TREATISE 
 
 ON 
 
 EPIDEMIC CHOLERA; 
 
 INCLUDING AN HISTORICAL ACCOUNT 
 
 ITS ORIGIN AND PROGRESS, 
 
 TO 
 
 THE PRESENT PERIOD, 
 
 COMPILED FROM THE MOST AUTHENTIC SOURCES. 
 
 > 
 
 BY A. BRIGHAM, M. D. 
 
 HARTFORD: 
 
 PUBLISHED BY H. AND F. J. HUNTINGTON. 
 
 1832. 
 
TREATISE 
 
 ON 
 
 EPIDEMIC CHOLERA: 
 
 INCLUDING AN HISTORICAL ACCOUNT 
 
 OF 
 
 ITS ORIGIN AND PROGRESS, 
 
 TO 
 
 THE PRESENT PERIOD, 
 
 COMPILED FROM THE MOST AUTHENTIC SOURCES. 
 
 BY A. BRIGHAM, M. D. 
 
 HARTFORD: 
 
 PUBLISHED BY H. AND F. J. HUNTINGTON, 
 
 1832. 
 
m 
 
ADVERTISEMENT. 
 
 The following work has been chiefly selected from nu- 
 merous but authentic Reports, Treatises, Lectures and Essays 
 upon the cholera, which has prevailed epidemically for the 
 last 15 years. It is intended to furnish a correct history 
 of the disease, together with all the most important prac- 
 tical information that has been published respecting its na- 
 ture, causes and methods of treatment. 
 
 For this purpose the writings of those practical medical 
 men, who have witnessed the disease in Asia, on the con- 
 tinent of Europe, in England, the Canadas, and the United 
 States, have been resorted to in making this selection. 
 
 The history of the cholera anterior to 1817, has been 
 chiefly derived from the Report of the Madras Medical 
 Board, drawn up by order of the government, in 1824. 
 The subsequent history of the disease, or from 1817 to 1831, 
 was written by H. O. Lombard, M. D., and was originally 
 published in French, in the Biliotheque Universelle for 1831, 
 from which I have translated it. 
 
 The other sources from which the principal part of the 
 
 volume has been derived, are indicated at the proper places 
 
 in the body of the work. They are principally the official 
 
 reports made by medical men to the governments of the 
 
 different countries where the disease has prevailed, the 
 
 valuable medical periodical journals, for several years past, 
 
 particularly The Medico Chirurgical Transactions, The 
 1* 
 
 ^ 
 
IV ADVERTISEMENT. 
 
 Edinburgh Medical and Surgical Journal ; The Medico 
 Chirurgical Review ; The American Journal of Medical 
 Sciences ; the Treatises, Essays, Lectures and Letters of 
 different medical men in various parts of the world, who 
 have had great experience in the disease. 
 
 A. B. 
 Hartford, August 20th, 183*2. 
 
CONTENTS. 
 
 History of the cholera previous to 1817, Page 13 
 
 History of the cholera from 1817 to 1832 . 26 
 
 Progress of the cholera in 1817, . . . 28 
 
 " 1818, ... 31 
 
 " 1819, ... 33 
 
 " 1820, ... 37 
 
 " 1821, ... 39 
 
 " 1822, ... 42 
 
 " 1823, ... 43 
 
 " 1824, ... 46 
 
 " 1825, ... 47 
 
 " 1826, ... 48 
 
 " 1827, ... 49 
 
 " 1828, ... 50 
 
 " 1829, ... 51 
 
 " 1830, ... 53 
 
 " 1831, ... 54 
 
 " 1832, ... 57 
 
 History of the symptoms of cholera, ... 59 
 
 Symptoms of the cholera in Asia, . n . 60 
 
 Europe, ... 76 
 
 " " America, . . . 101 
 
 Appearances on dissection, . . . . ] 05 
 
 Appearances on dissection in Asia, . . .106 
 
 Mauritius, . . 114 
 
 Europe, . . 117 
 
 Treatment of the cholera, . . . . 135 
 
 Treatment of the cholera in Asia, . . . 142 
 
 " " Mauritius, . . 162 
 
 " " Europe, . . 166 
 
 England, . . 181 
 
 " " " Canada and U. States, 230 
 
 Two Lectures on the cholera at Paris, by Broussais, 250 
 
 1## 
 
6 CONTENTS. 
 
 Causes of the cholera, 295 
 
 Evidence that the cholera is contagious, . . 296 
 Objections to the evidence that the cholera is con- 
 tagious, . . 298 
 
 Evidence of the non-contagious nature of the 
 
 cholera, 821 
 
 Evidence that the influenza is as contagious as the 
 
 cholera, 829 
 
 Means of prevention of the cholera, . . .831 
 Is the present epidemic cholera a different disease 
 
 from the common cholera morbus ? . . 839 
 Has a similar epidemic prevailed before in this 
 
 country? . . . . . . 841 
 
 Influence of fear in producing and aggravating the 
 
 epidemic cholera, . . . . .. 345 
 
 APPENDIX. 
 
 Recent progress of the cholera in Europe, . . 355 
 Canada and U. States, 363 
 
INTRODUCTION. 
 
 The pestilence which is now raging in various parts of 
 the United States, and which during the last fifteen years 
 has advanced over a large portion of the globe, is now 
 the most absorbing topic throughout the civilized world. 
 By many it is considered a new disease, while others say 
 it was known in the earliest ages. Whether the latter 
 is true or not, we have no account of its ever having 
 prevailed extensively and epidemically, and for years in 
 succession previous to 1817. We do not know, how- 
 ever, but some of the destructive diseases which swept 
 off vast numbers of the human race in remote times were 
 of the same nature. Our accounts of them are so imper- 
 fect that we are unable to determine their nature. The 
 learned M. Montbroin, conceives that a similar disease des- 
 troyed 70,000 of the subjects of King David from Dan 
 even to Beersheba. (II. Sam. xxiv.) Josephus' account of 
 this pestilence is as follows : " The terrible malady seized 
 them before they were aware and brought them to their 
 end suddenly, some giving up the ghost immediately, with 
 very great pains, and bitter grief, and some were worn 
 away by their distempers, and had nothing remained to be 
 buried, but as soon as ever they fell, were entirely mace- 
 rated ; some were choked, and greatly lamented their case, 
 as being also stricken with a sudden darkness ; some there 
 were who as they were burying a relative, fell down dead, 
 without finishing the rites of funeral. There perished of 
 this disease, which began with the morning, and lasted till 
 the hour of dinner, 70,000." 
 
 Several other mortal pestilences are alluded to by those 
 who have written concerning the diseases of ancient times. 
 
8 INTRODUCTION. 
 
 Dr. Webster in his work on Epidemic and Pestilential Dis- 
 eases,* mentions several that prevailed in this country about 
 the time of the first settlement by the English. 
 
 A pestilential and mortal disease prevailed among the 
 Indians in 1618, and to such an extent as to greatly dimin- 
 ish their numbers. When our ancestors arrived two years 
 after, they found the bones of those who perished, in many 
 place unhurried. But the accounts we have of these early 
 epidemics are so imperfect that we are unable to determine 
 the nature of the malady. 
 
 In the third year of the 87th Olympiad, answering to the 
 430th preceding the Christian era, a plague broke out in 
 the city of Athens, which was far more mortal than any 
 which before that time had been known to the Greeks. In 
 a short time it destroyed an immense multitude of the poor, 
 and five thousands of the flower of the Athenian armies. 
 It broke out in the second year of the Peloponnesian war, 
 when all the inhabitants of the Athenian territory were 
 crowded into the city to avoid the destructive ravages of 
 the Lacedemonians. 
 
 The population of Athens was thus increased from 50,000 
 to 400,000. " The city," says Thucydides, " was not 
 able to receive so large a conflux of people, many w T ere 
 forced to lodge in the turrets of the walls," &c. The 
 enemies of Pericles, says Plutarch, " attributed the oc- 
 currence and the great ravages of the pestilence to the 
 multitude of people he had collected into the city in the 
 heat of summer." And this was probably the true cause. 
 The exact nature of the disease we do not know, though 
 the symptoms of the disease are described by Thucydides ; 
 yet he makes no mention of the swellings of the glands 
 which usually occur in the plague. Dr. Webster thinks 
 
 * We are gratified to learn that the venerable author of this va- 
 luable and philosophical work is about publishing a new edition, with 
 additions, and a continuation to the present time. 
 
INTRODUCTION. 9 
 
 the disease resembled the worst forms of yellow fever. 
 The disease like the cholera first appeared in that part of 
 the city where there was the least cleanliness and among 
 the ill conditioned poor, here it " fell suddenly" and thence 
 gradually extended to other parts of the city. For a full 
 and philosophical account of this plague at Athens, see the 
 first article, in the first volume of the Medical Repository, 
 by the late Dr, E. H. Smith of New York. 
 
 During the reign of Justinian I. A. D. 542, a universal 
 and destructive plague prevailed to such an extent as to 
 dispeople some of the fairest portions of the world. " This 
 pestilence," says Procopuis, " which almost destroyed the 
 human race and for which no cause can be assigned but the 
 will of God, ravaged the whole world, without regard to 
 age, sex or condition and prevailed during the winter and 
 summer and all seasons of the year." It seized Constan- 
 tinople in the spring of 543 and according to Gibbon, " dur- 
 ing three months, five, and at length ten thousand persons 
 died each day at Constantinople ; many cities of the East 
 were left vacant and in several districts of Italy the harvest 
 and the vintage withered on the ground." 
 
 Those attacked by the disease were affected by swellings 
 and carbuncles and the characteristic symptoms of the 
 plague. 
 
 In 1345 the most general and destructive pestilence com- 
 menced that the world has ever known. This disease like 
 the cholera made its first appearance in the East. It com- 
 menced in Cathay, China, in 1345, and was so deadly that 
 at least one half or two thirds of the human race perished in 
 8 years. It did not entirely disappear until after about 20 
 years ? and after having overrun the world. 
 
 This awful pestilence was preceded by great and gene- 
 ral disorder of the elements such as had never before been 
 known. The mortality fell chiefly upon the lower classes 
 
10 INTRODUCTION. 
 
 of society ; not one king or prince of any nation died of the 
 disease, and the English nobility and people of distinction 
 and the higher orders of the church generally escaped. 
 
 Before the disease invaded Christendom, according to a 
 report made to the Pope, it had swept away twenty three 
 millions eight hundred thousand persons in the East in the 
 course of a single year. At length it passed into Italy ; and 
 at Florence 60,000 persons died in one year. The malady 
 proceeded north to Germany and France. At Paris it cut 
 off 50,000 persons ; and at Lubeck according to several 
 accounts it swept away 90,000 persons in one year, of 
 whom 1,500 died in the space of four hours. 
 
 It reached England in 1348, where it raged to an extent 
 almost incredible. According to the historians of that 
 time, out of the whole population, hardly one person in ten 
 was left alive. In the city of Norwich 57,374 persons died 
 in six months, and at York and London it was horrible be- 
 yond imagination. In London 50,000 persons were burried 
 in one grave yard. Such was the consternation through- 
 out England that the cattle were neglected and run at large, 
 the corn perished for want of reapers and whole villages 
 were depopulated. 
 
 This disease has been compared to the cholera, but the 
 symptoms were somewhat different. It was usually ac- 
 companied by violent affection of the head and stomach, 
 glandular swellings, blisters over the body and hemorrhages 
 from the mouth and nose. (For a full account of this great 
 plague in the 14th century, see Fraser's Magazine, for 
 May 1832.) 
 
 The last pestilence which I shall notice, is the Great 
 Plague of London which prevailed in 1665, and the memo- 
 ry of which has been rendered immortal by eloquent des- 
 criptions in prose and poetry. It first attracted attention 
 in London about the middle of summer, and was preceded 
 and accompanied by a peculiar state of the atmosphere. 
 
INTRODUCTION. 11 
 
 Its ravages soon augmented, and in the autumn 8,000 per- 
 sons died in one week, though two thirds of the inhabitants 
 had fled the city. From this time it grew milder, and by 
 the spring, had totally vanished. According to the bills of 
 mortality, London lost upwards of 68,000 inhabitants by 
 the plague, in 1665. This was the last plague that appear- 
 ed in Great Britain. 
 
 These are but a small number of the visitations of pesti- 
 lence which the generations of men have experienced. 
 They have all been, to be sure, most afflicting events, not 
 only from the destruction of human life which they pro- 
 duce, but from the pain and suffering which those who sur- 
 vive must endure, and the destitution of innumerable widows 
 and orphans, and helpless beings. But though exceedingly 
 distressing calamities for a time, yet history shows that ul- 
 timately they may not prove injurious to the welfare of 
 mankind in general. Though many valuable members of 
 society are cut off at such times, yet in general the greatest 
 lavages are among those least necessary to the welfare of 
 society. They have most frequently occurred in thickly 
 populated places, in countries overflowing with inhabitants, 
 like Hindostan and China, where the common necessaries 
 of life, even in productive seasons, are furnished only in 
 sufficient quantity to barely allow a miserable existence to 
 the great mass of population, and when a failure of crops 
 occurs, multitudes die from famine. The writings of Mal- 
 thus and Say, and the tables of Sussmilch, and others, shew 
 that in many countries, after the plague had swept off a 
 third of the population, the annual number of births be- 
 came greater than before the pestilence. 
 
 In all countries, innumerable beings die of want, not 
 that they actually starve for want of food, but for want of 
 the care of parents or nurses, or medical advice, or rest, 
 which many in all countries are unable to have. In gene- 
 ral, pestilential and mortal epidemics have apparently been 
 
12 INTRODUCTION. 
 
 caused by a want of some of the necessaries of life, among 
 the people, — very frequently, by famine, or want of food. 
 But not always a want of food, but a want of pure air, 
 cleanliness, warm clothing and lodging, or rest, or medical, 
 and other attention, which none but those who are supplied 
 with other products necessary for man can obtain. They 
 therefore must occur whenever the population is not sup- 
 plied with the necessaries of life. 
 
 Hence we see all such general calamities are most fatal 
 in cities and populous places. In the Hebrew scriptures, 
 the prophets Jeremiah and Ezekiel often speak of the pesti- 
 lence sent in judgement upon men, but it is curious to notice 
 that it is the peculiar scourge of cities. The siege of Je- 
 rusalem is thus foretold, — 1 1 will smite the inhabitants of this 
 city, they shall die with a great pestilence. He that abi- 
 deth in the city shall die, but he that goeth out and falleth 
 to the Chaldeans that besiege you, he shall live. 9 Jer. xxi. 
 Ezek. chap. v. declares thus, — c those in the field shall 
 die by the sword, and he that is in the city, by famine and 
 pestilence ;' and again, chap, xxxiii. < they that are in the 
 wastes shall fall by the sword, and him that is in the open 
 field, will I give to the beasts to be devoured, and they that 
 be in the forts and caves shall die by pestilence.' 
 
 But such a calamity may, in other ways, prove beneficial 
 to succeeding generations. It teaches, or should teach, 
 mankind how to live ; to be frugal, to provide beforehand 
 for sickness, to be temperate in all things ; to avoid and 
 prevent accumulations of filth, and impure air, and crowded 
 rooms and cities. 
 
 Take for instance the present epidemic, and though no 
 language can describe the suffering, the agony, and the 
 innumerable evils that it brings upon mankind ; yet will it 
 pass away without inculcating any important truth ? will it 
 teach no profitable lesson to the present and succeeding gene- 
 rations ? 
 
 Considering the enquiring and investigating age in which 
 
INTRODUCTION. 13 
 
 this calamity has appeared, we can hardly believe but that 
 some of the causes which has produced or aggravated this 
 pestilence will be ascertained, and may hereafter be avoid- 
 ed, and thus succeeding generations profit by the sad expe- 
 rience of this. 
 
 It can hardly fail to prove one of the greatest reformers 
 the world has ever known. It can not fail to teach man- 
 kind temperance, frugality and innumerable other virtues. 
 It will apprise men of the danger of small ill ventilated and 
 crowed houses, streets and cities. It will guide them in 
 constructing and locating dwellings — and large towns ; and 
 it may teach men to forsake cities, and the strife for gain, 
 and seek quiet and competence in the pure air of the coun- 
 try. This is no unimportant lesson for man to learn. And 
 but few more necessary for the moral advancement of man- 
 kind. Large cities, are the chief hot-beds and nurseries of 
 vice. They congregate within their walls a large and 
 combined mass of ignorant, vicious, evil disposed beings, 
 that benevolence does not and cannot rescue, and which 
 thwart all the efforts of the philanthropic ; and serve as 
 schools of vice and dissipation for rising generations. They 
 also by their prodigality, imprudence and sensuality, conta- 
 minate the atmosphere and produce disease and aggravate 
 pestilence. 
 
 While therefore every measure should be adopted likely 
 to arrest the present general and distressing calamity, let 
 us not forget to profit by it when it has past ; and by keep- 
 ing steadily and constantly in mind the causes that have 
 now produced or greatly aggravated the disease, endeavor 
 to prevent its recurrence by our conduct hereafter. 
 
EPIDEMIC CHOLERA MORBUS. 
 
 HISTORY OF THE EPIDEMIC CHOLERA, 
 PREVIOUS TO 1817. 
 
 When the Epidemic Cholera Morbus appeared at 
 Jessore, in 1817, it was supposed to be a new disease; 
 but upon enquiry, it was ascertained that a com- 
 plaint similar in all its symptoms, had not only been 
 described in several publications on the diseases of 
 India, but had been noticed in the earliest records of 
 medicine. Hippocrates speaks of it, and it is de- 
 scribed by Aritjss, of Cappadocia. 
 
 Bontius, a Dutch physician residing at Batavia, 
 and who wrote in 1629, thus accurately describes it. 
 
 " Besides the diseases above treated of as endemic 
 in this country, the cholera morbus is extremely fre- 
 quent ; in the cholera, hot, bilious matter, irritating 
 the stomach and intestines, is incessantly, and copi- 
 ously discharged by the mouth and anus. It is a dis- 
 order of the most acute kind, and therefore requires 
 immediate application. The principal cause of it, 
 next to a hot and moist disposition of the air, is an 
 intemperate indulgence of eating fruits, which, as 
 they are generally green, and obnoxious to putrefac- 
 tion, irritate and oppress the stomach by their super- 
 fluous humidity, and produce an eeruginous bile. 
 The cholera might, with some degree of reason, be 
 reckoned a salutary excretion ; since such humors 
 
 2 
 
14 EPIDEMIC CHOLERA 
 
 are discharged in it, as, if retained, would prove pre- 
 judicial. However, as by such successive purgations., 
 the animal spirits are exhausted, and the heart, the 
 fountain of heat and life, is overwhelmed with putrid 
 effluvia, those who are seized with this disorder general- 
 ly die, and that so quickly, as in the space of four and 
 twenty hours, at most. 
 
 Such, among others, was the fate of Cornelius Van 
 Royen, steward of the Hospital of the sick, who be- 
 ing in perfect health at six in the evening, was sud- 
 denly seized with the cholera, and expired in terrible 
 agony and convulsions before twelve o'clock at night ; 
 the violence and rapidity of the disorder surmounting 
 the force of every remedy. But if the patient should 
 survive the period above-mentioned, there is great 
 hope of performing a cure. 
 
 This disease is attended with a weak pulse, difficult 
 respiration, and coldness of the extreme parts ; to which 
 are joined, great internal heat, insatiable thirst, per- 
 petual watching, and restless and incessant tossing of 
 the body. If together ivith these symptoms*, a cold and 
 fetid sweat should break forth, it is certain that death 
 is at hand." 
 
 Sydenham, and other writers*, notice its prevalence 
 in London, in 1669 — 1676, and in 1741. It is said 
 to have prevailed in several parts of Europe, from 
 1600 to 1780. At Paris extensively in the summers 
 of 1730, 1750, and again in 1780, and in Switzerland 
 in 1696. 
 
 Anterior to the present age, the epidemic or pesti- 
 lential form of Cholera, had, however, rarely appear- 
 ed in Europe. It had occurred more frequently in 
 India, and its ravages there had been greater. 
 
 * Huxham, Dr. Brady, &c. 
 
PREVIOUS TO 1817. 15 
 
 Lebegue de Presle says it prevailed in Uppe 
 Hindostan in 1762, where it destroyed 30,000blacks, 
 and 800 Europeans. 
 
 Dr. Paisley, in a letter dated at Madras, 12th Feb- 
 ruary, 1 774, and published by Curtis, in his work on 
 diseases of India, says that the cholera is often epi- 
 demic there, and destroys quickly great numbers of 
 the Blacks, though it prevails among both Europeans 
 and natives, He observes, " it is totally a disease of 
 highly putrid bile, which operates on the system as 
 poison, and brings on sudden prostration of strength, 
 and spasms over the whole surface of the body." 
 
 M. Sonnerat, in his travels in India from 1774 to 
 1781, says that cholera prevailed epidemically on 
 the Coromandel coast, and at one period assumed a 
 very malignant character, destroying above sixty 
 thousand people, from Cherigam to Pondicherry. The 
 following is his account of it. 
 
 " There is also another epidemical disorder, which 
 reigns, and in twenty-four hours, or sometimes less, 
 carries off those who are attacked. It never appears 
 ~ but in cold weather.' 5 
 
 " Debauchees, and those who have indigestions, 
 are attacked with a looseness, or rather with an in- 
 voluntary flux of the excrementary matter become 
 liquid, but without any mixture of blood. They 
 have no remedy for this current of the bowels,* which 
 they call a sharp flux, but leave the cure to the care 
 of nature. 1 " 
 
 " The flux of this kind which reigned some years 
 ago, spread itself in all parts, making great ravages : 
 above sixty thousand people, from Cherigam to Pon- 
 
 * Probably " cours de ventre," in the original. The edition here 
 quoted, is a translation by Francis Nagnus, Calcutta, printed 1773* 
 
16 EPIDEMIC CHOLERA 
 
 dicherry, perished. Many causes produced it. Some 
 were attacked for having passed the night and slept 
 in the open air ; others for having eat cold rice and 
 curds ; but the greater part for having eat after they 
 had bathed and washed in cold water, which caused 
 an indigestion, an universal spasm of the nervous 
 kind, followed by violent pains and death, if the pa- 
 tient was not speedily relieved. This epidemical 
 disorder happened during the Northerly winds in De- 
 cember, January, and February ; when they ceased 
 the malady disappeared. The symptoms of this dis- 
 order were a watery flux, accompanied with vomit- 
 ing and extreme faintness, a burning thirst, an op- 
 pression of the breast, and a suppression of urine. 
 Sometimes the deceased felt violent cholicky pains ; 
 often lost his speech and recollection, or became deaf, 
 the pulse was small and concentered, and the only spe- 
 cific which Choisel, a foreign Missionary, found, was 
 treacle and Drogue amere. The Indian physicians 
 could not save a single person." 
 
 " There is great reason to imagine that the perspi- 
 ration being stopped and reflowing into the mass of 
 blood, by finding its way to the stomach and bowels, 
 occasion the vomiting, which termitated by this flux." 
 
 " That which followed, two years after, was the 
 most dreadful. It did not proceed from the same 
 cause as the first, as it began in July and August: 
 it first showed itself by a watery flux, which came 
 in an instant, and sometimes cut the deceased off in 
 less than four and twenty hours. Those who were 
 attacked had thirty evacuations in five or six hours ; 
 which reduced them to such a state of weakness that 
 they could neither speak nor move. They were often 
 without pulse ; the hands and ears were cold ; the face 
 
PREVIOUS TO 1817. 17 
 
 lengthened ; the sinking of the cavity of the socket of 
 the eye was the sign of death ; they felt neither pains 
 in the stomach, cholics, nor gripings. The greatest 
 pain was a burning thirst. Some brought forth worms 
 by stool ; others by vomiting. This cruel pestilence 
 affected all the castesin general, but particularly those 
 who eat meat, as the Parias. The native Physi- 
 cians succeeded no better in their treatment of this 
 disorder, which was again renewed during the north 
 winds." 
 
 The epidemic cholera morbus, prevailed at the 
 island of Mauritius in 1819 and 1820, and from en- 
 quiries then made by a Committee of British Medical 
 Officers, it was ascertained that a similar disease 
 prevailed there in 1775, and which continued about 
 two months, causing great mortality, particularly 
 among the blacks and people of color. A hurricane 
 was supposed to have put a stop to its ravages. 
 
 The disease raged with great violence in India, in 
 1781. Mr. Jameson, Secretary to the Calcutta Med- 
 ical Board, thus alludes to it : 
 
 "A division of Bengal Troops, consisting of about 
 5,000 men, was proceeding under the command of 
 Colonel Pearse of the Artillery, in the Spring of 1781, 
 to join Sir Eyre Coote's Army on the Coast. It 
 would appear that a disease resembling cholera 
 had been prevalent in that part of the country, (the 
 Northern Circars,) some time before their arrival ; 
 $nd that they got it at Ganjam on the 22d March. 
 It assailed them with almost inconceivable fury. 
 Men previously in perfect health dropt down by do- 
 zens ; and those even less severely affected were gen- 
 erally dead or past recovery within less than an 
 hour. The spasms of the extremities and trunk 
 
18 EPIDEMIC CHOLERA 
 
 were dreadful; and distressing vomiting and purging 
 were present in all. Besides those who died, above 
 five hundred were admitted into hospital on that day. 
 On the two following days, the disease continued un- 
 abated, and more than one half of the Army was 
 now ill." 
 
 " The disease to which we allude, has not been 
 confined to the country near Ganjam. It afterwards 
 found its way to this place (Calcutta) ; and after 
 chiefly affecting the native inhabitants, so as to oc- 
 casion a great mortality during the period of a fort- 
 night, it is now generally abated, and pursuing its 
 course to the northward." 
 
 The disease was referred to the great fatigue of the 
 soldiers, after marching for several days and nights, 
 through sand and salt water, exposed to heavy dews 
 and a damp and variable atmosphere. 
 
 Curtis, in his work on the diseases of India, speaks 
 of the unusual prevalence of cholera in 1782. 
 
 He says " that the fleet in which he served, joined 
 Sir Edward Hughes's squadron at Madras, in the 
 beginning of 1 782 ; in May of that year, his ship, the 
 Seahorse, arrived at Trincomalee, and he says, ' The 
 mart de chien, or cramp, I was also informed by the 
 attending Surgeon, had been very frequent and fatal 
 among the seamen, both at the hospital and in some 
 of the ships, particularly in the Hero and Superb/ 
 The Seahorse had no case of the disease till the 21st 
 of June, when between that day and the 25th they 
 had eight cases. 
 
 " In every one of the eight cases the symptoms were 
 so much alike, both in order and degree, that a de- 
 scription of any one would answer almost equally 
 well for every other. Any difference that took place 
 
PREVIOUS TO 1817. 19 
 
 was in the suddenness of the attack, or the rapidity 
 with which the symptoms succeeded each other. In 
 all of them the disease began with a watery purging, 
 attended with some tenesmus, but with little or no 
 griping. This always came on some time in the 
 night, or early towards morning, and continued some 
 hours before any spasms were felt ; and light affec- 
 tions of this kind being very common in the country, 
 the patients seldom mentioned them till they began to 
 be more severe^ and extended to the legs or thighs. 
 This purging soon brought on great weakness, cold- 
 ness of the extremities, and a remarkable paleness, 
 sinking and lividity of the whole countenance. Some 
 at this period had some nausea, and retching to 
 vomit, but brought up nothing bilious. In a short 
 time the spasms began to affect the muscles of the 
 thighs, abdomen, and thorax, and lastly they passed 
 to those of the arms, hands and fingers ; but I never 
 saw, then or afterwards, those of the neck, face or 
 back at all affected. The rapidity with which these 
 spasms succeeded the first attack, and their severity, 
 especially as affecting the muscles of the thorax and 
 abdomen, denoted in general the degree of danger in 
 the case* The affection is not, as in tetanus, confi- 
 ned to a single muscle, or to a certain class of muscles 
 only. Neither does it, as in the spasmus clonicus, 
 move and agitate the members. It is a fixed cramp 
 in the belly of the muscles, which is gathered up into 
 a hard knot, with excruciating pain. In a minute or 
 two this relaxes, is again renewed, or the affection 
 passes to others, leaving the miserable sufferer hard- 
 ly an interval of ease ; and lastly, it passes from one 
 set to another; from those of the inferior extremity to 
 those on the upper parts, leaving the former free. 
 
£0 EPIDEMIC CHOLERA 
 
 The patients complain much of the pain of these 
 cramps ; think they obtain some relief by friction of 
 the parts, and cry to their companions to rub them 
 hard. As the disease proceeded, the countenance 
 became more and more pale, wan, and dejected ; the 
 eyes became sunk, hollow, and surrounded w 7 ith a 
 livid circle. The pulse became more feeble, and 
 sometimes sunk so much as not to be felt at the wrist, 
 in two or three hours after the spasms came on. But 
 so long as it could be felt, it was but little altered in 
 frequency. If the spasms happened to intermit, it 
 would sometimes rise a little, and the countenance 
 assume a better look. The tongue was generally 
 white, and more or less furred towards the root; the 
 patients had all great thirst, or rather a strong desire 
 for cold drinks ; but there was no head ache or affec- 
 tion of the sensorium commune throughout." 
 
 " The coldness of the extremities, which was per- 
 ceptible from the very first, continued to increase, and 
 spread over the whole body? but with no moisture in 
 the skin till the severity of the pain and spasms forced 
 out a clammy sweat, which soon became profuse. 
 The hands now began to put on a striking and peculiar 
 appearance. The nails of the fingers became livid, 
 and bent inwards ; the skin of the palms became 
 white, bleached, and wrinkled up into folds, as if long 
 soaked in cold water ; the effect, no doubt, of the pro- 
 fuse cold sweat, which is one of the most pernicious 
 and fatal symptoms of the disease, both from the effect 
 it has in such a climate, of exhausting the strength, 
 and in abstracting heat from the system. In some of 
 the present cases, and in many others after this, we 
 had recoveries from the severest degrees of spasmodic 
 affection ; even where the pulse had been for hours 
 
PREVIOUS TO 1817. 2l 
 
 completely lost at the wrist, and the body perfectly 
 cold ; but never of any who had these profuse cold 
 clammy sweats, and where the hands had put ont his 
 appearance," 
 
 ' " All this while the purging continued frequent, and 
 exhibited nothing but a thin watery matter or mucus. 
 In many, the stomach became at last so irritable, that 
 nothing could be got to rest upon it ; but every thing 
 that was drank was spouted out immediately ; with- 
 out straining or retching. The countenance and ex- 
 tremities became livid, the pulsations of the heart 
 more quick, frequent, and feeble ; the breathing be- 
 gan to become laborious and panting ; and, in fine y 
 the whole powers of life fell under such a great and 
 speedy collapse, as to be soon beyond the power of 
 recovery. In this progression, the patient remained 
 from three to five or six hours from the accession of 
 the spasms ; seldom longer. These began at last to 
 abate, but with more internal oppression, great jac- 
 titation, panting and gasping for breath, from the di- 
 minished action of the respiratory organs ; for there 
 were no marks of oppression or effusion on the lungs ; 
 and the motion of the heart, so long as it could be 
 felt, became more and more quick and irregular, till 
 death came at last to the relief of the miserable suf- 
 ferer. Sometime before that event took place, the 
 spasms gradually abating, left the sufferers entirely, 
 and so much possession of their faculties did they 
 retain, that they would continue to talk sensibly to 
 their messmates, to the last moment of their life, even 
 when the whole body had become perfectly cold, and 
 all pulsation of the heart had ceased for a long time 
 to be distinguishable." 
 
 "About the middle of July, 1782, 1 entered on du- 
 
22 EPIDEMIC CHOLERA 
 
 ty at Madras Hospital. Here again, 1 had occasion 
 to see many more cases of the mort de chien. It was 
 frequent in the fleet in the month of August, and be- 
 ginning of September, the season at which the land 
 wind prevails on this part of the coast. We had 
 some cases in the hospital in the end of October, and 
 November after the monsoon, but few in compari- 
 son." 
 
 Girdleston, also, alludes to the ravages of the same 
 epidemic, among the newly arrived troops from Eng- 
 land, in his Essay on the Spasmodic affections of In- 
 dia. 
 
 He observes, " Spasms were the first disease which 
 appeared amongst the troops w T ho arrived at Madras 
 in October, 1782, under the command of Major Gen- 
 eral Sir John Burgoyne. More than fifty of these 
 fresh men were killed by them within the first three 
 days after they were landed in that country, and in 
 less than a month from that time, upwards of a thou- 
 sand had suffered from attacks of this complaint." 
 
 " The symptoms which commonly first presented 
 themselves were coldness of the surface of the body, 
 especially of the hands, feebleness of the pulse, and 
 .spasmodic contractions of the lower extremities, soon 
 extending to the muscles of the abdomen, diaphragm, 
 and ribs. As the spasms advanced, the muscles 
 might be seen to assume the rigidity of cartilages ; 
 sometimes causing the body to remain immovea- 
 bly extended, sometimes bending the trunk through 
 its whole length, anteriorly ; and sometimes, though 
 seldomer, backwards. The parts in which the 
 spasms began generally remained rigid ; but those 
 which were subsequently seized with them, had mo- 
 mentary intermissions of the contractions 5 the only 
 
PREVIOUS TO 1817. 23 
 
 intervals of relief experienced by the patient from the 
 most tormenting pains. The hands and feet then 
 generally became sodden, with cold sweat, the nails 
 livid, the pulse more feeble and frequent, and the 
 breath so condensed as to be both seen and felt, issu- 
 ing in a cold stream at a considerable distance. The 
 thirst was insatiable, the tongue whitish, but never 
 dry ; vomitings became almost incessant ; the spasms? 
 cold sweats, and thirst, increased with the vomitings ; 
 which last, if not checked, soon terminated the exist- 
 ence of the patient/ 5 " In this manner, most com- 
 monly, was the succession of phenomena ; but often 
 they were so rapid in their attack, that they seemed 
 to seize the patient all in conjunction instantaneous- 
 ly." 
 
 " In some few, the extremities remained warm ; 
 in others also the spasms were only clonic or convul- 
 sive. Some died in the first hour of the attack ; oth- 
 ers lived a day or two with remissions; when they 
 died, either of universal spasms or an apoplexy. On 
 dissection of the bodies after death, it appeared that 
 no injury had been sustained by the brain, liver, gall- 
 bladder, stomach or heart. The prognosis of this dis- 
 ease is formed with greater certainty from the warmth 
 or coldness of the extremities, than from either the 
 universality of the spasms, or the frequency or steadi- 
 ness of the pulse. Thus if the spasms were ever so 
 general, with warmth of the extremities, there was no 
 immediate danger ; on the contrary if the spasms were 
 ever so trifling, with coldness, there was every danger 
 to be feared." 
 
 It is also stated in the Bengal Report, that the cho- 
 lera appeared at Hurdwar on the Ganges, in April, 
 1783. Its prevalence at this place is very deserving 
 of attention. 
 
24 EPIDEMIC CHOLERA 
 
 Hurdwar on the Ganges, is a place held particu- 
 larly sacred by the Hindoos. At this time an im- 
 mense multitude had assembled on occasion of a re- 
 ligious festival. 
 
 It was computed that from one to two millions of 
 people had assembled here on the banks of the holy 
 Ganges, where they passed several days and nights, 
 crowded together, and exposed to a burning sun by 
 day, and to heavy dews and cold blasts from the 
 mountains at night. 
 
 The cholera suddenly appeared among this crowd 
 of devotees, and was undoubtedly generated among 
 them, and raged with such violence as to destroy 
 above 20,000 people in the short space of eight days. 
 But it is a remarkable fact that this disease did not 
 spread from this point, not even to the villages within 
 a few miles, and ceased immediately on the disper- 
 sion of the multitude who had assembled at Hurd- 
 war. 
 
 In 1787 the cholera prevailed at Vellore, Arcot, 
 and Trincomallee, and has been described by Dr. 
 Duffin, Dr. Davis, and Mr. Thompson. At these 
 places it raged with great violence, and so rapid in 
 its progress, that many were carried off in twelve 
 hours. It prevailed here most in October and No- 
 vember. Nausea, frequent heats and chills, cold 
 sweats, severe gripings and purgings, retchings to vo- 
 mit, intense thirst, with spasms and a sinking of the 
 pulse, were the characteristic symptoms of the disease 
 at these places. 
 
 In 1 790, the cholera was again very prevalent, says 
 the Calcutta report, and very destructive in a detach- 
 ment of Bengal troops marching through the North* 
 
PREVIOUS TO 1817. 25 
 
 ern Circars, in the months of March, April, May and 
 June of 1790. The disorder was characterized by 
 precisely the same symptoms which mark the present 
 epidemic. u It began with violent pain and spasm 
 in the stomach and bowels, which were followed by 
 purging, vomiting, and all the signs of extreme debili- 
 ty." In one division consisting of 1000 artillerists, 
 the cholera appeared, and destroyed 700 of them in 
 six days. 
 
 Dr. James Johnson, in his work on the diseases of 
 tropical climates, alludes to the prevalence of this dis- 
 ease in the vicinity of Trincomallee, about the year 
 1804, and refers to Curtis's description of the same 
 disease. The following is one of the cases he gives 
 of the complaint. 
 
 " A seaman on waking after a debauch, repaired to 
 the deck, and there again he fell asleep, during the 
 chilly part of the night. c About 4 o'clock in the 
 morning he awoke with a shiver and left the deck, 
 but was soon seized wdth frequent purging and gri- 
 ping, his stools consisting of mucus and slime. Nau- 
 sea and retching succeeded ; nothing being ejected 
 but phlegm, and the contents of the stomach. His 
 pulse was small, quick, and contracted ; his skin dry, 
 but not hot. About eight o'clock in the morning he 
 began to feel spasms in different parts of his body, 
 which soon attacked the abdominal muscles, and 
 threw him into great pain. During these paroxysms, 
 a cold clammy sweat would be occasionally forced 
 out, especially in the face and breast. The extre- 
 mities now became cold ; his features shrunk ; the 
 stomach rejecting every thing which was offered either 
 as medicine or drink. The abdomen and epigastrium 
 
26 HISTORY OF THE CHOLERA 
 
 all this time were distended and tense, with incessant 
 watery purging and painful tenesmus. By ten o'clock 
 his pulse could scarcely be felt ; his breathing was 
 oppressed and laborious, his eyes sunk, and the whole 
 countenance singularly expressive of internal agony 
 and distress. The extremities were cold, shrivelled, 
 and covered with clammy sweats. The violence of 
 the spasms now began to relax ; and by eleven o'clock, 
 or seven hours from the attack, death released him 
 from his sufferings.' This may serve as a specimen 
 of the worst form of that dreadful disease, which has 
 obtained the appellation of c mort de chien,' or the 
 'death of a dog.'" 
 
 Several other w T riters allude to the prevalence of 
 this disease in India previous to 1817, and although 
 its ravages have not been so great as subsequent to 
 that period, yet no doubt can exist in the mind of any 
 one who examines the subject, of the fact that chole- 
 ra has very frequently prevailed epidemically in In- 
 dia, previous to its appearance at Jessore. But as it 
 did not attract much attention in Europe previous to 
 its occurrence at this last place, we shall endeavor to 
 be more minute and particular in describing its ap- 
 pearance in 1817, and its progress since that time. 
 
 HISTORY OF THE EPIDEMIC CHOLERA 
 FROM 1817 TO 1832. 
 
 Dr. Robert Tytler, who practiced medicine at Jes- 
 sore, a city situated a little less than one hundred miles 
 northeast of Calcutta, was called, on the 19th of Au- 
 gust, 1817, by a Hindoo physician, to visit one of 
 his countrymen, a Hindoo, who, the preceding night, 
 
FROM 1817 TO 1832. 27 
 
 had been attacked with violent pains in his bowels, 
 accompanied with diarrhea and vomiting. Dr. Tyt- 
 ler found the man to be dying, and believed it to be a 
 case of poisonings and was about to report so to the 
 authorities of the town, when he learned the next day, 
 that in the same part of the Bazar,* ten other Hin- 
 doos had died with the same symptoms, and in anoth- 
 er Bazar, seven others, with a like disease, which had 
 attacked many persons in the street. 
 
 It was now no longer possible to mistake an epi- 
 demic influence, especially as the number of deaths 
 increased rapidly. In 2 months from the invasion of 
 the disease, it destroyed more than ten thousand of 
 the inhabitants of Jessore. 
 
 Such is the origin of what has been called this new 
 pestilence ; and which, since 1817, has prevailed ev- 
 ery year in India ; has overrun all parts of it ; and 
 which has extended over most of the eastern conti- 
 nent ; to New Holland, China, the isle of Bourbon, 
 and to the centre of Europe 5 and finally has reached 
 this western continent, and appears by its violence at 
 Quebec and Montreal, not to have yet lost any of its 
 malignancy. 
 
 The resemblance which exists between this dis- 
 ease and that long known in Europe as Cholera Mor- 
 bus, induced the English physicians to give it the 
 same name, and though there are some differences, 
 yet it is very true that this Spasmodic Cholera of In- 
 dia, resembles more the common Cholera Morbus 
 than any other disease yet discribed ; and therefore 
 
 * Bazar, Bazaar, or Basar, a market place in the East, in the 
 neighborhood of which are the coffee houses and places of resort 
 among the orientals. Bishop Heber, speaking of those at Calcutta, 
 says, " they are wretchedness itself," 
 
28 PROGRESS OF THE 
 
 the name has been well chosen. Indeed many are 
 of the opinion that it is in no respect different, but is 
 only the common Cholera, prevailing epidemically. 
 Sydenham alludes to its prevalence in London, in 
 1676. He says, " at the close of the summer, the 
 Cholera Morbus prevailed epidemically, and being 
 rendered more severe by the extraordinary heat of 
 the season, was accompanied with more violent 
 and inveterate convulsions, than I had hitherto 
 known ; for not only the abdomen, but all the mus- 
 cles of the body, and especially those of the arms and 
 legs, were affected with terrible spasms." 
 
