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Marlborough House. The pass-examination was held at King’sCollege, in five or six different rooms, each room being presidedover by some unknown-certainly not the examiners, whonever appeared. A few days after the pass-list was published,I presented myself at the appointed time at King’s College,

with the intention of "going in" for honours. On inquiringin which room the examination was held, I was informed, ’’ Noexamination was held there, and I had better try MarlboroughHouse." On reaching the two-pair lack, I found no one inattendance but a little urchin, something between a printer’sdevil and an errand-boy, and half-a-dozen students in thesame quondary as myself. After pacing round the courtyardfor half an hour, an official conducted us to the examination-room, still more classic ground than the ttvo-pair back-namely, " The Thatched House Tavern" !

It is, I believe, an almost indisputable fact, that the exa-minations of the University of London are of a charactereminently calculated to raise the st,tfU8 of the profession: I,for my part, would sooner attach to my name 1’1. D. Lend. thanall the rest of the English and Scotch medical degrees puttogether. As the Marquis of Lansdowne well remarked inthe House recently, " The University of London has now un-deniably proved itself entitled to the approval of the public bythe very excellent way it has educated those men who haveresorted to it." But the arrangements and appointments, asthey at present remain, would utterly disgrace a charity school.I would ask, Where is the University of London ? It is not forme to suggest where it should be; but with such an influentialbody as the senate at its head, I should imagine a more dignifiedplace might be found for the dispatch of business than a two-pai-r hack, and a more appropriate spot for examination thanThe Thatched HOU8 2’cczvw.

I am, Sir, faithfully yours,AN UNDERGRADUATE IN HONOURS OF THE

August, 1854. UNIVERSITY OF LONDON.

THE CHOLERA.

VARIOUS, contradictory, and often violent as have been thearguments and discussions carried on relative to the mode ofpropagation and pathology of cholera, the battle-ground hasbeen still more hotly contested in respect to its th3rapeutics.As the organ representing the scientific and practical progressof medicine, our pages have necessarily been the medium fromtime to time of expressing the particular opinions and practice

I

of a great body of the profession of this country and of ourIndian possessions, and the result has been, of course, that wehave helped to make known the most opposed doctrines, eachoften most positively maintained, sometimes, we regret to sayit, upon grounds, too, which rather should have authorised theutmost amount of diffidence. To go through the list of"advised methods of procedure," "best modes of treatment,""safest plans," &c. &c., to say nothing of the specifics recom-mended, would be to pass in review a very fair share of all themore effective agents of the Pharmacopoeia. Even then manythings would be left unnoticed, such as transfusion into theveir.s, hot-air baths, the " cold sheet," and other appliances,which are not to be found printed in the College list. Shouldthe reader be curious, however, upon these points, if he willrefer to our second volume for the year 15.3, page 416, "hewill find something to his advantage. " Out of the manyplans of treatment which have been advised, there are twowhich have had more extensive trials perhaps than any other;these are the " saline plan" of Dr. Stevens, and the " smalldoses of calomel frequently repeated" of Dr. Ayre, of Hull. ’"

Both these plans have been largely and extensively put inforce, and, according to the evidence of the witnesses, bothwith the utmost benefit, and with the most complete inutility.Between these contradictory verdicts, it was necessary for cer-tain authorities on particular occasions to strike a mean, whichshould direct the current value to be allotted to the methodsunder consideration. In 1849, learning that the College of

Physicians had appointed a "commission" on cholera, Dr.Stevens requested one or two interviews with the President,after- having had a few with the " Central Board ofHealth," to inquire as to the opinion held of, and makesome further suggestions about, the saline plan" of treat-

* The sulphwric aeid p1_an" is now rivalling the passing reputation of theabove methods.

ment. The result of his inquiries and suggestions, (accordingto his own account,) in connexion with the former, may begleaned from the following extract from Dr. Stevens’ book*(reviewed by us in a former number, vol. ii. 1853, p. 58):-

" The learned president advanced towards me, &c.. - . ...’I am

very sorry,’ he said, ’very sorry indeed, sir, that you have againintruded yourself on me. I am very busy, too busy indeed, tohave my time-my precious time-was ed in any idle discus-sion about either the cholera or your saline treatment. (xxvii.p. op. cit.) )

Dr. Stevens’ application to the Central Board having alsobeen "a complete failure, (xxxiii. op. cit.,) in 1853 appearedthe voluminous " Observttions, contravening what had beensaid against the success of the " saline plan," asserting that theinvestigation made as to its results was a " shtni inquiry," andmaintaining it was "eminently successful" in practice.

