SINCE infantile diarrhoea is unusually virulent in London and in other large towns, no less than 1126 deaths from diarrhoea having occurred in the thirty-three largest towns in England during the week ending July 22nd last, and since it has shown a tendency to affect adults in the form of "cholera nostras," a brief account of its treatment may not be out of place in the columns of THE LANCET at the present time. The disease is undoubtedly due to the development of a special short, rod-shaped

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... illus in the intestines, and the poisoning of the individual by the absorption of the ptomaines produced by its growth in the intestines. The stools in severe cases consist almost entirely of the organism in question, mixed with a little mucus and a few putrefactive bacteria and amceboid bodies similar to those found in dysentery, and which are in all probability altered white corpuscles. The bacilli are absent from the blood and tissues of the body ; the renal epithelium is found swollen and degenerated, the nutrition of the lungs suffers, so that broncho-pneumonia is almost always found post mortem. The last-named changes are probably the result of the accumulation of ptomaines in the blood and the rapid withdrawal of water from the tissues. Clinically the disease is seen in three forms :-(1) The mildest form is seen as a simple diarrhoea, with offensive pultaceous yellow stools containing a large quantity of mucus ; (2) in the commonest form early vomiting is marked, with extreme and rapid depression, the stools being greyish-yellow in colour, thin and slimy and very offensive, having an odour like rotten cheese and composed almost entirely of bacilli; (3) the most intense form is characterised by thin watery grey-brown fetid stools, the brown colour being due to admixture with blood. The passage of membranous shreds, so common in Leicester, I have not observed in London. In all these forms that most powerful antiseptic the perchloride of mercury is the only drug to be relied upon. For the first two forms the best results will be found from subnitrate of bismuth, ten grains ; liquor hydrargyri perchloridi, six minims ; mucilage, one drachm; water, one drachm, to be given every two hours. For the form last mentioned accompanied by haemorrhage, dilute sulphuric acid (ten minims), liquor hydrargyri perchloridi (six minims), and syrup (one drachm), to be given every two hours, will be found most effectual. The doses should be doubled in the case of adults. This treatment should be commenced at once in all cases ; if any dose is vomited soon after its administration it should be repeated in a few minutes. Pure water should be supplied from the first to quench the extreme thirst, to keep up the action of the skin and kidneys and assist the elimination of the poison circulating in the blood. The patient should be at once wrapped in a blanket and hot-water bottles applied to keep the blood circulating on the surface as much as possible, and prevent the tendency to its accumulation in the internal organs. Absolute rest is essential from the first ; the patient should not sit up, even for the purpose of vomiting. Alcohol is required from the beginning, and it is best given in the form of rectified spirit, of which two minims may be added to each dose of medicine for an infant. If one is unfortunately called to a case in which collapse and coma have set in, every means must be taken to restore the circulation by the application of external heat to the surface of the body, and the addition of water to the blood by injecting saline solution into the subcutaneous tissue of the body by means of an exploring syringe. The administration of water by the mouth cannot be relied upon, since vomiting is especially severe in this stage. Lastly, it must not be forgotten that the disease is very infectious; if a case is admitted into a children's hospital it almost always spreads in a viru-lent form and will attack adults, the dissemination probably taking place by the discharges drying upon linen and thus becoming volatilised into the atmosphere and contaminating all articles of food. I USED chlorobrom in all cases of sea-sickness to which was called whilst ship's surgeon to the s.s. Rimutaka during a voyage to and from New Zealand, and I now desire to state my experience as to its action. I always gave it in threedrachm doses in the second stage of this distressing ailment, when retching, headache, depression and sleeplessness were the prominent symptoms, the hour selected for administration being 10 P.M. in order to secure a good night's rest. The results were very satisfactory. The chlorobrom was always retained and was always followed by sleep (generally sound). The patients awoke much refreshed in the morning, with an appetite and able (except on one occasion) to eat and retain something light.