 In India the disease has received various names. 
 The Hindoo physicians call it Vishuchi, or Vishu- 
 chiki ; but the common people give it a name which 
 signifies vomiting and purging. When it prevailed 
 epidemically, and with great severity at Bagdad, in 
 1821, it was called by the natives, Haouwa, which 
 signifies tornado. 
 
 PROGRESS OF THE CHOLERA IN 1817, 
 
 The first ravages of the Cholera at Jessore, were f 
 very considerable ; twenty to thirty people died of it 
 each day. At first, the Hindoo population only were 
 attacked ; but afterwards, theEuropeans were seized 
 with it, and died in great numbers. The evil, for a 
 short time, was confined within the walls of Jessore, 
 but afterwards it extended to the neighboring cities 
 and villages. The first invaded by this epidemic 
 were Nuddea and Kishnagur, both situated on a 
 small branch of the Ganges. Afterwards, Chitta- 
 
CHOLERA IN 1S17. 29 
 
 gong, towards the east, and Silhet, on the north, and 
 Calcutta, towards the south-west, became the prey 
 to this terrible disease. 
 
 Until September, 1317, the Cholera had not ap- 
 peared as an epidemic at Calcutta 5 some Hindoos 
 were occasionally attacked with it, but the disease 
 rarely proved fatal, and for the ten years previous to 
 1817, not a single case had been treated at the gene- 
 ral hospital for Europeans at Calcutta. But the 
 disease appeared at Calcutta as a violent epi- 
 demic the first week in September. Few were 
 seized in the beginning ; but of those few scarcely 
 one survived. Each successive week added strength 
 to the malady and more extended influence to its op- 
 erations. It has been calculated that 36,000 were 
 attacked in the first three months. The proportion 
 of men to women who were attacked, was as 4 to 1. 
 
 In the district of Dacca 5 between the Ganges and 
 the Burrampooter rivers, the disease made great rav- 
 ages in the first six months ; of those attacked, more 
 than half died. At Sylhet, a city which contained 
 1 9,000 inhabitants, 10,000 persons had the disease 
 during the first five months of its prevalence. In the 
 district of Nuddea, containing 1,300,000 inhabitants, 
 25,500 had the disease, and 16,500 died from it. 
 
 A great number of cities and military stations were 
 successively invaded by the Cholera, in the course 
 of the year. The principal were those of Balasore, 
 Burrisaul, Burdwau, Rungpore, Malda, Baugulpore, 
 Chuprah, Monghyr, Buxarand Ghuazeepore. Among 
 many, the invasion was so sudden that the roads were 
 covered with the dead and the dying, who had not 
 time to regain their tents or houses. Men mounted 
 on horses were seen to fall from them, unable to rise 
 again. 3* 
 
30 PROGRESS OF THE 
 
 The epidemic this year extended in almost every 
 direction around Jessore, to the distance of 250 miles, 
 and it has been supposed that at least 600,000 men 
 died of Cholera in thirty two cities, during its preva- 
 lence in 1817. 
 
 The first week in November, it broke out in the 
 grand army under the command of the Marquis of 
 Hastings, which was composed of 10,000 English, 
 and 80,000 natives, and who were encamped on the 
 right bank of the Betoah, and concentrated at Jubel- 
 pore, Mendelloa, and Sangor. The first victims were 
 very numerous, but on the fifth and sixth days, the 
 mortality became so great that despair seized the 
 most brave. To the usual noise and gayety of a 
 camp, succeeded a mournful silence, or nothing was 
 heard but the groans of the dying, and the lamenta- 
 tions of those that survived. The principal roads 
 and fields around the camp, were strewed with the 
 dead bodies of those who, by flight, had hoped to 
 have escaped this terrible devastation. No express- 
 ion can properly describe the spectacle of desolation 
 which this army, recently so brilliant, now exhibited. 
 In twelve days, 9,000 men had died, as was ascer- 
 tained, and a still greater number had fled. The 
 survivors, overwhelmed by so great a disaster, disre- 
 garded the voice of their chief, and sought only to 
 save their lives, or stun themselves by debauchery. 
 Happily, ihe Marquis of Hastings marched his army 
 across the Betoah, and fixed his camp on dry and 
 elevated ground, and very soon the disease sub- 
 sided. 
 
 
 
CHOLERA IN 1818 31 
 
 PROGRESS OF THE CHOLERA IN 1818. 
 
 In 1818, the epidemic cholera spread in every di- 
 rection, and over a vast extent of country. It pre- 
 vailed on the river Jumna, from its connection with 
 the Ganges, to the distance of 200 leagues. Patna, 
 Agra, Multra and Delhi, were visited by the disease. 
 Patna, containing 250,000 inhabitants, of whom 
 1 ,539 died by cholera. At Sharunpore, 250 perished 
 out of 30,000 people. Agra suffered severely. At 
 Delhi, the victims were numerous. At Benares, 
 1 5,000 persons died in two months ; and at Allahabad, 
 40 to 50 died in a day. In fine, there were but very 
 few cities or villages in the space of 450 square miles, 
 following the course upwards of the Ganges and the 
 Jumna, that were not ravaged by the cholera in 1813. 
 i\t Calcutta, 13,920 persons were attacked in the 
 last three months of 1818, and the registers of deaths 
 caused by cholera, among the Indians and Mussul- 
 men population, show that above 5,000 perished. 
 
 From Bengal, the disease spread to the north, 
 towards Nepaul, and to the east, towards the Bir- 
 man Empire, on the west, to the coast of Malabar, 
 and through the whole extent of the Coromandel 
 coast in the south. Traversing the peninsula of In- 
 dia, the cholera penetrated, in the month of August, 
 1818, the village of Panvvel, and the island of Bom- 
 bay, where, in fourteen days, 537 persons were de- 
 stroyed by it. 
 
 From Bombay, the epidemic extended itself to- 
 wards the north, ravaged Surat, Poonah, Serror and 
 Ccllapore. At Poonah, 30 to 40 persons died in a 
 day ; and at Serror, 200 Hindoos and 20 Europeans 
 died in 24 hours. In the south, Calicut, Cochin, and 
 
32 PROGRESS OF THE 
 
 several other cities were successively attacked by 
 the disease, The disease prevailed to an equal ex- 
 tent, in the interior of the peninsula. It appeared 
 successively at Husscinabad, Aurengabad, Amena- 
 gar, Hydrabad, Seringapatam, Madura, and most of 
 the towns even to Cape Comorin. By many it was 
 supposed to have been brought into this part of In- 
 dia by a detachment of troops that was directed 
 from INagporto Jaulnah and Aurengabad. 
 
 In the course of July, the disease appeared atPon- 
 derpour, at the time when the celebration of a great 
 festival had drawn a great number of people together ; 
 at this place, more than 350 died each day, so that 
 in a short time 3,000 persons perished of the disease. 
 In the month of September, the cholera appeared 
 among the inhabitants ofBellary, and afterwards the 
 troops at that place were attacked by it. In the 
 month of November, it prevailed at Seringapatam, 
 and at the same time at Mysore andCoimbatore. 
 In this last place, containing 15,000 inhabitants, 70 to 
 80 died in a day. 
 
 The cholera prevailed during the first year on the 
 Coromandel coast, and extended to Jaggrenah, and 
 in 1818 it appeared at JVlasulipatam, and at Fort 
 St. George, and Madras. In the months of January 
 and February, a number of Hindoos had the disease 
 at the fort, and in the course of the year, above three 
 thousand Hindoos were attacked, of whom 664 died ; 
 and out of 1 1,000 Europeans, 1,087 had the cholera, 
 of whom 232 died. In the month of J une, Pondicher- 
 ry was invaded by the epidemic, and at the same 
 time it prevailed at Carnate and Bellary. 
 
 Towards the east, the epidemic cholera extend- 
 ed in 1818, to the Birman Empire, and to the King- 
 
CHOLERA IN 1819. 33 
 
 dom of Arracan ; and the same year it also prevailed 
 in the peninsula of Malacca, though the extent of its 
 ravages in that country is not known. 
 
 Its prevalence this year in the north was remark* 
 able. It was noticed among the inhabitants on the 
 high mountains which separate Hindostan from Na- 
 paul, and also in the vallies of Catmandou, Patun 
 and Bhatgoun, the elevation of which, is more than 
 4000 feet above the level of the sea. 
 
 During the year 1818, its ravages were as great, or 
 greater than they have ever been since, in the course 
 of one year. 
 
 More than 1 40 cities or villages were visited by it, 
 and it extended from the equator to the 28° of north 
 latitude, and over an extent of 30 degrees of longi- 
 tude. 
 
 PROGRESS OF THE CHOLERA IN 1819. 
 
 In 1819, the progress of the cholera was not so 
 great as in the two preceding years. 
 
 It prevailed for a considerable portion of the year 
 in Calcutta, but the number of deaths did not exceed 
 1459. In the Presidency of Bengal, a great number 
 of cities in which the cholera prevailed the year be- 
 fore, were visited by it this year also. This was the 
 case w 7 ith Nagpore, a city situated in the centre of 
 the peninsula, and in which a great number of 
 people died with the cholera in the months of April 
 and May. 
 
 Many of the military stations were attacked, but 
 the disease raged less than in 1818. 
 
 The citadel of Jaragurth, built on an isolated rock, 
 
34 PROGRESS OF THE 
 
 at a height of 1000 feet above the plain, was visited 
 by the epidemic, whilst the inhabitants of a city situ- 
 ated at the foot of the mountain entirely escaped. 
 
 The course of the Ganges and the Jumna were 
 again visited by the disease. Many cities, as Mora- 
 habad, Kiurnaul, Bareilly, Almora and Saharun- 
 porte lost many inhabitants. 
 
 The high regions of Nepaul, even to Catmandou, 
 were this year spared. 
 
 From Madras, the disease advanced towards the 
 south ; passed Trichinopoli ; ravaged Areot, and pre- 
 vailed at Cape Comorin. From here, it passed to 
 Cochin, Calicut and Bombay. 
 
 On all this coast, a great number of towns which 
 had escaped the preceding year, were now desolated 
 by a frightful mortality. It has been calculated that 
 150,000 people died in the Presidency of Bombay, of 
 the disease in 1819. Entire villages were depopula- 
 ted, and the terror was so great that the crews of 
 many vessels, loaded with cotton, deserted and fled in 
 the night. 
 
 At Bombay, it was ascertained that from the month 
 of April, 15,945 individuals were attacked by the 
 disease, and the Medical Commission affirmed that 
 this number was one quarter or one third below the 
 true number. The progress of the cholera was very 
 extensive on the southeast coast in 181 9. 
 
 The kingdom of Arracan, the peninsula of Malac- 
 ca, and the kingdom of Siam, were successively in- 
 vaded. At Malacca, more than 400 persons perished 
 in a few days. Bankok, the capital of Siam, lost 
 more than 40,000 of its inhabitants by cholera. 
 
 As the people attributed this disease to the influ- 
 ence of an evil genius, which, under the form of a fish, 
 
CHOLERA IN 1819. 35 
 
 had sought refuge in the Gulf of Siam, the sovereign 
 authority ordered the celebration of a great religious 
 solemnity on the coast, in order to exorcise this evil 
 being, but the collection at one place of a great mass 
 of human beings, redoubled the fury of the disease. 
 Eye witnesses stated that of this collection, 7000 died 
 of cholera in a ve^ short time. 
 
 Until about the commencement of 1819, the chol- 
 era had confined its ravages to the continent, but in 
 the month of January, 1619, it appeared at Trinco- 
 malee, in the island of Ceylon. By many, it was sup- 
 posed to have been imported there, by the vessel Le- 
 ander, from Calcutta. After this, it appeared at 
 Kandy, the capital city, built on the borders of an ar- 
 tificial lake, 1400 feet above the level of the sea, and 
 surrounded by wooded hills and mountains. About 
 the same time, the disease appeared in the island of 
 Penang, situated in the straits of Malacca. Eight 
 hundred inhabitants of the English colony of Charles- 
 town died in the course of twenty-one days. The 
 population of Charles-town was above one thousand, 
 two thirds of whom were swept away by the invasion 
 of the cholera in 1819. 
 
 The island of Sumatra was also devastated the 
 same year by this epidemic. So violent was the dis- 
 ease in the capital, Acheen, that the king sought 
 refuge at the mouth of the rivef, where he formed a 
 camp. But the disease followed to this place, and 
 destroyed sixty persons a day. 
 
 This year, the epidemic cholera made its appear- 
 ance at a great distance from India, in Mauritius or 
 isle of France, a distance of 3000 miles from the other 
 places at which the epidemic raged. Its appearance 
 
36 PROGRESS OF THE 
 
 at this place has given rise to much discussion as to its 
 importation. 
 
 It first appeared at Port Louis, the principal town 
 in the Isle of France, the 16 th of Nov. 1819. Seven- 
 teen days before this, the Topaze, a frigate of 46 guns 
 from Ceylon, anchored in the harbor of Port Louis, 
 after a very unhealthy voyage, during which, several 
 men had died of cholera morbus. 
 
 These circumstances have been appealed to, as 
 proof positive that this vessel brought the disease to 
 the island ; but it should be recollected that although 
 the cholera did not prevail epidemically, or to much 
 extent at Port Louis until after the arrival of the ves- 
 sel, yet Dr. Kinnis states that several cases occurred 
 during the month previous.* 
 
 At first, the disease was confined to Port Louis, 
 and out of a population of 8000, destroyed fifty a day, 
 for the first ten days. The patients consisted princi- 
 pally of the black population of the Mozambique 
 caste. These are curly headed negroes ; low in the 
 scale of civilization ; too unintelligent to learn trades, 
 and generally employed as porters. They are an un- 
 interesting quiet race, not given to excess, living chief- 
 ly on rice and Indian corn. The disease soon spread 
 from the Port to the district of Pamplemouses ; thence 
 to the districts of Floeg, Mohebany, and to the Sa- 
 vannah, and is said to have destroyed from 10,000 to 
 20,000 persons in the island. 
 
 Thus we have seen, that during 1819, the cholera 
 extended to many and very distant countries. The 
 space over which it spread is about 40 degrees of lati- 
 tude, and 50 of longitude. 
 
 J See Edinburgh Medical and Surgical Journal for 1821. 
 
CHOLERA IN 1820. g 7 
 
 Th» number of cities in which it prevailed during 
 the year is about 64, or only one half as many as it 
 ravaged in 18L8. 
 
 PROGRESS OF THE CHOLERA IN 1820. 
 
 In 1 320 the Presidency of Bengal was again a prey 
 to cholera morbus. A great number of people be- 
 longing to the first ranks of society, were attacked by 
 it. The disease appeared at the end of February 
 Sixty-eight persons perished in the last week of this 
 month : 657 died in March : in April and May, the 
 number of deaths increased, but in June the mortality 
 of the disease diminished rapidly, but it did not en- 
 tirely cease until September. 
 
 The course of the Ganges and that of the Jumna 
 were also attacked in 1 820. 
 
 Jessore, the cradle of the epidemic, was also visit- 
 ed this year by it, but with less intensity than the 
 year preceding. 
 
 In the Presidency of Madras, a great number of 
 people died in the course of the year. In many cities, 
 such as Nagore, Negapatam, Madura, Palamcottah] 
 and Tmnevelly, the epidemic commenced in 1819. 
 and raged until the middle of 1821. At Madras, in 
 1820, there perished of the disease in the army,' 69 
 Europeans, and 758 natives. In the other classes of 
 the population, the number of deaths was not so 
 great. 
 
 The environs of the city, however, suffered severe- 
 ly, especially the troops in the camps at Peddapoor 
 and Bochuly. Arcot and cape Comorin were again 
 invaded by the disease, which spread this year to Co- 
 
 4 
 
88 PROGRESS OF THE 
 
 chin, and penetrated into the interior, as far as Hy- 
 drabad and Nagpor. 
 
 In the month of April, it attacked S urate and its 
 environs, afterwards it appeared at Bombay, where 
 the greatest mortality prevailed, in the months of May 
 and June. 
 
 The islands attacked by the cholera in the course 
 of 1820, were Penang, which had already suffered in 
 1819, and also Ceylon, where it ravaged Candy and 
 Columbo. 
 
 The island of Bourbon also experienced a sfightat- 
 tack of the disease. By many it was supposed to 
 have been imported into this place from the isle of 
 France, as it appeared in January, 1 820, in the isle of 
 Bourbon at the same time it prevailed at the isle of 
 France, 
 
 The disease this year appeared in the Philippine 
 islands, and at Manilla in September, after the arri- 
 val of vessels from Bengal. The terror produced at 
 Manilla was so great that it caused an insurrection, 
 in which perished many Europeans, and a great 
 number of the natives. 
 
 The inhabitants of the island of Sumatra were at- 
 tacked this year by cholera ; not only those who lived 
 on the low grounds and banks of rivers, but those 
 who resided on the high lands of the interior. The 
 city of Bancoo alone escaped, though in the immedi- 
 ate neighborhood, and in free intercourse with places 
 where the disease prevailed. This year the cholera 
 prevailed at Siam and at Tonquin, and also extend- 
 ed to all Cochin China. It appeared at the same 
 time at Canton and many other cities of Chin^ 
 
 This year, though a less number of cities hare been 
 
CHOLERA IN 182i. 39 
 
 attacked by cholera than in 1819, (42 instead of 64,) 
 yet it appears that the morbific influence extended 
 farther, and comprehended 60° of longitude, and 40° 
 of latitude^ 
 
 PROGRESS OF THE CHOLERA IN 1821. 
 
 i# 1821, the cholera invaded countries that it had 
 not before visited. The Presidency of Bengal was, 
 however, as formerly, the principal seat of the disease. 
 At Gorruckpore, the number of deaths was so great, 
 that the Rajah and the most part of the inhabitants 
 fled. The army encamped on the Nerbudda suffer- 
 ed severely from the disease, which also prevailed in 
 the cities of Chittagong, Ghazepore, Balassore, San- 
 gor, Dacca, and many others. 
 
 The malady reappeared at Calcutta, in the course 
 of June. It appeared at Jaggrenah during the annu- 
 al religious festival, which brought a great number of 
 pilgrims together. The ravages of the cholera were 
 so great as to hinder one of the principal ceremonies, 
 that which consisted in drawing the car of the idols 
 around the temple, so that this year no pilgrim was 
 enabled to offer himself as a sacrifice by precipitating 
 himself under the wheels of the car. 
 
 Go the Coromandel coast, a great number of cities 
 were visited by the epidemic in the course of 1821, 
 The principal were Cudalore, Durwar, Salem and 
 Madura. At Madras the Indian troops were se- 
 verely visited. Pondicherry and Trichinopoli suffer- 
 ed very greatly. At St. Thome the missionary, Pierre 
 Drujillard, died of cholera, after having fulfilled the 
 
40 PROGRESS OF THE 
 
 duties of his pious ministry to many of those sick with 
 the same disease. 
 
 The cholera also prevailed this year among the 
 troops at Jaulnah, in the middle of the peninsula, and 
 spread from there to the camp of Venkettagury and 
 to Nagpore. The Presidency of Bombay was this 
 year the seat of the disease, in its most mortal and 
 malignant form. Salsette, Baroda, Poonah, Servor, 
 and Surat, were the principal cities affected. In the 
 capita], 235 persons died in less than one week. The 
 disease prevailed most in May, but in November had 
 not entirely disappeared. 
 
 Kishme, an island situated at the entrance of the 
 Persian Gulf, was visited by the cholera this year. 
 It has been said that the germs of the disease were 
 brought here by a convoy of English troops. The dis- 
 ease extended itself along the gulf, visited Ormus ? 
 Mascate, and Bender Abouehir ; extended also to 
 the isle of Bariem, and finally reached Bassora, in 
 which city it manifested extraordinary violence. Of 
 60,000 inhabitants, 15,000 to 18,000 died of cholera 
 in eleven days. From Bassora, it was carried as has 
 been supposed to Bagdad, by caravans and vessels on 
 the river Tigris* At any rate it appeared at Bagdad 
 soon after it raged at Bassora, and according to Dr. 
 Meunier, one third of the population of Bagdad were 
 destroyed by it. Inhabitants of the suburbs of the 
 town, also became affected by the disease, and from 
 here the disease spread to the surrounding country. 
 A Persian army, which at this time menaced Bagdad, 
 recoiled before this new enemy, but carried the dis- 
 ease with them into the centre of Persia. At the 
 same time the disease spread from Bender Abouchi? 
 
CHOLERA IN 1821. 41 
 
 to Shiraz, in which city the disease was as mortal as 
 at Bassora. Front the frequent communication be- 
 tween these places, it would seem as if the disease 
 might have been transported by travellers from one 
 place to the other, and many writers say this was 
 actually the case ; but it is impossible, at this time, 
 to obtain all the facts respecting its progress in India 
 and Persia, to enable us to determine the important 
 question as to the contagiousness of the complaint. 
 Besides, this can more easily, and more satisfactorily 
 be determined, by an examination of its progress in 
 Europe, and within a few years past. 
 
 At Shiraz the disease raged with great violence. 
 The Prince Royal lost many persons belonging to his 
 harem. Both his mother and son died of the disease, 
 and it has been calculated that in 18 days, 6,000 
 people died of cholera, out of a population of 35,000. 
 
 On the eastern coast the progress of the disease 
 was less extensive, and was chiefly confined to two 
 islands in the Indian Archipelago, Borneo and Java. 
 
 In the island of Borneo, the Dutch garrison of 
 Pontianah was nearly destroyed •, the resident was 
 the only person who was able to administer medi- 
 cine. In the island of Java, Samarang was the first 
 city invaded by the disease ; afterwards it prevailed 
 at Batavia, Sourabaya, Kandal and Japara. At Sa- 
 marang, 900 persons perished in seven days. Bata- 
 via lost 17,000 inhabitants, and the entire island of 
 Java 102,000. 
 
 Such was the progress of the cholera in the course 
 
 of the year 1821. We have seen that it spread from 
 
 places situated under the 40 Q of longitude and 35° 
 
 of north latitude, even to Java, under the 110° of 
 
 4* 
 
42 PROGRESS OF THE 
 
 longitude, and the 8° of south latitude ; a space of 
 43° of latitude and 70°. of longitude. 
 
 PROGRESS OF THE CHOLERA IN 1829. 
 
 The presidency of Calcutta suffered but little from 
 the cholera during the course of- this year. It did not 
 prevail at Calcutta until the month of December, 
 and then but few died of it ; probably owing to the 
 adoption of measures to secure the health of the city, 
 which until now had not been attended to. The disease 
 prevailed again, however, at Jessore, Chittagong, 
 and Serampore, though with less violence than for- 
 merly. 
 
 The Coromandel coast was invaded by the disease 
 at many points, even as far as Cape Comorin. At 
 Madras, the troops suffered severely. A vessel an- 
 chored near the harbor, lost all her crew, by the 
 cholera, excepting two sailors. The vessel William 
 Fairlie, lost seven men in five days. " When we re- 
 tired for the night," said one of the officers of this 
 vessel, " we took leave of each other, certain that we 
 should not all meet again." 
 
 The coast of Malabar, and the city of Bombay, 
 were not attacked in the course of 1822. On the 
 eastern coast, the ravages were less than in the two 
 preceding years. 
 
 From Cochin China, where it had been very se- 
 vere since 1820, it extended towards China, where 
 it raged two years before. Canton, Pekin, and many 
 other cities of China lost great numbers of their in- 
 habitants. The Philippine islands still continued to 
 experience the ravages of this epidemic, but in a lees 
 
CHOLERA IN 1822. 43 
 
 degree, as this year Manilla was the only place where 
 the disease prevailed. 
 
 On the western coast, the progress was towards 
 Europe. In Mesopotamia, the disease re-appeared 
 in the spring, though it was arrested during the win- 
 ter. Bagdad, Mosul, Merdine, and Diarbeker suf- 
 fered successively. Many cities in Syria were in- 
 fected by the epidemic in the course of the year. 
 The cholera also progressed on the side of Persia. 
 From Ispahan, where the disease reigned in 1821, it 
 reached Kashan in July, 1822, and soon after, Khow, 
 Casbin, and Kermandah. In the month of Septem- 
 ber, it appeared at Tauris, and extended immediate- 
 ly to Erzerum. 
 
 The Prince Royal of Persia having attacked the 
 the Turkish army, saw, a few days after the victory, 
 his army swept away by the epidemic. It was com- 
 puted that 2,000 soldiers died in one march. When 
 the army arrived at Tauris, 30 to 40 persons died 
 each day. The total number of deaths was 4,800 
 in the 25 days that the disease prevailed. This num- 
 ber constituted about one twentieth of the population. 
 In conclusion, the number of deaths from cholera, 
 and the number of cities infected, were much less 
 than in the preceding years. Its progress was also 
 much less extensive, being confined to ten degrees of 
 latitude, — in Persia, Syria, and Mesopotamia, and 
 o about the same space in the Chinese Empire* 
 
 PROGRESS OF THE CHOLERA IN 1823. 
 
 In the Presidency of Bengal, only four cities were 
 visited by cholera this year, Calcutta, Nagpore, 
 
44 PROGRESS OF THE 
 
 Kampti and Jaulnah, in each of which, the number 
 of deaths was very inconsiderable. The Coroman- 
 del coast also suffered but little this year: Madras, 
 Trichinopoli, Arcot and St. Thome were the principal 
 cities where the disease prevailed. In the Presiden- 
 cy of Bombay, the capital alone suffered from the 
 cholera, and here it prevailed in a very light degree. 
 
 In general, British India nearly escaped the chol- 
 era during the year 1823. It prevailed, to be sure, 
 in various parts of the country, but very few died of 
 it. But it was very different in the Birman Empire. 
 There, its progress was extensive, and the mortality 
 very great, notwithstanding the numerous and diverse 
 preservatives extravagantly praised by the govern- 
 ment. Neither the name of the heir to the crown, 
 worn as an amulet around the neck, nor the detona- 
 tions made to chase the evil demon from the country, 
 were able to arrest the progress of the epidemic, or to 
 lessen its mortality. 
 
 In China the ravages of the cholera were also great, 
 in consequence of the numerous canals, and the im- 
 mense population of the country. The Russian au- 
 thorities urged the Mandarins to arrest the disease by 
 adopting some preventive or preservative measures. 
 But they were told in answer, that the malady would 
 give more space in the w r orld to those who survived it, 
 and besides, that the cholera chose its victims from 
 among the filthy and the intemperate, and that no per- 
 son of courage, who lived with moderation and sur- 
 rounded by cleanliness, would die of the disease. On 
 this occasion, the Mandarins stated that the Emperor 
 had said to his subjects, " Do not believe the disease is 
 more powerful than yourselves ; timid people are the 
 only ones who die of it." And it was added that 
 
CHOLERA IN 1823. 45 
 
 after this the people took courage, and the disease 
 left the country. But the vast provinces of China 
 were not the less ravaged by the epidemic, which 
 extended even to Kukuchoton, a Russian city north 
 of Pekiu, in the 40° of north latitude. Macao and 
 Nankin also suffered very much from the disease. 
 
 The progress of the cholera was also considerable 
 on the western coast. The north of Persia continued 
 to be the seat of the epidemic in its most mortal form, 
 and from here it penetrated into the Russian territory 
 by two points, Gilan Suillau on one side, and Astra- 
 chan on the other. Jn this last city, 216 had the dis- 
 ease, 144 of whom died. The borders of the Medi- 
 terranean, and also those of the Caspian sea, were 
 this year visited by the cholera. It prevailed at 
 Lataquiein June, 1823, and afterwards at Antioch, 
 Tortose, Tripoli and Luedie, though not with great 
 severity. From here it spread to Damir in the neigh- 
 borhood of Damascus. On the other side, it spread to 
 the foot of mount Libanon, and threatened Palestine. 
 The most northerly point where the cholera ap- 
 peared this year was Orenbourg, a city situated on 
 the confines of Asia and Europe. At this city, nume- 
 rous caravans arrived yearly, by two different ways. 
 Those fromBucharia and China, and which traversed 
 Chinese Tartary, arrived from the east, while those 
 *that brought merchandise from Hindostan, and tra- 
 Iversed the territory of the Kirghises arrived from the 
 [ south. By either of these ways the cholera might 
 have been brought to Orenbourg, for the disease pro- 
 availed both at China and Hindostan. The first in- 
 vasion of the disease at Orenbourg was not formida- 
 ble, but few died of it, and it did not extend far into 
 the surrounding provinces. 
 
46 PROGRESS OF THE 
 
 In the course of the year 1823 the cholera prevail- 
 ed but little in those places where it had formerly 
 raged, it extended however to the frontiers of Europe* 
 to Astrachan and Orenbourg. 
 
 The appearance of the disease on the borders of the 
 Mediterranean created great alarm, in consequence 
 of the frequent communication which existed be- 
 tween Europe and the ports of Syria ; but now, 
 events have shown that such fears were not well 
 founded, as the disease has not penetrated into Eu- 
 rope by maratime communications, but has passed by 
 land from one country to another. 
 
 PROGRESS OF THE CHOLERA IN 1824. 
 
 But few countries were visited by the cholera in 
 i824. In British India it prevailed but very little^ 
 and only in a few cities* Calcutta lost a few hun- 
 dred inhabitants by the epidemic in the course of the 
 year. At Madras, the army suffered but little, while 
 the vessels anchored near the fort lost great numbers 
 of their crews. 
 
 The coast of Malabar, and the capital of the prov- 
 ince were invaded at some points. But the ravages 
 of the epidemic w 7 ere very inconsiderable, though 
 they attracted great attention by the rank of the vic- 
 tims of the disease, who belonged to the most wealthy 
 and elevated classes in society. 
 
 On the eastern coast, the Birman empire and the 
 northern provinces of China w 7 ere the only countries 
 infected by the disease in 1824. 
 
 The towns in the west, in Persia and Arabia, 
 where the disease had prevailed with frightful mortal- 
 
CHOLERA IN 1825. 47 
 
 ity for three years past, this year were entirely ex- 
 empted from the epidemic. Mesopotamia was also 
 delivered this year from the complaint, which raged 
 there with great severity the year preceding. In 
 Syria, the city of Tiberiade was the only one where 
 the cholera appeared, and here the cold of winter put 
 an entire stop to it. 
 
 In conclusion, the march of the destroying epidem- 
 ic which had menaced both Europe and Africa, seem- 
 ed to be arrested in the year 1824. 
 
 PROGRESS OF THE CHOLERA IN 1825. 
 
 The Presidency of Calcutta again saw the cholera 
 reappear and prevail with greater violence than in 
 the course of the year 1824. More than 500 persons 
 died in Calcutta, daily, in August and September. 
 
 At Jessore, the disease again appeared and destroy- 
 ed more than thirty a day. 
 
 At Benares, more than 6000 Hindoos died of chol- 
 era in the course of the summer. Many other cities, 
 such as Mirapore, Dinapore, Gasepore, Chunar, &c, 
 were infected in the course of the autumn. The Co- 
 romandel coast was more fortunate than Calcutta, as 
 the disease had not visited it for two years. 
 
 At Bombay, the return of the disease created great 
 alarm. The inhabitants built hospitals for those sick 
 with cholera; they set fire to immense masses of 
 wood in the infected districts, and burnt large quan- 
 tities of vinegar, tar and gun powder. The environs 
 * of Bombay also suffered from the disease, which ex- 
 tended to Surat on the north, and Belgaum and Cola- 
 pore in the country of the Marattes. In Western 
 
43 PROGRESS OF THE 
 
 Asia, Arracan and the empire of the Birmans were 
 the only places infected by the disease in 1825, and 
 it is said that the north of China and Chinese Tartary 
 suffered greatly from the disease in the course of this 
 year. 
 
 PROGRESS OF THE CHOLERA IN 1826. 
 
 The Presidency of Calcutta suffered but little this 
 year from the epidemic. At the city of Calcutta, the 
 Hindoos perished in considerable numbers. Patna 
 and Benares experienced the same calamity. In this 
 last city, the disease destroyed one hundredth part of 
 the population. The Goromandel coast was, as in 
 1825, completely preserved from the disease. On 
 the coast of Malabar, only a small number of cities 
 were infected, but when the disease did prevail, it 
 was so mortal that indescribable terror seized the 
 people, who fled at its approach, 
 
 In eastern Asia, the epidemic continued to progress 
 towards the north — passed -the great wall of China, 
 and visited Kukuchoton, a Russian city, situated on 
 the 42 Q of north latitude. From there, it penetrated, 
 perhaps by the aid of caravans, from Kiachta, even 
 to the centre of Asiatic Russia. 
 
 Western Asia was this year completely exempted 
 from this epidemic which had ravaged it for five years. 
 In conclusion, there has been no year since the com- 
 mencement of the disease in 1817, in which so few 
 cities were infected. According to M. Moureau de 
 Jonne's there were only five ; but this number is 
 probably below the truth. It is certain, nevertheless, 
 that the diminution of this malady gave birth to the 
 
CHOLERA IN 1827. -* 49 
 
 hope that its ravages, which, for ten years, had ex- 
 tended over a considerable portion of the world, were 
 now about to cease. 
 
 PROGRESS OF THE CHOLERA IN 1827. 
 
 From the month of January, the city of Calcutta 
 was infected by the cholera. First, the garrison was 
 attacked, and afterwards the Hindoo population, 
 which sickened in great numbers. The animals also 
 experienced the epidemic influence, and to such a 
 degree, that they were killed in great numbers. The 
 prolongation of the epidemic gave rise to various and 
 singular conjectures and opinions. The Europeans 
 attributed it to the heat of the sun and the coldness 
 of the nights; whilst the Hindoos considered it to 
 arise from the anger of the Divinity or God of the 
 Cemeteries, in consequence of the cessation of hu- 
 man sacrifices. 
 
 At Palcal, a Hindoo woman resolved to burn her- 
 self on the body of her husband, who had died of 
 cholera, but the Rajah refused to authorize such a 
 procedure. The widow, however, was urgent in her 
 request, and declared that the cholera would cease in 
 five days if she might be permitted thus to sacrifice 
 herself. The Rajah yielded to this assurance, and 
 permitted the sacrifice ; but the disease was not seen 
 to lessen. 
 
 Many cities in the Presidency of Bengal and of 
 Hindostan, were invaded by the cholera, in the 
 course of the year, the principal of which, were Jes- 
 sore, Jaypour, Jubulpore, Rewa, Sangor, &c. The 
 disease prevailed also at some places on the Coro-% 
 
50 PROGRESS OF THE 
 
 mandel coast; at Madras, Jaulnah, Hyderabad and 
 Husserabad ; but every where, it was, this year, 
 less malignant than it had been during the preceding 
 years. This was particularly the case at Bombay, 
 where only a very few died of the disease in 1827. 
 
 At the north, the cholera appeared at different pla- 
 ces. On one side, it reached the high grounds in the 
 neighborhood of the Himaleh mountains, and on 
 the other it opened to itself a new route towards Eu- 
 rope, from the centre of Asia. It passed from Lahore 
 to Cashgar, and to Caboul, where it prevailed several 
 months. From this last city, which is the great em- 
 porium of the merchandize oflndia, it was supposed to 
 have been transported with the caravans, to the bor- 
 ders of the Caspian sea. By this route, Persia on 
 the west, and Russia on the north, appeared to have 
 received the disease in 1828 and 1829. At the east, 
 we see the disease extend itself further into Chinese 
 Tartary, and into Russia in Asia, where it had al- 
 ready prevailed in 1826. 
 
 PROGRESS OF THE CHOLERA IN 1828. 
 
 As in the four preceding years, the ravages of the 
 cholera in 1828 were not great, and were confined 
 almost exclusively to British India. In the neighbor- 
 hood of Calcutta, more died of the disease than for- 
 merly ; several villages were entirely depopulated. 
 The mountainous districts of Kemaon, Almorah, 
 Cawnpore and Chittagong, were successively affect- 
 ed with the cholera. 
 
 At Madras, the disease did not appear before the 
 month of August ; but then it destroyed a great num- 
 
CHOLERA IN 182& 51 
 
 ber of Europeans. All the coast was ravaged by 
 the disease even to Trichinopbli, where it prevailed 
 until the end of December. On the coast of Mala- 
 bar, Bombay was nearly the only city where the dis- 
 ease prevailed in 1828 5 but here the victims belong- 
 ed to all classes of society •, the rich and the poor, of- 
 ficers and soldiers, Europeans and Hindoos, were 
 alike affected and destroyed by the malady. 
 
 This year, the cholera continued its march towards 
 the north. From Lahore, where it destroyed 30,000 
 inhabitants in 1827, it extended to the neighboring 
 towns, in the autumn of 1828. But the cold very 
 soon mitigated its violence, and lessened its rav- 
 ages. 
 
 PROGRESS OF THE CHOLERA IN 1829, 
 
 The disease did not, this year, appear in the Presi- 
 dency of Bengal. Madras, Madura, Verdaputty and 
 Royapettah, were nearly the only cities visited by 
 the cholera on the Coromandel coast, in the course of 
 the year 1 829. At Bombay, there were a few cases, 
 but the disease exibited nothing remarkable. 
 
 The cholera appeared anew in Persia in 1829. 
 The precautions taken to prevent the disease being 
 imported into Teheran, in 1822, and which were sup- 
 posed to have prevented its appearance there at that 
 time, were said to have been neglected in 1829, and 
 the disease appeared there towards the end of Octo- 
 ber. It was supposed to have been brought there by 
 communication with Caboul. The severity of the 
 cold season, however, prevented the disease prevail- 
 
52 PROGRESS OF THE 
 
 with great violence, and after a few weeks it entirely 
 disappeared. 
 
 During this year, the cholera, as if impatient of the 
 limits within which it had hitherto been confined, 
 crossed the Ural mountains, which separate Asia from 
 Europe, and appeared in the city of Orenbourg, lying 
 in the 51° of north latitude, and 72° of east longitude. 
 This city is situated upon the river Ural, between 
 two chains of the Ural mountains, in a spacious and 
 open valley, extending in a direction from northeast 
 to southwest, and contains 11,000 inhabitants, of 
 which number, six thousand are soldiers. The first 
 case was that of a soldier in the garrison at Oren- 
 bourg. He was attacked on the morning of the 26th 
 of August, and died in 12 hours. One week after, a 
 woman died of suspicious symptoms, and after anoth- 
 er week, on the 8th of September, another suspicious 
 and fatal case occurred. Neither of these persons 
 had any communication with any infected place, and 
 no trace whatever could be found of the way in 
 which the cholera arrived at Orenbourg. The next 
 day, two other cases occurred, and on the 10th of 
 September, two more, after which, the disease spread 
 rapidly, and became prevalent. Between this time 
 and the 20th of November, when the disease entirely 
 ceased, 1,100 cases occurred, of which 200 died. No 
 other place in the Orenbourg government was visited 
 by the disease, until the 23d of September, when it 
 broke out at Rasufina, 60 miles west of Orenbourg ; 
 soon it appeared at other places, and by the middle 
 of November, it had spread over a district of country 
 200 miles square $ but by the 23d of February, 1830, 
 the disease was every where extinct in the Oren- 
 bourg government. 
 
CHOLERA IN 1830. 53 
 
 PROGRESS OF THE CHOLERA IN 1830. 
 
 This year the cholera spread over various provin- 
 ces around the Caspian sea. It was noticed at sev- 
 eral places in the Persian province of Ghilan. It 
 prevailed all along the shores of the Caspian, — at 
 Sherran, Maranderen, Reschd and Baku. In the 
 town of Taurus, the mortality was not less than 5,000. 
 It appeared at Tiflis, the capital of Georgia, on the 
 27th of July, and in ten days attacked 579 persons, 
 of whom 237 died. The city of Tiflis was nearly 
 depopulated by death and flight, which reduced the 
 number of the inhabitants from 30,000 to 8,000. In 
 this city, the rites of religion were interposed to stay 
 the calamity. 
 
 On the 19th of July, the disease reached Astrachan, 
 where it had prevailed several years before. Astra- 
 chan is a large town, situated on an island in the prin- 
 cipal mouth of the Volga, about thirty miles from the 
 northern shore of the Caspian. The town contains, 
 according to Malte-Brun, from 40 to 70,000 inhabit- 
 ants. In ten days after the disease first appeared, 1 ,229 
 persons were attacked, of whom 433 died. 
 
 From Astrachan it spread along the Volga river, 
 and appeared at Taritsin, 220 miles above Astra- 
 chan, by the 4th of August, and at Saraton, 200 miles 
 further north, on the 6th of the same month. After 
 this, it extended to the government of Kien, 500 miles 
 west of the Volga. On the 27th of August, it ap- 
 peared at Samarov, a town on the Volga, 200 miles 
 north east of Saraton ; and by the last of the month, 
 it reached Nischnei Novgorod* On the 9th of Sep- 
 tember, it broke out at Kasan, two hundred miles 
 
 down the Volga ; and about the same time, at Kos- 
 
 5* 
 
54 PROGRESS OF THE 
 
 troma, two hundred miles up the river ; and on the 
 15th of September, it arrived at Moscow, about two 
 months and a half after its second appearance at As- 
 trachan. 
 
 The occurrence of the disease in Moscow occasion- 
 ed great alarm ; 50,000 persons are said to have fled 
 the city in a few days. More than 200 cases were 
 reported in the first twelve days, and at the height of 
 the epidemic, 244 persons were attacked in one day. 
 The consternation was great throughout the Russian 
 Empire. The Emperor liberally offered a reward of 
 25,000 rubles, (about #5,000,) for the best disserta- 
 tion on the nature, causes, prevention, cure, &c of 
 cholera. A council of health was formed at Mos- 
 cow, composed of physicians from Paris, Berlin, Got- 
 tingen, and other places, who, after having devoted 
 themselves to the study of the epidemic, reported, 
 that at the end of three months, more than 8,000 ca- 
 ses had come under their observation, and that of 
 this number, more than one half had died. The dis- 
 ease had, however, nearly subsided in Moscow at 
 the close of the year 1830. 
 