Since the appearance of Dr. Stevens’ reclamation, the Collegeof Physicians have published their last Report, (reviewed in ourfirst volume for 1854, page 250,) and in connexion the " salineplan." It is stated-" We have no evidence that they [salines]possessed anv influence over the local morbid action in themucous membrane. It was not until this surface had in partrecovered its function of absorption that any good resultedfrom their employment.’’-(page 196, second part.) This sameReport of the College has, however, called up another and moretemperate reclaimer-viz., Dr. Ayre, the great advocate ofthe "calomel treatment" previously alluded to. The reportsays-" In general no appreciable effects followed the adminis-tration of calomel, even after a large amount in small andfrequently-repeated doses had been administered. For themost part it was quickly evacuated by vomiting or purging, orwhen retained for a longer period, was afterwards passed fromthe bowels unchanged. Salivation but very rarely occurred,and then only in the milder cases. We conclude that calomelwas inert when administered in collapse; that the cases ofrecovery following its employment at this period were due tothe natural course of the disease, as they did not surpass theordinary average obtained when the treatment consisted in theuse of cold water only."-(page 177, second part.)

In Dr. Ayre’s tract+ (the contents of which first appeared inTHE LANCET) now before us, the main points sought to beinculcated, are the following :-

1st.-That the inquiry of the " College Committee" into thetreatment of cholera has been badly conducted, and the cha-racter of the evidence adduced by it is defective.-(page 28.)2nd.-That Dr. Gull represents not merely the writer of the

Committee’s Report, (second part,) but was himself the com-mittee on the subject of the treatment, and is alone responsiblefor all that is contained in it.-(page 57.3rd.-That while " calomel is indeed not remedial in cholera

when given in large doses, or in small ones at wide intervals,when administered in small doses, according to prescribed con-ditions, and without any other adjuvant than cold water adlibitum, it exhibits a remedial power well nigh approaching to ,that of a specific; so that in very truth the cases which Dr.Gull has brought forward in support of his views, tell sostrongly against the conclusion which he aims to establish,that I have only to avail myself of them as arguments to provethe truth of the position, that calomel, when rightly given, illtruly a remedy in this disease."Between the College Report and Dr. Ayre we attempt no

reconciliation, leaving this for the present in the hands of thereporter of the second portion of the committee’s labours, Dr.Gull. From the same evidence, or rather the same sources ofthe evidence used by both parties, different conclusions havebeen arrived at. Some great error, therefore, must somewhereexist, and we cannot say that we think it beneath the dignityof the College committee to reply, through its reporter, to thereclamation of the physician of Hull. In the meantime, it maynot be out of place if we indicate once more the exact methodof procedure recommended by Dr. Ayre. It "consists, duringthe stage of collapse, in giving one or two grains of calomelevery five or ten minutes, with one or two drops of laudanumwith the first few doses of the drug, and in perseveringly con-tinuing the same dose at the same intervals of time, until thesymptoms of collapse become materially subdued.......... I

have never given stimulants in any form, because I found themnot to be necessary, and believed they would prove perniciouswhen, from the long duration of the collapse, and the delay in

’ commencing the treatment, consecutive fever might be feared;‘ Observations on the Nature and the Treatment of the Asiatic Cholera. By

William Stevens. M.D.. D.C.L. Oxon. &e. &c.† A Letter to the President and Fellows of the Royal College of Physicians,

in relation to the Evidence cited in their late Report on the Treatment ofEpidemic Cholera. By Joseph Ayre, M.D., &c. &c. London. 1854. pp. 71.

