelled up, his whole body icy-cold, his face and hands turned purple, while death comes on in a few hours. We cannot refrain from reproducing the quotation very happily brought in by Dr. Aitkin:

"Its effect

Holds such an enmity with blood of man
That, swift as quicksilver, it courses through
The natural gates and alleys of the body;
And, with a sudden vigor, it doth posset
And curd, like eager droppings into milk,
The thin and wholesome blood."

The well-known and especial danger in cholera is also its proper and distinctive symptom, characterized by the French pathologists by the term "algide," the sensation and fact of cold being one of the most remarkable and constant phenomena; the thermometer in the axilla falling to 92°, more than six degrees below the natural standard in health, while under the tongue it is known to have fallen to 79°. Vomiting, purging, and cramps have long ceased to be regarded as essential phenomena. Hale and hearty men have been suddenly seized, and have collapsed, and died within five minutes, without any evacuation; and death has repeatedly occurred within two or NO. 240.

VOL. CXVII.

3

three hours after access, without any other cause than stagnation of the blood.

Dr. George Johnson, long known to the profession in connection with the correct pathology of kidney diseases, communicated to the Medico-Chirurgical Society of London, in 1868, the doctrine that the poison of cholera was received into the system from without, by inhalation or in food and water, and absorbed into the circulation; that if the vascular excretion was checked, the risk of fatal collapse was greatly increased; and that the object in treatment should be, not to excite discharges from the mucous surface, but to facilitate the removal of matters lodged there, and that elimination of the poison from the system was the condition of recovery.

Half a century ago the English physicians in India" aimed to get rid of the offensive morbid secretions" in cholera, but it was quite natural to attribute collapse to the drain of fluid matters from the blood by the profuse and repeated fluxes from the bowels and stomach; and the treatment this view suggested was the "locking-up" plan by opium and astringents and by stimulants. Dr. Johnson's opinions were not well received, and violent controversy grew out of them. It was soon settled that the collapse was not due to the evacuations, but that these were, in fact, eliminative of the poison. To establish relations of cause and effect between them, it should happen that the more profuse the discharge the more decided and certain should be the collapse; while in fact the most hopeless cases were those of scanty evacuations or of none at all. Also the continuance of the discharge should cause a more prolonged, deeper, and more dangerous collapse. But, on the contrary, patients not only emerge from the collapse while the evacuations are going on, but a cessation of them is always a fatal sign. If a vein is opened in cholera, after a moment or so, the dark treacly blood grows brighter, and the patient has been known to cry out that "it had made a new man of him"; therefore collapse has nothing in common with ordinary syncope, which is relieved by stimulants, but would be disastrously affected by blood-letting. Dr. Johnson's own paper in the "Transac tions" is immediately followed by another, containing details of treatment upon his plan, on a large scale, in which the re

sults corroborated the theory, and which demonstrated the remarkable fact that recovery never occurred without a continuance of the discharges or their restoration, if previously arrested. So great a change in medical opinion was effected by the new views, that Sir Thomas Watson, the president of the society, upon a careful revision, has fully recanted his own published opinions and adopted those of Dr. Johnson in the last edition of his well-known work on the Principles and Practice of Physic, and he pays their author a noble tribute by declaring that "he has by his methodical display of facts, by his close and conclusive reasoning, now triumphantly established his own views of the pathology and treatment of cholera."

Lörstofer's Corpuscles. - During the past few years much attention has been given to the connection between what are called microscopic growths and contagious and infectious diseases. In Professor Stricker's laboratory in Vienna, especially, attempts have been making to explain different diseases, particularly the infectious ones, by the presence of fungous growths in the blood, and in the secretions and excretions, as well as in the tissues of the body, but with hitherto only negative results. In the blood of syphilitic patients especially it was hoped to find traces of a low grade of organism. Could such once be detected, the discovery would not only have a vast specialistic importance, but would give a positive basis to an assumed theory. Dr. Lörstofer conceived that the negative results were due to low magnifying powers, and to the fact that the experiments had all been made with fresh blood in which such bodies may have existed in a state too minute for detection, and that they might grow to be visible (this very idea of growth, we may remark in passing, being corollary to the very idea underlying the research), if the specimens could be preserved for examination without destroying the organisms. Lörstofer commenced his experiments in August, 1871; and in January, 1872, at a meeting of the Vienna Medical Society, he announced the discovery of a form of corpuscle peculiar to the blood of syphilitic patients, and through which the diagnosis of syphilis might be made by a microscopic examination of the blood.

In specimens properly prepared, in from one to three days, he averred that certain minute bright corpuscles became visi