 PROGRESS OF THE CHOLERA IN 1831. 
 
 Early in the spring of 1831, the cholera re-appear- 
 ed in Europe. It was seen in the north, as far as 
 Archangel, and in the west, at the Baltic sea; 
 Spreading to the south and west, it reached Warsaw 
 about the middle of April. Here it attacked all 
 ranks and ages, though most prevalent among the 
 lower orders. In July, its ravages were very great, 
 not only in Warsaw, but in almost every village of 
 
CHOLERA IN 1831. 55 
 
 unfortunate Poland. In May, it broke out in 
 Riga, where it raged until late in J uly. It also pre- 
 vailed at the same time at Polangen, Dantzic, and 
 other ports on the Baltic. 
 
 On the 26th of June, the cholera appeared in the 
 imperial city of St. Petersburg. The Czar became 
 terrified, and with his court retired from the city, 
 and surrounded himself with a cordon rnilitaire^ 
 allowing no approach from without. Thousands of 
 the inhabitants of St. Petersburg fled the city to pla- 
 ces where the disease had not prevailed. At one pe- 
 riod, from five to six hundred new cases occurred dai- 
 ly, but towards the end of July the epidemic gradually 
 subsided, and by the 15th of August the disease had 
 entirely ceased, and the fugitives returned to their 
 homes. 
 
 About the same time that the disease prevailed at 
 St. Petersburg, it also appeared at Archangel, on the 
 Dwina, near the White sea, and at Odessa on the 
 Black sea. It broke out at Mecca, about the first of 
 May, 1831, at the time when innumerable pilgrims 
 from every part of the empire were collected there to 
 visit the holy places. It is said that of 50,000 pilgrims 
 to the shrine of Mecca in 1831, about 20,000 perished 
 of the cholera. 
 
 The disease appeared at Berlin in the course of 
 this year. It was officially announced as prevailing 
 there the first of September, but a few cases had been 
 noticed during the month previous. At first, the dis- 
 ease at Berlin was very violent, but after a few weeks 
 it assumed a much less malignant character, and by 
 the end of the year had almost entirely disappeared. 
 The disease prevailed at Berlin about three months 
 and a half. The greatest number of new cases oc- 
 
56 PROGRESS OF THE 
 
 curred about the third week after the disease broke 
 out, and the greatest number of deaths the following 
 week. From the 1st of September, to the middle of 
 December, the number of cases which had occurred 
 at Berlin amounted to 2,230, and the number of 
 deaths to 1,407. 
 
 The disease prevailed this year to a great extent in 
 Hungary, and the numerous communications which 
 existed between Hungary and Austria, by means of 
 the Danube, created great fears in Vienna, the capital 
 of Austria. The city was surrounded by a double 
 cordon, but notwithstanding this precaution, the dis- 
 ease appeared the 16th of August, though the author- 
 ities did not acknowledge the disease to exist in Vi- 
 enna until the 15th of September, At this time it 
 raged with great violence. During the first week 
 764 cases occurred, and 303 deaths ; after this, the 
 disease diminished. The disease prevailed at Vien- 
 na about three months, during which period 4046 
 cases were noticed, and 1936 died of the disease. 
 The cholera at Vienna destroyed more of the nobility 
 and people belonging to the upper classes of society 
 than it ever had at any other place : and it was like- 
 wise more fatal here, than it had ever before been no- 
 ticed, to the physicians and other attendants on the 
 sick. 
 
 The cholera also prevailed this year at Constanti- 
 nople. The Turkish government did not however 
 establish any quarantines, but distributed gratuitous- 
 ly, small pamphlets throughout the empire, giving a 
 history of the disease, the means of guarding against 
 it, and the best treatment to be employed. Its rava- 
 ges at Constantinople were not very great, but it pre- 
 vailed with great severity at Smyrna. 
 
 
CHOLERA IN 1832. g? 
 
 The cholera first appeared at Hamburgh on the 
 11th of October, though not with great severity, as out 
 of a population of 100,000, only 874 had the disease, 
 and 455 died. 
 
 The 26th of October, the Board of Health of Sun- 
 derland in England, officially announced that the 
 cholera existed there. A few cases of the same dis- 
 ease had been noticed in August previous, but it did 
 not prevail epidemically until the last of October. 
 
 All attempts to prove that the disease was import- 
 ed into Sunderland and England, have as yet failed, 
 and the opinion that it was not imported at all, has 
 become very general, not only at Sunderland, but 
 throughout England, and especially among the mem- 
 bers of the medical profession. 
 
 In a few weeks after the first appearance of the 
 cholera at Sunderland, it broke out at New Castle, 
 Gateshead, and numerous places in that vicinity, and 
 the 17th of December, it first appeared in Scotland, 
 at Haddington, a town situated on the river Tyne^ 
 distant about 17 miles from Edinburgh, and 100 from 
 New Castle. 
 
 PROGRESS OF THE CHOLERA IN 1832. 
 
 The progress of the cholera since the commence- 
 ment of the present year, has been greater in extent 
 than during any previous year, for not only has it 
 spread to most of the great towns in Europe, but the 
 mighty epidemic has now reached this western con- 
 tinent 5 and this country, which has until the present 
 year escaped the ravages of a general pestilence, is at 
 present overshadowed by the angel of death. 
 
88 PROGRESS OF THE CHOLERA IN 1832. 
 
 The cholera appeared at Edinburgh, the 27th of 
 January, 1832, but its ravages in that city were not 
 great. It also appeared about the same time at vari- 
 ous places in the neighborhood of Edinburgh and 
 Glasgow, and early in the year it reached London, 
 the largest city ever visited by pestilence ; but very 
 unexpectedly its ravages in this modern Babylon 
 were very inconsiderable. It appeared for the first 
 at Paris, the 24th of March, and in this splendid city 
 it prevailed with great severity. It also appeared in 
 many other towns in France. Soon after this, it 
 broke out in Dublin, and other towns in Ireland, and 
 it now appears to be prevailing, though in a mitigated 
 form, in numerous places in England, Ireland and 
 France.* 
 
 The first appearance of cholera on this continent, 
 was at Quebec, where it broke out as an epidemic of 
 great malignity, the 8th of June. Less than one 
 week after this, it appeared at Montreal, where it has 
 prevailed with uncommon violence. 
 
 The last week in June, the disease appeared at 
 New York, and about the same time at Albany, but 
 as the facts connected with the first appearance of 
 the cholera in this country, and its subsequent pro- 
 gress, are imperfectly known at present, we refer the 
 reader for further details, to the appendix to this 
 work.t 
 
 * For further details respecting the recent progress of the chol- 
 era in Europe, see Appendix, note A. 
 f See Appendix, note B. 
 
HISTORY OF THE SYMPTOMS OF CHOLERA. 59 
 
 HISTORY OF THE SYMPTOMS OF CHOLERA. 
 
 Having brought down the history of the epidemic 
 cholera to the present time 5 having traced its rava- 
 ges year after year, from 1817 to 1832 ; having fol- 
 lowed it from India to Europe, and from Europe to 
 North America, we shall now proceed to describe 
 the symptoms of the disease as they have been wit- 
 nessed in the different countries where it has pre- 
 vailed. 
 
 The symptoms of this disease have been nearly the 
 same in all countries. In all countries, some patients 
 have experienced premonitory symptoms for several 
 hours or days, such as diarrhea, nausea, and slight 
 vomiting ; and in all countries, some have been pros- 
 trated at once by the disease, as if by a blow ; such 
 become suddenly cold, the pulse ceases, and they ex- 
 pire in a short time. 
 
 In all countries, the following have been among the 
 most prominent and essential symptoms of the dis- 
 ease. Immediate sinking of the circulation, coldness 
 of the skin, tongue, &c, vomiting, purging and spasms, 
 and a livid or blue or blackish color of the lips and 
 surface of the body. The skin of the hands and feet 
 becomes corrugated, and assumes a dark color, as if 
 these members had been soaked for a long time in a 
 pale blue dye. Generally, the patients manifest 
 great desire for cold water to drink, and even when 
 the tongue and mouth are moist and cold. Such 
 were the symptoms of the cholera in India, in Russia, 
 in England and Canada, as they have been described 
 by those who have witnessed much of the disease at 
 those places. Such are the symptoms which I have 
 
60 HISTORY OF THE 
 
 just witnessed at New York, among those affected 
 by the disease. Indeed, many of the descriptions of 
 the disease as it appeared in India, would be very ac- 
 curate and just descriptions of the disease as it now 
 prevails in this country. 
 
 The following history of the symptoms of the choU 
 era, as they were first noticed in India, was drawn up 
 by the Bengal Medical Board, and was considered 
 so accurate, that the Bombay Medical Board thought 
 proper to adopt it, and embody it in their report : 
 
 " The attack was generally ushered in by sense of 
 weakness, trembling, giddiness, nausea, violent retch- 
 ing, vomiting and purging of a watery, starchy, whey- 
 colored, or greenish fluid. These symptoms were 
 accompanied, or quickly followed by severe cramps ; 
 generally beginning in the fingers and toes, and 
 thence extending to the wrists and fore-arms, calves 
 of the legs, thighs, abdomen, and lower part of the 
 thorax. These were soon succeeded by pain, con- 
 striction, and oppression of the stomach and pericar- 
 dium 5 great sense of internal heat ; inordinate thirst, 
 and incessant calls for cold water, which was no soon- 
 er swallowed than rejected, together with a quantity 
 of phlegm, or whitish fluid, like seethings of oatmeal. 
 The action of the heart and arteries now nearly ceas- 
 ed ; the pulse either became altogether imperceptible 
 at the wrists and temples, or so weak as to give to the 
 finger only an indistinct feeling of fluttering. The 
 respiration was laborious and hurried ; sometimes 
 with long and frequently broken inspirations. The 
 skin grew cold, clammy, covered with large drops of 
 sweat, dank and disagreeable to the feel, and disco- 
 lored, of a bluish, purple, or livid hue. There was 
 great and sudden prostration of strength 5 anguish 
 
SYMPTOMS OF CHOLERA. 61 
 
 and agitation. The countenance became collapsed ; 
 the eyes suffused, fixed, and glassy, or heavy and dull ; 
 sunk in their sockets, and surrounded by dark cir- 
 cles ; the cheeks and lips livid and bloodless ; and the 
 whole surface of the body nearly devoid of feeling. 
 In feeble habits, where the attack was exceedingly 
 violent, and unresisted by medicine, the scene was 
 soon closed. The circulation and animal heat never 
 returned ; the vomiting and purging still continued, 
 with thirst and restlessness ; the patient became de- 
 lirious or insensible, with his eyes fixed in a vacant 
 stare, and sunk down in the bed ; the spasms increas- 
 ed, generally within four or five hours. 
 
 " The disease sometimes at once, and as if it were 
 momentarily, seized persons in perfect health ; at 
 other times, those who had been debilitated by previ- 
 ous bodily ailment, and individuals in the latter pre- 
 dicament, generally sunk under the attack. Some- 
 times the stomach and bowels were disordered for 
 some days before the attack ; which w 7 ould then come 
 on in full force, and speedily reduce the patient to 
 extremities. 
 
 -" Such was the general appearance of the disease 
 where it cut off the patient in its earlier stages. The 
 primary symptoms, however, in many cases, admit- 
 ted of considerable variety. Sometimes, the sickness 
 and looseness were preceded by spasms. Sometimes, 
 the patient sunk at once, after passing off a small 
 quantity of colorless fluid by vomiting and stool. The 
 matter vomited in the early stages was, in most cases, 
 colorless, or milky -, sometimes it was green. In like 
 manner, the dejections were usually watery and mud- 
 dy ; sometimes red and bloody ; and in few cases, 
 they consisted of a greenish pulp, like half digested 
 
62 HISTORY OF THE 
 
 vegetables. In no instance was feculent matter pass- 
 ed in the commencement of the disease. The 
 cramps usually began in the extremities, and thence 
 gradually crept to the trunk ; sometimes they were 
 simultaneous in both ; and sometimes the order of 
 succession was reversed ; the abdomen being first af- 
 fected, then the hands and feet. These spasms hard- 
 ly amounted to general convulsion. They seemed 
 rather affections of individual muscles, and of partic- 
 ular sets of fibres of those muscles ; causing thrilling 
 and quivering in the affected parts, like the flesh of 
 crimped salmon ; and firmly stiffening and contorting 
 the toes and fingers. The patient always complain- 
 ed of pain across the belly 5 which was generally pain- 
 ful to the touch, and sometimes hard and drawn back 
 towards the spine. The burning sensation in the sto- 
 mach and bowels was always present, and at times ex- 
 tended along the cardia and oesophagus to the throat. 
 The powers of voluntary motion were in every in- 
 stance impaired, and the mind obscured. The pa- 
 tient staggered like a drunken man ; or fell down like 
 a helpless child. Headach, over one or both eyes, 
 sometimes, but rarely occurred. The pulse, when 
 to be felt, was generally regular, and extremely fee- 
 ble, sometimes soft, not very quick ; usually ranging 
 from 80 to 100. In a few instances, it rose to 140 or 
 150, shortly before death. Then it was distinct, 
 small, feeble, and irregular. Sometimes very rapid, 
 then slow for one or two beats. The mouth was hot 
 and dry ; the tongue parched, and deeply furred, 
 white, yellow, red, or brown. The urine at first gen- 
 erally limpid, and freely passed ; sometimes scanty, 
 with such difficulty as almost to amount to strangua- 
 ry ; and sometimes -hardly secreted in any quantity, 
 
SYMPTOMS OF CHOLERA. 63 
 
 as if the kidneys had ceased to perform their office. 
 In a few cases, the hands were trenaulous. In others, 
 the patient declared himself free from pain and unea- 
 siness ; when want of pulse, cold skin, and anxiety 
 of features, portended speedy death. The cramp 
 was invariably increased upon moving. 
 
 " Where the strength of the patient's constitution, 
 orthe curative means administered, were, although in- 
 adequate wholly to subdue the disease, sufficient to re- 
 sist the violence of its onset ; nature made various ef- 
 forts to rally ; and held out strong, but fallacious prom- 
 ises of returning health. Tn such cases, the heat was 
 sometimes wholly, at others, partially restored ; the 
 chest and abdomen in the latter case becoming warm, 
 whilst the limbs kept deadly cold. The pulse would 
 return ; grow moderate and full ; the vomiting and 
 cramps disappear ; the nausea diminish ; and the 
 stools become green, pitchy, and even feculent, and 
 with all these favorable appearances, the patient 
 would suddenly relapse ; chills, hiccup, want of sleep, 
 and anxiety would arise ; the vomiting, oppression, 
 and insensibility return, and in a few hours terminate 
 in death. 
 
 " When the disorder ran its full course, the follow- 
 ing appearances presented themselves: — What may 
 be termed the cold stage, or the state of collapse, usu- 
 ally lasted from 24 to 48 hours, and was seldom of 
 more than three complete days' duration. Through- 
 out the first 24 hours, nearly all the symptoms of 
 deadly oppression, the cold skin, feeble pulse, vomit- 
 ing and purging, cramps, thirst, and anguish, contin- 
 ued undiminished. When the system show r ed symp- 
 toms of revival ; the vital powers began to rally ; the 
 circulation and heat to be restored ; and the spasms 
 
64 HISTORY OF THE 
 
 and sickness to be considerably diminished. The 
 warmth gradually returned ; the pulse rose in 
 strength and fulness, and then became sharp, and 
 sometimes hard. The tongue grew more deeply fur- 
 red ; the thirst continued, with less nausea. The 
 stools were no longer like water ; they became first 
 brown and watery ; then dark, black, and pitchy ; 
 and the bowels, during many days, continued to dis- 
 charge immense loads of vitiated bile, until, with re- 
 turning health, the secretions of the liver and other 
 viscera gradually put on a natural appearance. The 
 fever which invariably attended this second stage of 
 the disease, may be considered to have been rather 
 the result of nature's effort to recover herself from the 
 rude shock which she had sustained ; than as form- 
 ing any integrant and necessary part of the disorder 
 itself. It partook much of the nature of the common 
 bilious attacks prevalent in these latitudes. There 
 was the hot, dry skin •, foul, deeply furred, dry tongue ; 
 parched mouth ; sick stomach ; depraved secretions, 
 and quick variable pulse 5 sometimes with stupor, de- 
 lirium, and other marked affections of the brain* 
 When the disorder proved fatal, after reaching this 
 stage, the tongue, from being cream-colored, grew 
 brown, and sometimes dark, hard, and more deeply 
 furred ; the teeth and lips were covered with sordes ; 
 the state of the skin varied, chills alternating with 
 flushes of heat ; the pulse became weak and tremu- 
 lous ; catching of the breath; great restlessness, and 
 deep moaning succeeded : and the patient soon sunk, 
 insensible, under the debilitating effects of frequent, 
 dark, pitchy, alvine discharges." 
 
 The following account of the invasion of the dis- 
 ease, and its symptoms, resemble very much the fore- 
 
SYMPTOMS OF CHOLERA 65 
 
 going, and are equally interesting. It is taken from 
 the Report of the Madras Medical Board, drawn up 
 by order of the Government, by Wm. Scott, surgeon, 
 and secretary to the Board, and was published at 
 Madras in 1824. The accompanying remarks are 
 from the Edinburgh Medical and Surgical Journal, 
 for 1825. 
 
 "The invasion of the cholera generally takes place 
 in the night, or towards morning. The patient is 
 sick at stomach ; he vomits its contents, and his bow- 
 els are at the same time evacuated. This evacua- 
 tion is of a nature quite peculiar to the disease ; the 
 entire intestinal tube seems to be at once emptied of 
 its faecal or solid matters ; and an indescribable, but 
 most subduing feeling of exhaustion, sinking, and 
 emptiness is produced. Faintness supervenes, the 
 skin becomes cold, and there is frequently giddiness, 
 and ringing in the ears. The powers of locomotion 
 are generally soon arrested ; spasmodic contractions, 
 or twitchings of the muscles of the fingers and toes 
 are felt ; and these affections gradually extend along 
 the limbs, to the trunk of the body. They partake 
 both of the clonic and tonic spasm, but the clonic 
 form chiefly prevails. The pulse, from the first, is 
 small, weak, and accelerated ; and, after a certain 
 interval, but especially on the accession of spasms, 
 or of severe vomiting, it sinks suddenly, so as to be 
 speedily lost in all the external parts. The skin, 
 which, from the commencement of the disease, is be- 
 low the natural temperature, becomes colder and 
 colder. It is very rarely dry ; generally covered with 
 a profuse cold sweat, or with a clammy moisture. 
 In Europeans, it often partially assumes a livid hue ; 
 the whole surface appears collapsed, the lips become 
 
66 HISTORY OF THE 
 
 blue, the nails present a similar tint ; and the skin of 
 the feet and hands become much corrugated, and 
 exhibits a sodden appearance. In this state the skin 
 is insensible, even to the action of chemical agents; 
 yet the patient generally complains of oppressive 
 heat on the surface, and wishes to throw off the bed 
 clothes. The eyes sink in their orbits, which are sur- 
 rounded by a livid circle; the comae become flaccid, 
 the conjunctiva is frequently suffused with blood ; the 
 features of the face collapse, and the whole counte- 
 nance assumes a cadaverous aspect, strikingly char- 
 acteristic of the disease. There is almost always ur- 
 gent thirst, and desire for cold drinks, although the 
 mouth be not usually parched. The tongue is moist, 
 whitish, and cold. A distressing sense of pain and of 
 burning heat at the epigastrium are common. Little 
 or no urine, bile, or saliva, is secreted. The voice 
 becomes feeble, hollow, and unnatural. The respi- 
 ration is oppressed, generally slow, and the breath is 
 deficient in heat. 
 
 " During the progress of these symptoms, the ali- 
 mentary canal is very variously affected. After the 
 first discharges by vomiting and purging, however se- 
 vere these symptoms may be, the matter evacuated 
 is always watery, and in a great proportion of cases 
 it-is colorless, inodorous, and often homogeneous. In 
 some, it is turbid, resembling muddy water ; in oth- 
 ers, it is of a yellowish or greenish hue. A very com- 
 mon appearance is that, which has been emphatically 
 called the " conjee stools,' 5 an appearance produced 
 by numerous mucous flakes floating in the watery or 
 serous part of the evacuation. The discharges from 
 the stomach, and those from the bowels, do not ap- 
 pear to differ, except in the former being mixed with 
 
m 
 
 SYMPTOMS OF CHOLERA. 67 
 
 the ingesta. N either the vomiting nor the purging are 
 symptoms of long continuance. They are either ob- 
 viated by art, or the body becomes unable to perform 
 these violent actions ; and they, together with the 
 -spasms, generally disappear a considerable time be- 
 fore death. If blood be drawn, it is always dark," or 
 almost black, very thick, ropy, and generally of slow 
 and difficult effusion. Towards the close of the at- 
 tack, jactation comes on, with evident internal anx- 
 iety and distress : and death takes place, often in 
 ten, or twelve, generally within eighteen or twenty, 
 hours from the commencement of the attack. 
 
 " During all this mortal struggle and commotion in 
 the body, the mind remains clear, and its functions 
 undisturbed, almost to the last moment of existence. 
 The patient, though sunk and overwhelmed, listless, 
 averse to speak, and impatient of disturbance, still 
 retains the power of thinking, and of expressing his 
 thoughts, as long as his organs are obedient to his will. 
 Such is the most ordinary course of cholera asphyxia, 
 when its tendency to death is not checked by art. 
 
 " A favorable issue is denoted by a rising of the 
 pulse, a return of heat to the surface, inclination to 
 natural sleep, and a diminution or cessation of vomit- 
 ing, purging, and spasms ; these indications being 
 succeeded, after an interval, by the re-appearance of 
 foecal matter in the stools, of bile, of urine, and of sa- 
 liva." pp. xx. xxi. 
 
 The symptoms or phenomena of cholera, however, 
 are liable to variation. In some, vomiting is slight, or 
 soon ceases, or is altogether absent ; and the substan- 
 ces ejected may vary, being sometimes bilious, in 
 other instances, thin watery fluid. Purging is more 
 constant, and is rarely altogether absent ; but the 
 
68 HISTORY OF THE 
 
 matters discharged are liable to extreme variety. 
 After the first emptying of the bowels, they have been 
 observed to be greenish, or yellowish, turbid, frothy 
 like yeast, and sometimes bloody, or even pure bile. 
 In some cases they are inodorous, in others, they 
 have a rank fleshy smell. But by far the most com- 
 mon is that of pure serum, so thin and colorless as 
 not to stain the patient's linen ; next is the conjee-like 
 fluid, the mucus, however, being always so thorough- 
 ly mixed with serum as to give the whole the appear- 
 ance of milk ; and in cases which proved to be mild, 
 the matters discharged resembled soojee in color and 
 consistence. The quantity of clear watery fluid dis- 
 charged is sometimes very great ; and if it w r ere uni- 
 form, the reporter remarks, it would readily explain 
 the weakness, thirst, thickness of the blood, and oth- 
 er symptoms ; but it is unquestionable, that the most 
 fatal and rapid cases are by no means those which 
 are distinguished by excessive discharges. The de- 
 jections sometimes take place without effort or unea- 
 siness, at others they are discharged with great force, 
 in general, simultaneously, with vomiting, spasm, and 
 stoppage of the pulse, — seldom attended with much 
 griping or tenesmus, though the calls are sudden and 
 irresistible. Pain of the belly, felt on pressure, is on- 
 ly occasionally remarked. 
 
 Of the phenomena referred to spasms, we find the 
 following account : — 
 
 " In the low, and most dangerous, form of cholera, 
 whether in European or native cases, spasm is gen- 
 erally wanting, or is present in a very slight degree. 
 The muscles most commonly affected are those of the 
 toes and feet, and calves of the leg ; next to them, 
 the corresponding muscles of the superior extremities \ 
 
SYMPTOMS OF CHOLERA. 69 
 
 then those of the thighs and arms ; and lastly, those 
 of the trunk, producing various distressing sensations 
 to the patient. Amongst these, hiccup is not unfre* 
 quent, but it has been observed that this symptom, 
 in cholera, is not at all indicative of danger. The 
 muscles of the eye- balls have not been observed to 
 be affected with spasm, unless the sinking of these or- 
 gans in their orbits may be considered to be an effect 
 of it. The reports make frequent mention of a re- 
 markable permanent contraction of the muscles pf the 
 abdomen, by which the belly is drawn towards the 
 spine. The spasms attending cholera are of a mix- 
 ed nature, not strictly clonic ; the relaxations being 
 less prompt and frequent than in epilepsy or convul- 
 sion, and seldom durable as in tetanus. The con- 
 tractions of the muscles are invariably attended with 
 pain, and some medical officers have observed, that a 
 degree of spasmodic stiffness has continued for seve- 
 ral days afterwards. It has also been remarked, that 
 spasmodic twitchings of the muscles have taken place 
 after death, and have continued for a considerable 
 time. In one case, where a man had been paralytic 
 in his limbs, with a total numbness of them, they 
 were severly affected with spasms, and became ex-, 
 quisitely sensible. If was pretty evident, that there 
 either has been an inaccuracy in the description of 
 spasm occurring incases of cholera, or a sensation 
 differing from that of spasm has been confounded with 
 it ; for, by the descriptions, we would be led to sup- 
 pose that the spasms begin, and are felt, in the toes 
 and fingers, which cannot be the case. As the ex- 
 treme muscles, however, are generally first seized 
 with spasm, it is probable that the small fleshy bun- 
 dles in the palms of the hands and soles of the feet, 
 
70 HISTORY OF THE 
 
 are affected ; but there seems reason farther to con- 
 clude, that pain is really felt in the fingers and toes, 
 and that it is referable to a sort of nervous twinge o^ 
 tic doloureux in those parts, distinct from spasm, 
 which is not uncommon in other disordered states of 
 the digestive organs." — Report, pp. xxiv. xxv. 
 
 The following observations on the assemblage of 
 phenomena, to which the East Indian practitioners 
 give the name of Collapse, are very interesting. 
 
 " Of all the symptoms of Cholera, none is so inva- 
 riably present, none indeed so truly essential and di- 
 agnostic, as the immediate sinking of the circulation. 
 It must nevertheless be admitted, that, where instant 
 remedial measures have been successfully practised, 
 this symptom may not have developed itself; and 
 that there are even cases where an excited vascular 
 action has been observed to accompany the first 
 movements of the system in cholera. Some intelli- 
 gent practitioners have entertained doubts whether 
 such cases belong indeed to this disease ; and there 
 seems reason to imagine that those inflammatory af- 
 fections with spasm, known in this country, and al- 
 luded to in several reports, may, in some instances, 
 have been mistaken for it. It is farther to be remem- 
 bered, that these are precisely the cases w 7 hich yield 
 most certainly and readily to our remedial means : 
 and it consequently follows, that a medical man can 
 seldom have the opportunity of observing whether or 
 not this form of cholera will degenerate into the low 
 stage. There is, however, direct evidence in support 
 of the fact, that they have so degenerated and gone 
 on to a fatal termination. In the case of soldiers too, 
 in whom such symptoms have chiefly appeared, we 
 must make some account of the quantity of spirits 
 
SYMPTOMS OF CHOLERA. 71 
 
 usually drank by them at the commencement of the 
 disease, producing ah effect on the circulation. The 
 period at which a marked diminution of vascular ac- 
 tion takes place, is somewhat various. The pulse 
 sometimes keeps dp tolerably for several hours, though 
 very rarely. It more generally becomes small and 
 accelerated at an early stage •, and, on the accession 
 of spasm, or vomiting, suddenly ceases to be distin- 
 guishable in the extremities. The length of time du- 
 ring which a patient will sometimes live in a pulse- 
 less state, is extraordinary. Dr. Kellett relates a case, 
 where the pulse wasgone within three hours from the 
 attack ; yet the man lived in that state from the 3d Oct. 
 at 4 P. M., to the 6th at 2 P. M. On the cessation of 
 the spasm or vomiting, and sometimes, apparently, 
 from the exhibition of remedies, the pulse will return 
 to the extremities for a short time, and again it will 
 cease. The superficial veins and arteries are not al- 
 ways collapsed, even when the pulse has ceased. If 
 these vessels be opened in this condition, the contain- 
 ed blood flows out •, their walls then collapse, and no 
 more blood can be extracted. There is no authenti- 
 cated fatal instance of cholera on record, where the cir- 
 culation has not been arrested, in the extremities at 
 least, long before death took place." Report, p. xxv. 
 The reporter proceeds to describe, in a minute, but 
 instructive manner, the various forms assumed by 
 such symptoms as thirst, sense of heat in the epigas- 
 trium, and internal burning in general ; (he temper- 
 ature, shrinking and insensibility of the skin to its or- 
 dinary irritants ; the shrinking of the countenance; 
 the changes which respiration undergoes, especially 
 in becoming much slower, less frequent, and more 
 lat>orious than during health ; the occurrence of the 
 
32 HISTORY OF THE 
 
 state termed jactitation; the comparative clearness 
 and integrity of the intellectual faculties ; the state of 
 the urine and the state of the blood. Of his observa- 
 tions on each of these, we can make room only for 
 those relating to the state of the skin and that of the 
 blood, which form features of the morbid process of 
 cholera so characteristic, that they deserve to be gen- 
 erally known. 
 
 " The state of the skin in cholera is, in general, 
 what we might expect to find it in patients laboring 
 under such affections of the alimentary canal, and 
 with the subdued circulation which takes place in 
 that disease. It is cold, generally clammy, and 
 often covered with profuse cold sweats. Neverthe- 
 less, varieties occur in this, as in the other symptoms 
 of cholera. The skin is sometimes observed to be 
 dry, though cold ; and sometimes natural, nay, in 
 some rare instances, of preternatural warmth. An in- 
 crease of temperature has been repeatedly observed 
 to take place just before death : but the development 
 of heat appears to be confined then to the trunk and 
 head; and, in almost all cases, this partial develop- 
 ment of heat is found to be a fatal symptom. It is 
 entirely unconnected with any restoration of the en- 
 ergy of the arterial system, or any improvement in the 
 function of respiration. The heat, in such instances, 
 has been observed to continue considerable, for some 
 hours after death. 
 
 " The sensation imparted by touching the skin of a 
 person ill with cholera is very peculiar, and reminds 
 one of that imparted by a dead body. The skin, 
 when much collapsed, becomes insensible, even to 
 the action of chemical agents; and hence the usual 
 vesicatories fail in producing any effect. The appli- 
 
SYMPTOMS OF CHOLERA. 73 
 
 cation of mineral acids, and of boiling water, in this 
 condition of the skin, produces little or no effect, and 
 some patients are said not to have been sensible of 
 the operation. 
 
 " The action of mineral acids on the skin, is not, 
 however, vesication, but rather that of a cautery, the 
 cuticle and the extremities of 1 he subjacent vessels 
 appearing to be destroyed by thorn. It has been said, 
 that vesication could not be p roduced in some sta- 
 ges of cholera, because the pro/ Auction of serum was, 
 in common with the glandular secretions, arrested ; 
 but when we reflect on the readiness with which se- 
 rous fluids are poured out in that disease, we shall be 
 rather disposed to refer the faih .re in the action of 
 vesicatories, even of hot water, t< the diminution or 
 destruction of the nervous energy of the skin. It is 
 certain, that in a body but just dead, the application 
 of boiling water will vesicate readily ; and, if the ac- 
 curacy of the observation respecting its non-vesica- 
 ting power in advanced stages of cholera be establish- 
 ed, we must infer that there is less vitality in the skin 
 in such cases, the patient being sti.U alive, than in 
 that of a body recently dead of some other disease." 
 Report, pp. xxvi. xxvii. 
 
 It is also remarked, that, at an early period of the 
 disease, leeches can procure no blood from the skin. 
 
 On the state of the blood and its circulation, we 
 are informed that " though the reports afforded ample 
 reference on the subject, yet it appeared to the Medi- 
 cal Board, to be one of such importance in the pathol- 
 ogy of the disease, that a circular letter was address- 
 ed to about thirty Medical Officers, who were sup- 
 posed, from their experience in the treatment of it, to 
 be best qualified to afford information. Attention 
 
74 HISTORY OF THE 
 
 was especially directed to the following considera- 
 tions : first, the influence .which the state of the blood 
 in those affected with cholera, might be supposed to 
 have in producing some of the symptoms : second, the 
 color of the blood abstracted from a vein, in a person 
 affected with cholera : third, the color of the blood 
 after a certain quantity had been taken, and, the ef- 
 fect which any alteration of color might have on the 
 condition of the patient : fourth, if arteriotomy had 
 been practised, the color of the arterial blood in chol- 
 era : and lastly, the period from the first attack of the 
 disease, at which blood was abstracted. It is estab- 
 lished by the replies to this letter, as well as by an im- 
 mense mass of concurrent evidence, that the blood oi 
 persons affected with cholera,isof an unnaturally dark 
 color and thick consistence. These appearances are 
 very uniformly expressed by the terms dark, black, 
 tarry, in regard to color ; and by thick, ropy, syrupy, 
 semicoagulated, in respect to its consistence. The 
 change in the condition of the blood is likewise fully 
 proved to be in the ratio of the duration of the disease ; 
 the blood at the commencement, seeming to be near- 
 ly, or altogether natural, and more or less rapidly as- 
 suming a morbid state, as the disease advances. 
 Some very rare cases are recorded where, however, 
 this morbid state of the blood was not observable, al- 
 though the disease had been for some time establish- 
 ed ; and instances have occurred where the blood 
 flowed readily, sometimes little altered, where, never- 
 theless, death ultimately ensued. The abstraction 
 of blood has been found by all practitioners, to be 
 very difficult and uncertain ; and the uncertainty has 
 been variously imputed to the feebleness of the circu- 
 lation, to the thick consistence of the blood, and to 
 
SYMPTOMS OF CHOLERA. 75 
 
 the combined operation of these causes. The blood 
 drawn from patients suffering under cholera, is stated 
 to be generally very destitute of serum, never to exhi- 
 bit the appearance of buff, and to be generally dis- 
 posed to coagulate quickly. Several instances, how- 
 ever, have occurred, where the coagulation was slow 
 and imperfect. A great majority of the reports state 
 unequivocally, that, after a certain quantity of dark 
 and thick blood has been abstracted from a patient 
 under cholera, it is usual for its color to become 
 lighter, its consistence to become less thick, and for 
 the circulation to revive ; such appearances always 
 affording grounds for a proportionably favorable prog- 
 nosis. In many instances, however, no such changes 
 have been observed to accompany the operation of 
 bleeding, while jet the result was favorable. The 
 blood is generally found to be less changed in appear- 
 ance, in those cases of cholera which are ushered in 
 with symptoms of excitement, than where the col- 
 lapsed state of the system has occurred at an early 
 period. The blood has been occasionally found, on 
 dissection, to be of as dark a color in the lefU as in the 
 right side of the heart ; affording reason to believe that 
 in the whole arterial system it was equally changed. 
 The temporal artery having been frequently opened, 
 the blood was found to be dark and thick, like the 
 venous blood : but it would appear that this opera- 
 tion has not been performed in general, until the at- 
 tempts to procure blood from the brachial or jugular 
 yeins had failed : little or no blood could be obtained, 
 the artery merely emptying itself in a languid stream, 
 not in a jet, and then collapsing. An instance is sta- 
 ted where the surgeon, despairing of other means, cut 
 down upon the brachial artery, but so completely had 
 
76 HISTORY OF THE 
 
 the circulation failed, that no blood flowed. When 
 reaction has been established, the blood occasionally 
 shows the buffy coat." pp. xxix. xxx. 
 
 SYMPTOMS OF THE CHOLERA IN EUROPE. 
 
 The symptoms which this disease manifested in 
 Russia and other parts of Europe, several years af- 
 ter the foregoing account of the disease, as it was no- 
 ticed in India, was written, are strikingly similar, 
 as is evident from the following accounts of the dis- 
 ease; selected from various authorities, who were eye 
 witnesses. 
 
 Drs. Russell and Barry, in a joint report made to 
 the British Government respecting the disease as it 
 appeared in Russia, say, — 
 
 " St. Petersburgh, July 27, 1831. 
 
 Although there can be no doubt that the disease 
 now prevailing here is strictly identical, in all essen- 
 tial points, with the epidemic cholera of India ; and 
 although there are many descriptions extant of that 
 malady, much more ably and accurately drawn up 
 than any which we can pretend to give 5 yet we are 
 induced to believe that a short account of the symp- 
 toms which we ourselves have actually witnessed 
 and noted at the bedside in some hundreds of cases, , 
 since our arrival here, may be useful, — first, because 
 we are not aware that any description by an eye wit- 
 ness of European cholera has yet been addressed to 
 the British Government ; secondly, because the dis- 
 ease, as it has shown itself in this capital, when closer 
 ly compared with the Indian cholera, appears to have 
 undergone some modifications 5 thirdly, because. 
 
SYMPTOMS OF CHOLERA IN EUROPE. 77 
 
 having now studied the disease in all its stages, our 
 description, however imperfect, will at least assist 
 towards establishing a standard of comparison with 
 other local epidemics of cholera in Europe, and may, 
 perhaps, enable those who have not seen this disease, 
 to recognise it with more certainty than they would 
 otherwise be able to do. 
 
 The cholera morbus of the north of Europe, to 
 which the Russian peasants have given the name of 
 4 Chornaia Colezn,' or black illness^ like most other 
 diseases, is accompanied by a set of symptoms which 
 may be termed preliminary ; by another set which 
 strongly mark the disease in its first, cold, or collapse 
 stage ; and by a third set, which characterizes the 
 second stage, that of re-action, heat, and fever. 
 
 Preliminary Symptoms. — We have but few oppor- 
 tunities of witnessing the presence of all these symp- 
 toms, some of which precede the complete seizure 
 by so short an interval, that the utmost diligence is 
 scarcely sufficient to bring the patient and the physi- 
 cian together, after their occurrence, before the dis- 
 ease is fully formed. Diarrhea, at first feculent, with 
 slight cramps in the legs, nausea, pain, or heat about 
 the pit of the stomach, malaise, give the longest warn- 
 ing. Indeed, purging, or ordinary diarrhea, has been 
 frequently known to continue for one, two, or more 
 days, unaccompanied by any other remarkable symp- 
 tom, until the patient is suddenly struck blue, and 
 nearly lifeless. Often, the symptoms just mentioned 
 are arrested by timely judicious treatment, and the 
 disease completely averted. When violent vertigo, 
 sick stomach, nervous agitation, intermittent, slow T ,or 
 small pulse, cramps, beginning at the tips of the fin- 
 gers and toes, and rapidly approaching the trunk, give 
 
 7* 
 
78 History of the 
 
 the first warning ; then there is scarcely an interval. 
 Vomiting or purgirig, or both these evacuations, of a 
 liquid like rice-water, or whey, or barley-water, 
 come on ; the features become sharp and contracted, 
 the eye sinks, the look is expressive of terror, wild- 
 ness, and, as it were, a consciousness on the part of 
 the sufferer that the hand of death is upon him. The 
 lips, the face, the neck, the hands, the feet, and soon 
 the thighs, arms, and whole surface, assume a lead- 
 en, blue, purple, black, or deep brown tint, according 
 to the complexion of the individual, varying in shade 
 with the intensity of the attack. The fingers and 
 toes are reduced at least a third in thickness ; the 
 skin and soft parts covering them are wrinkled, shriv- 
 elled, and folded ; the nails put on a bluish pearl- 
 white, the larger superficial veins are marked by flat 
 lines of a deeper black ; the pulse is either small as 
 a thread, and scarcely vibrating, or else totally ex- 
 tinct. The skin is deadly cold, and often damp ; the 
 tongue always moist, often white and loaded, but flab- 
 by and chilled, like a bit of dead flesh. The voice is 
 nearly gone ; the respiration quick, irregular, and 
 imperfectly performed. Inspiration appears to be 
 effected by an immense effort of the chest, whilst the 
 alse nasi (in the most hopeless cases, and towards 
 their close), instead of expanding, collapse, and 
 stop the ingress of the air. Expiration is quick and 
 convulsive. The patient asks only for water, speaks 
 in a plaintive whisper, (the ' vox cholerica,') and on- 
 ly by a word at a time, from not being able to retain 
 air enough in his lungs for a sentence. He tosses in- 
 cessantly from side to side, and complains of intole- 
 rable weight and anguish around his heart. He strug- 
 gles for breath, and often lays his hand on his stom- 
 
SYMPTOMS OF CHOLERA IN EUROPE. 79 
 
 ach and chest to point out the seat of his agony. The 
 integuments of the belly are sometimes raised into 
 high irregular folds, whilst the belly itself is violently 
 drawn in, the diaphragm upwards and inwards to- 
 wards the chest ; sometimes there are tetanic spasms 
 of the legs, thighs, and loins ; but we have not seen 
 general tetanus, nor even trismus. There is occa- 
 sionally a low, suffering whine. The secretion of 
 urine is always totally suspended, nor have we ob- 
 served tears shed under these circumstances ; vomit- 
 ing and purging, which are far from being the most 
 important or dangerous symptoms, and which, in a 
 very great number of cases of the present epidemic, 
 have not been profuse, generally cease, or are arrest- 
 ed by medicine easily in the attack. Frictions re- 
 move the blue color for a time from the part rubbed ; 
 but in other parts, particularly the face, the livor be- 
 comes every moment more intense and more general. 
 The lips and cheeks sometimes puff out and flap, in 
 expiration, with a white froth between them, as in 
 apoplexy. If blood be obtained in this state, it is 
 black, flows by drops, is thick, and feels to the finger 
 colder than natural. Towards the close of this scene, 
 the respiration becomes very slow, there is a quiver- 
 ing among the tendons of the wrist, the mind remains 
 entire. The patient is first unable to swallow, then 
 becomes insensible ; there never is, however, any 
 rattle in the throat, and he dies quietly after a long 
 convulsive sob or two. 
 