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and lastly, I fixed no other limit to the quantity of calomelwhich I gave than that which the duration of the collapseprescribed, having become early assured that pending its con-tinuance no absorption of the calomel into the system takesplace; that whilst it is given no salivation or other incon-venience is induced by it. "-(p. 4.)

Relative to the progress of cholera in the metropolis, wehave condensed the following from the last " Weekly Return" ’of the Registrar-General (Aug. 12th):- ,

Of this number, 208 were under fifteen years of age, 347between fifteen and sixty, and 89 above sixty.The deaths from diarrhœa numbered 195.The progress of the present epidemic, which slightly mani-

fested itself in the second week in July, is shown by thefollowing numbers :-Deaths from cholera, 5, 26, 133, 399, and644; deaths from diarrhoea and dysentery, (also in the lastfive weeks,) 51, 63, 87, 146, and 200. Of last week’s deathsfrom cholera, 446, as is shown above, occurred on the southside of the river, a proportion to the total number of 69 percent.We select the following memoranda from the previous

Weekly Return" of the Registrar-General, as offering pointsof special interest :-

" In Unit6 hospital-ship, on 26th July, a convict aged thirtyyears, ’cholera (six hours).’ (Inquest.) The registrar remarks,’It appears the deceased drank a large quantity of cold waterwhen heated. The - convicts on board the hospital-ship, Ibelieve, drink the water of the river Thames, and this issufficient of itself to predispose every man on board to anattack of cholera, as it is well known that the river is defiledwith every kind of impurity.’-Borough-road: At 2, Union-street, on 27th of July, the widow of a master shoemaker, agedseventy-three years, diarrhoea, (seven days,) cholera Asiatica(eight hours).’ It is stated on medical certificate that thispatient had been suffering from a severe diarrhoea for sevendays without receiving medical advice.’-At 23, Cambridge-terrace, Clapham-road, on 30th July, the daughter of a com-mercial traveller, aged twenty years, choleraic diarrhcea,(twenty-four hours,) debility of constitution, increased by thetoo active operation of a black draught.’-At 4, Queen-street,on 31st July, late a brewer’s servant, aged seventy-six years,’cholera (one day).’ Dr. F. E. Jones appends the following note :- ‘ This man was taken ill at eight o’clock in the morning, andwhen I saw him at seven o’clock in the evening, he was in a stateof collapse. The treatment was ’fifteen drops of diluted sulphuricacid, and two grains of calomel every fifteen minutes.’-At 6,Strand, on 2nd August, a commercial-traveller, aged thirty-seven years, ’diarrhoea, (four days,) cholera, (ten hours.’) The

registrar adds :-‘ The diarrhœa was neglected, and visits toCrystal Palace, &c., made. Brandy and water was the remedytaken, and a rapid termination was the consequence.’-At theworkhouse, Islington, on 2nd August, a female domestic ser-

vant, aged thirtv-three years, ’cholera, collapse.’ Mr. Wattsremarks :-‘This is the first case of cholera which has occurredin this district this year, and the particulars and treatment aregiven from the physician’s notes. The deceased was broughtin a cab from her home, Trinity-street, Islington, to the work-house, labouring under vomiting and diarrhoea ; was seen andprescribed for by the house-physician ; when on the followingday at noon collapse-came on, warm applications were adminis-tered, both externally and internally, and at evening the ex-tremities obtained warmth, and the pulse was moderatelygood ; a large turpentine embrocation was placed over the ab-domen, brandy, beef-tea, and medicinal stimulants continuedduring the night, but as morning approached she was found tobe in a helpless state of collapse, and died in the afternoon ofthe third day.’ "

