Corporations, do not carry into effect their important trusts, the remedy is in the hands of their constituents, who have been wisely allowed the opportunity of periodically returning them. To the rate-payers of this country the largest amount of representation, responsibility, and freedom has been confided.

Although ardent and enthusiastic sanitary reformers have desired that the unlimited powers and jurisdiction of a Haussmann should be placed in the hands of the central authority, they should remember that the highest authority-John Stewart Mill—has laid down, in his celebrated Essay on Liberty, that "to secure as much of the advantages of centralized power and intelligence as can be had without turning into governmental channels, too great a proportion of the general activity, is one of the most difficult and complicated questions in the art of government." He believes that the practical principle in which safety resides, may be conveyed in these words:"The greatest dissemination of power consistent with efficiency; but the greatest possible centralization of information, and diffusion of it from the centre." He adds that the central organ should know all that is done, and its special duty should be that of making the knowledge acquired in one place available for others. Emancipated from the petty prejudices and narrow views of a locality by its elevated position and comprehensive sphere of observation, its advice would naturally carry much authority; but its actual power should, he conceives, be limited to compelling the local officers to obey the laws laid down for their guidance. For the violation of rules, they should be responsible to law, and the rules themselves should be laid down by the Legislature; the central administrative authority only watching over their execution; and if they were not properly carried into effect, appealing, according to the nature of the case, to the tribunals to enforce the law, or to the constituencies, to dismiss the functionaries who had not executed it according to its spirit. "Such, in its general conception, is the central superintendence which the Poor Law Board is intended to exercise over the administrators of the poorrate throughout the country." "A government cannot have too much of the kind of activity which does not impede, but aids and stimulates individual exertion and development. The mischief

begins when, instead of calling forth the activity and powers of individuals and bodies, it substitutes its own activity for theirs ; when instead of informing, advising, and, upon occasion, denouncing, it makes them work in fetters, or bids them stand aside and does their work instead of them."

PART III.

MEDICAL MISCELLANY.

Reports, Retrospects, and Scientific Intelligence.

TRANSACTIONS OF THE MEDICAL SOCIETY OF THE KING AND QUEEN'S COLLEGE OF PHYSICIANS.

Special meetings of this society were held on 27th March, and 4th and 5th April, to receive and consider reports from the hospitals in which cases of cholera were received during the late epidemic.

ABSTRACT OF REPORTS ON THE LATE EPIDEMIC OF CHOLERA.

MEATH HOSPITAL.

Short Abstract of Facts Connected with the Epidemic of Cholera. By GEORGE ROE CARTER, late Resident Pupil. (On the part of himself and other Assistants).

1. Time occupied.-The first patient was admitted on the 8th of August into the cholera wards of the Meath Hospital, between which date and the 14th of October 116 patients were admitted, all of whom were under the supervision of Dr. Hudson. An interval of about six weeks occurred between the closing of the wards on the 20th of October, and opening of the sheds, which were opened on the 1st of December, and closed on the 28th of the same month; during that time fourteen cases were admitted into the sheds, and treated according to Dr. Stokes' directions.

2. Accommodation provided.—The wards of the Meath Hospital for the reception of such cases were first opened under very unfavourable circumstances, which, no doubt, is well known to a great number of the profession, inasmuch as they were quite inadequate in size, situation, ventilation, and other common necessaries, which are of such vital importance, not only for the welfare of the patients, but even for the attendants.

The cubic space of the wards are as follows:

Female ward, 3,432 feet; male ward, 4,302; they contained six beds each, which only allows 572 cubic feet for each female patient, and 717 for each male, giving an average of 644 cubic feet for each, without any current of air. The sheds which were erected are in every respect well adapted for the requirements of such patients.

3. Stage of disease on admission.-Out of the 116 cases admitted into the above named wards which were treated by Dr. Hudson-five were in the premonitory stage, 108 in collapse or approaching it, and three in consecutive fever; of the fourteen cases which were admitted into the sheds and treated by Dr. Stokes, three were in the premonitory stage, nine collapse, or approaching it, and two in consecutive fever.

4. Mortality at different periods and different ages. From the 8th August to the 1st of September the mortality was 48.9 per cent., and from the latter date to the 20th October raised to 54.5 (the increase of which we consider was due to the overcrowding of the wards), and to the condition of the patients on admission, as the earlier cases were more amenable to treatment, while, as the epidemic advanced, the disease assumed a more malignant type, which was probably aggravated by the crowding in our small wards. In December, on opening our large and airy sheds, it went down again to 42.8 per cent., averaging on the whole 51.5 per cent. Over twenty of those patients died within five hours after admission, some in a quarter of an hour, others in from half an hour to two hours. The mortality in children and adults was much under that of the aged, and particularly those whose constitution had been broken down by dissipation, few, if any of them, recovered.