 The above is a faint description of the very worst 
 kind of case, dying in the cold stage, in from six to 
 twenty four hours after the setting in of the bad symp- 
 toms. We have seen many such cases just carried 
 to the hospital from their homes or their barracks. 
 
SO HISTORY OF THE 
 
 In by far the greater number, vomiting had ceased, 
 in some, however, it was still going on, and invariably 
 of the true serous kind. Many confessed that they 
 had concealed a diarrhea for a day or two 5 others 
 had been suddenly seized, generally very early in 
 the morning. 
 
 From the aggravated state which we have just de- 
 scribed, but very few indeed recover, particularly if 
 that state has been present even for four hours before 
 treatment has commenced. A thread of pulse, how- 
 ever small, is almost always felt at the wrist, where 
 recovery from the blue or cold stage is to be expect- 
 ed. Singular enough to say, hiccough coming on in 
 the intermediate moments, between the threatening 
 of death and the beginning of re-action, is a favora- 
 ble sign, and generally announces the return of circu- 
 lation. 
 
 In less severe cases, the pulse is not wholly extin- 
 guished, though much reduced in volume ; the respi- 
 ration is less embarrassed ; the oppression and an- 
 guish at the chest are not so overwhelming, although 
 vomiting and purging and the cramps may have been 
 more intense. The coldness and change of color of 
 the surface, the peculiar alteration of the voice, a 
 greater or less degree of the coldness of the tongue, 
 the character of the liquids evacuated, have been in- 
 variably well marked in all the degrees of violence of 
 attack which we have hitherto witnessed in this 
 epidemic. In no case or stage of this disease have 
 we observed shivering ; nor have we heard, af- 
 ter inquiry, of more than one case, in w T hich this feb- 
 rile symptom took place. 
 
 Fever or Hot Stage. — After the blue "cold period 
 has lasted from twelve to twenty-four, seldom to for- 
 
SYMPTOMS OF CHOLERA IN EUROPE. 81 
 
 ty-eight hours or upwards, the pulse and external 
 heat begin gradually to return, head-achis complain- 
 ed of, with noise in the ears, the tongue becomes more 
 loaded, redder at the tip and edges, and also drier. 
 High colored urine is passed with pain, and in small 
 quantities, the pupil is often dilated, soreness is felt on 
 pressure over the liver, stomach, and belly, bleeding 
 by the lancet or leeches is required. Ice to the head 
 gives great relief. In short, the patient is now labor- 
 ing under a continued fever, not to be distinguished 
 from ordinary fever. A profuse critical perspiration 
 may come on, from the second or third day, and leave 
 the sufferer convalescent ; but, much more frequent- 
 ly, the quickness of pulse and heat of skin continue, 
 the tongue becomes brown and parched, the eyes 
 suffused and drowsy, there is a dull flush, with stupor 
 and heaviness about the countenance, much resem- 
 bling typhus, dark sordes collect about the lips and 
 teeth, sometimes the patient is pale, squalid, and low 7 , 
 with the pulse and heat below natural, but with the 
 typhus stupor, delirium supervenes, and death takes 
 place from the fourth to the eighth day, or even later, 
 in the very individual, too, whom the most assiduous 
 attention had barely saved in the first or cold stage. 
 To give a notion of the importance and danger of 
 cholera fever, a most intelligent physician, Dr. Rei- 
 mer, of the merchant hospital, informs us, that of 
 twenty cases treated under his own eye, who fell vic- 
 tims to the disease, seven died in the cold stage, and 
 thirteen in the consecutive fever. 
 
 The singular malady is only cognizable witli cer- 
 tainty during its blue or bold period. After re-action 
 has been established, it cannot be distinguished from 
 an ordinary continued fever, except by the shortness 
 
82 HISTORY OF THE 
 
 and fatality of its course. The greenish or dark, and 
 highly bilious discharges produced in the hot stage, by 
 calomel, are not sufficiently diagnostic, arid it is curi- 
 ous that the persons employed about these typhoid 
 cases, when they are attacked, are never seized with 
 ordinary fever, but with a genuine cold, blue cholera; 
 nothing, therefore, is more certain, than that persons 
 may come to the coast of England, apparently labor- 
 ing under common feverish indisposition, who really 
 and truly are suffering under cholera in the second 
 stage. 
 
 The points of difference between the present epi- 
 demic and the cholera of India, when the two diseas- 
 es are closely compared, appear to us to be the follow T - 
 ing :— 
 
 First, The evacuations, both upwards and down- 
 wards, seem to have been much more profuse and un- 
 governable in the Indian, than in the present cholera, 
 though the characters of the evacuations are precise- 
 ly the same. 
 
 Secondly, Restoration to health from the cold 
 stage, without passing through consecutive fever of 
 any kind, was by far more frequent in India than 
 here, nor did the consecutive fever there assume a 
 typhoid type. 
 
 Thirdly, The proportion of deaths in the cold 
 stage, compared with those in the hot, was far greater 
 in India, according to Dr. Russell's experience, than 
 here. 
 
 Fourthly, The number of medical men and hospi- 
 tal attendants, attacked with cholera during the 
 present epidemic, in proportion to the whole employ- 
 ed, and to the other classes of society, has been be- 
 yond all comparison greater here, than in India under 
 
 
SYMPTOMS OF CHOLERA IN EUROPE. 83 
 
 similar circumstances ; twenty -five medical men 
 have been already seized, and nine have died out of 
 two hundred and sixty-four. Four others have died 
 at Cronstadt, out of a very small number residing in 
 that fortress, at the time the disease broke out there. 
 Six attendants have been taken ill at a small tempo- 
 rary hospital behind the Aboucoff, since we wrote 
 last. It is certain, however, that in some cholera 
 hospitals, favorably circumstanced as to size, ventila- 
 tion, and space, very few of the attendants have suf- 
 fered.' 
 
 Of these facts we are likely to receive accurate 
 statements, in answer to the written questions which 
 we have submitted to the medical authorities through 
 the Government here. 
 
 Convalescence from cholera has been rapid and 
 perfect here, as is proved by the following fact. The 
 Minister of the Interior had given orders that all con- 
 valescents, civil as well as military, at the General 
 Hospital, should be detained fourteen days. We in- 
 spected about two hundred of these detenus some days 
 back, with Sir James Wylie, and found them in ex- 
 cellent health, without a single morbid sequela a- 
 mongst them. 
 
 Relapses are rare in this epidemic, nor have they 
 been often attended with fatal results ; hospital ser- 
 vants seem to have been most liable to them. One 
 physician had three attacks, the second severe, in 
 which he states that he derived great benefit from the 
 Magisterium bismuthi." 
 
 Sir William Crichton, physician in ordinary to the 
 Emperor of Russia, in a memorial presented to the 
 medical council of St. Petersburg, says the symp- 
 toms of the cholera at Moscow were " General unea 
 
84 HISTORY OF THE 
 
 siness ; violent headache and giddiness •, great lan- 
 guor ; oppression at the chest ; pain at the pit of the 
 stomach and at the sides ; a very weak pulse, and fre- 
 quent vomitings, first of undigested food, and then of a 
 watery fluid mixed with phlegm 5 frequent purging ; 
 severe pains, which make the patient roll about and 
 scream ; cessation, or very scanty secretion of urine ; 
 excessive thirst ; cramp in the legs, beginning at the 
 toes, and by degrees reaching the body ; voice feeble 
 and hoarse; the eyes dull and sunk in the head 5 the 
 features changed, and like those of a corpse J cold- 
 ness \ contraction and blueish tinge of the extremi- 
 ties ; a coldness over the whole body ; the lips and 
 tongue become blue 5 a cold and clammy perspira- 
 tion. The vomiting and purging soon exhaust the 
 strength of the patient. The spasms become greater, 
 attacking, successively, the most vital parts. The 
 pulse ceases, the beating of the breast becomes 
 scarcely sensible, and the patient, after having suf- 
 fered the most horrible martyrdom, dies quietly, hav- 
 ing a few minutes ease just before his end. The du- 
 ration of the malady is, generally speaking, from 
 twenty-four to twenty-eight hours; but sometimes 
 its course is still more rapid, and sometimes slower." 
 
 The symptoms of the cholera in England are thuF, 
 described in the Medico-Chirurgical Review fq»r 
 April, 1832. 
 
 " The cholera in England has maintained a striking 
 resemblance to the oft repeated descriptions of its 
 symptoms in other countries. Thus, the severe vom- 
 iting and purging of peculiar characteristic secretions ; 
 the nausea, internal burning at the epigastrium, intol- 
 erable weight, anguish, and oppression ; the parox- 
 ysms of severe pain commencing at the stomach, and 
 
SYMPTOMS OF CHOLERA IN EUROPE. 85 
 
 rapidly extending over the whole alimentary canal ; 
 the ardent thirst; the cramps ; the deadly prostra- 
 tion, anxiety, and dejection ; the conscious feeling of 
 the hand of death ; the failing of the circulation and 
 animal heat ; the peculiar cold sweat 5 shrinking of 
 the skin and subjacent tissues; sharpening of the fea- 
 tures ; contraction of the fingers, and prominence of 
 the tendons ; the hollow, sunken eye ; the leaden as- 
 pect of the surface, particularly visible in the hands, 
 feet, nails, lips, and the circles around the mouth and 
 eyes ; the black, thick blood, often not to be obtained ; 
 the difficult and slow respiration ; cold breath and 
 tongue ; the whispering voice, and if death comes 
 not in this shape, the fever rapidly coming on, often 
 takes the last stage of typhus. The sudden invasion, 
 speedy death, or, as rapid recovery, have all been 
 witnessed in England, as well as in the north of Rus- 
 sia, and on the banks of the Ganges. 
 
 But this alarming catalogue, drawn up from the 
 whole, presents no current picture of any individual 
 case. These different symptoms in different persons 
 vary infinitely in the degree of their severity, from the 
 common diarrhea, with little pains and no cramps, 
 and no greater affection of the circulation and tem- 
 perature of the surface, than occurs from the opera- 
 tion of an ordinary purgative, up to the sudden attack 
 of a prostration so alarming, that the sick man 
 becomes scarcely sensible of pain when the secre- 
 tions are retained, and the heart's action sinks at once. 
 
 To illustrate these different forms, we have made 
 the following selection of cases. 
 
 The following bears a greater resemblance to cook 
 ! mon cholera, than to the severer cases of the present 
 
 epidemic. 
 
 8 
 
86 HISTORY OF THE 
 
 Mr. A. Hopton, Deputy Governor of the Goal at 
 Durham, age 58, of rather free habits 5 general health 
 not very good. On the 14th of January, he felt op- 
 pression at the stomach, sense of heat and uneasiness, 
 with occasional nausea. At two o'clock on the 
 morning of the following day, he was seized with vi- 
 olent purging, attended with most distressing cramps 
 in the limbs : the evacuations were almost incessant 
 throughout the day ; thin and watery, of a pale white 
 color, almost without smell ; at eight in the evening, 
 there was great alteration in his appearance ; coun- 
 tenance blanched and anxious 5 features sharp ; skin 
 rather cold, and covered with a clammy sweat ; 
 pulse slow and weak ; breathing oppressed ; com- 
 plains of most distressing thirst, some softening of cu- 
 ticle of fingers 5 the cramps are not constant, but re- 
 cur at intervals ; most violent in the hands and feet ; 
 occasionally extending to the thigh 5 inclined to sleep 
 in the intervals. 
 
 Treatment. Coffee, mustard, brandy, opium, cay- 
 enne pepper, camphor, carb. ammonia, and oil of 
 peppermint. The symptoms continued somewhat 
 mitigated on this day and the following. 
 
 The premonitory symptoms have been, in some 
 cases, of long duration ; in others absent. They are 
 uneasiness ; a sense of heat and disorder in the stom- 
 ach and bowels ; frequently diarrhea, which at first 
 presents no peculiar character, so that no man could 
 tell whether an attack of the cholera was impending 
 or not ; this has prevailed, in some cases, for a week 
 or more before the attack, in others, it has only pre- 
 ceded the other symptoms for a few hours, or a short- 
 er period. 
 
 The elder Sproat, aged 69, the first case of acknowl- 
 
SYMPTOMS OF CHOLERA IN EUROPE. 87 
 
 edged cholera in Sunderland, had been laboring un- 
 der diarrhea a week or ten days before his seizure. 
 On Wednesday, Oct. 19th, he had been taken worse : 
 on Thursday and Friday, he had vomiting and pur- 
 ging of feculent matter, but no symptoms of collapse. 
 On Saturday he was greatly better, took a mutton 
 chop to his dinner, and went out to his keel in the 
 afternoon. In about 20 minutes he returned, and 
 was taken very ill, with severe shivering, giddiness, 
 cramp at the stomach, violent vomiting and purging. 
 On Sunday morning he was sinking 5 pulse impercep- 
 tible ; extremities cold ; skin dry ; eyes sunk ; lips 
 blue ; features shrunk ; whispering voice 5 violent 
 vomiting and purging ; cramp of the calves of the 
 legs, and complete prostration. In the afternoon his 
 skin became warmer, but the other symptoms contin- 
 ued. On the 24th he was quite collapsed, with ag- 
 gravation of all the symptoms, except the vomiting, 
 which had entirely ceased ; stools passed involunta- 
 rily. On the following morning he was less collapsed ; 
 countenance more natural ; blueness of the lips had 
 disappeared ; the vomiting had ceased ; but the pur- 
 ging still continued less violent, and nearly impercep- 
 tible 5 extremities cold ; spasms of the legs continued. 
 Towards evening, the purging and vomiting had en^- 
 tirely ceased : he became sleepy ; the other symp- 
 toms continuing. On the morning of the 26th he was 
 much weaker ; pulse scarcely perceptible ; counte- 
 nance quite shrunk ; eyes sunk ; lips blue, as well as 
 the lower extremities ; the nails were livid. He was 
 comatose, and died at 12 at noon. 
 
 2. Premonitory Symptoms slight*, and of very short 
 duration. 
 
 Susanna Clark, aged 18. December 5th, about 5 
 
88 HISTORY OF THE 
 
 in the evening, she complained of uneasiness and dis- 
 tension of the stomach and bowels 5 her countenance 
 became pallid, and expressive of much anxiety and 
 distress. She was attacked with vomiting and pur- 
 ging of bilious fluids, and with cramps. She contin- 
 ued in this state until 8 in the evening, when bleed- 
 ing was unsuccessfully attempted. She took brandy, 
 and a mixture containing laudanum, capsicum, and 
 ammonia. The vomiting ceased, she became much 
 better in the night, and, on the morning of the 6th, 
 her pulse was full and her body warm, complaining of 
 little except a pain in the head : but, about midnight, 
 the cramps, vomiting, and purging returned ; she 
 became cold, and apparently almost lifeless, though 
 still sensible. Her pulse was gone ; her eyes deeply 
 sunk ; she remained in the same state through the 
 day, until 6 at night, when she became comatose, 
 and died at 8." 
 
 Dr. Lawrie, Professor of Surgery, Andersonian 
 University, thus describes the disease as it appeared 
 at Sunderland, Newcastle, Gateshead, &c. 
 
 He divides the malignant cholera, as it appeared 
 at these places, into five stages. 1. Premonitory: 
 2. The acute: 3. The collapsed: 4. The rallying: 
 5. The febrile. 
 
 " The premonitory consists essentially of diarrhea, 
 with a slight degree of the cold stage, malaise, and 
 perhaps spasmodic twitchings of the limbs. This 
 stage varies from a very few hours to two, four, or 
 even six days. The acute stage is always rapid, 
 though varying in its symptoms. In some, it con- 
 sists of a very sudden increase of the preceding 
 symptoms, and the stage of collapse speedily super- 
 
SYMPTOMS OE CHOLERA IN EUROPE. gy 
 
 venes. In others, there is vomiting as well as purg- 
 ing acute spasms, thirst, often acute spasm at the pit 
 ot the stomach, and almost constantly a burning un- 
 quenchable, gnawing sensation ; the pulse continues 
 good, and the surface is not very cold. The face 
 becomes more sunken and anxious, and the patient 
 is very restless. Respiration is rather slow, the se- 
 cretions are diminished, that of the urine suspended, 
 tne skin clammy, sometimes perspiring profusely,- the 
 voice husky. A vein opened yields blood freely. 
 Um stage may be very short, or some hours may 
 elapse before collapse be fairly established. In some 
 instances, the attack is instantaneous, the patient 
 falling senseless, and recovering to be plunged into 
 more prolonged agony. The fact is, that the modes 
 oi attack are various, and the symptoms differ in dif- 
 ferent cases." 
 
 "The majority of medical men affirm that the 
 mmd is always unimpaired. I can only say that it 
 appeared to me in many cases affected, to a degree 
 little short of what we find it in concussion of the 
 brain, probably owing to congestion in the vessels of 
 the head. I remarked this particularly in several 
 children. When undisturbed, they lay in a dull 
 sleepy, semi-comatose state, breathing with perfect 
 calmness. When roused, they thought only of re- 
 lieving their distressing sensations, and vociferated 
 for cold water. I had at one time five of the same 
 family in one bed, all calling loudly fcr fluid to allay 
 their ■burning thirst. So urgent were they, that they 
 could be bribed to swallow any medicine, by the 
 promise of a mouthful of cold water. When appeas- 
 ed, they relapsed into their previous sleepy condi- 
 tion. 
 
 8* 
 
90 HISTORY OF THE 
 
 " It is hardly necessary to say, that confirmed col- 
 lapse is a state of extreme danger, and that it is it 
 which destroys the vast majority of cholera patients. 
 The cause of death, in many cases, is a failure of the 
 functions of animal life alone ; in others, affection of 
 the brain, induced either by venous congestion or the 
 absence of arterial blood, hastens the fatal termina- 
 tion. 
 
 I am borne out in this last view of the cause of 
 death, by the fact, that, although the powers of ani- 
 mal life are first affected, they are in some cases 
 the last destroyed. Convulsive movements are com- 
 mon after mental life is quite extinct; and, as I for- 
 merly remarked, it is almost impossible to say at 
 what moment the vital motions have ceased to vi- 
 brate; A body lies apparently lifeless ; suddenly a 
 convulsive shudder shakes it ; its hands are clench- 
 ed, if you put your own within them, and force them 
 open, they shut again with a spasmodic catch. It is 
 not to be wondered at if these appearances have a 
 powerful effect on the superstitious feelings of the un- 
 educated, and make them averse to very early inter- 
 ments.' 
 
 " The 4th stage is that of rallying. Sometimes, but 
 these are the exceptions, it is complete and rapid ; 
 usually it is of some hours' duration, nay, even of two 
 or three days, and the animal powers seemed placed 
 in a delicate balance. In some of the most rapidly 
 fatal cases, Dr. L. had seen the heat partially return 
 to the surface, the pulse flicker^ and sensation slight- 
 ly restored, immediately before death. 
 
 ' 5th. Febrile Stage. A patient who has entered 
 the stage of collapse, is rarely restored to health, with- 
 out passing through a fever closely resembling ty- 
 
SYMPTOMS OF CHOLERA IN EUROPE. 91 
 
 phus. My residence in Newcastle was too short to 
 enable me to say from personal observation, what is 
 its usual duration, but I understood that it varied from 
 seven to fourteen days. The ordinary cases present 
 no peculiarity of symptoms, which could distinguish 
 them from those of common continued fever. At first I 
 thought the tongue cleaner, and the pulse less rapid ; 
 but more extended observation showed, that these, 
 especially the clean reddish tongue, are occasional, 
 but by no means invariable symptoms. 
 
 Congestion of particular organs is met with at the 
 commencement or during the progress of the febrile 
 stage. By far the most common is that of the vessels 
 of the brain, marked by apathy, listlessness, dilata- 
 tion of the pupils, suffused eyeballs, low muttering 
 delirium, or total insensibility. The fauces, in some 
 cases, in which the voice had been much affected, 
 inflamed and suppurated. Inflammation of the brain 
 followed one case of inflamed throat. The chest I 
 rarely found affected. The respiration in the febrile 
 stage is usually healthy, and the lungs free from con- 
 gestion. I do not pretend to say that affections of 
 the chest have no place among the sequelae of chole- 
 ra, but that I have not met with them. > 
 
 Congestions and inflammatory affections of the 
 abdominal viscera are very frequent ; indeed it sel- 
 dom happens that the functions of these organs are 
 speedily restored. Under proper treatment, the liver 
 is not very obstinate. I thought affections of the 
 stomach, probably its mucous surface, as indicated by 
 troublesome retching and vomiting, and of the bow- 
 els, in the shape of constipation, fulness, and pain on 
 pressure, much more common. The secretion of 
 urine is restored, the skin assumes its ordinary hue, 
 
92 HISTORY OF THE 
 
 and attains a febrile heat. The recovery is progres- 
 sive, as from continued fever.' 
 
 " Dr. L. considers the disease to be the same as the 
 Indian cholera, but characterised by certain pecu- 
 liarities which he enumerates. 
 
 ' First, The premonitory stage occurs in a much 
 larger proportion of cases in the English than in the 
 Indian disease. In the latter it was the exception, 
 in the former it is the general rule. 
 
 Second, The febrile stage is incomparably more 
 frequent. I have met with it in India, but it general- 
 ly appeared to me to be connected with derange- 
 ments of the abdominal viscera. In Sunderland and 
 JN ewcastle the experience seems to be, that very few 
 who have fairly entered the collapsed stage, escape 
 the secondary fever. 
 
 Third, I think the head is more frequently affected 
 in the British disease than in the Indian — as indica- 
 ted by greater mental oppression and insensibility 
 during the collapse, and more congestion in the fe- 
 brile stage. In this last particular, I believe I differ 
 from some other observers. I speak, however of my 
 own experience only. 
 
 Fourth, My observations would lead me to say, 
 that the frequent discoloration of the surface consti- 
 tutes a fourth peculiarity. I neither met with it so 
 frequently, nor to the same extent in India.'* 
 
 Dr. James B. Kirk, in a communication to the 
 Greenock Board of Health thus alludes to the Cholera 
 Asphyxia, as he saw it at Musselburgh, Newcastle, 
 and the infected districts in the north of England. 
 
 " Let me now give you as short a description as I 
 
 * See Medico-Chirurgical Review for 1832. 
 
SYMPTOMS OF CHOLERA IN EUROPE. 93 
 
 can of the premonitory disease. The patient com- 
 plains of lassitude ; he has frequently partial uneasi- 
 ness in the region of the stomach, but this not to such a 
 degree as to alarm him. He has frequent evacuations 
 from the bowels— from two to a dozen times a day— 
 not attended with much griping. His countenance 
 is sharp and dark. He knows not of this symptom, 
 and it is only recognizable to the eye of experience. 
 Occasional nausea may oppress him ; but this is not 
 a very common symptom. These symptoms may 
 continue, varying in severity, from one to ten days, 
 before the second stage of the disorder supervenes. 
 The evacuations at the first, are generally of a dark 
 brown or blackish hue. As the looseness continues 
 they gradually become less and less of a natural ap- 
 pearance, until they assume the consistence and as- 
 pect of dirty water. Some headach, cramp of the 
 fingers, toes, and abdomen, and almost always slight 
 giddiness and rigging of the ears, accompany these 
 symptoms. Sometimes an intervening two or three 
 days of costiveness supervenes, which is followed 
 again by the diarrhea, and in a few hours collapse 
 supervenes, and in general, nausea and vomiting. 
 The skilful practitioner will now give pills composed 
 of aloes and calomel, or a pill composed of scammo- 
 ny, calomel, and aloes. The bowels then in general 
 act briskly. Continue the course for three days- 
 keep the patient warm in bed — give him mild and 
 gentle nourishment ; and, after an immense quantity 
 of horribly offensive dejections, the patient is com- 
 pletely recovered, and snatched from the jaws of 
 the dreadful fate which awaited him. Some practi- 
 tioners prescribe the mustard emetic in this state, 
 small doses of calomel and ginger, and bleeding free- 
 
94 HISTORY OF THE 
 
 ly 5 but I prefer, decidedly, and on experience, the 
 purgative system. 
 
 This is the stage to which I wish to reduce all our 
 cases of cholera. If we get them in this stage we can 
 cure them with as much certainty as I have indica- 
 ted. The natural secretions can be speedily restored, 
 and health to a certainty induced. In the hospital at I 
 Gateshead, every attendant had the premonitory 
 symptoms 5 but the skill of their scientific attendants 
 was at hand. Medicines were duly and regularly 
 prescribed, and not one of them took the extreme 
 symptoms. This has been the case, too, with al- 
 most all the medical strangers who have visited the 
 disease, and almost all the practitioners of the district 
 of Newcastle have had premonitory symptoms. If, 
 after this warning, cholera should break forth, in any 
 district to which it has been addressed, I hesitate not 
 to say to the municipal authorities of that place, the 
 blood of the sufferers will rise in judgment against the 
 cruel apathy of those who ought to have been their 
 guardians, natural protectors, and fathers. 
 
 If your patient, in this stage, is very robust, you 
 must take blood to subdue irritation and high action ; 
 but this will be very seldom necessary, and must al- 
 ways be taken with the finger on the pulse, so as 
 never to induce faintness. The disease now advan- 
 ces to another stage if it has been left unassisted. 
 The cramps become stronger, and the sickness fre- 
 quent and considerable. There is pain in the region 
 of the stomach, and restlessness, and much thirst. 
 The countenance is anxious, and the features sharper 
 than natural. The evacuations become like barley 
 gruel. Still, however, the pulse is not depressed, 
 and in general, the patient can keep on foot. He is 
 
SYMPTOMS OF CHOLERA IN EUROPE. 95 
 
 often harassed with fits of vomiting. In this stage, 
 too, the patient begins to experience excessive cold- 
 ness of the extremities, and even partial coldness of 
 the trunk. In all stages of the disease, except the 
 consecutive fever, the tongue is moist, and slightly, 
 but not deeply furred. The practitioner in this stage 
 must step in with calomel and opium, till the healthy 
 secretions are restored — say two grains of the for- 
 mer, and the fifth of a grain of the latter, continued 
 according to circumstances. If the discharges are 
 very violent, the quantity of opium maybe increased 
 to the fourth, the third and the half of a grain. Keep 
 the patient warm in blankets — keep his arms and 
 legs in strong worsted stockings. Appy heat to all 
 parts of his body, by tins and bricks, and sand-bags ; 
 and in eight cases out of ten, the disease will not run 
 into the stage of collapse. If the pulse will bear it 
 do not hesitate to take a moderate bleeding, but not 
 so free as in the last stage. I am aware that the 
 common practice in this stage is to give, in the first 
 place, a mustard emetic ; but I decidedly disapprove 
 of it 5 for 1 have seen, in this stage, collapse most cer- 
 tainly produced by the emetic. 1 am well aware of 
 the partiality of many to this emetic, and of their re a- 
 ; sons ; but 1 must say that 1 disapprove of producing 
 " vomiting, in all stages of the disease, except the bil- 
 a ious stage of consecutive fever. I think it is apt to 
 ' depress the energy of the system still farther. You 
 ! will be told it gives an impulse to the system, and 
 * that it produces bilious evacuations. This forced im- 
 - r pulse is too often the precursor of the indirect debil- 
 ') ity it produces, and hastens collapse. I entertain, 
 m however, the highest respect for the opinions of those 
 ( who still practice the mustard emetic 5 but I am bound 
 
96 HISTORY OF THE 
 
 to declare my conviction, and I trust in stating my 
 opinion, they will charitably give me that liberty they 
 would take to themselves. 
 
 The horrible symptom, collapse, comes next in or- 
 der. It is characterized by pulselessness, coldness, 
 loss of voice, terrible purging, and frequent vomiting, 
 and a total cessation of the secretion of urine. Bleed- 
 ing, and large opiates by the mouth, and stimulation 
 by brandy, have been the practice in this stage ; but 
 I have no hesitation in saying that large opiates are 
 wrong; and that general bleeding, in general imprac- 
 ticable, is often hurtful, and seldom useful. I dare 
 not detain you in giving my reasons for this opinion ; 
 but I have studied the subject with intense anxiety, 
 and watched the practice in various hands, and I am 
 bound to declare my conviction. 
 
 The best practice is to give a large enema, of from 
 three to four pounds, of as hot water as the hand can 
 bear, with six ounces of brandy and two drachms of 
 laudanum. After one hour, this enema should be 
 withdrawn, by a tube introduced into the rectum. 
 The enema is generally returned very cold, and an- 
 other hot injection should then be thrown in. 
 
 All the ordinary means of restoring heat should be 
 studiously attended to : warm diluents frequently giv- 
 en, with small portions of brandy. An insatiable 
 thirst prevails, and the patient should be occasionally 
 indulged in his anxiety for cold water. He is gene- 
 rally denied it, but this is as cruel as it is unnecessary. 
 I would certainly be careful of the quantity. I would 
 withdraw this injection at the end of another hour, 
 and then introduce an enema of a pound and a half 
 of warm water, in which two drachms of common 
 tobacco is infused. In nineteen cases which 1 have 
 
SYMPTOMS OF CHOLERA IN EUROPE. 97 
 
 witnessed, pulsation and reaction have followed the 
 use of the tobacco, and bilious evacuations and in- 
 creased temperature. The action of vomiting has 
 nothing to do with the result ; for in three cases which 
 I witnessed, there was no vomiting after the exhibi- 
 tion of the medicine. We are indebted for this prac- 
 tice to an ingenious and most amiable gentleman, 
 Mr. Baird, of Newcastle. If there is much pain of 
 the bowels, particularly about the stomach, you can 
 raise an instantaneous blister by applying to the 
 stomach a cloth lifted out of boiling water, with great 
 and immediate advantage. ] consider the vapor bath 
 and air bath as very inefficient and trivial remedies ; 
 but the hot tin mattress which is used in the Hospi- 
 tals of Edinburgh, will be found the greatest improve- 
 ment possible ; because it will heat the back, which 
 was never effected by any other process before. 
 Next to this, I prefer sand-bags to all other modes of 
 giving heat. During the whole stage of collapse, I 
 would recommend that from two to three grains of 
 calomel be given every two hours; and if the cramps, 
 pains, and sickness are severe, I would add to the 
 calomel a quarter of a grain of opium. I would satis- 
 fy the raging thirst; and, from its saline qualities, 
 perhaps contribute to the melioration of the state of 
 the blood, by giving every hour, or after every fit of 
 vomiting, an effervescent draught, composed as fol- 
 lows: Three drachms of super-carbonate of soda, 
 dissolved in eight ounces of water; a dram-glassful 
 j mixed with one table-spoonful of lemon juice, and a 
 glass of water. This is an invaluable remedy, and 
 should never be omitted. If you are fortunate enough 
 to begin to see that the evacuations become feculent, 
 then step in with full doses of calomel, with the addi- 
 
 9 
 
98 HISTORY OF THE 
 
 tion of jalap or rhubarb. If vomiting is a harassing 
 symptom, cup the epigastrium, and add a few drops 
 of laudanum to your effervescing draught. If the 
 collapse is very complete, the actual cautery is some- 
 times practised over the course of the spine ; from the 
 accounts of my friends, and the three cases which I 
 witnessed, 1 would think often with advantage. I 
 cannot take leave of this stage without again most 
 earnestly recommending the large hot injections. 
 
 Blueness has been said generally to characterize 
 this stage ; but in this country that is not the fact. 
 The skin of the hands and face is brownish, not blue. 
 If death is to ensue, there is a dreadful low wail of 
 voice, which no man who has heard can ever forget. 
 The lowest moan of the most wretched mendicant 
 goes not to the heart so poignantly. A cold, clammy 
 sweat breaks forth on all the surface ; the tempera- 
 ture rises, and the pulse even becomes more percep- 
 tible ; the dejections become frequent and severe ; 
 and vomiting sometimes, though not always, is ex- 
 cessive ; in a very short time the patient is a corpse. 
 Sometimes, indeed, the vomiting and purging, and 
 even the cramps cease In collapse, altogether ; and 
 when the spasms cease. 1 have observed that the 
 cases are always the most incurable. But if nature 
 is to rally, the dejections become less frequent and 
 more feculent ; the vomiting diminishes or ceases; 
 the pulse gradually and steadily improves in fulness 
 and in tone ; the voice becomes more powerful ; the 
 strength improves, and the unfortunate is snatched 
 from the dreadful fate that seemed to await him. 
 But the horrors of this dreadful disease do not stop 
 here. The system, by the peculiar poison producing 
 this distemper, has been sunk into the lowest state of 
 
SYMPTOMS OF CHOLERA IN EUROPE. 99 
 
 human existence. Those vessels which had ceased 
 to beat, and all those muscular fibrils which have 
 been for days convulsed and sealed up in spasm, can- 
 not at once resume their healthy action. The vis 
 medicalrix nature in resuming her play, seems over 
 solicitous for the restoration of the functions ; and 
 consequently she institutes an increased, and danger- 
 ous action in every artery of the system. 
 
 The tenderest and most important organs of the 
 system, the brain, the lungs, and the liver, are now in 
 imminent danger ; and the skill of the physician is 
 called into play, not to be executed in stages and de- 
 grees, but at once, promptly, and decidedly. Does 
 congestive action manifest itself in the head, t le cup- 
 ping glass or leeches should instantly be applie !, and 
 vesication produced over the whole scalp in twenty 
 minutes, by an application of a strong infusion of 
 cantharides in the strongest acetic acid. The lancet 
 must not now be spared, and drastic purgatives are to 
 be freely administered. If the lungs are the seat of 
 high action, indicated by oppression of breathing, 
 sense of suffocation, full, large, and bounding pulse, 
 and often spasm in the chest, bleed freely, and do not 
 spare purgation ; and give 30 drops of wine of anti- 
 mony every three hours. In bad cases, place the 
 patient in a half-sitting posture. This practice is 
 most important. 1 am indebted for this hint, to John 
 Fyfe, Esq. of Newcastle, an excellent and eminent 
 Surgeon, and I think, from positive experience, that 
 it is a practice highly worthy of atterltion. A green- 
 ish matter is now often largely discharged from the 
 stomach, for which one or two emetics of common 
 salt may be given with advantage. You must now 
 attend carefully to^the state of the bladder, as now the 
 
100 HISTORY OF THE 
 
 urine is secreted largely, and dangerous retention fre- 
 quently takes place. The eminent Mr. Fyfe thinks 
 that the duration of the consecutive fever is commen- 
 surate with the duration and severity of the collapse ; 
 and not much dependent on the kind of remedies em- 
 ployed. This conclusion is doubtless generally cor- 
 rect. But sometimes a very mild case precedes a 
 dangerous fever \ and sometimes after the severest 
 collapse, there is no fever at all. This fever, unless 
 strictly watched, is more frequently fatal than collapse 
 itself. After the purgatives 1 have recommended, 
 three grains of calomel every four hours till the mouth 
 is touched, is the best practice ; but it is difficult to 
 touch the mouth. At the end of two days, the calo 
 mel should be succeeded with mild aperients, castor 
 oil, and laxative enemata. When the pulse rises 
 under depletion, do not hesitate to repeat the bleeding 
 boldly. Even three or four days after reaction, 
 dreadful oppression of the brain frequently supervenes. 
 This state should be treated exactly as we do Hy- 
 drocephalus Acutus. I ought to remark that the 
 consecutive fever always assumes the shape of Hy- 
 drocephalus Acutus in infants, and should be treated 
 accordingly. If recovery is effected from this conse- 
 cutive fever, it is not uncommon that relapses more 
 or less severe take place. These relapses take place 
 as often after the mild, as after the severest form of 
 the disease ; and may be generally traced to some 
 imprudence in diet, or exposure to cold. We must 
 treat them in the same mode as the original disease, 
 diminishing the quantity of our doses." 
 
 For the symptoms, &x. of the disease, as they ap- 
 
SYMPTOMS OF CHOLERA IN AMERICA. 101 
 
 peared at Paris, the reader is referred to the excellent 
 lectures of Broussais, in another part of this work. 
 
 In Canada, and all the other places on this conti- 
 nent where the disease has prevailed, it has exhibited 
 the same symptoms as in Asia and Europe. Great 
 hopes were long entertained that if the cholera should 
 appear in this country, that our climate, habits, and 
 sparseness of population would modify the disease, 
 and mitigate its severity. But facts show us that 
 such hopes are not to be realized, for the malady has 
 been as fatal here as in Europe. 
 
 Dr. Robert Nelson, member of the Medical Board 
 and Commmissioner of Health at Montreal, thus de- 
 scribes the mode of attack and symptoms of the dis- 
 ease in Canada : — 
 
 " During the first four or five days of the epidemic, 
 the patient was subject, for the most part, in one of 
 the two following modes : — 1st. After a trifling di- 
 arrhea, of several days duration to a few hours only, 
 nausea, quickly followed by vomiting, and an in- 
 crease of diarrhea, would usher him into that stage of 
 the disease, which may be called the 2nd mode of at- 
 tack. 2d, The patient is affected with a slight blue- 
 ness of hands and face, sometimes accompanied by 
 a distressing sensation of weight and burning in the 
 stomach, rapidly followed by vomiting and diarrhea ; 
 when the vomting had once come on, the thirst would 
 commence and be intolerable ; cramps in the limbs, 
 and about the pericardia, blueness quickly extending 
 towards the trunk ; profuse cold perspiration, (if per- 
 spiration it be) and loss of voice. The severer cases 
 would terminate in death, in a period from three to 
 9* 
 
102 HISTORY OF THE 
 
 six hours, while some might run on to twelve or 
 more. 
 
 After the first four or five days, the mode of attack 
 was not so invariable, for while burning thirst, pain at 
 the stomach, cramps, asphyxia, perspiration, cada- 
 verous coldness and aphonia, characterized the mal- 
 ady, vomiting and purging might be absent, and yet 
 the case would rapidly run to a fatal termination. 
 
 About this time, and still later, many cases assu- 
 med a febrile character, the first pyrexial period of 
 which might be called the choleric stage. But as 
 the danger resided in this choleric stage, and the re- 
 covery of the patient wholly depended on arresting 
 some one or two of the symptoms, it will be proper, 
 in order to found a rational mode of treatment, to an- 
 alyse these latter. 
 
 However, before taking up that subject, let us stop 
 a moment to examine the matter voided. The mat- 
 ter vomited was at first what happened to be in the 
 stomach ; after that it was watery. The alvine dis- 
 charges were without odor, in large quantities, whi- 
 tish, like rice water, or a mixture of arrow root and 
 water ; this white substance has been ascertained to 
 be fibrin. Perspiration abundant, cold, and slightly 
 adhesive as if mixed with dissolved epidermis — doubt- 
 less it also contained fibrin 5 but this last fact has not 
 been decided. 
 
 Besides the intestinal canal and the skin, all other 
 organs furnished no secretion. Tears, pituita, saliva 
 and urine, the secretion of which is totally suspended ; 
 as to tears, the greatest anguish of dying, in full pos- 
 session of the intellect, surrounded by all that is at 
 once endearing and afflicting, could not produce them. 
 Some complained of great pain, and desired to make 
 
SYMPTOMS OF CHOLERA IN AMERICA. 103 
 
 water, but the bladder contained no urine, and after 
 death was found to be contracted to the smallest size ; 
 this desire of voiding water might arise from the con- 
 traction of the posterior disk of the bladder hard 
 against the internal meatus, which on autopsy was 
 found to be the fact. In this disease, there is every 
 reason to believe that every species of secretion, in all 
 parts of the body, is abolished. No known function 
 of the intestinal mucous membrane could form mat- 
 ter like unto that discharged, and as there is no cir- 
 culation going on in the skin, but rather a complete 
 state of asphyxia in that part, there can be no secre- 
 tion of perspiration. We now naturally come to the 
 question — Whence and how come these discharges ? 
 On the skin, certainly not from circulation, for there, 
 there is none — ex nihilo nihil fit — and it is more than 
 probable, that the capillary circulation of the mucous 
 membrane of the intestines is equally absent. It 
 would appear as if the elements of the body, compo- 
 sing the parts nearest to the surfaces, became subject 
 to new affinities, forming new substance, incapable 
 of being retained by the membranes, but rapidly 
 oozing through them. Two facts go to support such 
 an hypothesis. 1st. The abundant new formation 
 transuded, where no circulation exists ; and 2d, the 
 rapid amaigrissement of the body. This wasting of 
 the body is not apparent, it is real ; the usual round- 
 ness of parts is taken off, and tendons and other sali- 
 ent points become strikingly prominent." 
 
 In the cases which have occurred at New-York 
 and Albany, the same symptoms have been noticed. 
 The second week in July, I saw many cases of the 
 disease in New-York, in all of which, the above 
 
104 History of the symptoms of cholera, &c. 
 
 symptoms were present. First, diarrhea, though oft- 
 en of only short duration, then nausea and vomiting, 
 though in some instances the vomiting was slight, to 
 which succeeded a sinking of the circulation, cold- 
 ness and blueness of the surface, burning thirst, 
 spasms, and death. In most of the cases that 1 have 
 seen, the discharges from the the stomach and bowels 
 were light colored, resembling arrow root and water, 
 or starch and water, and were without odor. In 
 many cases, however, vomiting and purging were not 
 among the most prominent symptoms, and the stage 
 of collapse or great prostration, did not appear to 
 arise from profuse discharges, as in many of the cases 
 the most remarkable for sudden prostration, coldness, 
 blueness, &c, the patients had vomited or purged but 
 very little. 
 
 Having thus completed an account of the symp- 
 toms of the cholera, as they have been witnessed in 
 different parts of the world, we shall now give an ac- 
 count of the appearances found on dissection of the 
 bodies of those who have died of the disease in Asia, 
 Europe, and in this country. 
 
APPEARANCES ON DISSECTION, &c. 
 