In spite of the remonstrances which have been made, no lessthan seventy-three interments have taken place at St. James’sChurch, Bermondsey, since Monday last, the greater num-ber consisting of deaths from cholera. What notice has beentaken of the representation of this nuisance by the Secretary-of-State? During the raging of this pestilence the rector of the

mother church, (according to a correspondent in the Daily News),who monopolises all the fees, has been refreshing himself at NewBrighton, and the parish clerk of St. James’s may be seen al-most daily inhaling the breeze at Ramsgate, while the incum-bent of St. James’s is doing the whole of the duties. Theeffluvium arising from re-opened graves is now beyond endur-ance, and the only redress to be got from the functionaries ofthe church is, " There is no room, we have no alternative."Lord Jocelyn died on Saturday last, after a few hours’

illness, of the prevailing malady; and a vacancy at the Post-office has occurred through the sudden death, by cholera, ofMr. J. P. Godby, the chief clerk to Mr. Rowland Hill.The Postmaster-General has appointed Dr. Gavin to be

Medical-Superintendent of the General Post-office during theprevalence of the cholera. The health of the officers of the de-partment is therefore closely watched, and a supply of medi-cines being kept at the chief office in St. Martin’s-le- Grand,and at the principal branch offices, immediate relief can begiven in cases of illness.We may also record the death of Mr. A. Cooke, one of the

principal performers at Astley’s Theatre, and brother of theproprietor, who died of cholera on Monday morning, havingbeen seized with the premonitory symptoms on Sunday whilein a railway train midway between Margate and London.To the above list must also be added the death of J. E. Win-

terbottom, M.B., (Oxon.,) the scientific traveller, who wasseized at Rhodes with cholera, and died after a short illness.Dr. Winterbottom was possessed of a varied and extendedacquaintance with the science of zoology and botany.A few days ago Mr. Langham held an inquest at the West-

minster Hospital, on the body of inlr. G. Allen, aged 32, archi-tect and surveyor, in extensive practice at St. Ives, Hunting-donshire, who, while passing Kennington-cross, was suddenlyattacked with cramps and other symptoms of Asiatic cholera.Mr. Newcome, apothecary at the hospital, stated that thedeceased was seized with a most severe attack of cholera. Itwas one of the worst forms, and Mr. Allen died about eleveno’clock the same night.At some inquests lately held in Milbank Penitentiary, it was

stated in the evidence of the authorities that there were 1122

prisoners in the gaol, of whom 129 were in the infirmary.. Therehad been 35 cases of cholera, and at present there were 22 undertreatment. The Government had handed over barracks at Dor-chester for the reception of the prisoners, and 600 would be reomoved there next week. Spirits were daily served out to theprisoners. From further accounts we learn that the firstdivision of prisoners, who are at present in good health, to thenumber of 300, were on Monday conveyed in a number ofomnibusses to the Great Western Railway, where a specialtrain was in readiness to convey them to Dorchester Gaol, (tobe followed by other divisions as soon as they can possibly begot away.) The above measures were considerably acceleratedby the fact of three more deaths having occurred on Saturdaylast, one on Sunday morning, and the fifth while the jurywere sitting upon the bodies of the other four on Monday after-noon. At first it was thought that the Thames water, whichhad hitherto been used, was the principal source of the disease,but the river supply had been abandoned, and the prison wasnow served with water from the artesian wells which supplythe fountains at Charing-cross, and yet there was no diminutionwhatever of the disease. It was stated during the inquestthat when the wind blew from the direction of the oone factoryat Lambeth and the adjoining gas works, the smell was in-tolerable, and the sickness was sure to increase throughout thewhole prison.

In reference to the above, Mr. Penryn Aston has thus ad-dressed the public :-I observe the mournful accounts of thecholera in the Milbank Prison, such as commenced in 1849, andit will always be so when cholera comes, unless the prison isbetter ventilated. The place is built in a bog, walled up itselfinto a well. All this could be greatly alleviated by very freelypiercing the walls at their bases to let the air in. The buildingitself might be served in the same way, and immediately thegreatest benefits would be felt by the inmates. This I proposedyears ago to a minister, and expect it was considered ridiculous,as regarding the safety of the prisoners. But the thing couldbe done with safety to their persons, and great benefit to theirhealth.As precautions against cholera on the river, her Majesty’s old

