1410. In The Diarrhoea Of Infants, Dr

Underwood justly observes, that when laxative, alkaline, and absorbent medicines have been found to produce no permanent good effect, Calomel often proves a sovereign remedy. It may be given in doses of

* Indian Annals of Med. Science, No. 2, p. 432.

On Dis. of Children, 9th Ed. p. 198.

gr. 1/2, for two, three, or four nights in succession, and in general no purgative should be given in the morning, but the Mercury should be left to its proper action.

1411. In Dyspepsia depending upon a vitiated state of the biliary secretion, a mild mercurial course will often be effectual when other remedies fail. It is not advisable, at any period, to carry it to the extent of salivation. The Hyd. c. Cret. or Plum-mer's Pill are the best formulae. Dr. W. Philip * recommends Calomel in doses of 1/20 of a grain; a seton, at the same time, being placed over the region of the liver.

1412. In Dysphagia dependent upon Organic Stricture of the (Esophagus, the employment of Mercury is often attended with marked benefit. A case illustrative of its powerful influence, and in which an eventual cure was effected, is related by Mr. Nunkeley. In this case it was carried to salivation.

1413. In Jaundice complicated with a deranged state of the duodenum, one full dose of Calomel (gr. v.), followed by a saline draught, will often entirely remove the disease. ''When it occurs," observes Dr. Watson, "in connection with acute or chronic inflammation of the liver, Mercury forms an essential part of the treatment;" and, unless the disease yields sooner, he urges the remedy until its effect upon the gums be apparent. In Icterus Calculosus, when the presence of gall-stones in the ducts is the cause of the disease, or when organic disease of the liver is present, Mercury is inadmissible; indeed, Dr. Prout § considers that the use of Mercury under these circumstances is calculated to do great and irreparable mischief. Dr. Thudichum also strongly condemns the practice of giving Mercury, so as to produce its constitutional effects to persons suffering from Gall Stones at any stage of the malady. (Ranking.)

1414. Cholera

The value of Calomel in the treatment of Cholera; the doses in which, and the period at which, it should be given; whether it is best administered alone or in combination with Opium, stimulants, &c, are all points on which much discrepancy of opinion exists among medical men. Mr. Ross,|| in a series of valuable papers, has attempted to clear up these difficulties; and much credit is due to him for the judgment and talent he has displayed in his task. He has furnished us with the following analysis of above 6,000 cases, in which the treatment has been recorded, drawn from all sources, in England and on the Continent.

* On Protracted Indigestion, Lond. 1827. Med. Times, vol. i. Lectures, vol. ii. p. 559.

§ On Stomach and Renal Diseases, p. 254.

|| Med. Times, vol. xix.

A General Synopsis of Treatment and Mortality of Cholera.

Treatment.

Cases.

Deaths.

Rate per Cent

Venous Injection........................

Stimulants - viz , Brandy, Ammonia, Tur-

Pentine, Cajeput Oil, &c...........

8,055

1,792

Ditto, with emetics of Ipecacuanha......

Ditto, with Calomel and Opium.......

Ditto, with Ice..................

Opium..............

Calomel and Opium............

Calomel..................

Blood-letting, with Calomel and Opium, and

antiphlogistic medicines............

Ipecacuanha............

Ditto, with stimulants, as above......

Ditto, with blood-letting and Sulphate of

Quinine.............

Ditto, with blood-letting alone..........

Ditto, with moderate warmth...........

34 9

Salt, with cold water...............

Tartar Emetic......................

Ice, with stimulants, as above.............

Ice, alone...................

Dr. Stevens' combination of Salts..........

Greville-street ditto, with cold water........

Miscellaneous.................

Total......................

6,296

3,210

Mean rate per Cent.

A glance at this table will show the comparative mortality which has occurred under various modes of treatment, and it will be seen that though the mortality of cases treated with Calomel is much less than those treated by transfusion, stimulants, &c, yet it is much greater than those treated by Ice, Tartar Emetic, and salines. In 376 cases treated by Calomel, the percentage, we see, is about 36; but of this number, Mr. Ross observes, are 331 cases treated by Dr. Ayre * and Dr. Peacock; if these had been omitted, the percentage would have been 62 9 instead of 36. Now the plan of treatment adopted by these gentlemen was the administration of gr. j. - ij. of Calomel, with gutt. j. - v. T. Opii, every five, ten, or fifteen minutes. Dr. Ayre omitted the Opium when lx. or lxxx. drops had been given. Under this treatment Dr Peacock states that he did not lose a single case out of 30; and the mortality among 191 cases treated by Dr. Ayre was not more than 18 per cent. Dr. Ayre subsequently states that the total number thus treated was 219, deaths 43, being a mortality of 19.6 per cent. Stimulants were strictly forbidden, and the patient was allowed to drink as much cold water as he pleased. On the other hand, small doses of Calomel were given by Mr. Banner, of Liverpool, in conjunction with Port Wine, and the mortality was 526 per cent. At the Cholera Hospital, Holbeck, small doses of Calomel, with large doses of Brandy, and subsequently large doses of Calomel, with small doses of Brandy, were administered, and the mortality was 53 per cent. When Calomel was given with large doses of Opium, the mortality was 57.14 per cent. The mortality in London, under large doses of Calomel, is stated by Mr. Ross to be 46.66 per cent. Compare this with the result of the same practice elsewhere. Dr. Stilson,* of Malta, when the disease prevailed in that island, in 1837, administered j. doses of Calomel every half-hour or hour during the stage of collapse; but, when the urgent symptoms began to abate, the interval was lengthened. During the epidemic he distributed eighty-seven thousand grains of Calomel to 373 patients, being, on an average, 230 grains to each individual. One man took eleven hundred and sixty grains, and recovered. The mortality under this practice was 52 per cent. The above data are not without a valuable moral, assuming them to be correct, which there is no reason to doubt. They point out that Calomel, to be efficacious, should be given in very small doses, and uncombined with other remedies, unless it be a minute portion of Opium. Stimulants and large quantities of Opium are shown to interfere with the action of the remedy, and to neutralize the good effects which would otherwise follow. Dr. Ayre's success has been, without doubt, very great, and depends, in all probability, in a great measure, upon his allowing the patient to drink freely of cold water, a practice which seems not only safe, but in the highest degree beneficial.

* On the Treatment of Malignant valuable Treatise. Cholera, Loud. 8vo, 1833; a very

1415. In Tabes Mesenterica, Calomel was a remedy formerly in high esteem, but it has been almost entirely superseded by Cod Liver Oil and Iodine. When these fail, the following formula of Mr. Abernethy's may occasionally prove useful: -

1414 Cholera 117 Calomel, gr. ss., Pulv. Rhei gr. iij., Pulv. Zingib. gr. ij., M. ft. pulv. altern. nocte sumend.