 We have seen in the foregoing accounts of the 
 symptoms of the epidemic cholera, selected from va^ 
 rious writers, that a most remarkable uniformity oij 
 symptoms has been noticed, in all countries where 
 the disease has prevailed. The accounts of this dis- 
 ease, from Asia, Persia, Russia, Poland, England, 
 Canada, and the United States, all agree as respects 
 the symptomatology, and as 1 have before observed,, 
 the description of the symptoms of the cholera, as they 
 were noticed in India, would be an accurate account 
 of the epidemic, as it now appears in New York. 
 
 But notwithstanding this agreement respecting the 
 symptoms of the disease, we are surprised to find that 
 the accounts of the morbid appearances discovered 
 on the dissection of those who had died of the disease, 
 are exceedingly variable, and often contradictory ; 
 and as yet have thrown but little light on the pathol- 
 ogy of the disease, or furnished any important gui- 
 dance as regards the treatment of it. 
 
 This disagreement respecting the morbid appear- 
 ances, has not, however, arisen from any neglect of 
 authors and observers to describe the appearances 
 discovered on dissection ; but they have unquestion- 
 ably been different ; and this difference has probably 
 been caused by the greater violence of the disease in 
 one case than in another ; by the age and constitution 
 of patients, and the remedies administered. 
 
106 APPEARANCES ON* 
 
 The accounts from India, respecting the morbid 
 appearances, are numerous and full. 
 
 The Bengal Medical Report, drawn up and pub- 
 lished soon after the appearance of the disease in 
 India, thus refers to the results of post mortem re- 
 searches. 
 
 " Of those who died, it was believed, perhaps rather 
 fancifully, that the bodies sooner underwent putre- 
 faction, than those of persons dying under the ordi- 
 nary circumstances of mortality. The bodies of those 
 who had sunk in the earlier stages of the malady, ex- 
 hibited hardly any unhealthy appearance. Kven in 
 them, however, it was observed, that the intestines 
 were paler and more distended with air than usual ; 
 and that the abdomen, upon ^>eing laid open, emitted 
 a peculiar offensive odor, wholly different from the 
 usual smell of dead subjects. In the bodies of those 
 who had lived some time after the commencement of 
 the attack, the stomach was generally of natural ap- 
 pearance externally. The color of the intestines 
 varied from deep rose to a dark hue ; according as 
 the increased vascular action had been arterial or ve- 
 nous. The stomach, on being cut into, was found 
 filled, sometimes with a transparent, a green, or dark 
 flaky fluid. On removing this, its internal coats in 
 some cases were perfectly healthy ; in others, and 
 more generally, they were crossed by streaks of a 
 deep red 5 interspersed with spots of inflammation, 
 made up of tissues of enlarged vessels. This ap- 
 pearance was frequently continued to the duodenum. 
 In a very few cases the whole internal surface of the 
 stomach was covered with coagulable lymph ; on re- 
 moving which, a bloody gelatine was found laid on 
 the interior coat, in ridges or elevated streaks. The 
 
DISSECTION, &c. 107 
 
 large intestines were sometimes filled, with muddy flu- 
 id, sometimes livid, With dark bile, like tar ; just as 
 the individual had died in the earlier or later periods 
 of the attack, in most cases, the liver was enlar- 
 ged, and gorged with blood. In a few it was large, 
 soft, light-colored, with greyish spots, and not very 
 turgid. In others again it was collapsed and flaccid. 
 The gall bladder was, without exception, full of dark 
 green or black bile. The spleen and thoracic vis- 
 cera where in general healthy. The great venous 
 vessels were usually gorged ; and in one case the 
 left ventricle of the heart was extremely turgid. The 
 brain was generally of natural appearance. In one 
 or two instances, lymph was effused between its mem- 
 branes, near the coronal suture, so as to cause ex- 
 tensive adhesions. In other cases, the sinuses, and 
 the veins leading to them, were stuffed with very dark 
 blood." 
 
 Dr. Burrell, of the 65th Regiment, thus described 
 the appearances found on dissection, and the good 
 effects of bleeding in cases that occurred among the 
 European soldiers. 
 
 " Seroof, 10th August, 1818. 
 
 " As dissections of cases of cholera morbus w 7 ere 
 not sent you along with my statement of the 28th 
 ult. 1 beg to send you a few remarks on this subject. 
 
 As congestion has been found in all our former fa- 
 tal cases, 1 yesterday had another demonstrative in- 
 stance of the eligibility of bleeding in cholera. 
 
 John Stokes, of the 65th regiment, a man recov- 
 ered from chronic syphilis, was attacked inour wards 
 with vomiting and purging, at eight P. M. of the 8th 
 inst. When seen, his hands and feet were cold, with 
 
108 APPEARANCES ON 
 
 some rigidity. Under these circumstances, and he 
 being of a weakly habit, bleeding (I may say unfor- 
 tunately) was not used. The usual remedies, with 
 ^the hot bath, were tried. He died on the 9th inst., 
 at two, P. M. 
 
 In company with Dr. White, of the 2d N. I., and 
 Assista,nt-surgeon O'Reilly, 65th regiment, I opened 
 the body. The liver was found of a dark color, dis- 
 tended with blood, and the gall-bladder full of bile. 
 The spleen of an extremely blue color. The omen- 
 tum inflamed, and veins filled in every part. The 
 small arteries of the intestines of a lively red, and the 
 colon contracted through its length to the size of a 
 middle finger, and its calibre so small as hardly to 
 allow a scalpel handle to be introduced. 
 
 The veins of the stomach more particularly ar- 
 rested our attention. On the great curvature, they 
 were of an intermediate size, between a crow's and 
 a common quill. These turgid veins were more ap- 
 parent internally, and the most forcible injection could 
 not have more completely filled the vessels. The 
 mesenteric vessels, as well as the vessels of every 
 other internal membrane, partook of this appearance 
 of formerly increased action. The lungs were dark, 
 and suffused with blood ; this, most probably, is the 
 cause of the stertorous and labored breathing pre- 
 sent in almost every fatal case. 
 
 From former dissections, and the appearances in 
 this case, little doubt ought to arise regarding the ex- 
 igence of bleeding in almost every case, but more 
 especially in the first hours of attack. If even during 
 the cold and rigid state of the limbs, should the pulse 
 rise in the hot bath, which it generally does, we ought 
 not to hesitate in opening a vein; as recovery from 
 
DISSECTION, &c. 109 
 
 this stage is most precarious, and every experiment 
 may therefore be tried. 
 
 As dissection in this disease has shown, and will 
 in every case show, turgidity, if not inflammation, of 
 the vessels of the internal parts, no hesitation as to 
 what line of practice is best, should harbor in the 
 minds of medical men during the prevalence of so 
 dreadful a disease. 
 
 Under this idea of increase bf action internally, 
 and consequent want of balance in the circulation, 
 from which arises the coldness and shrinking of the 
 external parts, 1 commenced the bleeding system ; 
 and of the cases admitted of cholera, since the 21st 
 ultimo, up to the 10th August, the casualties run 
 thus, 
 
 Bled, 88 Dead, 2 
 
 Not Bled. 12 Dead, 8 
 
 Total admissions, 100 Deaths, 10 
 
 Our cases of dysentery in the chronic stage, in the 
 hospital, have been aggravated in many instances, ap- 
 pearing as if the epidemic give a peculiar character of 
 symptoms to the usual endemical diseases. 
 
 Relapses of cholera have not been unfrequent, and 
 the regularity of the bowels must be strictly attended 
 to in the stages of convalescence. 
 
 Some of these relapses require the same treatment 
 i as the original attacks. In one European woman the 
 attack proved fatal." 
 
 The Madras Medical Report, drawn up by Mr, 
 Scott, thus fully describes the morbid appearances dis- 
 covered on dissection, by the medical men in India. 
 
 •• The external appearance of European subjects, 
 
 I f 
 
HO APPEARANCES ON 
 
 who have sunk under cholera, closely resemble that 
 which has been noticed as taking place during life. 
 The surface is livid, the solids are shrunk, the skin of 
 the hands and feet is corrugated. There seems no 
 sufficient evidence of any uncommon tendency in the 
 body to putrefaction after death, nor of any char- 
 acteristic fetor from the abdominal cavity. No par- 
 ticular morbid appearances have been found in any of 
 the cavities of the body, which are lined with serous 
 membranes, or in these membranes themselves. The 
 cavities of the pleura, of the pericardium, and of the 
 peritorium, have almost uniformly been found in a 
 natural state ; or the deviations from that state have 
 manifestly had no connexion w r ith cholera. The sur- 
 faces which are lined, or covered with mucous mem- 
 brai.es, have, on the contrary, very generally exhibit- 
 ed signs of disease. These will be noticed, as the or- 
 gans connected with them come to be mentioned. 
 
 The lungs have not unfrequently been found in a 
 natural state, even in cases where much oppression of 
 respiration had existed previously to death. Much 
 more generally, however, they have been found either 
 to be gorged with dark blood, so that they have lost 
 their characteristic appearance, and have assumed 
 more that of liver or spleen ; or they have been found 
 to be in the opposite state ; that is, collapsed into an 
 extremely small bulk, and lying in the hollow on each 
 side of the spine, leaving the cavity of the thorax near- 
 ly empty. This appearance has been so remarkable 
 as to induce Dr. Pollock, of H. M's. 53d regiment, to 
 conceive, that it could only be produced by the extrica- 
 tion of a gas within the cavity of the pleura, capable 
 of overcoming the atmospheric pressure. It is under- 
 stood, however, that opportunities were had of pier- 
 
DISSECTION, &c. Hi 
 
 cing the thorax of the dead body under water., and 
 that no gas was extricated. As there appears to have 
 been an absolute vacancy in the cavity of the pleura, 
 that is to say, the lungs did not by any means fill it, it 
 would seem that the viscus had exerted a contractile 
 power, adequate to overcome the pressure of the at- 
 mosphere. The blood found in the lungs has been al- 
 ways very black. The heart and its larger vessels 
 have been found to be distended with blood, but not so 
 generally as the apparent feebleness of their propel- 
 ling power, and the evident retreat of the blood to the 
 centre, would have led us to expect. The right auri- 
 cle and ventricle being gorged with blood, is nothing 
 peculiar to cholera ; but some dissections have shown 
 the left cavities to be filled even with dark or black 
 blood, which we may reckon as a morbid appearance 
 more peculiar to it. In the abdominal cavity, the peri- 
 toneal coverings of the viscera, being serous mem- 
 branes, present in general but little deviation from the 
 healthy state : occasionally, indeed, the morbid ac- 
 cumulation of blood in the vessels of the viscera, im- 
 parting an appearance of turgidity and blueness, is evi- 
 dent on their exterior surfaces. We also find them 
 bearing marks of inflammation, especially where the 
 patient may have lingered before death. In other ca- 
 ses, the whole tube has had a blanched appearance, 
 both externally and internally. The stomach and in- 
 intestines generally preserve their ordinary volume. 
 The appearance of the omentum is not sensibly affect- 
 ed in cholera. The stomach is found to be so various- 
 ly affected, as to destroy all grounds for pathological 
 reasoning. It is very rarely found empty or much 
 contracted after death, nor has any appearance of 
 spastic stricture of the pylorus been often detected. 
 
112 APPEARANCES ON 
 
 It has, however, sometimes occurred. Its contents ap- 
 pear to be chiefly the ingesta, in an unaltered state ; in 
 some cases, greenish, or yellow, or turbid matters are 
 found. The stomach has been said to have been 
 found Mined with calomel/ Various appearances, 
 either of active inflammation, or a congested state of 
 the vessels, have been noticed, sometimes in one part, 
 and sometimes in another. The parts seem as if they 
 were sphacelated, thickened, softened, and friable ; 
 and, in short, exhibit so great a variety of appearances, 
 from a perfectly natural state, to the most morbid, that 
 no particular light is thrown by them on the disease* 
 
 The intestinal tube is sometimes collapsed, but oft- 
 ener found to be more or less filled with air ; distend- 
 ed in some parts into bags or pouches, containing whi- 
 tish, turbid, dark, or green colored fluid ; and, in oth- 
 ers, presenting the appearance of spastic constriction. 
 The latter, however, is not common. No faecal or 
 other solid matters are found in the intestines ; but, 
 very commonly, large quantities of conjee-looking flu- 
 id, or of turbid serous matter. The duodenum, and 
 occasionally, the jejunum, have been found loaded with 
 an adherent, whitish, or greenish mucus ; at other 
 times they have been found seemingly denuded of their 
 natural mucus ; and often perfectly healthy. Traces 
 of bile in the intestines, or of any substance apparently 
 descended from the stomach, are exceedingly rare. 
 Sanguineous congestion, and even active inflammation, 
 are stated to be more common in the bowels than in 
 the stomach ; but, on the other hand, instances are 
 very numerous where no such indications have been 
 detected. The thoracic duct is stated to have been 
 empty of chyle. The liver has been commonly found 
 gorged with blood, but not always ; it is an organ usu- 
 
*$$ 
 
 DISSECTION, &c. 113 
 
 ally very vascular ; and it would probably demand a 
 nicer discrimination than has been bestowed on the 
 subject, to distinguish the degree of congestion in 
 which it is naturally left by the settling of the blood 
 after death in ordinary diseases, from that which has 
 been observed after an attack of cholera. The gall 
 bladder has almost universally been found to contain 
 the bile, and, in the great majority of cases, even to 
 be completely filled with it. As is usual with this 
 secretion, in cases of retention, it is of a dark color. 
 Very different states of the gall-ducts have been de- 
 scribed ; cases of constriction and impermeability, 
 seeming to be equally numerous with those of an op- 
 posite character. 
 
 The urinary bladder is found, we may say uni- 
 versally, without urine, and very much contracted. 
 The lining of mucous membranes of the bladder and 
 ureters, have been found coated with a white mucous 
 fluid. The smallness of the bladder, after death, has 
 been generally adduced in proof of great spasms ; but 
 it is not unfrequently found to be equally small after 
 death, from other diseases ; and it seems the nature 
 of that organ, when it contains no urine, to contract, 
 so as to leave no cavity. Dr. Baillie, in his morbid 
 anatomy, thus notices this fact. ' The bladder is al- 
 so found contracted to such a degree as hardly to 
 have any cavity. This is generally not to be consid- 
 ered as a disease, but simply as having arisen from a 
 very strong action of the muscular coat of the blad- 
 der previously to death.' The appearance of the 
 spleen, which is so various under the ordinary condi- 
 tions of the body after death, has indicated nothing 
 that can be mentioned as belonging to cholera. The 
 
 vessels of the mesentery have been very generally 
 10* 
 
114 APPEARANCES ON 
 
 found to be uncommonly full of blood; In the head, 
 appearances of congestion, and even of extravasation, 
 have been frequently observed ; but not so uniformly 
 nor to such extent as to require any particular notice. 
 Only one case has been given where the state of the 
 spinal marrow was examined 5 and, in that, indica- 
 tions of great inflammation were detected in its 
 sheath ; the case, however, was, in some degree, a 
 mixed one. 
 
 From this general view of the appearances found 
 on dissection of the bodies of persons who have died 
 from cholera, it is manifest that the information 
 thence derivable, is, in a pathological view, of a neg- 
 ative nature only. It is nevertheless of consequence, 
 in a practical sense, especially in treating the seque- 
 lae of cholera*" 
 
 Dr. John Kinnis, in a report addressed to Sir James 
 M'Gregor, Director General of the Medical Depart- 
 ment of the Army, thus sums up the morbid appear- 
 ances in those who died of cholera at Mauritius, in 
 1819 and 182-0:— 
 
 " In one case, the brain was mangled by an officious 
 orderly, during a momentary absence of the operator ; 
 and in another, appeared natural ; but in all the rest, 
 there was serous effusion into the ventricles ; and in 
 the greater number, likewise between the membranes 
 and on the base of the cranium 5 when between the 
 membranes, before these were divided, it resembled 
 a transparent jelly. 
 
 In exactly one half of the cases, there was effusion 
 under the dura mater of the spinal cord. The veins 
 of its pia mater generally appeared very turgid, but. 
 having very lately begun to examine the spine on dis- 
 
DISSECTION, &c. 115 
 
 section, I was doubtful whether to consider this a 
 natural or a morbid appearance, and seldom noted it 
 down. In one case, the blood contained in these 
 vessels was of an arterial color, resembling a coarse 
 injection ; in another, it was partly venous and partly 
 arterial. 
 
 The circulating system presented, in general, no 
 deviation from the usual appearances; none of that 
 congestion in the lungs or any of the viscera, which 
 others have found, and which seemed to offer so plau- 
 sible an explanation of the most remarkable symp- 
 toms attending the disease. In one case, all the cav- 
 ities of the heart were empty ; and in three, the inter- 
 stices betwixt its columns carneae and musculi 
 pectinati, filled with a frothy blood. In two cases, 
 the heart appeared unusually flaccid ; and in one of 
 them, the parietes of its left ventricle unusually thin. 
 Once the pericardium contained two drachms of a 
 pale reddish fluid. 
 
 The abdominal viscera seldom presented any 
 thing unusual externally ; yet in one case there was 
 scattered over them gelatinous, semi-transparent 
 flakes, and the abdomen contained half a pint of se- 
 rum. The small intestines exhibited in four cases 
 a very light arterial blush, and in the one where this 
 appearance was most distinct, the omentum adhered 
 to the peritonaeum for some inches on the right side. 
 In several cases, the large intestines and the mesen- 
 tery were loaded with venous blood, and in two, the 
 lower portion of the ilium, and the large intestines, 
 were blue, or greenish blue externally, and dark red 
 internally. 
 
 The speckles, natural to the mucous coat of the 
 stomach, were sometimes merely paler than usual, 
 
116 APPEARANCES ON 
 
 or of a dark venous hue ; in other cases, instead of a 
 speckled surface, there were large black or greyish 
 black patches, at one time distinct, at another coales- 
 cing into ridges upon the rugae of the stomach, and 
 apparently arising from effused blood. Where mer- 
 cury had been taken in great quantity, these patches 
 were few in number, or rather obscured by a black 
 or dull green thick ropy mucus, which lined the sto- 
 mach, and was interspersed with greyish portions ; 
 in such cases, the stomach contained a considerable 
 quantity of a similar substance, in a more liquid form ; 
 in one case it contained a thick grey and dark red- 
 dish colored mucus. 
 
 The small intestines were generally thickened, and 
 lined with a substance resembling in color and con- 
 sistence shoemaker's paste* In eight of the cases 
 examined, the lumbricus teres was found imbedded 
 in this substance, sometimes to the number of eight or 
 nine ; and one patient, in whom none were found on 
 dissection, had vomited them before death.* 
 
 The large intestines were either contracted and 
 empty, or filled with a greyish white puriform, some- 
 times foetid, or dark brown fluid. In one case, the 
 rectum resembled an hour glass, being distended with 
 fluid, and contracted in the middle. 
 
 In three or four instances, the gall-bladder was 
 flaccid 5 in general, it was distended beyond the mar- 
 gin of the liver, with blackish green thick bile. It 
 was, in one subject, whitish, translucent, and about 
 
 * My friend, Mr. Gillespie, one of the surgeons to the civil hospi- 
 tal, informs me, that he has seldom had occasion to open a Black 
 subject, without finding worms in the intestines. Whether they may 
 equally infest European adults in this island, I have yet had few 
 opportunities to determine. They are here, as every where else, 
 very common in children. 
 
DISSECTION, &c. 117 
 
 an inch from its fundus, divided by a narrow neck 
 into two bags, both of which were filled with a thin 
 white fluid, intermixed with purulent looking flakes ; 
 the cystic duct appeared at first imperforate, but with 
 a very little force, the probe could be passed to the 
 duodenum. The gall-bladder communicated freely 
 with that gut, in every other case. 
 
 In the patient who had complained of inability to 
 void urine, the bladder was contracted and empty, 
 as it almost always is after death. 
 
 Dr. Annesley, who has furnished one of the best 
 descriptions of the disease, finds from Autopsic inves- 
 tigation that the intestines present a vermilion color, 
 which he says is peculiar to the disease. Dr. A. fur- 
 ther declares that the anatomical appearances are the 
 same in all the cases he examined. 
 
 Dr. Alexander Gordon, a surgeon attached to the 
 Bombay Presidency, a man of great merit, and who 
 fell a victim to the disease, says the lesions of the brain 
 were primitive and essential, while those of the intes- 
 tines were only secondary. 
 
 In Europe, the same diversity of morbid appearan- 
 ces have been noticed, as have been found in India, 
 Dr. Kier, in a report respecting the cholera at Mos- 
 cow, in the autumn of 1830, thus describes the post 
 mortem appearances : 
 
 " The appearances in the dead bodies were not 
 uniform, and varied according to the duration of the 
 disease, and the circumstances under which the pa- 
 tient had died. As this was the case, I conceive the 
 most satisfactory way by which I can answer the in- 
 quiry on this head will be to transmit the printed ac- 
 counts of the dissections made at Moscow, and pre- 
 
118 APPEARANCES ON 
 
 sented to the Medical Council there, by its members 
 who occupied themselves the most with this part of 
 the duty ; while 1 here add the impressions made on 
 my own mind, by the dissections at which I was 
 present. 
 
 The extremities in genera!, were more or less livid 
 and contracted, and the skin of the hands and feet 
 corrugated, the features sunk and ghastly ; on open- 
 ing the scull, the blood-vessels of the brain and its 
 membranes were more or less turgid with blood, par- 
 ticularly towards the base ; the arachnoidea had 
 sometimes in several places lost its transparency, and 
 adhered to the pia mater ; a fluid was sometimes 
 found effused into the convolutions of the brain, in 
 some quantity, and more or less serum in the lateral 
 ventricles. The blood-vessels of the vertebral col- 
 umn and spinal chord, more or less loaded with 
 blood, which was sometimes effused between its 
 arachnoid and dura mater ; partial softening of the 
 substance of the spinal chord was sometimes met 
 with, and marks of inflammatory congestion in the 
 larger nerves. The lungs were generally gorged with 
 dark-colored blood, the cavities of the heart filled with 
 the same, and frequently containing polypous concre- 
 tions. In all the dissections 1 was present at, very 
 dark-colored blood, which, when extended on a white 
 surface, resembled the color of the darkest cherry, 
 was found in the arch of the aorta, and in other arte- 
 ries. 
 
 The state of the abdominal organs varied conside- 
 rably, the stomach and different parts of the intestines 
 were frequently found to be partially, but considerably 
 contracted ; the internal surface of the stomach some- 
 times seems to be little affected. A whitish or yellow 
 
 3*fc£ 
 
DISSECTION, &c. 119 
 
 fluid matter resembling the evacuations, was fre-- 
 quently found in the alimentary canal, which now 
 and, then contained a good deal of air. In either 
 case, both stomach and intestines bore marks of con- 
 gestion, and of a' sub-inflammatory state, varying 
 from dark-colored spots of small extent, to several 
 inches, affecting the whole internal surface of the in- 
 testines. The color of these parts also varied a good 
 deal, from dark-colored venous congestion, to rose- 
 colored inflammation. In one case, the internal sur- 
 face of the stomach was so strongly and so generally 
 tinged of a very dark color, that it might easily have 
 been mistaken for gangrene. On exposing the stom- 
 ach between the eye and the light, it was evident that 
 there was neither gangrene, nor solution of continuity, 
 but that the dark color proceeded from a very general 
 and great congestion of very dark colored blood, in 
 the vessels of the organ. The subject of this case, 1 
 was told, had died with symptoms of a typhoid nature, 
 after suffering fromtheusual symptoms of the epidem- 
 ic. Excepting in this case, which was evidently one 
 of congestion, and not of inflammation, I saw nothing 
 in the morbid appearances from which a conclusion 
 could be drawn, that inflammation was a very gene- 
 ral morbid change in the alimentary canal, or a com- 
 mon cause of death : however, by its presence in 
 the second period of the disease, it might add to the 
 general irritation, or, even as a consequence of prece- 
 ding congestion, be itself occasionally, the cause of 
 the fatal event. Both stomach and bowels were fre- 
 quently of a paler color than natural, both on the out- 
 er and inner surface ; but neither thickening nor con- 
 densation from inflammation, nor exulceration, de- 
 
120 APPEARANCES ON 
 
 struction of substance, nor abscess, appeared in any 
 of the dissections 1 was present at. 
 
 The liver was generally pretty full of dark-colored 
 blood, the gall-bladder frequently much distended 
 with tenacious ropy bile, of a dark yellow or green 
 color ; the gall-ducts sometimes contracted, at other 
 times not; the appearance of the pancreas, spleen, 
 and kidneys was various, frequently differing but little 
 from their natural state, in other cases, rather sur- 
 charged with blood, the urinary bladder almost 
 always collapsed and empty, the uterus generally 
 natural." 
 
 The Medico-Chirurgical Review for 1832, thus 
 describes the results of post mortem inspections in 
 England : 
 
 " Dissection of the subjects dead of this disease, 
 have not been frequently performed : the same preju- 
 dices of the ignorant multitude have forbidden it here, 
 as in all other countries. Yet so far as opportunities 
 have been afforded, and these have been few indeed, 
 the same general appearances, and similar varieties 
 in different cases, have been observed in this country. 
 
 The entire absence of faecal matter in the contents 
 of the intestines: the presence, in greater or less 
 quantity, of matter such as the peculiar evacuation ; 
 the serum-like fluid, more or less abounding with 
 floculi of coagulated albumen, which are occasional- 
 ly found in such quantity, as to line the mucous mem- 
 brane with a tenacious substance, like paste ; an 
 odor of putrifying mucus, somewhat like that of offen- 
 sive lochial discharges, occasionally present ; the se- 
 rous fluid being frequently more or less tinged with 
 blood, and that of the stomach often mixed with the 
 
DISSECTION, &c. 121 
 
 latest ingesta ; the upper part of the duodenum often 
 slightly tinged with bile ; frequently contractions of 
 different portions of the colon; occasionally introsus- 
 ceptions ; the gall-bladder distended with unhealthy 
 bile ; its ducts sometimes strictured, and the urinary 
 bladder empty and remarkably contracted. 
 
 The mucous membrane of the alimentary canal, 
 generally somewhat softened; sometimes of an un- 
 natural paleness throughout, but oftener having vari- 
 ous portions tinted of different hues, from the pale 
 rose, to dark brick-dust and slate colors, as venous or 
 arterial injection predominates; patches of ecchymo- 
 sis and arborisations of the larger branches are fre- 
 quent ; but the most common appearances have been 
 a red or purplish speckling of the membrane, general- 
 ly over the whole, or more apparent in some parts 
 than in others { or an injection confined to the promi- 
 nent parts of the rugae of the stomach and valvulse 
 conniventes of the intestines. Sometimes these dif- 
 ferent appearances are scattered throughout tho 
 whole extent of the mucous membrane ; at other 
 times, the stomach alone is colored, and the intestines 
 pale, or the stomach pale, and different portions of the 
 intestines darkly injected ; however, these appearan- 
 ces are most frequent about the smaller extremity of 
 the stomach and lower portion of the ileum. The ve- 
 nous trunks of the stomach and intestines .are gene- 
 rally found greatly engorged ; such also frequently 
 takes place with the liver and spleen, and almost in 
 every case in the venee cavse, and auricles of the heart. 
 The blood remaining fluid, of an exceeding dark and 
 peculiar consistence and adhesiveness, likened by 
 some to treacle poured over the cavities of the heart. 
 
 The lungs frequently exhibit a remarkable shrinking, 
 
 11 
 
122 APPEARANCES ON 
 
 like that of the skin and subcutaneous tissues (which 
 Jed in India to the body being opened under water, to 
 ascertain if air existed in the cavity of the pleura), 
 then blood of the same dark hue; frequently they 
 are engorged so as to resemble hepatization some- 
 what, but still crepitous and lighter than water. The 
 obstruction of the bronchise, by peculiar secretions, 
 has not here been noticed amongst the cases from 
 the North of England: the brain of two only has 
 been examined ; in one, the vessels were very turgid, 
 and half an ounce of serum was contained in the la- 
 teral ventricles; in the other, a very highly injected 
 state of the vessels externally to the brain, and in the 
 cortical substance of the upper parts of the hemi- 
 spheres, and in the cortical substance or upper part 
 of the medulla oblongata was found, with depositions 
 of lymph upon the surface of the brain and cerebellum, 
 and five or six ounces of serum in the base of the 
 skull. 
 
 Turgesence of the vessels of the brain and spine 
 has been at all places a very frequent appearance, 
 and serous effusion beneath the arachnoid in the cavi- 
 ty of the cranium and spinal canal, and in the lateral 
 ventricles! It has seldom been observed how often 
 these appearances have existed ; but in the report of 
 Dr. Kinnis, from the Mauritius, decidedly the best 
 of any which have yet been published, as affording 
 the greatest extent of information on the many impor- 
 tant considerations connected with the cholera, in 13 
 cases, where the brain was examined, serous effusion 
 was found in all but two, one of which appeared na- 
 tural, the other was mangled by an officious orderly 
 during a momentary absence of the operator, and in 
 one half of the cases where the spine was examined, 
 
DISSECTION, &c. 123 
 
 there was effusion under the dura mater of the cord, 
 and the veins generally turgid. 
 
 It has been a general complaint, that the state of 
 the organs after death has thrown no light on the na- 
 ture or causes of the disease, and that they afford no 
 explanation of the severity of the symptoms. It is 
 true that they do not explain these, as the inflamma- 
 tion, tumefaction of the membrane, and fibrinous effu- 
 sion in croup does the affection of the voice, and suffo- 
 cation met with in that malady ; but they do throw 
 as much light, as post mortem examinations in gene- 
 ral, on the seat and nature of diseases; and this in- 
 stance may serve as a useful comment on the present 
 mania for the exclusive cultivation of morbid anato- 
 my : we feel and acknowledge its great advantages, 
 and the precision in this obscure science, which is de- 
 rived from such researches j but the man who wishes 
 to treat disease successfully, must not consider his 
 only aim and object to be the knowledge of the vari- 
 ous morbid changes which take place in the structure 
 of the different organs, and of the symptoms by which 
 they are distinguished ; his researches must be direct- 
 ed beyond this — to the laws of vital actions; to the 
 manner in which they are disordered, and to the 
 agents capable of restoring them to their healthy state. 
 
 We regret exceedingly that any idea of post mor- 
 tem examinations being of little utility in investiga- 
 tions into the nature of the disease, should have 
 thrown a damp on the interest with which they have 
 been prosecuted, and thus have deprived us of much 
 valuable information. It is, unquestionably, impor- 
 tant to ascertain if any connexion exists between the 
 various fatal forms of the cholera, and the different 
 pathological conditions of the organs affected : but 
 
126 APPEARANCES ON 
 
 Post Mortem Examination ten hours after death. 
 
 Examination of Margaret Black's body. On open- 
 ing the chest and abdomen, the omentum exhibited 
 no unnatural appearance; the mesenteric veins were 
 in a state of complete congestion ; the stomach con- 
 tained from two to three pounds of the same veal 
 soup-like fluid as had been vomited during life ; the 
 internal and peritoneal linings were very pale and 
 bloodless, and in several parts there were vascular 
 patches ; the duodenum contained a quantity of the 
 same turbid fluid, which the whole canal was less or 
 more filled with ; the lining of the pylorus was unu- 
 sually pale, but there were a few gangrenous patch- 
 es on it 5 a considerable quantity of pearly colored 
 mucous was found covering the lining membrane of 
 the intestines ; submuriate of mercury was blended 
 intimately with this mucous, which produced the ap- 
 pearance of black-wash, proving, perhaps, that lime 
 was present. Super-carbonate of soda was mixed 
 with another portion of it, but no effervescence took 
 place. Spleen much darker than natural, and more 
 engorged with black blood ; liver pale, of a mottled 
 appearance, and much softer than natural ; gall blad- 
 der about two thirds full of a very dark green bile ; 
 gall ducts not closed or filled up, so that bile could 
 be pressed out of the bladder with ease ; lungs w^ere 
 of a dark mottled appearance. Left lung of a dark 
 buff color, and highly congested, — right lung extreme- 
 ly dark and gorged with grumous black blood ; heart 
 appeared of a natural size, — both right and left ven- 
 tricle contained about two ounces of coagulated 
 black blood, both ventricles were also distended with 
 the same impure blood, particularly the right ; kid- 
 ney was pale and bloodless, bladder entirely empty, 
 
DISSECTION, &c. 127 
 
 and contracted to a great degree. A number of gan- 
 grenous patches in the lining membrane of bladder. 
 
 Post Mortem Temperature. — Apartment, 58 Fah- 
 renheit. 
 
 Temperature of the Body. — Half-past three o'clock, 
 82— half past 4, 90—5, 92—6, 96— half-past 6, 96— 
 7,90. 
 
 Second Case. 
 
 Walter Hovveiston was admitted into Vennel Hos- 
 pital on the 21st March, at half past nine, A. M. in a 
 complete state of collapse, and died at two, P. M. the 
 same day, after energetic treatment by enemata, cal- 
 omel, opium, and latterly, a tobacco injection. 
 
 Examination after death. — Lungs seemed healthy ; 
 heart of usual size, and contained two or three oun- 
 ces of grumous blood in each auricle ; liver paler than 
 natural; gall bladder full of bile, and easily dischar- 
 ged ; spleen healthy ; stomach contained a great quan- 
 tity of fluid resembling dish w r ater. Towards the 
 pylorus, in the inner membrane of the stomach, there 
 were several patches, approaching to gangrene ; duo- 
 denum much injected ; much glary fluid adhering to 
 the whole inner coat of the bowels ; kidneys pale, and 
 the left contained pus; bladder firmly contracted ; no 
 urine ; gangrenous patches at the fundus of the stom- 
 ach 5 did not examine the brain. 
 Third Case. 
 
 Robert Forfar, eetatis 12, idiot. Epilepsy since 3 
 years old. Was in the habit of eating coals and any 
 other dirt. Had purging three days previous to attack. 
 Was seized on Sunday morning, Jan. 22, at 3 o'clock, 
 I with both vomiting and purging, but no cramps. Vi- 
 sited at 12 o'clock — found the patient laboring under 
 
 i 
 
126 APPEARANCES ON 
 
 Post Mortem Examination ten hours after death. 
 
 Examination of Margaret Black's body. On open- 
 ing the chest and abdomen, the omentum exhibited 
 no unnatural appearance; the mesenteric veins were 
 in a state of complete congestion ; the stomach con- 
 tained from two to three pounds of the same veal 
 soup-like fluid as had been vomited during life ; the 
 internal and peritoneal linings were very pale and 
 bloodless, and in several parts there were vascular 
 patches ; the duodenum contained a quantity of the 
 same turbid fluid, which the whole canal was less or 
 more filled with; the lining of the pylorus was unu- 
 sually pale, but there were a few gangrenous patch- 
 es on it; a considerable quantity of pearly colored 
 mucous was found covering the lining membrane of 
 the intestines ; submuriate of mercury was blended 
 intimately with this mucous, which produced the ap- 
 pearance of black-wash, proving, perhaps, that lime 
 was present. Super-carbonate of soda was mixed 
 with another portion of it, but no effervescence took 
 place. Spleen much darker than natural, and more 
 engorged with black blood ; liver pale, of a mottled 
 appearance, and much softer than natural ; gall blad- 
 der about two thirds full of a very dark green bile ; 
 gall ducts not closed or filled up, so that bile could 
 be pressed out of the bladder with ease ; lungs were 
 of a dark mottled appearance. Left lung of a dark 
 bufif color, and highly congested, — right lung extreme- 
 ly dark and gorged with grumous black blood ; heart 
 appeared of a natural size, — both right and left ven- 
 tricle contained about two ounces of coagulated 
 black blood, both ventricles were also distended with 
 the same impure blood, particularly the right ; kid- 
 ney was pale and bloodless, bladder entirely empty, 
 
DISSECTION, &c. 127 
 
 and contracted to a great degree. A number of gan- 
 grenous patches in the lining membrane of bladder. 
 
 Post Mortem Temperature. — Apartment, 58 Fah- 
 renheit. 
 
 Temperature oj the Body. — Half-past three o'clock, 
 82— half past 4, 90—5, 92—6, 96— half-past 6, 96— 
 7,90. 
 
 Second Case. 
 
 Walter Howeiston was admitted into Vennel Hos- 
 pital on the 21st March, at half past nine, A. M. in a 
 complete state of collapse, and died at two, P. M. the 
 same day, after energetic treatment by enemata, cal- 
 omel, opium, and latterly, a tobacco injection. 
 
 Examination after death. — Lungs seemed healthy ; 
 heart of usual size, and contained two or three oun- 
 ces of grumous blood in each auricle ; liver paler than 
 natural; gall bladder full of bile, and easily dischar- 
 ged ; spleen healthy ; stomach contained a great quan- 
 tity of fluid resembling dish w r ater. Towards the 
 pylorus, in the inner membrane of the stomach, there 
 were several patches, approaching to gangrene ; duo- 
 denum much injected ; much glary fluid adhering to 
 the whole inner coat of the bowels ; kidneys pale, and 
 the left contained pus; bladder firmly contracted ; no 
 urine ; gangrenous patches at the fundus of the stom- 
 ach ; did not examine the brain. 
 Third Case. 
 
 Robert Forfar, aetatis 12, idiot. Epilepsy since 3 
 years old. Was in the habit of eating coals and any 
 other dirt. Had purging three days previous to attack. 
 Was seized on Sunday morning, Jan. 22, at 3 o'clock, 
 with both vomiting and purging, but no cramps. Vi- 
 sited at 12 o'clock — found the patient laboring under 
 
128 APPEARANCES ON 
 
 well marked symptoms of cholera, and quite cold. 
 Enema of warm starch, one pound, tincture of opium 
 three drachms. 
 
 Monday.— Much in the same state, though he look- 
 ed better. Still cold, but not so livid. Continue med- 
 icine and hot applications. 
 
 Tuesday. — Continued in same state until 4 P. M., 
 when the surface of his body became warmer, which 
 continued until his death, which took place at 9 P. 
 M. The patient was warmer two hours before his 
 death, than he was two days before. Had a purging 
 enema at 2 o'clock this day, which produced a bilious 
 stool, with a long round worm in it. No urine was 
 secreted or voided since three o'clock on Sunday 
 morning. 
 
 Examination of Robert Forfar >s body, 25th Jan. 
 1832. — Sixteen hours dead. No offensive odor. 
 The surface of the body leaden hue. Belly hollow. 
 Reddish ecchymosis of the limbs. Pupil nearly na- 
 tural. No difference in the color of the muscles or 
 fat. On laying back the sternum the internal mamma- 
 ry artery and veins were displayed. The blood in 
 the artery certainly lighter red than in the vein, not 
 more turbid than natural. Very collapsed lungs. No 
 fluid in the chest. Upper surface of the liver darker 
 than natural, but posterior natural. Gall bladder 
 very turgid. All the bowels much injected with 
 blood except the colon. The Neurilema of the 
 pneumogastric nerves bright red and injected. Right 
 side of the heart relaxed, left contracted. Spleen 
 natural. The injection of the intestines is very minute, 
 exceedingly distinct and arborescent. Some grum- 
 ous blood in the right ventricle. There is also some 
 blood in the left ventricle, which is more coagulated. 
 
DISSECTION, &c. 22^ 
 
 Internal texture of the liver natural. Blood in the 
 stomach dark brown, the villi injected, (and Mr, 
 Earle. of London, who is present, says that in some 
 parts of the stomach it is exactly like the stomachs of 
 those who die of hydrophobia,) corrugated in a pecu- 
 liar way, more particularly about the rugee. This 
 dark fluid adheres tenaciously to the coats of the 
 stomach, and through the whole line of the intestines, 
 except the colon. At the commencement of the jegu- 
 num an indurated superficial ulcer, size of a six- 
 pence. About half a table-spoonful of urine in 
 bladder. Several large dead lumbrici. Kidney na- 
 tural, but darkish. 
 
 Chemical examination of Urine taken from the Mad-, 
 der on Wednesday, during the post mortem examina-* 
 Hon, — Was acid, and if it contained urea at all, it 
 contained it in a very minute quantity. 
 
 Examination of the Bile. Ten grains dried at a 
 heat of 140, calcined, left one grain. Distilled water 
 poured on this and heated, slightly restored reddened 
 litmus. 
 
 Blood.— A quantity of blood was collected from 
 the heart. It was gelatinous, but the greater part 
 appeared to have remained fluid. The whole collect- 
 ed was dried at a heat of 140. The mass after ex- 
 siccation weighed 200 grains, which, by exposure in 
 a crucible to a red heat for two hours, was reduced 
 to two grains. Boiling distilled water was poured 
 on these, till nothing more was dissolved. The inso- 
 luble mass weighed one and three-fourth grains. 
 Hence 200 grains of this blood dried at 140, only 
 contained one fourth grain of salts soluble in water. 
 These consisted of an alkaline carbonate, muriate 
 and sulphate of soda. The following experiments 
 
130 APPEARANCES ON 
 
 with this aqueous solution show — 1st, Turmeric pa- 
 per was not reddened, but the blue color of litmus 
 reddened by an acid was very gradually restored. 
 2d, Muriate of silver, a copious precipitate, insoluble 
 in nitric acid. 3d, Nitrate of barytes, a copious pre- 
 cipitate, insoluble in nitric acid. 
 
 A young friend who accompanied me to Newcas- 
 tle, and who has been for several years much en- 
 gaged in the investigations of animal chemistry, has 
 communicated to me the following as the result of 
 his inquiries : — 
 
 1st, In the fluid vomited which you brought from 
 Newburn, there was neither free acid nor free alkali, 
 nor albumen. It, however, contained a peculiar 
 animal matter, for when it was slowly evaporated at 
 a low heat, a yellowish brown extract remained, re- 
 sembling in appearance that of urine. Its chemical 
 properties were, however, wholly dissimilar, as it 
 contained no urea, or matter capable of causing a 
 precipitate with the tincture of galls. 
 