42 gun-frigate Baccha;. te has been sent from Chatham to theThames, for the reception of patients, the Dartmouth beingfound unfit for that purpose.On Saturday last two fatal cases of cholera occurred in the Lon-

don Hospital. One case was that of a nurse employed in the insti-tution, who died after a few hours. The second patient was a

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female who was brought in a cab, but she died notwithstandingall that could be done by the medical staff of the establishment.The increase in the duties of the officers has been so great, thatadditional medical men have been supplied to wait upon theout-door cases of choleraic diarrhoea, and 300 have been pre-scribed for during the last three days. A ward has been fittedup in the hospital expressly for cholera, by order of the directors,and a great number of bad cases have been admitted. Theprincipal portion of the applicants have been men employed onthe river and in the docks.More than six gallons of chalk-mixture, with catechu, &c.,

have been dispensed in a single day at a dispensary inSouthwark.In consequence of the disease having broken out in an over-

crowded lodging-house in Shadwell, the board of guardians ofthe Stepney union have appointed a sanitary committee, whosit every morning at Ratcliffe workhouse, near Stepney church,and a dispensary has been opened in York-square, which is inthe centre of the union, where there are two persons to dispensemedicine night and day, to all applicants in the district.Cholera mixtures have also been sent by the board to thepolice-station in King David-lane, Shadwell, where the poorare supplied at all hours by the officers on duty, in cases ofemergency.During the past week, several fatal cases of cholera have

occurred at Greenwich. The epidemic has made its appearancein those localities where it formerly prevailed, and whereabsence of drainage, water, and pure air, present predisposingcauses of disease and death.The Essex Herald says : We regret to state that this malig-

nant scourge has visited Essex with all its untamed virulence.On Friday week it first made itself apparent in Epping union-house, and since that time no fewer than sixteen inmates havedied, and five of them since Friday night. In Romford union-house, too, the disease has made its appearance, six cases

having occurred there last week; and deaths have taken placeat Dagenham and Ilford.The accounts from Trimdon are not so favourable as they

were a short time ago. The Sunderland News states thatthere have been eleven deaths during the past week. The pit-houses have been converted into a temporary hospital, and theassistance of an eminent practitioner from London has beensecured.

Cholera has made considerable progress, both in Glasgow andneighbouring parishes. On the south side of the river, also,where the cases used to be few in number and far between,there has been a marked increase, and the disease has beenextremely rapid with its victims. The Glasgow returns ofcholera cases are rather irregular, but it would appear thatduring the first three days of this week there were at least101 cases, and thirty-six deaths.Some strongly-marked and rapidly-fatal cases of cholera have,

within the last eight days, appeared at Hamilton. The patientshave in every case neglected the premonitory symptoms, andmedical aid was only called in when collapse had begun.The progress of cholera in Belfast is thus noticed in the Bel-

fast Mercury:-" We are sorry to observe that the last weeklyreturn presents a considerable increase in the number of cholerapatients. There were in the dispensary districts for the weekending Tuesday last: -New cases, 53; died, 12; dischargedcured, 18; sent to hospital, 21 ; remaining under treatment, 9.There have been since the first appearance of the disease :-Total number of cases, 310; died, 82; cured, 92; sent to hospital,129. We are glad to learn that no further cases have occurredin the barracks since the death of private William Frazer."

"

THE WAR.HEALTH OF OUR ARMY AT ALEDYN.

(FROM OUR SPECIAL CORRESPONDENT.)CAMP, NEAR ALEDYN.