5. Modes of treatment pursued, varied according to the stage, as follows:(a.) In premonitory diarrhea and early stage, in two cases castor oil was given, but with discouraging results. Acetate of lead with small quantity of opium, sulphuric acid, and chalk mixture, with kino and catechu succeeded in a number of instances; the vomiting was checked in some cases by freshly prepared charcoal, in a few by bisulphite of soda, but with most effect by creosote and acetic acid, which was subsequently prescribed by Dr. Stokes. We also found a solution of camphor and chloroform useful in cramps of the stomach, particularly so when combined with capsicum, and the inhalation of chloroform most effectual in allaying cramps in some bad cases; in addition to those internal remedies, hot stupes of mustard and turpentine were applied, and friction of the surface and extremities with the hands; flannel bandages being applied after friction. Brandy was given freely, and ice ad libitum, the latter of which was of much use in allaying thirst and checking vomiting. (b.) In collapse or approaching it, the patient was enveloped in a blanket wrung out of hot water and mustard, and sprinkled with turpentine, over which a number of dry ones were put, removed when it got

cool, and repeated if necessary; this we found to be most efficacious in rousing the patient and raising the temperature of the body, after which mode of packing the radial pulse, which was before it imperceptible, invariably returned, and the patient expressed himself as being much better. We have also tried, with some advantage, Sir D. Corrigan's button-shaped cautery, heated by boiling water, and applied over the vagus, and on either side of the spine, which would arouse the patient greatly for the time, though he frequently relapsed into his former condition. In addition to those external applications, calomel and bismuth from gr. togr. of the former, to gr. v. of the latter were given every hour, until the secretion of bile and urine was restored; the dose of calomel was subsequently increased (to gr. v. followed by one grain every hour) by Dr. Stokes, also with good results; camphor and chloroform, and the inhalation of chloroform were also employed in this stage of the disease for the relief of cramps. At the suggestion of Dr. White tinct. of canabis indica was extensively tried (in 20 to 30 drop doses) as a stimulant, in some cases with apparent benefit; brandy was freely given also in this stage of the disease. Seven cases were treated by calabar-bean at the request of Dr. Mapother, which Dr. Mapother reported in The Medical Press and Circular of the 12th of September; in these seven cases three proved fatal, and with one or two of those who survived we were obliged to discontinue the use of the drug, and put them on calomel, on which treatment they speedily recovered. In some of those cases it produced dysenteric stools, and contraction of the pupil with the cornea slightly injected. (As the number of cases treated by the drug were insufficient to test its value in this disease, we cannot either condemn or recommend its use; but we are of opinion that the results from its more extensive trial would not have been so favourable as those of the calomel treatment). Two cases were treated by Dr. Stokes, by the injection of salines into the veins, which proved fatal (but as they were previously treated by calomel, and the number not sufficient to test its value, we cannot say anything in favour of it or otherwise).

Stage of suppression of urine, and consecutive fever.-(c.) For suppression of urine the patient was cupped over the lumbar region, and 3 or 4 3 removed, after which a hot bran poultice was applied to the feet, and diuretics administered. In several instances the cupping was repeated with great advantage, and we have succeeded in bringing on the flow of urine in a good many cases, when complete suppression of that secretion had existed for over forty-eight hours, and even from patients who were far advanced in uremia by those measures; calomel and bismuth was also given in this stage of the disease as before, but stimulants were not administered so freely. In the consecutive fever, if the evacuations from the bowels were bilious and copious, the calomel was either discontinued

altogether or given in small doses at long intervals; if the pulse was strong and regular, tongue moist and rather clean, no gastric irritation or delirium, the patient got a moderate quantity of brandy or wine, chicken broth or weak beef-tea, bread and milk or tea and ice ad libitum. In the advanced stage of uremia, when head symptoms were present, the characteristic odour from the patient, with complete suppression of urine, we have seen the best results follow, repeated cupping over the loins with the administration of diuretics, the shaving of the head and blistering the nape of the neck, and the application of leeches to each mastoid process, with a calomel and rhubarb purge when there was no motion of the bowels for a few days. Such were the modes of treatment adopted during the late epidemic by Dr. Stokes and Dr. Hudson, and if time or space would admit, we could bring forward a number of important cases which were successfully treated. During the whole epidemic only two cases occurred in the hospital, which was in the interval when no cholera cases were in the wards, or had been for ten days previous. One of those patients was convalescent from typhoid, and died in nine hours' illness, the other was in the thirteenth day of typhus, with high nervous symptoms, and died in about twelve hours' illness. The night nurse and washerwoman attending on the cholera wards were attacked; the former made a wonderful recovery, but the latter died in less than twenty-four hours' illness. We also had a case associated with pregnancy, who was admitted in a very precarious state; the woman was six months pregnant. The treatment as in other cases was adopted, and the patient left hospital perfectly well, without any sign of abortion.

HOUSE OF INDUSTRY HOSPITAL.

Summary Report on the Cases of Cholera Admitted to the Hardwicke Hospital, 1866. Collated by Mr. J. ADAMS CLARKE, Clinical Clerk. Edited by DR. LYONS.

During this epidemic a total of 277 cases were admitted into the cholera wards, and no case of cholera was refused admission; several were admitted which had failed to procure admission elsewhere. From these cases were rigidly excluded, by the clinical physicians, all instances of vomiting and purging, with or without cramps, which did not strictly correspond to the true type of Asiatic cholera. There were thus recorded of

Of diarrhea, including choleraic diarrhea, 68 cases were admitted, of