 2d, The alkaline muriates and phosphates appear- 
 ed to be present in the clear fluid. The insoluble 
 rice-looking matter was not sufficiently examined to 
 speak with confidence of its nature. Blood taken 
 from the heart of a blue collapse patient was not ma- 
 terially altered in any of its chemical properties. It 
 reddened by immersion in saline solutions immediate- 
 ly, but scarcely at all by exposure to the air. This 
 has been the case with the blood I have examined in 
 three other bad cases of the disease. The saline 
 matter of the blood appeared, by examination, to be 
 greatly diminished in quantity. 
 
 The bile appeared wholly unchanged in its chem- 
 
 ! 
 
 : 
 
DISSECTION, &c. 23! 
 
 i ical properties. Its physical properties were also the 
 same as usual. 
 
 The child's dejection, sent to you by Mr. Frost, 
 consisted of a dilute solution of albumen. It redden- 
 ed turmeric paper strongly. Solution of, the by-chlo- 
 ride of mercury dropped into it, and the mixture 
 heated, a copious precipitate fell. The same result 
 obtained with nitric and muriatic acids in a slighter 
 degree. These remarks only apply to the fluid part 
 of it. The rice-like sediment was not examined. 
 
 P. S.— The Gall duct of Forfar's case was found 
 completely impervious. 
 
 Fourth Case. 
 From the Case-Book of Fennel Hospital 
 Feb. 1332. Malcolm M'Millan, aged J 3, em- 
 ployed constantly in his father's pilot boat, was 
 brought to the Hospital in a state of collapse. His 
 'extremities cold and blue ; no pulsation to be felt at 
 the wrist, temples, or carotids ; face and lips very 
 cold s countenance dull 5 eyes suffused ; eyelids slug- 
 gish • tongue soft, clean, cold ; voice very feeble, and 
 said by his friends to be completely altered ; is ration- 
 al and drowsy ; complains of pain at and below the 
 navel which is not increased on pressure. Half-past 
 three. Has had an evacuation of about three ounces 
 of a light brown colored fluid, resembling boiled oat- 
 meal gruel, and of a slightly feculent smell. Four 
 o'clock. Apply a mustard poultice to feet ; has more 
 heat in his body and extremities; pulse perceptible 
 at the wrist, 108 j has some thirst • to have four grains 
 of calomel, and a small quantity of brandy and wa- 
 ter. Quarter past five. Symptoms muchthe same ; 
 
132 APPEARANCES ON 
 
 repeat the calomel. Six o'clock. Pulse impercepti- 
 ble 5 had a little brandy and water. Quarter to 
 seven. Pulse perceptible ; repeat the calomel. Half 
 past seven. Pulse very feeble, 1 16 ; delirious. Half 
 past eight. Repeat the calomel. JNine, P. M. Pulse 
 imperceptible; skin colder; face pale; eyes more 
 sunken ; repeated the brandy and water ; injected an 
 enema of three pounds of water, as hot as the hand 
 could bear, to which add an ounce and half of spirits 
 of wine. Ten, P. M. Face bedewed with cold clam- 
 my perspiration ; pulse still imperceptible; extremi- 
 ties warmer; has retained the enema; repeated 
 calomel and diluted alcohol. Eleven. Withdrew 
 the enema and injected another, with three pounds 
 of water and two ounces of brandy, and one drachm 
 of laudanum. Twelve. Continue medicine ; pulse 
 134. Half-past twelve. Pulse imperceptible ; ex- 
 tremities rather cold ; eyes suffused. Dr. Kirk now 
 pronounces the case incurable, from the state in 
 which he finds the brain. One, A. M. Reparations 
 34 in a minute, oppressed ; pulse imperceptible at 
 carotid; chest laboring; heat not increased; much 
 low moaning, of the most piteous description. Had 
 two drachms of alcohol in a little cold water a few 
 minutes since. Quarter past one. Countenance is 
 indescribably dark, sunk and cadaverous ; no evacua- 
 tions or vomiting. Twenty minutespast one. Breath- 
 ed his last. 
 
 Examination of M . HP Miliarias body Twelve Hours 
 after Death. — Ecchymosis of the lower limbs and 
 outside of arms ; abdominal viscera immensely in- 
 jected, as in high inflammation ; lungs collapsed; 
 blood fluid ; coagulable lymph filling the whole right 
 ventricle as a polypus, and a small polypus in the 
 
DISSECTION, &c. 133 
 
 left ; the various ganglia highly injected and redden- 
 ed : bladder empty, corrugated, and injected ; inter- 
 nal membrane of the bladder highly injected, like 
 acute inflammation ; heat of the apartment 58 ; ther- 
 mometer in the bowels 89; internal membrane of 
 bowels injected highly ; glary matter like dirty mu- 
 cous lining the whole cavity of the stomach and ileum ; 
 spleen turgid ; considerable quantities of pus in pel- 
 vis of kidney, and whole substance containing more 
 blood than natural ; gall bladder distended ; the lon- 
 gitudinal sinus of the brain containing in its whole 
 length a polypus, like a white worm, very firm in tex- 
 ture ; membrane of brain highly injected. 
 
 Post Mortem Temperature of the Skin. — Half-past 
 1 o'clock, 92—2, 92— half-past 2, 96—3, half-past 3, 
 96—4, 90. 
 
 In Canada and the United States, the results o* 
 Post Mortem examinations have been no more uni- 
 form and satisfactory than those furnished from India 
 and Europe, but for further details respecting the 
 cholera in this country the reader is referred to the 
 appendix to this work. 
 
 12 
 
TREATMENT OF THE CHOLERA. 
 
 Notwithstanding the prevalence of this disease 
 year after year in various parts of Asia, we yet find 
 that no fixed plan of treatment has been adopted or 
 discovered in that country. In India the treatment 
 of the cholera has been altogether empirical. Nu- 
 merous remedies were proposed, administered, com- 
 mended and condemned. 
 
 There is scarcely a remedy or medicine that can 
 be thought of, or imagined, that was not tried in some 
 of the towns in India, where the cholera prevailed. 
 Among the principal remedies, were bloodletting, 
 calomel in large doses, opium in a great variety of 
 forms and in great and small quantities, and by in- 
 jection ; ether, camphor, musk, castor, aromatic and 
 stimulating tinctures, essential oils of peppermint, 
 clove, cinnamon ; wine, ardent spirits, external heat, 
 warm bath, and hot bath, to blister the extremities ; 
 vapor bath, heated sand, friction with irritating ru- 
 befacients, blisters, the actual cautery applied near 
 the spine, and to the limbs, emetics, purgatives, gal- 
 vanism, electricity, cold bath, &c- &c. &c. 
 
 In the onset of the disease bloodletting was gene- 
 rally considered useful, but for the most part it was 
 serviceable only in the first stage of the disease, 
 though some few instances are given in which blood- 
 letting performed at an advanced period of the dis- 
 ease proved beneficial. 
 
 Calomel was very greatly administered in India in 
 cases of cholera, and its efficacy very generally ac- 
 
TREATMENT OF THE CHOLERA. 185 
 
 knowledged ; but we know that the mortality of the 
 disease was exceedingly great in that part of the 
 world, although nearly all the physicians gave calo- 
 mel to their patients. 
 
 Opium was also employed to a great extent ; and 
 under the use of it many died, and some recovered ; 
 and the same may be said of the efficacy of most of 
 the remedies resorted to. 
 
 When we pass from Asia to Europe, and inquire 
 respecting the treatment of cholera, in a northern 
 climate, we find the same remedies resorted to, that 
 where used in India, with some few additional ones, 
 proposed and employed by European physicians, but 
 all with nearly like success to those that had been 
 formerly used. 
 
 Calomel has not however been so largely employ- 
 ed in Europe as in India. 
 
 In Russia, Poland and some other places, the ex- 
 tracts of hyoscyamus and cicuta were administered, 
 and it is said with remarkable success. 
 
 The distilled water of cherry-laurel, and the dis- 
 tilled water of bitter almonds, were said to have been 
 of service in many cases. 
 
 Tobacco injections have been highly recommended 
 and many cases of cholera have been cured by the 
 use of them. 
 
 The siib-nitrate of bismuth was for a while highly 
 recommended and reported to have cured many. 
 
 Cinchona, serpentaria, capsicum, and various 
 other tonics and stimulants, separate and combined, 
 were proposed and administered, and in many in- 
 stances seemed to be beneficial 5 but we all know 
 that the mortality of the disease has been great in all 
 countries* and consequently we may feel assured that 
 
136 TREATMENT OF 
 
 no remedies have as yet been resorted to which have 
 generally proved serviceable, or that have not failed 
 in innumerable instances. 
 
 The deaths are most numerous in proportion to 
 the number of those attacked, at the commencement 
 of the epidemic cholera, in a place where it has not 
 before prevailed. This may be owing either to the 
 greater violence of the disease at first, or to the want 
 of care and proper treatment, which are always wit- 
 nessed on the sudden invasion of a malignant epi- 
 demic. 
 
 It would seem however that the cause or causes 
 that produce the disease are more violent at first ; 
 and after a short time the disease is observed to be- 
 come more mild and manageable. Remedies appear 
 to have more control over it, and the hope is then 
 entertained that the method of treatment adopted 
 has lessened the mortality and triumphed over the 
 disease ; and that if it was to recur it would be dis- 
 armed of its terrors by the remedies which have at 
 last been discovered. 
 
 But all such hopes are sure to be blasted on a re- 
 currence of the disease, or on trial of the same reme- 
 dies in other places at the commencement of the 
 epidemic. 
 
 In Germany and France and in this country, ice 
 and cold water have been administered, and frequent- 
 ly with most happy effects, snatching the patient as 
 it were, from the grave. 
 
 But this remedy has also failed in innumerable in- 
 stances; I have seen it administered, and have consi- 
 derable confidence in it as a remedy, but I have also 
 seen it of no further use than to afford a very shortlived 
 

 THE CHOLERA. 137 
 
 gratification to those whose only want when dying 
 was to have their thirst assuaged, and whose 
 
 " Burning mouth impel'd to crave 
 One drop — the last— to cool it for the grave." 
 
 Leeches* and cupping glasses, applied over the 
 stomach and bowels, have many times proved service- 
 able, especially in the early stage of the disease. 
 
 Colchicum has also been given in this disease, and 
 it is said with benefit. 
 
 M. Coster of Paris, administered large quantities 
 of oxygen gas to patients in cholera. A mixture of 
 three fourths oxygen and one fourth atmospheric air* 
 was the composition he made use of, and he says 
 great relief was given in all cases, and many cures 
 were effected by the use of it. Others have had re- 
 course to it, and have not had like success. 
 
 The nitrous oxyde gas or exhilarating gas has been 
 administered in Europe and this country in cases of 
 cholera, but I am not aware that it has been of ser- 
 vice. 
 
 M. Biett of Paris, administered with much bene- 
 fit animal charcoal in cases of cholera ; this remedy 
 has been greatly used by M. Recamier, at the Hotel 
 Dieu, under the name of black magnesia. 
 
 Owing to some analyses of the blood of patients 
 affected with the cholera, and which showed a defi- 
 ciency of the watery and albuminous portions, and 
 also a deficiency of the muriate of soda and potassa, 
 &c. injection of these ingredients into the veins has 
 been resorted to, and several patients have apparent- 
 ly been cured by this process 5 the particulars of 
 which are detailed in another part of this work. 
 
 But I will not further particularise the various re- 
 medies that have been employed, to subdue this ma- 
 
 12* 
 
138 TREATMENT OF 
 
 lignant and terrific epidemic ; but proceed in accor- 
 dance with the general plan of this work, to select 
 from various and experienced authors in the different 
 countries where the cholera has prevailed, some ac- 
 count of the remedies they have used, and which 
 they have found on trial to be beneficial. 
 
 It has been exceedingly unfortunate, that in most 
 of the countries where the cholera has prevailed, that 
 some specific, or universal antidote for the disease 
 has been sought for, as if the cholera was not only 
 always of the same nature, but of the same degree of 
 violence, affected the same organs and disturbed the 
 same functions in all cases •, and in all cases required 
 the same treatment. 
 
 On this subject the following remarks from the 
 New York Cholera Bulletin are deserving of consi- 
 deration : 
 
 " We are on debateable ground, with a host of 
 champions to encounter, arrayed in various style, 
 from the armories of ancient observation and modern 
 experience. The profession is indeed in the field in 
 motley garb to slaughter the monster of Epidemy ; 
 but the members of it agree not on the mode of de- 
 struction, and in the warmth of argument, and fury 
 of debate, turn many of the weapons that should be 
 directed against the enemy, towards their fellow 
 " filii Esculapii." — Alas ! then, for the public, for 
 whom Doctors and Cholera are contending ; they 
 watch the fierce onslaught, and ever and anon are 
 struck by the random blows that proceed from the 
 combatants. Yes ! for ' Cholera kills, and Doctors 
 slay, and every foe will have its way P 
 
 Let us view the medical army ! In the foremost 
 
 
THE CHOLERA. 139 
 
 rank stand the Bleeders, then advance the Calomel 
 Band, escorted by a troop of Opium foragers ; here 
 is a company of Stimulators, and there a Tobacco 
 brigade ; here a file of Saline Aperients, and there 
 again a guard of Leechers and Blisterers. The men 
 of friction are in the van, and the rear is composed of 
 the Icy legion. All these characters appear in the 
 force raised to subdue the cholera, and by such a 
 medley is the fell disease of Asia assailed. 
 
 It may not be denied that in many instances, men 
 are firmly wedded to an opinion, founded upon a suc- 
 cessful report ; for instance, with few exceptions we 
 know little of the nature of cholera upon this conti- 
 nent, but what we have learnt from the writings of 
 others in the situations where the demon malady 
 yearly demanded a hecatomb for sacrifice ; it was 
 therefore very natural that the fond enthusiast should 
 lend his attention to the well told and promising tale, 
 that after pourtraying the sad miseries of the disease, 
 should describe its cure, and under circumstances 
 that belied hope, and attracted disappointment ; of 
 such tales there have been many, and surely there 
 has been no want of listeners : the wildest theories 
 have gained proselytes, the strangest romance has 
 won a credence, and what has been wildly described, 
 has been servilely imitated by the Physicians at a 
 distance, who were thus improperly prepared to treat 
 a pestilence, should it unfortunately visit the scene of 
 their exertions. 
 
 It is of course then said by some that the lancet 
 will effect a cure, that calomel singly, or combined 
 with opium is a specific ; that stimulants will restore 
 the depressed, or tobacco will weaken the fiercest 
 action ; that saline aperients will act successfully 
 
140 TREATMEMT OF 
 
 through the circulation, that friction will stay the 
 spasm, or that ice will moderate the accompanying 
 fever. Now hovvever valuable all or any of these 
 remedies may prove, if accepted exclusive of other 
 treatment in every case, they will destroy more fre- 
 quently than they can save : there are shades in cho- 
 lera as in all other diseases— time for action is de- 
 manded, time for repose is required: the available 
 means suggested by medical skill are not invariable, 
 either in the time or manner of their application, and 
 however clearly the essentials of the disease may be 
 evidenced, there are yet circumstances to be further- 
 ed or modified, that attach an apparently new char- 
 acter to it, and render the physician the servant in- 
 stead of the controller of events. 
 
 The remedies to which we have alluded have pro- 
 bably cured many patients laboring under cholera ; 
 in fact we have unquestionable testimony from the 
 physicians in India and Europe of their value — what 
 objection then can be raised to their employment ? 
 None but their indiscriminate use ! If, as is surely 
 the fact, scarcely two persons have suffered in chole- 
 ra under the same identical symptoms, as if in addi- 
 tion, what is as surely true, that no two systems ever 
 exactly corresponded in power or peculiarity, each 
 attempt to bring a variety of cases within the same 
 remedial treatment is likely to be as injurious to the 
 patients as it is absolutely ridiculous on the part of 
 the practitioners. We have heard that some medi- 
 cal men regard cholera in one light, and some in 
 another: with one it is simply a " disease of excite- 
 ment,' 1 with a second, it is marked by congestion in 
 its earliest stage, and with a third, the nervous func- 
 tion is primarily attacked, rapidly inducing a cessa- 
 
THE CHOLERA, 141 
 
 tion of the accustomed secretions. As one of these 
 causes is always considered in operation, one plan of 
 treatment is as regularly brought into play : a hot 
 skin, a frequent and bounding pulse, a coated tongue, 
 the utmost anxiety and restlessness, are regarded and 
 treated the same, as when a cold surface, a w r eak and 
 tremulous pulse, a chilled tongue, and a state of co- 
 ma are apparent : whatever the theory may be, the 
 practice is the same in various stages and degrees, 
 sometimes perhaps to the salvation, sometimes, alas ! 
 to the destruction of the patient. We have moreover 
 heard of confusion between the states of congestion 
 in its most considerable extent, and exhaustion in its 
 lowest condition, when stimulants and sedatives 
 have exchanged the places they were intended to 
 fill. 
 
 Is there then a difficulty in the treatment of chole- 
 ra ? We think not ! A close observance of prevail- 
 ing symptoms will ever tell to the intelligent physi- 
 cian the amount of danger, and the quarter in which 
 it may be apprehended : whether the danger be gene- 
 ral or local (for these distinctions may with propriety 
 be drawn,) there are means within his power for their 
 abatement, in the majority of cases where his aid is 
 promptly demanded : such a physician will advance 
 to the bed side of his patient with a mind w r ell stored 
 with the observations of others on the character of 
 the disease, but yet untrameled by any specious rea- 
 sonings : he will investigate, as far as may be, the 
 history of his case, and endeavor to detect the cause 
 and the attendant circumstances of its appearance. 
 Gifted with sound common sense, that rare but ines- 
 timable quality, and possessed of a corresponding 
 medical knowledge, he applies the resources at his 
 
142 TREATMENT OF 
 
 command according to the necessity existing, and 
 triumphs when many fail, and only fails when none ; 
 may triumph. 
 
 Without refraining from the use of each recom- 
 mended measure, when prudence demands its em- 
 ployment, he yet avoids its abuse, and wisely selects 
 from the experience of others, that which confirms 
 his own. 
 
 We may therefore regard cholera in the same point 
 of view as any other disease ; it is almost needless to 
 pronounce it specific in its character, for what disease 
 is not ? And it therefore becomes the physician to 
 conduct himself in the treatment of cholera as in oth- 
 er maladies, where symptoms are watched and aba- 
 ted, and where each remedy is proposed with a ra- 
 tional expectation of success, so far as medicine can 
 ensure an auspicious result. 
 
 The lancet therefore is useful ; so is calomel, opi- 
 um, tobacco, with the whole of the list so frequently 
 talked of, and so frequently admitted in practice ; the 
 sole difficulty is when to direct their power against 
 one of the fiercest diseases that has ever oppressed 
 mankind, and this is a difficulty that must be submit* 
 ted to professional skill for solution.' 5 
 
 TREATMENT OF THE EPIDEMIC CHOLERA IN INDIA, 
 
 One of the earliest accounts we have of this dis- 
 ease is contained in a letter from Frederick Corbyn* 
 Esq. assistant surgeon in the Bengal establishment, 
 to Sir Gilbert Blane, Bart, physician to the King of 
 England. This letter is dated at Sauger, September 
 ?th, 1819, and the following remarks respecting the 
 
THE CHOLERA. 143 
 
 treatment of the cholera are extracted from that let- 
 ter, as published in the Medico Chirurgical Transac- 
 tions for 1820. After describing the progress and 
 symptoms of the disease, Mr. Corby n says, 
 
 " It now affords me particular pleasure, as it will 
 be highly gratifying to you, to turn from the melan- 
 choly scene I have just described, and inform you 
 that the treatment I have hitherto followed, and 
 which the Marquis of Hastings, whose great anxiety 
 on the subject cannot be enough admired and com- 
 mended, did me the honor to have published in gen- 
 eral orders and circulated in the army throughout In- 
 dia, has proved eminently successful. I shall now 
 quote the authority of others for the excellence of the 
 remedies which I found so decidedly and invariably 
 successful in my own practice, and it is grati- 
 fying to me to reflect, that through the promul- 
 gation and general adoption of them, an incalculable 
 number of lives has been saved. 
 
 The outline of the treatment alluded to, is, to ad- 
 minister twenty grains of calomel (in powder., not in 
 pills) and to wash it down with sixty drops of lauda- 
 num, and twenty drops of oil of peppermint in two 
 ounces of water, to bleed freely in the early stage, and 
 to support the warmth by external heat, the hot bath 
 and hot friction, and internally by cordials. 
 
 The first report is dated Seroor, the 22d of July, 
 1818, by Mr. Assistant Surgeon Wallace. He re- 
 marks, ' The disease is most formidable. We have 
 found the large doses of calomel, oil of peppermint 
 and laudanum, generally succeed in checking the 
 purging and vomiting. But the most formidable symp- 
 toms are the sudden debility and coldness, which 
 seem to indicate the use of the most powerful stimu- 
 
14 4 TREATMENT OF 
 
 lants. The hot bath has been found very useful.' 
 This gentleman's third report states as follows ; ' I 
 believe Mr. Corbyn's practice to be very efficacious 
 when adopted early. The majority of cases did not 
 apply for relief until they had been attacked for some 
 hours, and the medicines were almost invariably re- 
 jected in common with every other liquid. I deter- 
 mined to administer the medicine in another form, 
 and rubbed up tw 7 o grains of soft opium, with fifteen 
 grains of calomel, and about two drachms of honey. 
 This was gradually swallowed, being dropt into the 
 patient's mouth by the finger. After this he was pla- 
 ced in the hot bath, and small quantities of hot arrack 
 and water mixed with spices and sugar given to drink. 
 The patient commonly fell asleep, and in favorable 
 cases, awoke free from danger. In others, the cold- 
 ness and spasms recurred, when recourse was again 
 had to the hot bath, and opium administered in vari- 
 ous forms. Twenty-two cases only were admitted 
 yesterday, and all of them except two have recover- 
 ed.' 
 
 Dr. G. Burrill, surgeon of the 65th regiment, dates 
 his report at Seroor, 27th July, 1818, and makes the 
 following return. It broke out on the 18th inst. 
 
 Admitted 21st 
 
 1 
 
 22d 
 
 6 
 
 23d 
 
 6 
 
 24th 
 
 18 
 
 25th 
 
 22 
 
 26th 
 
 7 
 
 60 Died, 4. 
 
THE CHOLERA. 145 
 
 < On admission, I bled in every instance, in gene- 
 ral, to a good extent. Where universal spasm exist- 
 ed, venesection was carried ad deliquium, and the pa- 
 tient was at the same time put into a hot bath of 110°. 
 The spasms were, by these means, invariably reliev- 
 ed, nausea and vomiting alleviated, so that the stom- 
 ach bore the exhibition of calomel in scruple doses, 
 combined with laudanum, which doses were fre- 
 quently repeated ; in short, the opium was given un- 
 der every denomination, with calomel, and 1 believe 
 the calomel will be found to rest on most stomachs 
 per se. 
 
 The next report is from Mr. Surgeon Whyte, da- 
 ted Seroor, the 28th of July, 1818. He states, ' The 
 practice 1 had followed was that first recommended 
 by Johnson*, and since by Mr. Corbyn, in which 
 the corner stone and sheet anchor is calomel, in a 
 dose of fifteen or twenty grains of the former, to an 
 adult, according to his strength.' 
 
 We now come to that of Mr. Assistant Surgeon 
 Daws. His letter is directed to Dr. Jukes at Tan- 
 nah, dated at Aurangabad, 2^th of July, 1818. He 
 remarks as follows : ' I presume you have seen the 
 letter written by Mr. Corbyn, who had charge of 
 the Native Hospital, centre division of the army, at 
 Eritch, to Captain Franklyn, Assistant Quarter 
 Master General of the same division. On this sub- 
 ject I could not perhaps do better than recommend 
 you to pursue the plan of treatment therein laid down, 
 as it is the same, with very little variation, that 1 have 
 
 * In his work on the influence of tropical climates on European 
 constitutions, where he quotes the case of a seaman who had swallow- 
 ed a scruple of calomel. 
 
 13 
 
146 TREATMENT OF 
 
 adopted, and you will be glad to hear that the suc- 
 cess of my own practice tends to corroborate it.' 
 
 The next report is from Mr. Surgeon Craw, dated 
 Seroor, 30th July, 1818. He observes; c The calo- 
 mel and laudanum plan, with most diffusible stimuli, 
 and the hot bath, have been eminently successful ; 
 and if application is made within four or six hours 
 from the first appearance of the disease, the cure is 
 almost certainly effected.' In another place he re- 
 marks, that a bleeding quoad vires, the calomel and 
 opiate, the hot bath, warm clothing, and frictions, 
 spiritous or anodyne, form the chain of treatment in 
 the European Hospitals here, and these are repeated 
 again and again as the symptoms may seem to de- 
 mand. Under this plan, and an early application 
 for relief, 1 think the disease is not fatal in more than 
 one in a hundred cases. The following report is from 
 Assistant Surgeon Campbell of the 22d dragoons, 
 dated from Seroor. ' The scruple dose of calomel 
 with Corbyn's anodyne draught was given every two 
 hours, but when the spasms and vomiting had ceased, 
 the laudanum was omitted, the calomel continued, 
 and the stimulants more frequently given.' 
 
 The next report is from Mr. Assistant Surgeon 
 Tod, dated Camp Chumargoody, Aug. 8, 1818. ' The 
 way I have administered medicine is by giving calo- 
 mel, one scruple, and washing it down with tinctura 
 opii, one drachm, and water, two ounces, and repeat- 
 ing them after an hour, if the first dose is rejected. 1 
 have sometimes left the interval of an hour, which 
 generally succeeds ; but 1 have, in a few instances, 
 been under the necessity of giving it three or four 
 times.' In another place, this gentleman adds,'! 
 have had altogether an hundred cases w 7 here the cal- 
 
THE CHOLERA. 147 
 
 orael and opium plan has been followed, and though 
 ten or twelve have died, these were either such aged 
 subjects that no rational hope of recovery could be en- 
 tertained, or were brought in at such an advanced 
 stage of the complaint, as to be beyond the power- of 
 medicine. 5 
 
 Mr. Assistant Surgeon Milwood writes the next re- 
 port, which is dated Ahmednugger, 2d August, 1318. 
 'I will now give my treatment, with my reason for 
 the addition I have made to Mr. Corbyn's. There 
 are two great objects to be attained for the recovery 
 of the patient. 1st, to allay the vomiting and pur- 
 ging ; — 2ndly, to restore the pulse and heat of the 
 extremities and produce sleep. In order to effect 
 these, I have, in addition to one scruple of calomel, 
 put five grains of antimonial powder, and added to 
 the draught one drachm of spt. aether, nitros. In the 
 course of two hours, I give ten grains of calomel and 
 five of antimonial powder, with half the draught 
 which 1 prepare with camphor mixture, in place of 
 plain water, and repeat this as it is required. The 
 best laxative I have found to be carbonate of mag- 
 nesia, four scruples. It remains on the stomach, and 
 generally causes two or three plentiful evacuations.' 
 
 Mr. Assistant Surgeon Richards reports as follows. 
 Punderpoor, 3d of August, 1818. ' Up to this morning 
 the admissions amount to 170; out of which eight 
 casualties have occurred.' This gentleman bled and 
 used the calomel and laudanum doses. 
 
 To evince how essentially necessary bleeding is, Dr. 
 Burrell sends the following return : — 
 
148 TREATMENT OF 
 
 Bled 88 Died 2 
 
 Not bled 12 " 8 
 
 Total admitted, 100 Died 10 
 
 I now come to Mr. Surgeon Longdill's report, da- 
 ted Seroor, 17th of August, 1818. 'My general plan 
 of treatment was to give the dose recommended by 
 Mr. Corbyn. If it was rejected, another was given, 
 after waiting an hour, with the warm bath, which 
 generally relieves the patients ; after which they re- 
 quired little else but cordials and a gentle laxa- 
 tive.' 
 
 Mr. Surgeon Robertson, of the European Regi- 
 ment, on the Bombay establishment, dates his report 
 from Keerky, and states that bleeding relieved them, 
 and that calomel and opium brought them quite 
 round. 
 
 The report which succeeds is from Mr. Surgeon 
 Gordon, dated Satara, 5th September, 1818. 'I sent 
 you a report in which I stated that I laid considera- 
 ble stress on free and early blood-letting. Since 
 then, 1 have had eleven cases, bled the whole of them, 
 then opened the bowels, and they are all quite well."' 
 
 Mr. Surgeon Coats reports to the President of the 
 Medical Board, that ' the practice followed in the 
 medical treatment of this disease at Aurangabad was 
 that recommended by Mr. Corbyn, and had been 
 particularly successful ; indeed, if the patient applied 
 in time, it was considered as infallible.' 
 
 Mr. Surgeon Jukes next reports, that £ experience 
 has now taught us that a very large proportion of 
 those attacked by the disease, recover by the calo- 
 mel and laudanum alone; but I feel satisfied that 
 there are many aggravated cases wherein nothing but 
 
THE CHOLERA. 149 
 
 the most prompt and decided use of the lancet could 
 possibly save the patient.' 
 
 The next report comes from Dr. Taylor, a gentle- 
 man who had the principal practice in the disease at 
 Bombay. This practice is precisely similar to the 
 foregoing ; he gives the following return : — 
 
 Medicine administered to 7,459 
 
 Of whom died 441 
 
 being a proportion of nearly six to an hundred. 
 
 The last report is from Geo. Ogilvy, Esq. Secretary, 
 to the Medical Board, confirming the treatment al- 
 ready mentioned, and the reports are concluded with 
 the following abstract of cases which occurred in the 
 
 island of Bombay. 
 
 
 
 1817. 
 
 Cases. 
 
 Deaths 
 
 August 
 
 4400 
 
 456 
 
 September 
 
 4804 
 
 287 
 
 October 
 
 2411 
 
 146 
 
 November 
 
 824 
 
 44 
 
 December 
 
 806 
 
 64 
 
 1819. 
 
 
 
 January 
 
 889 
 
 114 
 
 February 
 
 517 
 
 27 
 
 14651 1138 
 
 Proportion of deaths in those cases in which medi- 
 cine was administered, 6.6 per cent. In the same 
 space of time 1294 cases were reported by the police, 
 in none of which, medicine was administered, and it 
 is a most important remark by Mr. Ogilvy, Secretary 
 to the Medical Board, that it was not ascertained 
 13* 
 
150 TREATMENT OF 
 
 that any case had recovered in which medicine had not 
 been administered. 
 
 The population may amount to between 200,000 
 and 220,000. The number of ascertained cases was 
 15,945, which gives the proportion of the attacks of 
 the disease to the population, 1\ per cent. 
 
 I believe 1 have now satisfactorily proved to you 
 the efficacy of the treatment 1 recommended. 1 
 shall add the remarks of the Medical Board of Bom- 
 bay, made after summing up the whole of the opin- 
 ions regarding the proper mode of treatment to be 
 adopted. 
 
 4 On the subject of the cure of the disease, we need 
 say but little. The practice so j udiciously and speed- 
 ily adopted by Dr. Burrell in the 65th regiment, clear- 
 ly proves, that in the commencement of the disease 
 in Europeans, blood-letting is the sheet-anchor of 
 successful practice, and perhaps also with the natives ; 
 in this 1 have entirely concurred in my printed report, 
 but have there said nothing of this practice among the 
 natives. I tried bleeding with the natives, but could 
 get no blood from the arm, and finding every efficacy 
 from the medicine 1 prescribed, I had no occasion to 
 make a second attempt ; but I have no doubt you 
 will perceive, from the principles on which I ground 
 the cure, that the venesection is advisable in all cases 
 where blood can be obtained ;' to proceed — ' provi- 
 ded it can be had recourse to, sufficiently early in the 
 disease, and as long as the vital powers remain so as 
 to be able to produce a full stream, it ought never to 
 be neglected, it being sufficiently proved that the de- 
 bility so much complained of, is merely apparent. 
 Calomel as a remedy certainly comes next in order, 
 and when employed in proper doses with the assist- 
 
THE CHOLERA. 151 
 
 ance of opium, more particularly in the early stage of 
 the disease, seems to be equally effectual among the 
 natives, as venesection among the Europeans, in ar- 
 resting its progress. In all the cases formerly alluded 
 to, when we met with the disease in its first attack, a 
 single scruple of calomel with 60 minims of laudanum, 
 and an ounce of castor oil seven or eight hours after- 
 wards, was sufficient to complete the cure. The 
 practice of this place, as sufficiently appears from 
 Dr. Taylor's report, bears ample testimony to the 
 control which calomel possesses over this disease. 
 All other remedies must in our opinion be considered 
 as mere auxiliaries, no doubt extremely useful as 
 such, and ought never to be neglected, particularly 
 the warm bath and stimulating frictions.' 
 
 I trust, Sir, I have now performed my duty in giv- 
 ing you a full and accurate account of the nature and 
 treatment of this alarming epidemic. I am still ac- 
 cumulating information, but in the mean time, as my 
 object is utility and not emolument, I beg you will 
 give publicity to this letter, by procuring the insertion 
 of it in that excellent work, the Transactions of the 
 Medico-Chirurgical Society. 
 
 I am, my dear Sir, 
 Your very obedient Servant, 
 
 Frederick Coubyn. 
 
 To Sir Gilbert Blane, Bart." 
 
 Several years after the above was written, the 
 Madras Medical Board published an account of the 
 epidemic cholera, as it appeared in the territories sub- 
 ject to the Presidency of Fort St. George, 
 
 This report was drawn up by William Scot, sur- 
 geon and secretary to the Board, and the following 
 
152 TREATMENT OF 
 
 remarks respecting the treatment of the disease are 
 extracted from that report. The accompanying re- 
 marks are from the Medico Chirurgical Review for 
 
 1825. 
 
 " In no disease has the sovereign efficacy of nu- 
 merous specifics been more vaunted — in none have 
 they been more frequently inefficient, than in chole- 
 ra. While the general tendency of the disease was 
 almost invariably towards a fatal termination, there 
 was yet a certain stage, at which its progress might, 
 in very many instances, be arrested by the most op- 
 posite, and sometimes by the most trifling remedies. 
 The earliest movements in cholera, especially as it 
 first manifested itself, were generally confined to irri- 
 tation of the stomach and bowels — ; and in this stage 
 it is unquestionable that the mere exhibition of an 
 anodyne, a cordial, or an antispasmodic medicine 
 was sufficient, in numberless instances, to stop the 
 progress of the disease, and to effect a cure.' After 
 the first epidemic sweep, however, of the cholera, it 
 was universally acknowledged by practitioners, that 
 the remedies so successful in their former practice, 
 were almost totally unavailing in the subsequent visi- 
 tations. 
 
 Opium. JNo medicine has been so universally 
 used as this, and none, perhaps, has so generally re- 
 tained its reputation. It was more successful, how- 
 ever, among the natives than among the Europeans, 
 from their greater susceptibility to the action of medi- 
 cines. 
 
 ' While, as an anodyne and antispasmodic, the 
 efficacy of opium in the cure of cholera has been pro- 
 ved by experience to be great, it is painful to be 
 
THE CHOLERA. 153 
 
 obliged to acknowledge, that in many apparently 
 promising cases, where even its narcotic effect was 
 evident, it had no ultimate effect in warding off a fa- 
 tal termination ; and in the advanced stages of the 
 disease, whether it was first exhibited at that period, 
 or whether its use may have been begun earlier, and 
 then continued, its efficacy in restoring the depressed 
 or suspended functions, like that of all other remedies, 
 is extremely uncertain. Those cases may, with 
 most confidence, be chiefly trusted to the effect of 
 opium, in which the primary symptoms are seated, 
 apparently, in the stomach, as indicated by vomiting, 
 and spasmodic pain in that region ; and in the intes- 
 tines, as indicated by violent purging, and painful 
 contractions of the abdomen. Its effects are more 
 uncertain, where the affection of the stomach is ob- 
 scure ; where there is a moderate, but insidious purg- 
 ing ; where there is great sense of heat in the epigas- 
 trium, and in every case where collapse has come 
 on.' lv. 
 
 Passing over aether, ammonia, spirits, wine, and 
 other diffusible stimuli, we come to— 
 
 Calomel This was almost as universally given as 
 opium, and as indiscriminately. It was administered 
 for various indications, and with various views, ac- 
 cording to the practitioner's opinions respecting the 
 nature of the disease. Mr. Scot does not appear to 
 be favorable, on the whole, to the administration of 
 calomel, at least in the early stage of cholera. 
 
 ' The success of those practitioners, who did not 
 use calomel in the primary treatment of cholera, 
 has been fully as great as that of those who did : 
 while the arguments, distinctly brought forward by 
 various medical officers against its early exhibition^ 
 
154 TREATMENT OF 
 
 appear decisive against the observations which have 
 been offered in support of the practice. Calomel has 
 unquestionably a powerful effect in exciting the bilia- 
 ry system, and in this view, its exhibition is highly 
 necessary : but the suppression of the excretion of 
 bile being only a link in the common chain of symp- 
 toms, and its partial, or occasional removal, or even 
 its total absence, having been proved to be of little 
 consequence in the general course of the disease, to 
 attempt to excite it by particular means, may be con- 
 sidered as premature and injudicious. Whenever a 
 favorable change takes place, indicated by a renew- 
 al of the ordinary functions, then the exhibition of 
 the appropriate stimulus seems to be clearly indica- 
 ted, and not till then.' Ivii. 
 
 Blood-letting. This remedy was first proposed by 
 the editor of this Journal, from observing its effects in 
 one or two sporadic cases of cholera in the island of 
 Ceylon, more than twenty years ago. It will be seen, 
 from the following extract, that it has been an im- 
 portant measure of late, in the treatment of this ter- 
 rific malady. 
 
 ' The abstraction of blood, unless as an anti-spas- 
 modic, is a remedy so little indicated by the usual 
 symptoms of cholera, that its employment in the cure 
 of this fatal disease has afforded a signal triumph to 
 the medical art. It requires no common effort of rea- 
 soning or reflection to arrive at the conclusion, that, 
 when the powers of life appear depressed to the low- 
 est degree, the pulsation of the heart all but extinct, 
 the natural heat of the body gone, and the functions 
 of the system suspended and incapable of being re- 
 vived by the strongest stimulants, the abstraction of 
 blood might yet prove a remedy against a train of 
 
THE CHOLERA. 155 
 
 symptoms so desperate. Bleeding was, no doubt, 
 first employed in cases where there was much 
 spasm, and where the powers of the system had not 
 much declined : the relief was generally obvious and 
 immediate, and the practice in such instances was 
 thus established. Dissections having frequently 
 shown a loaded state of the vessels of the viscera, 
 and apparent inflammation of their mucous mem- 
 branes, venesection was also adopted to obviate 
 these conditions, and naturally enough : but the em- 
 ployment of blood-letting, without reference to either 
 of these states, and as a remedy for collapse in chole- 
 ra, must have been the result of reasoning and reflec- 
 tion, founded on the general principles of the science ; 
 a result highly honorable to the profession ; and, as 
 we shall endeavor to show, of the utmost practical 
 importance in the cure of the disease. 
 
 ' We have no precise information regarding the 
 manner in which venesection was performed in 
 general ; although, in such a disease, this seems a 
 matter of very considerable consequence. It is re- 
 markable, that in a disease like cholera, syncope 
 should be so rare a symptom. W hen it is brought on 
 by venesection, it is generally favorable, which may 
 most probably be imputed to its being employed dur- 
 ing violent spasm, and before any sinking has taken 
 place. We can then readily understand, that the 
 free evacuations of blood, which may be supposed to 
 precede the syncope, as well as that state of relaxa- 
 tion itself, will be followed by amendment : but there 
 is no information, which can lead us to believe, that 
 syncope has often followed the abstraction of small 
 quantities of blood, or that success had followed 
 small bleedings. The usual expression is, that after 
 
156 TREATMENT OF 
 
 a scanty discharge of blood, it ceased to flow, and 
 that depression of pulse, with faintness, not syncope, 
 came on, or was increased. We are not informed, 
 whether bleeding has been generally performed in the 
 recumbent, or half erect posture. It is evident from 
 the reports, that the mere act of elevating the body 
 has been followed by faintness and even death : and 
 if venesection has been often attempted in the half 
 erect posture, we may thence account in some mea- 
 sure, for the frequent want of success in obtaining 
 blood. 
 
 ' Few remedies, on a fair trial, have been more 
 generally and unequivocally advocated than free 
 blood-letting; and the most that has been urged 
 against it is, that it is not always successful. The 
 advocates for bleeding proceed, however, on the prin- 
 ciple, that a certain quantity of blood is to be obtain- 
 ed, in order to ensure success, which few of them 
 estimate at less than about 30 ounces. Those who 
 are disposed, either less favorably towards bleeding, 
 or to condemn it altogether, object, that if the circu- 
 lation is in a condition to admit of free bleeding, the 
 case is a mild or favorable one, and would probably 
 yield to other remedies. There is no doubt, that fa- 
 tal collapse has sometimes suddenly followed, even 
 large bleedings, which has staggered the faith of 
 many practitioners in the general safety of the reme- 
 dy; but in the great majority of cases, it is after small 
 bleedings that this has happened. There is the most 
 ample evidence also, that cases, especially in Eu- 
 ropeans, even under the most favorable appearances, 
 will often, in spite of all internal and external reme- 
 dies, go on to a fatal issue, when bleeding is not prac- 
 tised. 
 