SmcE I last wrote we have changed our encampment, beingobliged to do so on account of sickness. We have marchedabout four miles from Aledyn, still about ten miles from Varna,which we can now see, and are enabled to enjoy the sea breeze,as there is no hill to intercept it. I trust this will be an ad-

vantage ; we are now situated on a small plain on the top of ahill, having woods on the slopes on the south side, though notso much as at Aledyn, neither is the country so pretty, but Ihope it is more healthy. The reason of our sudden change wasthe amount of sick in the hospitals, each having a great numberof cases of diarrhcea, and within this last -week cholera hasbroken out, and carried several men off in a few hours. I think

about six cases have occurred, four of them of the last draftthat came out, men who had only arrived a few days. TheGuards have left a good many sick at Aledyn, who will comeon when able, most of them not very urgent cases, thoughunable to stand the jolting of the slow ox-drawn waggons overthese rocky roads. The Highlanders seem to suffer by far theleast, have the fewest men here in hospital, and I have notheard of any deaths, though I believe they live hard and drinka good deal of the country wine, which is very bad; perhapstheir kilts, from their coolness, may preserve them to a certaindegree. I have no doubt the Highlanders are a more hardyrace, and accustomed to greater work and fatigue; they all stillremain at Aledyn. The cases of cholera occurred nearlytogether, and after two deaths the Duke determined to moveif any more died. Tuesday evening, late, orders came, and onWednesday morning, at nine, we marched. I believe thisfearful scourge has broken out in the fleet, and many deathshave occurred.

For the next two months we expect a good deal of sickness,though, strange to say, as yet, except amongst the Highlanders,no cases of intermittent fever have occurred. They have hada few cases, I hear,-all have had cases, of slight fever; butthere have only been, as far as I can learn, three or four of atyphoid nature amongst the Heavy Division, none as yet fatal;very likely the fevers are to come.The temperature in the tent here now is 96°, but we have a

nice breeze now and then. Both the other divisions are suffer-ing greatly-much more than this division ; they are losingfifteen a day. One day the Light Division lost sixteen; andthe day before yesterday, the 2nd, so I was told by oneof our officers who was over there yesterday, lost nineteen. Icannot say how true it is, as I am unable to ride over therenow on account of duty. One of the regiments has lost itsquartermaster, but as yet none of the officers. The French are still worse off. Report says they have lost

an immense number, and are now much broken down both inhealth and spirits. They who came out in such excitement toenter the field and fight immediately, now they find that verylikely it will not be so this year, and that fatal disease isamongst them, are greatly disheartened. Our men are in verymuch better spirits than can be imagined; and a good brushwith the Russians would show that John Bull can stand a

great deal, and after all be victorious. Our French allieswould soon be all right if they had the same treat by oursides, and would soon discomfit the foe. The French generalis against going to the Crimea. I expect we shall do nothingthis year, except perhaps have a fight for winter quarters;and as soon as possible in the spring, and all in good health, Ihope gain additional laurels. All seem to bear this with greatpatience, and as soldiers, from officers to men. Of course, a

grumble is heard occasionally, but rarely; and, as you mayexpect, we are not in a land flowing with milk and honey.Not a luxury, even butter we cannot get, except very sour,and a very little of that.

I think I have told you all, and must draw to a close, so

as to catch the post. ’

P. S. Since I have written, the Highlanders have come up,and bring bad news from Aledyn; some of the sick leftbehind and the attendants are suffering from cholera, andsome, it is feared, are sinking.

CHOLERA AMONGST THE TROOPS AT DEVNA.

(FROM OUR SPECIAL CORRESPONDENT.)ON Saturday night, cases of a very fatal character appeared

amongst the regiments of the Light Division encampedat Devna. During the afternoon of the same day the wind,which had been blowing from the north and north-west, veeredround to the south-east, so as to blow directly over from’theDevna swamp upon the camp. Towards night the breezestopped, and was followed by a still, oppressive atmosphere, atthe same time that there was considerable electric disturbancearound, as evidenced by frequent flashes of sheet-lightening.No thunder or rain accompanied this, and clouds were few anddistant. Although the camp had occupied the same groundsince June the 30th, and the close congregation of so manyhorses and men in a limited space must be of course taken intoconsideration, and though some were inclined to attribute theoutbreak to imprudence on the part of the men in eating un-ripe fruit, there are many reasons to suppose that the changein the direction of the wind, and the concurrent importation ofmalaria from the marsh, were the first and direct causes. The

regiments of the cavalry encamped on the east side of the plainwere out of the line of direction of wind, being protected bythe high hills in their rear; while the regiments of the line on