THE CHOLERA. 157 
 
 * The cause of collapse coming on after, or during 
 bleeding, in cases of cholera, may perhaps be ex- 
 plained, so as to obviate the objections thence arising 
 against it as a remedy in that disease. It seems un- 
 questionable, that the evacuation of a small portion 
 of blood, such for instance, as we might suppose to 
 be yielded by the remoter branches of vessels, is fol- 
 lowed by increased debility : but if we succeed in 
 carrying on evacuation, till its effects reach the inter- 
 nal vessels and the heart itself, then the circulating 
 system seems to be freed from an oppression which 
 impeded its functions, and it becomes equal to the 
 task of propelling the mass of blood. This is a species 
 of indirect excitement. The powers are not raised, 
 but the resistance, or weight, is lessened. Such is the 
 theory, which has been adduced in support of blood- 
 letting in cholera. The reader will be aware, that it 
 is not new ; its application to the* particular disease, 
 of which we are now treating, being the only novel- 
 ty • If the theory be true, the presence or the superven- 
 tion oj collapse, so Jar from, deterring us from going on, 
 should only be regarded as additional reasons for re- 
 newing our efforts to get bloods 
 
 In proof of this, a great many testimonies are 
 brought forward drawn from the journals of medical 
 officers, after which Mr. Scot goes on thus : — 
 
 1 Besides the very ample evidence, which will be 
 found in the printed reports, in favor of blood-letting 
 as a remedy in cholera, the opinions of the majority 
 of medical officers whose observations are not insert- 
 ed, are also decidedly in its favor. The objection 
 chiefly urged, is not against the practice, but rests on 
 the too frequent impracticability of procuring a suffi- 
 cient quantity of blood. It is acknowledged, even by 
 
158 TREATMENT OF 
 
 the most zealous of its advocates, that this difficulty has 
 often occurred, and proved insuperable. When, how- 
 ever, the operation is performed with the moral con- 
 viction, that, if successful in obtaining blood, the life 
 of the patient will most probably be saved, the opera- 
 tor will presevere, undiscouraged, in his efforts : he 
 will call in every suitable aid, such as frictions, bath- 
 ing the arm in hot water, re-opening the orifices of 
 the vessels, administering stimulants, and external 
 warmth. He is not deterred and induced to desist 
 by any intermediate accession of debility, or collapse; 
 nor, is he tempted to rest satisfied with any tempora- 
 ry melioration of pulse ; his object goes beyond the 
 present moment, and he feels satisfied, that if he can 
 fuliy unload the internal vessels, he will save his pa- 
 tient, and if he fails, that he will most probably lose 
 him. It is not considered to be of much importance 
 whether the patient may have been bled before or not, 
 if his present symptoms indicate a repetition of the 
 operation. The principle is, that collapse, in cholera, 
 is not the consequence of the loss of blood, but is a 
 condition which nothing but its abstraction can be 
 trusted to for relieving. In the second case, however, 
 when the medical man is not decided in his own 
 mind, obstacles will be allowed to subdue his forti- 
 tude, and arguments will be then deduced to dissuade 
 him from perseverance. A sudden aggravation of 
 the symptoms of collapse will be regarded as an ef- 
 fect of a remedy, at least doubtful; or, a transient 
 return of vascular action will be held, either as a 
 sufficient advantage gained, or as an indication that 
 bleeding is no longer required. It is thus we may 
 account for a vast number of ineffectual, because un- 
 decided attempts at blood-letting; and for avast 
 
THE CHOLERA. 159 
 
 number of unsuccessful results, when the quantity 
 abstracted falls short of that which is required : for 
 the volume of the blood must be reduced in a given 
 proportion, in order to secure the effects expected 
 from it. Any thing short of this will only take away 
 from the patient's strength, and not augment the mo- 
 tive powers of the circulating system ; or what is the 
 same thing, will not diminish the resistance to the 
 motive powers. 
 
 ' Cholera is unquestionably a very dangerous dis- 
 ease, and so many circumstances concur in aggrava- 
 tion of its natural fatality, that we can scarcely hope 
 that any mode of treatment will ever be devised 
 which shall strip it of its formidable character. Much 
 injury has arisen, however, from remedies being 
 brought forward, and tried, as if they were absolute- 
 ly specific and infallible. And amongst others, blood- 
 letting has been put to this most unjust, and unphi- 
 losophical test. If strictly considered, it would, 
 perhaps, be the least of all entitled to the appellation 
 of a specific remedy ; for in truth, there is great rea- 
 son to doubt, whether it be directly curative of the 
 essential symptoms of cholera. Its warmest advo- 
 cates only consider it as an auxiliary, and never trust 
 to it, but in combination with other, and which indeed 
 appear to be, the strictly appropriate remedies. Con- 
 gestion, for which alone it is indicated, appears mere- 
 ly to be a symptom or consequence of that morbid 
 state, which forms the first and highest link in the 
 train of cholera actions. The removal of congestion, 
 which is mechanical, allows the heart to respond to 
 the action of the other remedies. Should it be ob- 
 jected, from a consideration of some dissections, that 
 no particular congestion has taken place, the blood 
 
160 TREATMENT OF 
 
 appearing to be equally diffused over the vascular 
 system ; and that in some instances, the circulation, 
 though ultimately affected, seems to retain its powers 
 for a time, without material depression, yet, even in 
 such cases, venesection, by lessening the volume of 
 the blood, may still have beneficial effects. We 
 should certainly apprehend no danger from it in cases 
 of this description, used, as it ought invariably to be 7 
 in conjunction with the other remedies.'* lxi. 
 
 These other remedies were principally antispas- 
 modics and stimulants. Of the various means, in- 
 ternal and external, not yet enumerated, it is quite 
 unnecessary to speak. Hot applications to the skin 
 had far less effect than might have been expected, 
 from the deadly coldness of the surface, and torpid 
 state of the extreme vessels." 
 
 Mr. James Annesley, of the Madras Medical 
 Establishment, and Surgeon of the Garrison and 
 General Hospital, Madras, published in 1825, a 
 Treatise on the epidemic cholera of the East, from 
 which the following remarks respecting the treatment 
 of the disease are taken : 
 
 " The following is the way in which this disease 
 has usually been treated under my direction : — 
 
 A patient is admitted into the hospital, I shall say 
 at noon, with all the symptoms of cholera; a vein is 
 immediately opened, and one scruple of calomel and 
 two grains of opium are given in the form of a pill, and 
 washed down with the camphor draught. The body 
 and extremities are well rubbed with dry flannels, 
 made warm, and bottles filled with hot water are ap- 
 plied to the feet and hands; but if the spasms are 
 severe, spirits of turpentine are used as an embroca- 
 
THE CHOLERA. 161 
 
 tion. In an hour, we generally perceive the effects 
 of these remedies, and whether the disease be in any 
 degree arrested, or be proceeding in its progress. If 
 the former, riothing more is to be done till evening, 
 when the calomel pill may be repeated, and an end- 
 ma exhibited. The following morning the bowels 
 should be again fully evacuated, and then the patient 
 may be considered safe. 
 
 When blood, however, cannot be drawn from the 
 arm, and the spasms continue ; when severe pain and 
 burning heat are felt at the umbilicus and scrobicu- 
 lus cordis, and are distressing ; when the skin is cold, 
 and deluged with cold clammy dew ; and when there 
 are oppression in the chest and difficulty of breathing 
 -—excessive pain and confusion about the head, with 
 great intolerance of light — no pulse, or a pulse scarce- 
 ly to be felt, and a cadaverous smell from the body, 
 twenty or thirty leeches should be applied immediate- 
 ly to the umbilicus and scrobiculus cordis ; the calo- 
 mel pill should be repeated, and the turpentine em- 
 brocations continued. Leeches ought likewise to be 
 applied to the temples and base of the scull. 
 
 When the leeches bleed freely, the application of 
 them is always attended with decided advantage, and 
 they should be allowed to remain till they have ful- 
 filled their duty ; after which, a large blister or sina- 
 pism should be applied over the whole abdomen. 
 Sometimes the leeches fasten, but do not draw blood. 
 In this case, they should be removed immediately, and 
 the sinapism or blister applied in their place. When 
 the bowels are very irritable, and constantly discharg- 
 ing a watery fluid, small anodyne enemas, with cam- 
 phor, may be given ; and the drogue amere, a nos- 
 trum used by the Jesuits, will be then found very use- 
 
 14* 
 
162 TREATMENT OF 
 
 ful in assisting the operation of calomel, which latter 
 should always be repeated every two hours, till three 
 or four scruples have been taken* 
 
 Whenever we fail in checking the disease at first* 
 we have no resource but to treat urgent symptoms, 
 and they must always be met with decision as they 
 occur. The patient ought never to be left a moment 
 without an attendant who is capable of acting ac- 
 cording to circumstances, and who may take advan- 
 tage of every change." 
 
 The cholera appeared at Port Louis, Mauritius, in 
 1819 and 1820, and the following account of the 
 treatment adopted at that place, is taken from a com- 
 munication by Dr. Kinnis, published in the Edin- 
 burgh Medical and Surgical Journal for 1821, 
 
 " In the fatal form of the disease, the chief reme- 
 dies employed, were bloodletting, the warm bath, 
 spirituous and dry frictions, rubefacients, the internal 
 exhibition of spirits, opium, calomel, Epsom salts, 
 and other purgatives. The extraordinary success of 
 Mr. Sheppard, in treating a similar disease by blood- 
 letting to syncope, as reported in Dr. Johnson's work 
 on tropical climates, induced me to practice it on 
 the two first patients attacked ; but from neither of 
 them, though veins were opened in each arm, could 
 more than twelve ounces of uncommonly dark blood 
 be obtained. Mr. Markham tried it with no better 
 success in two other cases. It was also tried, as we 
 have seen, in some of the less violent affections ; and, 
 the impression produced on me by the whole is, that 
 when only a few ounces can be obtained, their ab- 
 straction accelerates the fatal event, and when blood- 
 
THE CHOliERA. 163 
 
 letting can be carried to syncope, the disease is cura- 
 ble without it. 
 
 Opium seemed, in many cases, to prevent the ac- 
 tion of other remedies, by causing a torpor of the in- 
 testines ; and the warm bath contributed to the same 
 effect, by diverting the fluids to the external surface. 
 The first, 1 think, ought never to be exhibited after 
 vomiting has ceased ; nor the second, unless the skin 
 is dry and the cramps very severe* 
 
 The cold arising from their evaporation, appeared 
 to counteract the stimulant effects of the spirits em- 
 ployed in friction ; they were soon dropped altogeth- 
 er, and warm flannels substituted, particularly during 
 the spasmodic paroxysm, but friction of no descrip- 
 tion ever obviously contributed to restore the natural 
 warmth. Cataplasms of mustard, garlic, and capsi- 
 cum, beat up into a mass, with spirits of hartshorn 
 and vinegar, were suggested by Dr. Burke, and some- 
 times applied to the prsecordia and extremities ; but 
 in one case only produced the smallest rubefacient 
 effect. 
 
 At the commencement of the disease, spirits were 
 very liberally administered, both in the form of 
 draught and enema ; most of the patients swallowed 
 them with great reluctance, and rejected them im- 
 mediately, even when combined with tincture of 
 opium. 
 
 Though aware that calomel had been recommend- 
 ed in the cholera of India, the astonishing rapidity of 
 its course prevented me from thinking of that medi- 
 cine in the two first cases that occurred. Observing, 
 however, that bile was absent in the egesta and in 
 the alimentary canal of every patient 1 had seen ; that 
 one man, after overcoming the first symptoms, passed 
 
164 TREATMENT OF 
 
 nothing else ; and lastly, that every other remedy had 
 turned out either useless or prejudicial, I resolved to 
 try calomel, and to throw it in with a precipitance 
 which the nature of the disease seemed to justify, in 
 the unhappy case already detailed. That patient 
 was considered convalescent on the 6th December ; 
 and before the 14th of the same month, when the san- 
 guine expectations 1 had been led to entertain of his 
 recovery were exchanged for the bitter certainty of 
 his approaching dissolution, five other cases had been 
 admitted, and treated nearly in the same way. Two 
 only were salivated and recovered ; but one of these, 
 alluded to in describing the symptoms, shared the fate 
 of poor Reed, and died on the 1 2th day. The other 
 took twelve scruples of calomel, of which probably a 
 considerable quantity was vomited ; his ptyalism was 
 by no means severe ; and he was discharged nine 
 days after admission. 
 
 From all I had seen of the symptoms, and all I 
 could find on dissection, it now appeared to me that 
 mercury was the only known remedy on which any 
 dependence could be placed ; at the same time, that 
 I had lamentably mistaken the proper mode of intro- 
 ducing it into the system. Instead of a scruple eve- 
 ry two hours, 1 now gave that quantity on admission, 
 and repeated it as often as rejected by vomiting ; 
 when one scruple had been retained, five grains were 
 given every hour. Out of six cases, treated on this 
 plan, two recovered, though in neither of them the 
 mouth became affected. 
 
 The renewal of the secretion of bile, which is evi- 
 dently suspended in this disease, I consider to be our 
 grand object in the treatment; but the safest and 
 most speedy method of accomplishing that object, 
 

 THE CHOLERA. 165 
 
 when it is possible, my limited experience does not 
 enable me to point out. 
 
 Another desideratum in the treatment, is a method 
 of suppressing vomiting, that would not interfere with 
 the action of other remedies. Opium, calomel, and 
 sulphuric acid, separately or combined, are inadequate 
 to this effect ; abstinence from liquid ingesta might 
 perhaps answer, if one patient in twenty could sub- 
 mit to the torture of that privation. 
 
 Purgatives were generally exhibited by enema, 
 soon after admission, and by draught, the moment 
 there was any probability of their being retained. 
 Sulphate of magnesia and the infusion of senna were 
 preferred ; but the cathartic tinctures, also, were very 
 frequently administered in the form of enema. 
 
 Sometimes, immediately after recovery, the evacu- 
 ations consisted of a deep grass-green fluid, of the con- 
 sistence of a thin jelly. 
 
 Of the multiform, but less severe varieties, which 
 the epidemic assumed, the simplicity of the treatment 
 was only authorized by its unvarying success. Ten 
 grains of calomel, or, when the vomiting was severe, 
 a scruple, followed, at the distance of some hours, by 
 an ounce of salts, with or without infusion of senna, 
 and once or twice repeated, cured almost every case, 
 Most of the instances, in which blood-letting was re- 
 sorted to, have been given at length ; we have seen 
 that it seldom produced any decided relief until the 
 bowels had been freely opened ; and I am inclined to 
 think it might always have been very safely dis- 
 pensed with. When considerable debility and ano- 
 rexia survived all the other symptoms, the patient 
 used to be brought round, in a few days, by one of 
 
166 TREATMENT OF 
 
 the bitter infusions, mixed with a small proportion of 
 the compound tincture of bark." 
 
 TREATMENT OF THE CHOLERA IN EUROPE. 
 
 When this disease first appeared in Europe, re- 
 course was had to the publications from India, not 
 only for an account of the disease, but for the treat- 
 ment of it. And upon examination, we find nearly 
 the same remedies have been employed in all coun- 
 tries. Blood-letting, opium, calomel, and external 
 warmth, have every where been first resorted to, in 
 attempting to subdue the disease. 
 
 Drs. Russell and Barry, agents of the British Gov- 
 ernment, and who witnessed the disease in Russia, thus 
 allude to the treatment. 
 
 6 Of the two great classes of functions performed by 
 the organs of which man is composed, one only is at- 
 tacked in this disease. The operations of the senses 
 and of the intelligence are either left untouched, or are 
 affected but in a secondary manner. 
 
 Those functions, on the contrary, by which existence 
 as a living being is preserved, — those complicated 
 powers, by means of which we are forever appropria- 
 ting and converting into a part of ourselves, portions 
 of the matter around us, — are all and at once deran- 
 ged by the attack of this terrible malady. Nutrition 
 is annihilated ; respiration becomes difficult, irregular 
 and inefficient ; the involuntary muscles no longer per- 
 form their task ; the voluntary are drawn into con- 
 tractions by other powers than the will ; the blood 
 ceases to circulate ; its physical properties are alter- 
 
THE CHOLERA, 167 
 
 ed; its serous portion is suddenly thrown out upon 
 the intestinal mucous surface of the body ; the secre- 
 tions are all arrested ; and animal heat is no longer 
 produced. 
 
 Under such rapidly destructive, and almost univer- 
 sal derangement of functions, the most energetic efforts 
 should be directed to re-produce what the disease has 
 rendered nature unable to keep up, viz., 
 
 1st. Fluidity, heat, and motion in the blood. 
 
 2ndly. Regulated action in the voluntary and invol- 
 untary muscles. 
 
 Lastly, but above every other consideration, renewed 
 energy in the nervous centre, the source of all vitality 
 and function. 
 
 No remedy at all approaching to the nature of a spe- 
 cific has been as yet discovered for this disease. In 
 fact, no one mode of cure can be usefully employed un- 
 der all the circumstances of any disease. The grades 
 of intensity, and the grouping of the symptoms with 
 which spasmodic cholera makes its attacks, vary with 
 the conditions of the subject ; its treatment, therefore, 
 must vary with these grades and conditions. 
 
 The leading preliminary symptoms generally are, 
 either diarrhea, spasms, apoplectic vertigo, with nau- 
 sea, imperfect vomiting, or various combinations of 
 these symptoms. 
 
 When the diarrhea affords time for distinct treat- 
 ment, it ought to be arrested at once by the most 
 prompt and efficient measures ; by opium in moderate 
 doses ; astringents ? local bleeding by leeches, if the 
 subject be; plethoric ; by cordials and sulphate of qui- 
 nine, if there be cold sweats ; by confining the patient 
 strictly to bed, and keeping up heat ; by diet ; by 
 emetics. 
 
168 TREATMENT OF 
 
 Should spasms be the first and leading symptom, 
 subnitrate of bismuth, cupping along the course of the 
 spine, cordial and antispasmodic medicines, opium, 
 frictions, and dry warmth are indicated. 
 
 But when the patient is suddenly seized with ver- 
 tigo, nausea, coldnesss, loss of pulse, blueness of the 
 skin, shrinking of the features and extremities, with 
 more or less watery discharges and cramps ; constitu- 
 ting an aggravated case of the worst type ; whether 
 this state shall have come on without warning, or shall 
 have supervened upon either or both of the preliminary 
 sets of symptoms already mentioned, time must not be 
 wasted upon inert measures. Such a patient w r ill inev- 
 itably perish, and within a few hours, if the paralysed 
 vital functions be not quickly restored. 
 
 Let him then be immediately placed between warm 
 blankets ; and should no medical person be at hand, 
 let two table-spoons full of common kitchen salt, dis- 
 solved in six ounces of warm water, be given immedi- 
 ately, and at once if he be an adult. Let dry and 
 steady heat be applied along the course of the spine, 
 and to the pit of the stomach (if no other means be at 
 hand) by a succession of heated plates or platters. 
 Let the upper and lower extremities be surrounded 
 with bags of heated bran, corn, ashes, or sand, and as- 
 siduously rubbed with a warm hand, and a little oil or 
 grease to protect the skin. Energetic, complete vom- 
 iting will probably be produced by the salt ; and per- 
 haps bilious purging, with tenesmus. 
 
 Should a medical man be on the spot, a moderate 
 bleeding, if it can be obtained, would be desirable, 
 previously to, or immediately after the administration 
 of the salt, or of any other emetic which may be pre- 
 ferred. 
 
THE CHOLERA. 169 
 
 The extensively deranged action of those organs 
 whose nerves are chiefly derived from, or connected 
 with the spinal marrow, the anatomical characters 
 found about that great source of vitality after death, 
 in many cases of the disease, together w 7 ith the success 
 stated by Dr. Lang, chief physician at Cronstadt, to 
 have attended the practice mentioned below, founded 
 upon these views, in 12 out of 14 aggravated cases, 
 fully justify the following recommendation. 
 
 In cases such as those just described, let the actual 
 cautery be freely applied to one, two, or more places on 
 either side of the spine, as if for the purpose of form- 
 ing good sized issues. Should the heated iron have 
 produced any excitement of the nervous power, and 
 the salt emetic have caused any portion of the bile to 
 flow through its proper duct, a great step will have 
 been accomplished towards recovery from the stage 
 of collapse. Cordials and opiates judiciously adminis- 
 tered; sinapisms and other external stimulants; mer- 
 curials with mild aromatic aperients, which the intelli- 
 gence and activity of British medical practitioners will 
 not fail to adapt to the actual circumstances of each 
 case, will conduct the patient safely to the stage of re- 
 action. 
 
 The organs, during the collapse of this disease, prob- 
 ably owing to deficient vitality, often give no indica- 
 tion of having been acted upon by repeated doses of 
 certain powerful medicines, which under other cir- 
 cumstances would have produced the most decided 
 effects. It is therefore suggested that this temporary 
 insensibility of the system should nat inculcate the ad- 
 ministration of such quantities as could, by accumula- 
 tion, when the organs begin to recover their vitality, 
 give rise to unfavorable results. 
 
170 TREATMENT OF 
 
 Thirst being a most distressing symptom in this dis- 
 ease, the quality and temperature of the drink should 
 perhaps be left to the choice of the patient ; but the 
 quantity taken at a time should not exceed four oun- 
 ces, and should be acidulated with nitrous acid, if the 
 patient will bear it. 
 
 Should the disease prove extensively and rapidly 
 epidemic in a large community, it would be prudent 
 to establish stations at convenient distances from each 
 other, where medical assistance and medicines might 
 be procured without the risk of disappointment or de- 
 lay. The details of these arrangements are left to 
 the wisdom of local boards of health. 
 
 As to the symptoms of the consecutive stage of fe- 
 verish re-action in cholera, they differ but little, if at 
 all, from those of ordinary typhus, except, perhaps, 
 in the greater rapidity with which they but too often 
 run to a fatal termination ; and as this kind of fever 
 is treated in no part of the world with more success 
 than in England, the entire management of this stage 
 of the disease is left to the zeal and science of the pro- 
 fession at large. 
 
 Attentive nursing, and assiduous, well-directed 
 rubbing, are of the utmost importance ; a strictly hor- 
 izontal position, however, must be maintained until 
 the heart shall have partly, at least, recovered its ac- 
 tion. An erect, or even semi-erect position, during 
 the collapse, has been often observed to produce in- 
 stant death. Warm baths, therefore, for this and 
 other reasons, are worse than useless; evaporating 
 fluids, and indeed all moisture applied to the skin, 
 seem to be contra-indicated for obvious reasons. Hot 
 air baths, so contrived as to be applicable in a re- 
 
THE CHOLERA. 171 
 
 cimibent posture, and admitting access to the patient 
 for the purpose of friction, may be of use. 4 " 
 
 When the cholera first appeared in Russia, the 
 French Government also sent an agent to St. Peters- 
 burg to investigate the nature of the disease. 
 
 This agent had abundant opportunity to witness 
 and treat the disease in a large hospital of 250 pati- 
 ents at St. Petersburg, and the following are his 
 remarks respecting the treatment of Asiatic cholera 
 at that place in 1831. 
 
 " There is no disease in which the same treatment 
 will apply to all possible cases ; on the contrary, we 
 must always take into consideration the constitution 
 of the patient and the stage of the disease; and just 
 so it is with respect to the treatment of cholera. Let 
 it not be thought, that, in this malady, it is sufficient, 
 as it is in many others, to administer remedies inter- 
 nally : on the contrary, these remedies have produced 
 comparatively but little effect ; whilst assiduous care, 
 combined with exterior applications faithfully perse- 
 vered in, have succeeded in restoring patients labor- 
 ing under very severe attacks. 
 
 The treatment which 1 have followed, as well as 
 many of my colleagues, and from which we have 
 obtained the greatest success in the first stage or de- 
 gree of the malady, and which has produced four 
 times upon myself the most salutary effect during the 
 course of the epidemic, was the following : As soon as 
 the first symptoms indicated appear, that is, loss of 
 appetite, flatulent noise in the lower part of the ab- 
 domen, even vertigo and anguish, accompanied by 
 nausea and diarrhea, we must go to bed, and take 
 
172 TREATMENT OF 
 
 immediately a eup of strong coffee, without milk, 
 with or without sugar ; and, soon after, from four to 
 six drops of oil of peppermint upon a piece of sugar : 
 we must apply, at the same time, a bag filled with 
 oats, ashes or bran, very warm, upon the abdomen, 
 changing it as often as possible, and keeping our- 
 selves quite warmly covered. We may repeat the 
 same means, until we have succeeded in bringing on 
 a very copious perspiration, which, when it can be 
 produced, brings at once the attack to a favorable 
 crisis. If, however, much headach, and a severe 
 pain in the pit of the stomach should be experienced/ 
 and should not yield to a large mustard plaster ap- 
 plied to it, bleeding, to the amount of a pint, or even 
 a pint and a half, becomes indispensable, and must 
 even precede all other remedies, if the constitution of 
 the patient be strong and sanguine ; even the most 
 debilitated ought not to apprehend any ill conse- 
 quences from bleeding if the symptoms above detail- 
 ed are strongly marked, for their debility is deceitful, 
 and will cease as soon as they are delivered from the 
 blood which was stagnant, or had not a sufficiently 
 free circulation. 
 
 It is still more important to send the patient to bed, 
 if he has the diarrhea, for many people have experi- 
 enced the full development of cholera, and even have 
 died, for having, in the beginning, refused to take 
 their bed for a simple diarrhea. I have often cured 
 by mere repose, and the warmth of the bed, a diar- 
 rhea which would have certainly degenerated into 
 cholera. I did not even permit my patients to rise 
 from their beds for the purpose of evacuation, but they 
 made use of bed pans. 
 
 For diet, chicken broth, with a little rice or sago 
 
THE CHOLERA. 173 
 
 boiled 4 or 5 hours, to which we may add a little red 
 wine. A decoction of salep, in the juice of the 
 black muscade grape, is likewise to be recommend- 
 ed. The drink must consist of rice water, or toast- 
 water, with a little red wine. 
 
 If the oil. of peppermint, the tea of melissa, the 
 ipecacuanha administered every three hours in small 
 doses of one-tenth of a grain, and the warm bags, do 
 not stop the diarrhea, it becomes necessary to apply 
 mustard plasters upon the whole surface of the ab- 
 domen ; and, if we should not thus succeed in over- 
 coming the disposition to vomit, we may give soda 
 powders composed of acidulated carbonate of soda, 
 10 grains ; essential salt of tartar, 6 or 8 grains, and 
 of elio-sachar-citri, 10 grains; swallowing immedi- 
 ately after a tea-spoonful of lemon -juice, with a little 
 water. In such cases, I have often arrested the pro- 
 gress of cholera by means of emetics and castor oil, 
 the only purgative 1 have used during the epidemic. 
 I have not been less fortunate in cases of diarrhea. 
 
 In the second stage, in which medical aid is cer- 
 tainly very important, nothing however ought to be 
 done with precipitation. We must never forget that 
 the first thing to be attended to, is to restore the blood 
 to its circulation and organical warmth. In the 
 greater number of cases, w T e begin the treatment, by 
 applying to the whole surface of the abdomen a large 
 mustard plaster, which must cover the pit of the 
 stomach. If, however, the patient is too irritable, the 
 mustard plaster may be divided, and a number of 
 small plasters applied in different places, one after 
 another, though, to speak the truth, this last method is 
 not so active and effectual as the former. Frictions 
 
 must be instituted over the whole body of the patient, 
 
 15* 
 
174 TREATMENT OF 
 
 and that is best done by four persons rubbing all at 
 once, with dry flannel, powdered over with mustard. 
 1 have always observed, that frictions made with spi- 
 rituous liquors, were much less effectual, inasmuch as 
 the body grew cold as soon as they ceased rubbing it. 
 The same has been observed by many of my col- 
 leagues. For the parts of the body in which the 
 cramps became too severe, I made use of a mixture 
 of oil of turpentine, three ounces ; with oil of tusqui- 
 am, a half an ounce \ oil of gilliflower, three ounces 
 and a half; spirits of sal ammoniac, from half an 
 ounce to six drachms — oil preserving the heat of the 
 body much better than spirituous liquors. 
 
 This treatment is followed by mustard plasters on 
 the calf of the legs, the thighs, the soles of the feet, 
 the arms, the spine, either alternately, or even all at 
 once, according to the urgency of the case. 
 
 We have been taught by experience, that baths of 
 all kinds, including vapor baths with vinegar and 
 water, not only remained without effect, but even 
 give great pain to the patient, who is exposed to take 
 cold. If bathing was so effectual at Moscow, we 
 must attribute it to the season ; for the plague broke 
 out in that capital in the month of October, and lasted 
 the whole winter ; in consequence of which, the pa- 
 tients were carried to the hospitals half frozen. 
 
 It has been equally impossible for us to follow the 
 internal treatment prescribed either by the English 
 physicians, or by those of Moscow ; that is, we could 
 use opium only with the greatest circumspection, for 
 that active remedy has unfortunately produced, too 
 often, congestions of the brain so intense that nothing 
 could calm them ; and that, too, without arresting the 
 progress of the malady. 1 can say the same of calo- 
 
THE CHOLERA. 175 
 
 mel administered in large doses : the use of the latter 
 has been almost entirely rejected. 
 
 1 have been more fortunate in the use of bismuth 
 powders, recommended by Dr. Leo of Warsaw, and 
 taken every two hours in doses of three or four grains, 
 with ten grains of sugar, though this remedy has not 
 always answered my expectations. Much more fa- 
 vorable results were obtained from a remedy truly 
 Russian, and which has been lately recommended by 
 Dr. Searle of England, who practiced at Warsaw 
 during the epidemic. This remedy has been, for ve- 
 ry many years, used by the Russians in affections 
 analogous to cholera, but much less intense; it con- 
 sists in a solution of common salt, two table-spoons- 
 ful of which must be dissolved in a glass of boiling 
 water, strained, and taken in one draught, while yet 
 ukewarm; it is thrown up in a very few minutes, 
 md in the greater number of cases, it is already mix- 
 ed with a little bile ; which circumstance is a favora- 
 ble one, since it proves that the spasm of the biliary 
 ducts has diminished. One table-spoonful of the 
 same solution is afterwards given every hour ; this 
 dose is taken cold ; and is followed by a smaller dose 
 still ; that is, by a tea-spoonful, taken at a time, until 
 all alarming symptoms have subsided. It has also 
 frequently happened, and that even in very severe at- 
 tacks, that the first dose was sufficient. At other 
 times, namely, when there was no bile mixed with 
 the water thrown up, I have been obliged to make a 
 venesection for the purpose of taking six or eight 
 ounces of blood ; and, when the blood would not run, 
 I applied leeches to the pit of the stomach, or drew 
 blood from it by cupping, and the relieved the pa- 
 
176 TREATMENT OF 
 
 tients of a burning sensation, and of the fatigue of fre- 
 quent vomiting. 
 
 The patients treated in this manner, that is, with 
 a solution of common salt, were often very soon re- 
 stored to health, and could hardly be recognized af- 
 ter a few hours. In a few cases, the disease took the 
 character of a congestive typhus, but not very intense. 
 In a very few cases, I have been obliged to discontin- 
 ue the solution of common salt to give the bismuth in 
 the above indicated doses, or camphor dissolved in 
 ether, or mixed with the tincture of canclla, or any 
 kind of aromatic water, to which should be added, a 
 mucilage of gum-arabic and sugar. Such are the 
 remedies which have best succeeded. As soon as 
 the cholera assumed the character of a typhus fever, 1 
 applied leeches behind-theears or on the neck and cold 
 water and even ice on the head, blisters on the neck and 
 calf of the legs; prescribed castor oil when it became 
 necessary, and chiefly oxygenated muriatic acid, ta- 
 ken in doses of half an ounce, or even an ounce, upon 
 six ounces of decoction of salep or marsh-mallow. 
 
 With respect to drink, 1 consulted the patient's own 
 wishes, not, however, before he had thrown up the 
 solution of salt. The best drink, however, was cold 
 water often repeated, but in small quantities : I ob- 
 served that the patients always ejected w r arm drinks. 
 I have even given ice broken in small pieces, and 
 recommending that only a part of it should be swal- 
 lowed, and the other suffered to melt in the mouth. 
 
 In the third stage, which is that of paralysis, there 
 is hardly any remedy. Emetics, phosphorated ether, 
 that is, two grains of phosphorus and two drachms of 
 ether, well shaken together, on what is still better, a 
 solution of six grains of phosphorus in a half ounce of 
 
THE CHOLERA. I77 
 
 oil of sweet almonds, and taken every half an hour in 
 doses often drops, upon the same quantity of ether 
 as recommended by the physicians of Moscow. The 
 whole class of excitants, such as the spirits of harts- 
 horn, camphor, musk, Champaign wine, sulphate of 
 quinine, &c., administered in the supposition of an 
 intermittent fever ; frictions, mustard plasters, baths, 
 pumping of cold water upon the pit of the stomach 
 and spine : commonly produced no other effect than 
 to prolong, sometimes, the sufferings of the patient 
 If, however, we should observe some favorable symp- 
 toms, it becomes essential to avoid a too active inter- 
 nal treatment. 
 
 The faculty does not recognize any predominant 
 remedy, nor any one very remarkable for success in 
 particular cases ; a circumstance which may be at- 
 tributed to the rapidity of the progress, and the malig- 
 nant character of the epidemic. It is probable that 
 cholera, like all other epidemic diseases, such as small 
 pox, scarlet fever, &c.,is, perhaps, of different char- 
 acters, more or less malignant. That may also ac- 
 count for certain remedies, such as bismuth, having 
 proved sometimes so effectual. 
 
 Additional reflections upon the use of bleeding, and of 
 opium, in the treatment of cholera. 
 I have adopted bleeding only with the young and 
 plethoric patients, and that at the very beginning of 
 the attack, in case of severe pain, or when the above 
 indicated remedies for the first stage have not had the 
 desired effect ; it is then that bleeding was so effect- 
 ual, that no other remedy could be substituted for it, 
 The object of bleeding is to diminish that part of the 
 blood, which through the influence of miasm, isdis- 
 
}78 TREATMENT OF 
 
 posed to stagnate in the interior part of the body. By 
 means of bleeding, we prevent, or at least, diminish 
 the spasm, as well as the venous congestion which 
 results from it ; and by that means relieve the heart 
 and lungs from all oppression, in order to restore to 
 them the full power of their respective functions. 
 We can obtain that result only in the first two stages 
 of the malady ; that is, before circulation has ceased 
 in the articulations of the hands. In cases requiring 
 bleeding, it is, consequently, of the greatest impor- 
 tance to bleed as soon as possible, for the blood sensi- 
 bly alters in its chemical nature, and no longer runs 
 from the vein, or, if it does, it is with with great diffi- 
 culty, and in so small a quantity as renders it inade- 
 quate to the relief of the patient. When the disease 
 has too far advanced, bleeding has sometimes hasten- 
 ed death. 
 
 The nature of the epidemic at St. Petersburg con- 
 vinced me of the impossibility of following the method 
 of the English physicians, who, in India, bleed to the 
 amount of more, and much more, than a pound of 
 blood. 1 have always confined myself to ten, eight, 
 or six ounces. 
 
 The use of opium, so much extolled by English 
 physicians in India, and by them prescribed in large 
 doses, has as little succeeded in my practice as in 
 that of my colleagues. It has, on the contrary, ac- 
 cording to all our observations, served only, as said 
 before, to determine the blood towards the brain, and 
 to render the state of stupor and somnolence much 
 more difficult to overcome, than when w 7 e made no 
 use of that remedy; hence 1 soon gave it up almost 
 entirely. What has led me to the adoption of that 
 plan, is, that vomiting and diarrhea are only symp- 
 
THE CHOLERA. 179 
 
 toms, which, in the more severe attacks, are not the 
 most prominent; it even very frequently happens, that 
 these symptoms are hardly perceptible : and, as we 
 cannot admit that the individual attacked with chol- 
 era, dies solely of starvation caused by vomiting and 
 diarrhea, but in consequence of the paralysis of the 
 nervous system, chiefly that of the lower part of the 
 abdomen, or ganglionic system, and of the chemical 
 and orgariical decomposition of the blood, we may 
 easily conclude that opium cannot be a universal 
 remedy for cholera. 
 
 The brilliant success mentioned by English physi- 
 cians has been of very rare occurrence, and due only 
 to the very large doses which they have had the cour- 
 age, or rather the temerity to administer. The ordi- 
 nary doses, as we have had occasion to observe in 
 our experiments at St. Petersburg, have been very 
 generally injurious ; for they are not active enough 
 in the beginning, and paralyze, in their secondary 
 effect, very visibly and strongly, all the functions of the 
 patient : they contribute very much to the complete 
 development of somnolence, which is sometimes con- 
 sequent to cholera ; but then it is less strong, and can 
 be soon removed, if no opium has been adminis- 
 tered." 
 
 Dr. Lefevre, physician to the British embassy at 
 St. Petersburg, and who had ample opportunities of 
 seeing the disease, and ascertaining the best method 
 of treatment, remarks, " The epidemic cholera, upon 
 its first invasion, baffles all attempts to conquer it ; 
 but it gradually loses its intensity, and towards its de- 
 cline, becomes as tractable as other disorders of the 
 alimentary canal." 
 
180 TREATMENT OF 
 
 Dr. L. witnessed the employment and the general 
 failure in the first of the epidemic, of the following 
 methods of treatment, all of which proved serviceable 
 at a more advanced period of the disease : — venesec- 
 tion, sweating by various processes, calomel and opi- 
 um, rhubarb and magnesia, sub-nitrate of bismuth, 
 hot baths, frictions with hot cloths, &c. &c. 
 
 Dr. L. is, however, an advocate for bleeding, and 
 thinks it decidedly beneficial, when employed judi- 
 ciously. He remarks, 
 
 " Bleeding from the arm in the first stage, when 
 the pulse is full and the temperature not reduced, is 
 often sufficient to cut short the disease. The quanti- 
 ty of blood to be drawn should be but small ; eight 
 ounces will be sufficient to allow the remainder to 
 circulate more freely and relieve the heart, and this 
 will not too much exhaust the patient. 
 
 The blood is generally thicker than usual, highly 
 carbonized, and forms a loose coagulum. I do not 
 know if the blood of cholera patients has been analy- 
 zed during the present epidemic. The patient usually 
 feels immediate relief, particularly where the head 
 has been much affected. He should be bled in the 
 horizontal posture, and remain quiet for some time 
 afterwards. The operation of medicines is generally 
 much facilitated by a small bleeding. 
 
 The absence of the pulse is no prohibition to the 
 use of the lancet, unless this is accompanied by other 
 symptoms of great debility, and the system has been 
 exhausted by previous evacuations, and the surface 
 is covered with a cold clammy sweat ; in such instan- 
 ces 1 have never seen blood-letting serviceable, 
 though many assert the contrary. In some cases, the 
 pulse ceases to beat very early, but upon opening a 
 
THE CHOLERA. 181 
 
 vein the blood flows slowly at first, gradually the cur- 
 rent becomes fuller and stronger, the pulse beats very 
 sensibly, and the heart thus relieved is enabled to 
 continue the circulation." 
 
 The following was Dr. Lefevre's own mode of 
 practice, when called in at an early period of the dis- 
 ease: 
 
 " If the patient is robust, the pulse still perceptible, 
 and the system not too much reduced by evacuations, 
 I order from six to eight ounces of blood to be drawn 
 from the arm, the patient being first put to bed in the 
 recumbent posture. 
 
 The following draught is then to be given : 
 
 Laudanum and asther, of each twenty-five drops. 
 Strong peppermint water, an ounce and a half. 
 
 If this be rejected, it should be repeated immedi- 
 ately ; if the second be likewise not retained, then a 
 clyster of linseed tea with fifty drops of laudanum 
 should be administered. 
 
 It often happens that the patient after taking the 
 first dose, falls asleep, and wakes in perfect health 
 
 A large sinapism to the abdomen, and bottles of 
 hot water to the feet, should not be omitted ; if these 
 means produce speedy relief, an ounce of castor oil 
 should be prescribed as soon as the stomach and bow- 
 els are quiet." 
 
 TREATMENT OF THE CHOLERA IN ENGLAND. 
 
 It has been already stated, that the cholera ap- 
 peared at Sunderland, in the north of England, in 
 
 the autumn of 1831. 
 
 16 
 
182 TREATMENT OF 
 
 Previous to that time, it was predicted by medical 
 men, that if the disease should appear in England, it 
 would exhibit a less violent character than it had in 
 India. 
 
 This prediction has hitherto proved correct. In no 
 country has the cholera been more mild than in the 
 large towns of England. In London, u the largest 
 city ever visited by pestilence," the disease prevailed 
 but for a short time, and destroyed a less number than 
 in almost every other city it has visited. 
 
 This exemption of modern Babylon, with its im- 
 mense mass of needy, filthy, starving and vicious 
 population, is one of the most mysterious circum- 
 stances that has hitherto occurred in the progress of 
 the cholera. 
 
 There is, however, reason to fear, that London, 
 Manchester, and many other of the large towns of 
 England have been spared only for a season ; like 
 several towns in Asia which were not visited for a 
 year or two while the disease prevailed around them ; 
 but were afterwards ravaged by this modern plague 
 in its most violent form. 
 
 The treatment of the cholera in England has not 
 varied much from that which had been adopted in 
 India and other countries. Bleeding, emetics, calo- 
 mel, opium and external heat, have been among the 
 chief remedies employed. 
 
 The disease, however, was not so new to the medi- 
 cal men in England, when it first appeared there, as 
 it was to the physicians in the north of Europe when 
 the disease first invaded Russia. 
 
 Many English Physicians had witnessed much of 
 the disease in India, and had given full and accurate 
 accounts of it, to the British public. Among other 
 
THE CHOLERA. 183 
 
 British physicians, now resident in England, and who 
 had seen the disease in India, and given accurate 
 descriptions of it, as it appeared in that country, is 
 the celebrated James Johnson, Physician Extraor- 
 dinary to the King of England, and editor of the far 
 famed Medico Chirurgical Review, &c. &c. 
 
 In November last, Dr. Johnson submitted to the 
 Westminster Medical Society, a series of proposi- 
 tions respecting the cholera ; and although but part 
 of them relate to the treatment of the disease, yet 
 they are all so correct and important ; embodying in 
 a small space most that we know concerning this dis- 
 ease, that I am induced to extract the whole of them, 
 and place them in this part of the volume. 
 
 Propositions. 
 
 " i. That in epidemic cholera, as in most other ep- 
 idemics, a poison or sedative principle, whether ema- 
 nating from the earth, from animal or vegetable bod- 
 ies on the earth, or engendered in the air, strikes a 
 predisposed individual, and, after an uncertain period 
 of incubation, produces a train of phenomena, form- 
 ing the subject of subsequent propositions. In spora- 
 dic cholera, the general or diffusive cause is absent ; 
 but when the common exciting causes are strong, 
 and the subject highly predisposed, severe, or fatal ca- 
 ses will occur, where the symptoms cannot be distin- 
 guished from those of the epidemic cholera. 
 
 2. The effects of the choleric poison exhibit a 
 great analogy to those produced by the virulent conta- 
 gion of typhus, and the concentrated miasmal exha- 
 lations that give rise to malignant fevers, remittent 
 
184 TREATMENT OF 
 
 and intermittent; such as have been seen in Batavia 
 and other highly malarious places. 
 
 3. This poison shows its effects according to the 
 evidence of our senses, first, on the nervous system, 
 as evinced by the prostration of strength, — by the af- 
 fection of the head, — by the arrest of the secretions 
 (dependent on nervous energy), and, in fact, by a 
 depression of the whole of the sensorial functions, as 
 well as those of the organic life. 
 
 4. The secondary effects of the choleric poison are 
 shown in the vascular system. The heart acts fee- 
 bly, — the circulation recedes from the surface, and 
 the blood accumulates in the vessels of the internal or- 
 gans ; decarbonization and calorification cease, or 
 are greatly diminished ; the temperature of the body 
 falls to that of surrounding inanimate substances ; 
 paleness is changed to blueness ; and the influence 
 of the ganglionic system of nerves seems to be near- 
 ly suspended, if not annihilated. 
 
 5. It is at this period that nature appears to make 
 violent, but too often unsuccessful efforts, to restore 
 the broken balance of the circulation, and to re-es- 
 tablish the secretions, by sickness and purging ; the 
 ejected fluids being exudations, rather than secre- 
 tions. 
 
 6. If nature does not succeed by the above men- 
 tioned efforts to restore circulation, secretion, and 
 consequently oxygenation and calorification, these 
 efforts themselves prove auxiliaries to the choleric 
 poison in destroying life. 
 
 7. We are not, in our present state of knowledge, 
 certain whether the spasms be merely the effects of 
 the poison on the nervous system, or an effort of na- 
 
THE CHOLERA. 185 
 
 ture to resist it ; but they, like the sickness and pur- 
 ging, tend ultimately to exhaust the powers of life. 
 
 8. If nature, (by which I mean the constitution), 
 whether with or without aid, be able to resist the first 
 or depressive shock of the poison, and institute a re- 
 action in the system, that re-action, in a great majori- 
 ty of cases, becomes a fever, exhibiting a new train of 
 phenomena, and demanding a different mode of treat- 
 ment. If this view be correct, it would lead to the 
 inference that the choleric symptoms constitute the 
 first or cold stage of a choleric fever. 
 
 9. If reaction, with restoration of circulation, secre- 
 tion, and oxygenation, do not take place, the patient 
 dies in a state of asphyxia, the intellectual powers oft- 
 en remaining but little impaired, till the last glimmer 
 of the lamp of life is extinguished. This has been 
 often witnessed in concentrated miasmal fevers, both 
 within and without the tropics. 
 
 10. Pathology. — All the changes which present 
 themselves in the dead body, are, in my opinion, ef- 
 fects^ not causes, of the disease ; with the exception 
 
 of the congestion of black blood in the internal or- 
 gans, which is almost the only phenomenon observa- 
 ble when cholera terminates fatally in a few hours. 
 The traces of inflammation in various organs after 
 death, indicate the causes or effects of the re-active fe- 
 ver, rather than of the cholera which precedes that 
 fever. 
 
 11. Treatment. — As we have no means of expel- 
 ling or neutralizing the poison, we can only endeavor 
 to counteract its effects, and to assist nature in her re- 
 medial movements. 
 
 12. The primary or essential indication is to restore 
 
 the equilibrium of the circulation. That equilibrium 
 16* 
 
186 TREATMENT OF 
 
 effected, a restoration of secretion, calorification, and 
 oxygenation follows. 
 
 13. The balance of the circulation is to be restored 
 partly by internal, partly by external means; but al- 
 ways by several means simultaneously employed, at 
 the very earliest period of the disease. 
 
 14. Venesection may appear a desperate remedy, 
 but we have a desperate disease to combat. I propo- 
 sed this measure many years before the epidemic 
 broke out, and it has been adopted to a very considera- 
 ble extent, both in Asia and Europe. I proposed, and 
 would still propose venesection, with a two-fold view ; 
 first, to relieve the heart and internal organs from a 
 portion of that deluge of black blood in which they 
 may be said to be drowning ; — secondly, to turn, as 
 it were, the tide of the circulation from the centre to 
 the surface of the body. This measure I would chief- 
 ly confine to the young, the robust, and the previous- 
 ly healthy, and in them contemporaneously with, or 
 subsequently to, the measure which forms my next 
 proposition. 
 
 1 5. The first internal remedy which I propose, both 
 in aid and in imitation of nature, is a stimulant emet- 
 ic, as infusion of mustard seed, or what perhaps would 
 be better, the sulphate of zinc. I propose this 
 from a conviction founded on observation, that of all 
 the means which nature or art can bring into opera- 
 tion, the act of 'Jull vomiting is the most powerful in 
 driving the blood from the trunks to the capillaries— 
 from the internal organs lo the periphery of the body. 
 It is also the most universal excitant of secretion 
 in every glandular structure of the living machine. 
 Nausea and retching are quite different in their effects 
 from the operation of full vomiting. Nausea and 
 
THE CHOLERA. 187 
 
 retching depress the power of the heart and nervous 
 system, and prevent the blood from flowing to the sur- 
 face ; full vomiting impels the circulation with such 
 force into the superficial vessels, that it is extremely 
 difficult to stop the flow of blood from the orifice of a 
 vein during vomiting. I have seen the blood come 
 from a vein under such circumstances;, with all the 
 characters, or at least the appearance of arterial 
 blood. This proposition is well exemplified by sea- 
 sickness^ of which I have had painful personal expe- 
 rience. An unfortunate landsman bears a close re- 
 semblance, during the first storm at sea, to a man 
 with cholera. He staggers about the deck, or clings 
 to the railings of the lee-gangway, striving to keep 
 down the rebellious heavings of his own stomach. 
 But all wont do 5 up it comes ; and during the first 
 vomitings, I have seen the blood gush from the mouth, 
 nose, and even the eyes of the sea-sick sufferer. From 
 being actually blue with nausea, his face becomes 
 red with vomiting. But the cause of the sickness 
 still continuing, he ultimately becomes pale and ex- 
 hausted ; he is like a man who takes a fresh dose of 
 tartar emetic, after each paroxysm of vomiting. The 
 wonder is that he does not die ; some have died. It 
 is curious that Coelius Aurelianus, who gives the best 
 ancient account of cholera morbus, places sea-voya- 
 ging among the causes of that disease. 
 
 It is but justice to state that Mr. Boyle proposed 
 and practiced full vomiting in the epidemic cholera 
 ten years ago 5 and I have the Very best authority for 
 affirming that this practice, when it was pursued on 
 the Continent, was eminently beneficial. 
 
 16. As soon as vomiting has produced its salutary ef- 
 fect on the circulation, or has failed to produce that ef- 
 
188 TREATMENT OF 
 
 feet after a fair trial, I would propose diffusible stimuli, 
 with calomel and opiates, but not in immoderate do- 
 ses. Brandy and laudanum , as the most readily pro- 
 cured, and the least likely to be loathed, are perhaps 
 the best. But the choice of stimulants must be left to 
 the practitioner ; and the danger of inducing subse- 
 quent inflammation should be carefully borne in mind. 
 Calomel alone would probably be the best medicine 
 after the emetic. 
 
 17. The remedies above mentioned, in moderate, 
 but efficient doses, seem to impart vigor to the heart 
 and nervous system, through the medium of the stom- 
 ach, while they mitigate the spasms, and restrain the 
 useless or injurious exudations of fluids from the in- 
 testinal canal, the mercury changing that exudation 
 into secretion. 
 
 N. B. Would not the inhalation of oxygen gas be 
 beneficial ? 
 
 18. The external remedies are three — heat, fric- 
 tion, and counter-irritation. These three means 
 should be employed, not only simultaneously with re- 
 spect to each other, but contemporaneously with the 
 internal remedies. They should be also so employ- 
 ed, that the patient may not be required to throw a 
 single voluntary muscle into action. Every muscu- 
 lar movement, even in that of sitting up in bed, is pre- 
 judicial, or absolutely dangerous, during the exhaust- 
 ing orgasm of cholera. An apparatus permitting the 
 application of heat, friction, and counter-irritation, 
 without the necessity for any muscular exertion on 
 the part of the patient, will be shown to the So- 
 ciety. 
 
 Query. — As the cramps and spasms are chiefly 
 confined to the extremities, and as the exhausting 
 
THE CHOLERA. 1§9 
 
 pain of these cramps is in proportion to the contrac- 
 tion and swelling of the affected muscles, would not 
 firm compression by a bandage, mitigate the spasms ? 
 Patients in cholera often cry out for the most violent 
 extension and pressure of the craiftped muscles. 
 
 1 9. Prophylaxis. — Conceiving myself, as well as 
 every member of this Society, bound to abstain from 
 all discussion of the question of contagion, 1 shall 
 condense the subject of prevention into four words, — 
 temperance, cleanliness, ventillation, and fearless- 
 ness : — in fine, the pursuance of all those means 
 which tend to preserve general health, and the avoid- 
 ing of all those causes which predispose to common, 
 or indigenous diseases of our own climate.' 
 
 In respect to the cause of the epidemic, we have 
 no reason to alter the conclusions to which we have 
 come on former occasions — namely, that the disease 
 originates in causes of which we are ignorant, and 
 over which we have no control, and that, in crowded, 
 filthy, and ill-ventillated places, it takes on an infec- 
 tious character, tending still farther to propagate and 
 heighten the danger of the disease. This is the doc- 
 trine which w 7 e have always maintained, from an un- 
 biassed consideration of facts. We shall be ready to 
 alter our opinion, whenever our experience and re- 
 flection shall convince us that we are wrong. The 
 disease has now come within the range of observa- 
 tion ; and English practitioners will not have to 
 ground their conclusions on reports from the banks of 
 the Ganges, the Ural, the Wolga, the Euphrates, or 
 the Nile, only— they will probably have ocular dem- 
 onstration — and to that ordeal we cheerfully sub- 
 mit." 
 
 When the cholera appeared at Sunderland, New- 
 
190 TREATMENT OF 
 
 castle, and the neighboring towns in the north of Eng- 
 land, medical men from all parts of the country, with 
 a noble and generous devotion to the cause of suffer- 
 ing humanity ; hastened to the places where this pesti- 
 lence prevailed, and observed for themselves the 
 progress and the nature of the malady, and endeavor- 
 ed to ascertain the means most likely to mitigate its 
 severity. 
 
 They did not wait to learn if the disease was conta- 
 gious or not, or to calculate the amount of the risk they 
 run, in thus visiting infected districts, and personally 
 examining the sick, the dying, and the dead. But 
 with a most praise-worthy spirit, which has been man- 
 ifested by the profession in all countries where the 
 •cholera has appeared, they determined to inform 
 themselves as soon as possible, by personal observa- 
 tion of the nature of the disease, and thus qualify 
 themselves to afford all the relief in their power to 
 their fellow men. 
 
 Several of the distinguished physiciansin England, 
 who thus left their homes and witnessed the disease 
 at Sunderland, Newcastle, and other places, have 
 published the results of their observations, and from 
 their publications I shall make large extracts. 
 
 Dr. Thackrah, of Leeds, previously known to the 
 medical profession by other publications, had ample 
 opportunities of witnessing the cholera at Newcastle 
 and Gateshead, and has given to the public the re- 
 sults of his experience at those places. Dr. T. 
 describes an epidemic cholera which appeared in 
 Leeds, in 1825, and which exhibited the same symp- 
 toms as the present epidemic. But 1 shall refer to 
 the epidemic of 1 825, in another part of this volume. 
 Dr. T. is a decided advocate for venesection, and for 
 
THE CHOLERA. 191 
 
 scruple doses of calomel. He saw this practice prove 
 decidedly beneficial in Sunderland, during the present 
 epidemic. 
 
 George Hamilton Bell, author of an excellent 
 treatise on the Cholera Asphyxia, and who had seen 
 the disease in other countries, was deputed by the 
 Edinburgh Board of Health to visit the places in the 
 north of England where it prevailed. He also bears 
 testimony to the beneficial effects of blood-letting, and 
 relates a case where it proved decidedly beneficial, in 
 a well marked case of cholera asphyxia, and w 7 hen 
 it was resorted to in the stage of collapse. 
 
 Dr. Ogden of Sunderland, in a letter to the Editor 
 of the Medical Gazette, thus refers to the treatment 
 of the disease in that place : 
 
 " On the important subject of cure, I fear there is 
 little satisfactory to be said. The number of recove- 
 ries from cold blue cholera has borne a very small pro- 
 portion to the deaths. Of the 330 recoveries reported, 
 a great majority was not attended with coldness and 
 lividity of the extremities, great collapse, and loss of 
 pulse, so characteristic of the dangerous cases. 
 
 The Indian rule of bleeding has been freely tried 
 with various success ; sometimes blood could be ob- 
 tained, at others it could not ; in the latter case, no 
 harm was done by the attempt. When blood was 
 obtained in the commencement, it was often product- 
 ive of benefit ; the circulation becoming equalized, 
 the patient expressing great relief, the pulse improving 
 and continuing perceptible to the termination, wheth- 
 er in death or recovery. Sometimes, again, it ap- 
 peared to diminish the powers of life. On the whole? 
 
192 TREATMENT OF 
 
 it is a doubtful remedy ; a criterion is wanting to 
 guide us in the employment of it. Dry external heat 
 is of great importance ; hot air baths have been tried, 
 but the deadly coldness of the extremities is totally 
 unaffected by them ; the contact of hot solids, as 
 bricks, bottles, bags of sand, is much better. Fric- 
 tion of the extremities with hot flannel should be next 
 to incessant ; it is one of the few means we possess of 
 restoring the circulation ; indeed, there have been re- 
 coveries principally due to the assiduity with which 
 it w 7 as employed. Brandy is always used, often re- 
 jected a few minutes after it is swallowed. Opium 
 sometimes relieves the sickness, sometimes it does 
 not. Calomel, in the majority of cases, appears to 
 possess little or no efficacy. Viewing the mucous 
 membrane and the skin as one continuous surface, 
 and considering the suspension of their powers of ab- 
 sorption, we are led to the employment of such reme- 
 dies externally and internally, as act as mere stimu- 
 lating applications. Sinapisms are to be applied to 
 the epigastrium, to allay the vomiting, and to the 
 calves and thighs to cure the spasm. A mustard 
 emetic has often succeeded in restoring the pulse. 
 Oil of turpentine by mouth in 3ss. doses, and by in- 
 jection, is a powerful stimulant. Camphor and the 
 essential oils of mint and cajeput are inferior to oil of 
 turpentine in stimulating power. I have not seen 
 any trials of the fixed alkalies, but have heard of their 
 failing like every thfng else. 
 
 The consecutive febrile state is to be treated like 
 fever under any other circumstances. There is 
 usually very great cerebral oppression, indicating 
 blisters to the nucha and shaving of the head. Small 
 doses of calomel are also beneficial. The greatest 
 
THE CHOLERA. 193 
 
 care is required in avoiding errors in diet during con- 
 valescence. 
 
 Dissection has hitherto revealed nothing which ac- 
 counts for the formidable train of symptoms whose 
 cause is sought. There is an accumulation of blood 
 in all parts of the venous system, with the curious ex- 
 ception of the vena portse and its branches. The en- 
 gorged state of the lungs, and the oppressed respira- 
 tion during life, point to the respiratory system as 
 principally suffering, either idiopathically, or symp- 
 tomatically of some altered condition of the nervous 
 system. 
 
 Prophylaxis. — The attack is generally preceded by 
 diarrhea, varying in duration from six hours to three 
 days : t hk> is the critical time for successful treatment. 
 I have found pills prepared according to the following 
 Ibrumla very successful in arresting the diarrhoea: 
 
 H. Gpii,gr. xv. 
 
 Hydrarg. Submur. 3J. 
 
 Pulv. Bacc. Capsici, 3iss, vel. 3ij. 
 
 Confec. Bosrc, q. s. ut fiant pil. Ix. As they are 
 in constant request when visiting the abodes of chol- 
 era patients, it is convenient to carry a box in the 
 pocket. One or two may be given every three hours 
 until relief is obtained. They produce a state of con- 
 stipation which continues two or three days, and 
 which it is quite unnecessary to remedy by laxatives, 
 as the bowels soon resume their natural functions. 
 When there is much pain of abdomen or griping at- 
 tending the diarrhoea, it is alleviated by hot fomenta- 
 tions or a sinapism. 
 
 During the prevalence of cholera, there are observ- 
 ed among persons otherwise healthy, various anoma- 
 lous affections of the nervous system, as spasms and 
 17 
 
194 TREATMENT OF 
 
 cold sensations of the hands, feet, and legs, peculiar 
 thrilling sensations of the extremities of the fingers 
 and toes, and a feeling of great anxiety in the praecor- 
 dial region. 
 
 I am, Sin, 
 Your obedient servant, 
 Henry Ogden, M. D. 
 Sunderland, Jan. 14, 1832." 
 
 Dr. James Adair Lawrie, Professor of Surgery, 
 Andersonian University, and Dr. David B. White, 
 one of the physicians to the Gateshead Dispensary 
 and Cholera Hospital, have also given to the public 
 the results of their experience in cholera. Their 
 views respecting the treatment of the disease are thus 
 given in the Medico-Chirurgical Review, for April, 
 1332: 
 
 " Both Dr. Lawrie and Dr. White insist on the 
 necessity of attending to the premonitory or diar- 
 rhoeal stage. Dr. L. recommends the patient to be 
 put to bed, kept warm, and to have a flannel band 
 round his abdomen — then to take half anlounce of cas- 
 tor oil with fiftee n or twenty drops of laudanum, and, 
 after this has operated, thirty drops of laudanum, or 
 one grain of opium. Saline and drastic purgatives 
 are strongly deprecated. If the discharges continue, 
 the opiates must be repeated with caution, and if two 
 or three grains of opium fail, Dr. L. would open a 
 vein, and in every case apply a sinapism or blister to 
 the abdomen. If the above measures fail, and col- 
 lapse threaten, he advises a mustard emetic, to be fol- 
 lowed up by twenty grains of calomel, and as much 
 laudanum or opium as the patient will bear. Opiate 
 enemata deserve trial, and if opium has been pushed 
 
THE CHOLERA. 195 
 
 as far as is safe, mucilaginous enemata should be 
 thrown up with a Jukes' syringe. 
 
 Dr. White remarks, that in some cases, not diar- 
 rhoea, but obstinate costiveness prevails, after a longer 
 or shorter duration of which, the disease suddenly 
 appears. For this costiveness he seems to recom- 
 mend a pill of scammony, jalap, calomel, and aloes. 
 In this stage Dr. W. also advises the washing of the 
 body with warm water, and subsequent friction with 
 coarse cloths. He seems to think that personal filth 
 is a great predisposing cause. He orders his patients, 
 on their retiring to bed, the lavation and rubbing- 
 then the pediluvium and a pill of cal. prep. gr. vi. 
 opii. gr. j. — in the morning castor oil and laudanum, 
 or pulv. rhei, 3ss. zinzib. pulv. gr. viij. to be repeated 
 if necessary. 
 
 Treatment of the Acute Stage. Dr. Lawrie re- 
 commends a mustard, or salt, emetic, the former not 
 too strong ; he doubts their efficacy or safety when 
 profuse vomiting of colorless fluid is a prominent 
 symptom. As soon as the emetic has been swallow- 
 ed a vein should be opened. His experience is in 
 favor of bleeding, and, as a general rule, the earlier 
 the better. In some cases it undoubtedly appears to 
 do harm, and it is difficult to explain this discrepan- 
 cy of effects. We may say that the earlier the better, 
 that it is more safe in the robust, probably more safe 
 after collapse than when it is just on the point of be- 
 ing established, and in the moderate than in the very 
 severe cases. Such are Dr. L's notions. After 
 these means we are to give a large dose of calomel 
 and opium, to a stout man thirty or forty grains of the 
 former within two hours. Of opium a large dose 
 should be given at first with the calomel, and its re- 
 
196 TREATMEMT OF 
 
 petition should be regulated by circumstances. Dr. 
 L. strongly recommends counter-irritants to the 
 throat; neck, spine, to the latter indeed the cau- 
 terizing-iron. Stimuli should also be given internally 
 if the stomach will retain them. 
 
 Dr. White thinks blood-letting has been too univer- 
 sally recommended. When vascular debility is very 
 apparent he would not employ it, but when the pulse 
 retains its force or rises during the operation, it is ad- 
 vantageous. Bleeding, too, he thinks an admirable 
 sedative, when great mental excitement prevails., 
 He recommends the exhibition of cold water slightly 
 colored with brandy. He speaks well of cupping, 
 external warmth, frictions for the spasms. He has 
 found nothing but disappointment from the exhibition 
 of stimulants 5 but speaks very highly of large injec- 
 tions of warm water. 
 
 Stage of Collapse. Dr. L. recommends warmth — 
 an emetic as before — the abstraction of a few ounces 
 of blood while the pulse can be felt in the brachial 
 artery— then warm injections of beef-tea with brandy 
 and laudanum — counter-irritation — diffusible stimuli 
 — cold drink in its most agreeable form, for which, 
 and for which only, the patient craves. All fluid 
 should be given in small quantities at a time; thin 
 arrow-root or beef-tea often remain on the stomach 
 when nothing else will. External warmth is to be 
 maintained by stoves or large fires in the room. 
 
 ' A very simple method of heating a room, is an 
 iron tube bent at its centre, the bent part converted 
 into a small reservoir or worm. The reservoir is put 
 into the fire and heated red hot ; to the one end of 
 the iron tube another of tin or of patent cloth is at- 
 tached, and to its extremity a pair of large bellows. 
 
THE CHOLERA, 197 
 
 Air is thrown into the reservoir or worm, becomes 
 heated, escapes at the opposite end, and is diffused 
 through the room. One of this kind has been describ- 
 ed to me ; the principle might easily be improved into 
 a very efficacious means of raising the temperature 
 of a room or bed, to any required height. The air- 
 bath is another means of applying heat to the surface 
 generally, but air being a bad conductor must not be 
 trusted to alone. Tin cases containing hot water, 
 light and shaped to apply to any part of the body, are 
 very useful for applying heat locally; to the same 
 class belong bricks, bags of heated salt or sand, hot 
 plates, and many others. My friend, Mr. Brady, at 
 Gateshead, was in the habit of using bran mashes, 
 for communicating heat to the surface, with good 
 effect. A quantity of bran is put into a tub, and 
 boiling water poured into it in such quantity as 
 merely to moisten it. It is then thinly spread in a 
 bag sufficiently large to cover the whole body, and 
 applied from the neck to the feet. It must not be 
 applied too hot. This mode has the advantage of 
 retaining the heat long, and is one of the best forms 
 of moist heat which I know. If we wish, to excite 
 the surface powerfully, we may add spirits of turpen- 
 tine to the bran. It is exceedingly difficult to pre- 
 vent the patient from tossing in bed, withdrawing 
 himself from the heated bags, and throwing off the 
 bran and bed-cloths. A nurse must be constantly 
 beside him to prevent this as much as possible.' 
 
 When the perspiration is profuse and cold, it should 
 be carefully wiped off with dry hot towels, and after- 
 wards camphorated or ammoniated oils should be 
 long and diligently rubbed on those parts where irri- 
 tants are not applied. When the head and face re- 
 17* 
 
198 TREATMENT OF 
 
 main deadly cold while the trunk and limbs are heat- 
 ed, it is a very bad symptom. It is singular that the 
 patient dislikes the application of heated cloths, and 
 begs for free cool air. Dr. Lawrie recommends the 
 employment of galvanism, the agent to which we our- 
 selves directed attention in our last number. He ad- 
 vises the application of the wire along the course of 
 the eight pair of nerves in the neck, and over the 
 region of the heart and stomach, Dr. L. would be 
 inclined to give calomel in moderate doses along with 
 the stimuli. Other means were employed with 
 doubtful results. Oxygen gas was given both by the 
 mouth and by injection, but with very little benefit. 
 It was recommended to throw large quantities of 
 heated air into the bowels, but Dr. L. does not seem 
 to have seen it attempted. Stimulating enemata of 
 sp. terebinth, and mustard were used by some ; they 
 frequently produced irritation of the rectum and 
 bloody stools; Mr. Baird, of Newcastle, used the 
 tobacco enemata in one case of collapse with seem- 
 ing benefit. Dr. L. tried it in two cases: in one it 
 did no good, in the other it appears to have done 
 harm. We think it a dangerous remedy, not war- 
 ranted by principle and reasoning. When dogs are 
 poisoned by tobacco injections the symptoms are pre- 
 cisely those of cholera : — purging, vomitings cessation 
 of the pulse, complete collapse. How such an agent || 
 should be likely to prove beneficial in cholera, we " 
 cannot so much as imagine. 
 
 Dr. Lawrie observes, that in the stage of collapse 
 nature does and will do nothing ; perhaps the express- 
 ion is too strong. If the following fact be one, it is 
 instructive. A medical man left a cholera patient, 
 saying that he could do no more for him, and that he 
 
THE CHOLERA. 199 
 
 must die ; another surgeon passing by accident, was 
 asked to see him, worked hard for four hours, and 
 saved him! 
 
 Dr. White's remarks on the treatment of this stage 
 are brief. 
 
 ? I have found the simplest, the most successful 
 treatment : — the calomel and opium, the carbonate 
 of ammonia, warm injections, stimulants as cordials, 
 friction where necessary, and warmth, essentially of 
 a dry kind; worsted stockings filled with hot sand, 
 as I learnt from the practice of Mr. Knaggs of Gates- 
 head, is admirably adapted for this purpose. 
 
 To allay the vomiting, as in the former instance, 
 effervescent draughts, &c. should be used. A most 
 salutary and speedy application, is by laying over 
 the stomach pledgets of linen, dipped in boiling water. 
 Whatever may be the plan adopted, all unnecessary 
 disturbance to the patient should be avoided. The 
 death-bed is often rendered more agonizing by the 
 mistaken, but well-intentioned, zeal, the benevolent 
 officiousness of inexperienced practitioners. An 
 enema, consisting of a warm infusion of tobacco, half 
 a dram to a pint, has been recommended by Mr. 
 Baird. I have seen recovery in two apparently hope- 
 less cases, in which this remedy has been employed.' 
 Dr. W. makes a remark which is highly deserving 
 of attention. When cholera first rages its inveteracy 
 is greater than at a subsequent period, and remedies 
 which utterly fail in the first instance, acquire a re- 
 nown and celebity when nature herself is at work to 
 assist them. Dr. White speaks slightingly of mustard 
 emetics ; he has never seen them serviceable in the 
 collapsed stage, whilst in some instances they were 
 incontrovertibly mischievous. 
 
200 TREATMENT OF 
 
 ' Prior to death, when it takes place during this 
 stage, the disease sometimes assumes a form, well cal- 
 culated to deceive those not acquainted with its char- 
 acter. The pulse rises, the skin becomes warm and 
 covered with perspiration, the patient expresses his 
 relief, and, perhaps, his full anticipation of recovery : 
 in an hour or two, all is over. The blueness, so pe- 
 culiar to this disease in other countries, has not been, 
 by any means, a general characteristic in this. In 
 not one instance in ten, has it assumed that form. 
 The skin of the hands and face often becomes of a 
 brownish hue. In the most deadly form of cholera, 
 there is a tone of voice, a wail, which once heard, can 
 never be mistaken ; to him upon whose ear it has 
 fallen in the accents of anguish, it can never be for- 
 gotten ; I have always found it the certain prognos- 
 tic of death.' 
 
 Here we see that the blue color, the true blue, as 
 the papers sarcastically term it, is not present in one 
 case in ten. Yet this true blue is one of the pathog- 
 nomonic symptoms that the ultra contagionists, that 
 is, the thick-and-thin importation and nova pestis 
 party hold by as their sheet anchor. But what signify 
 facts ? At the time we are writing, the 25th of Feb- 
 ruary, the epidemic is stealing over this metropolis.* 
 We have seen many, indeed most of the cases that 
 have hitherto occurred, but in no one instance could 
 our eyes, unassisted by the spectacles of quarantine 
 notions, and the mists of party feeling, discern any 
 shade of blueness. That color is seen in its deepest 
 dye in the visages of contagionists and sycophants.f 
 
 Treatment of the Rallying Stage. In this, the sur- 
 
 * London. t Reviewer. 
 
THE CHOLERA. 201 
 
 geon is to watch nature ; to prevent recurrence of 
 collapse on the one hand, and ward off congestions of 
 the head and viscera on the other. The first is avoid- 
 ed by externa] warmth, and by giving warm arrow- 
 root in moderate quantities, the second, by small 
 doses of calomel, taking care not to push it too far. 
 The head should be shaved ; when the stomach con- 
 tinues very irritable, blisters and effervescing draughts 
 with small quantities of laudanum are very benefi- 
 cial. 
 
 Treatment of the Febrile Stage. When congestions' 
 do not occur, a few grains of calomel and small doses 
 of castor oil and acidulated drinks are generally suf- 
 ficient. In common cases, the lancet is unnecessary, 
 and when congestion threatens, it is a hazardous 
 remedy. Dr. L. mentions a case in which it appear- 
 ed to re-induce collapse. When congestion threatens 
 the head, which is the chief danger, blisters to the 
 scalp, or nape of the neck, preceded by leeches and 
 cold lotions, and followed by calomel and mild pur- 
 gatives, are proper. The same principle applies ta 
 abdominal congestions. The patient often dies with 
 the worst form of typhus. 
 
 Dr. White remarks in this stage the redness of the 
 tongue ; he thinks this is the'most proper time for the 
 employment of the lancet with proper precautions ; 
 when there is obstinate greenish sickness he has seen 
 great benefit from the salt emetic, repeated till nothing 
 but the solution is rejected. He draws attention to 
 the peculiar tendency to affection of the head, insid- 
 ious in its progress, and fatal in its tendency.' 5 
 
 Mr. Greenhow, of New castle, Member of the Roy- 
 al College of Surgeons in London, in a late work upon 
 
202 TREATMENT OF 
 
 the cholera as it appeared in the towns of Newcastle 
 and Gateshead, lays down the following indications 
 in the treatment of this malady. 
 
 "1. The necessity of allaying irritation in the ner- 
 vous expansion of the stomach and bowels. 
 
 2. To excite the vascular system, and to restore 
 animal heat. 
 
 3. To restore the suppressed secretions. 
 
 4. To obtain healthy evacuations from the bowels 
 and kidneys. 
 
 5. To moderate re-action, and obviate congestions, 
 local determination, or organic inflammation. 
 
 The first indication may be considered as common 
 to the first and second stages of the disease, the three 
 succeeding ones relate principally to the second stage, 
 and the last indication is peculiar to the third stage of 
 cholera. We will consider them in the order of their 
 arrangement. 
 
 If the stage of collapse have not yet established it- 
 self, and if witlvbilious diarrhoea, the patient com- 
 plains much of nausea and occasional retching, the 
 matter ejected consisting principally of undigested 
 food, we shall probably find a dose \ of ipecacuanha* 
 with or without antimony, answer the purpose, or 
 even copious draughts of warm water will suffice to 
 wash out thoroughly the contents of the stomach. 
 Should the patient complain at this time of vertigo, 
 head-ach, or pain in the abdomen, with an accelera- 
 ted pulse, the greatest relief will arise from a full 
 bleeding, proportioned, however, to the strength of 
 the constitution, the effect produced upon the pulse 
 and the urgency of the symptoms. As the blood 
 flows, the pain in the abdomen and head will be re- 
 lieved, and the pulse will become slower and softer : 
 
THE CHOLERA. 203 
 
 a manifest diminution of gastric irritation will also 
 result from it." 
 
 " When the stage of collapse has set in, we require 
 stimulants — the mustard emetic —after this doses of 
 calomel and opium, the latter not in too large quanti- 
 ties, grain doses being generally sufficient — internal 
 stimulants, brandy perhaps the best — copious warm 
 stimulating injections into the intestines — external 
 heat and friction. Mr. Green how makes the follow- 
 ing remarks on the application of the latter : — 
 
 ' For the accomplishment of this purpose, one of the 
 first things to be attended to, is to clothe the person of 
 the patient in a large body-dress or shirt of thick flan- 
 nel, and to envelope him, when laid in bed, in an am- 
 ple supply of warm blankets ; heated bodies of any 
 convenient description, should also be constantly ap- 
 plied to the extremities, to the spine, and to the pit 
 of the stomach and abdomen. Various contrivances 
 have been made use of for applying heat to the sur- 
 face. To the employment of the warm or hot bath 
 it has been objected, that the exertion and fatigue at- 
 tendant on its use, are likely to be more injurious by 
 the exhaustion they would occasion, than could be 
 compensated by any benefit arising from the general 
 application of heat that would be obtained; and al- 
 though warm baths have been found beneficial in 
 India and on the Continent, in this place they have 
 not been resorted to in the treatment of cholera. Nev- 
 ertheless, I know a gentleman who suffered from chol- 
 era at Archangel, during the last Summer, and who 
 was restored from a state of complete asphyxia by 
 being kept in a warm bath, of a high temperature, 
 for an hour and a half. I am sufficiently sensible of 
 .the necessity of preventing the patient from using any 
 
204 TREATMENT OF 
 
 voluntary exertion, and more especially of strictly 
 preserving the horizontal position during arrested cir- 
 culation, having witnessed the fatal effects of a de- 
 parture from this rule in the almost immediate death 
 of the patient ; but 1 am yet inclined to believe, that 
 the prejudice against the use of the warm bath is 
 greater than necessary. The patient might surely be 
 placed in, and removed from it, with such quickness 
 and so little disturbance, as to obviate the objections 
 that have been made to it. It is, however, for the 
 most part, in hospital practice only, that the employ- 
 ment of this means of restoring the defective heat of 
 the system, could be available, since the houses of the 
 poor are seldom provided with the requisite conven- 
 iences for preparing a heated bath. Various ma- 
 chines have been invented for introducing heated air 
 into the bed of the patient, but the experience of our 
 hospitals has proved their inefficiency, I believe, with- 
 out an exception, and their use has been almost en- 
 tirely laid aside. Mr. Wood, a gentleman of consid- 
 erable ingenuity in this place, has contrived an appa- 
 ratus consisting of several thin bottles of tinned iron, 
 which are adapted to the extremities and other parts 
 of the body in such a manner, that when filled with 
 warm w'ater, and cased in bags of flannel, they have 
 been found to answer in a satisfactory manner, the 
 purpose of the external application of heat ; but on 
 ordinary occasions, w T e must content ourselves with 
 heated irons, bricks, bags of sand, flannels, &c. 
 
 Unless a considerable quantity (of the calomel) has 
 been already taken, a full dose, -varying from 5 grains 
 to a scruple (in truth I believe it is a matter of much 
 indifference which) may be given ; and to fulfil the! 
 fourth indication — to obtain healthy evacuations from 
 
 roi 
 
 
Dh 
 
 THE CHOLERA. 205 
 
 the bowels and kidneys— the exhibition of a purga- 
 tive may soon succeed. Castor oil, 1 am disposed to 
 believe, will be found the most effective and least ir- 
 ritating medicine of this class, but should it fail, other 
 means ought soon to be resorted to, and injections 
 may be employed to assist their operations. Calo- 
 mel and jalap, or a purgative infusion with carb. and 
 sulph. of magnesia, may be given at intervals until 
 discharges are obtained from the bowels ; these will 
 probably be found feculent and bilious, and, for the 
 present, we may consider our patient safe, especially, 
 if, as usually happens, urine be discharged at the 
 same time.' 
 
 • It is in this, as in most other violent diseases, w 7 hat 
 we do not ourselves superintend is inefficiently per- 
 formed by nurses. If the medical man has any care 
 for his patient in the stage of collapse, he will hardly 
 quit him till he has either recovered from, or past all 
 earthly hope. When the stage of fever has set in, the 
 farther use of stimulants is most pernicious, ' the anal- 
 ogy between this and the various forms of continued or 
 inflammatory fever, may be considered as complete,' 
 and the treatment must be of a corresponding descrip- 
 tion. Its leading feature is usually organic inflam- 
 mation, and the treatment must be conducted on gen- 
 eral principles. It is at the commencement of this 
 stage, that Mr. G. warmly recommends bleeding, < a 
 powerful remedy — powerful when employed at the 
 auspicious moment — powerless when used at a later 
 or an earlier period.' 
 
 ' When we are fortunate enough to be called to a 
 patient before the pulse fails, still more before the se- 
 rous evacuations commence, when he is suffering 
 
 from the symptoms which so frequently occur in the 
 18 
 
206 TREATMENT OF 
 
 first stage — nausea or vomiting, purging of bilious 
 matter, vertigo, head-ach, probably injected conjunc- 
 tivae, pain in the abdomen or at the pit of the stomach, 
 with a quick, sharp, or oppressed pulse, and probably 
 occasional cramps in the legs — a full bleeding will 
 be found of the greatest benefit, not only in relieving 
 the existing symptoms, but in averting the impending 
 horrors of the second stage of the disease ; this effect 
 may perhaps yet be produced, although the pulse 
 have become feeble and still more opppresed, but 
 not when imperceptible. In such cases it expands 
 and increases in strength and freedom as the blood 
 flows. If, however, asphyxia, coldness and blueness 
 of the extremities have fairly established themselves, 
 the attempt to obtain blood is vain ; thickened and 
 stagnant as it is in the vessels, it cannot be made to 
 flow, and if a few ounces be squeezed from the orifi- 
 ces, hangs from them in long strings, accumulating 
 like stalactites, without producing any beneficial ef- 
 fects. On the contrary, it fatigues the patient, expo- 
 ses him to the prejudicial influence of cold, and sus- 
 pends for a time, more efficient means of relief. I 
 must, therefore, hold bleeding in these circumstances, 
 to be inadmissible, principally because it cannot be 
 accomplished ; and the attempt injurious, since it di- 
 verts attention from measures of less doubtful utility, 
 because they are really practicable.' 
 
 Upon this passage, Dr. Johnson remarks, 'From 
 what we have seen of the disease now in London, 
 from the results of examination after death, from what 
 we have read of the practice in the north, from the 
 conclusion derived from reasoning on general princi- 
 ples, and from our experience in India, we do most 
 conscientiously believe, that the remedy which we 
 
THE CHOLERA. 207 
 
 first proposed and employed for the cholera in Indos- 
 tan, we mean blood-letting, is, after all, one of the sa- 
 fest and best, when judiciously timed and applied. 5 
 
 ' The chances of recovery,' says Mr. G. ' in cases 
 of cholera., must depend upon the stage oft he disease; 
 the duration of the attack before the employment of 
 judicous remedies, its severity, and upon the oge, con- 
 stitution, and previous state of health of the patient. 
 
 It has been seen that when the patient comes under 
 treatment in the early stage of the disease, before the 
 pulse and animal heat fail, his recovery may be cal- 
 culated upon w T ith much certainty. The abstraction 
 of blood if indicated, a single of dose of calomel and 
 opium, succeeded by castor oil, will frequently re- 
 store him to health in a few hours. 
 
 When the more formidable symptoms of the second 
 stage have set in with great severity, the chances of 
 recovery are, in all cases, very precarious ; and if the 
 constitution be enfeebled by previous disease, or old 
 age, the case may be considered as nearly hopeless. 
 In childhood, youth, and the vigor of life, an active 
 and diligent use of remedies will often be attended 
 with complete success ; and it is in these cases that 
 we are stimulated in our exertions by the satisfaction 
 of witnessing their utility. The warmth of the body is 
 in the first place restored ; the pulse becomes percep- 
 tible, it increases in strength and volume, and the nat- 
 ural color of the skin generally returns ; the secretions 
 become re-established, and the patient is brought in- 
 to a state of safety ; for, with vigilance, the succeed- 
 ing symptoms may, with much certainty, be obviated. 
 All this, however, does not go on uninterruptedly. 
 The patient has many uneasy sensations during his 
 recovery from the stage of asphyxia; he becomes 
 
208 TREATMENT OF 
 
 restless, complains of pain at the stomach, with oc- 
 casional nausea, or even vomiting. Still there is re- 
 stored action of the heart and arteries, the functions 
 of life are going forward, and we may fairly antici- 
 pate that, under judicious direction, they will lead 
 to the entire restoration of the patient. But when 
 the restorative efforts are opposed by previous or- 
 ganic disease, general feebleness of constitution, or 
 the worn* out energies of age, we must not calculate 
 too confidently upon any imperfect re-action that may 
 be induced. Heat and pulse may return, the former 
 perfectly, the latter in degreee only ; the spasms and 
 watery discharges may cease ; something approach- 
 ing to natural excretions may even take place, and 
 yet the patient will not unfrequently sink ; not from 
 violent re-action, or the development of local inflam- 
 mation, but from want of energy in the vital powers 
 to carry forward the attempts at restoration which 
 seem so happily commenced. 
 
 The danger of the case is by no means dependant 
 upon the quantity of matter discharged from the 
 stomach and bowels. In some of the worst cases, 
 this is not very considerable, and in some of the most 
 successful, it has been very great. Neither is cramp 
 or spasm a certain criterion. Many fatal cases have 
 occurred, wherein it was nearly entirely absent, or 
 soon ceased. The great danger appears to arise from 
 imperfect or suspended circulation. Let this be re- 
 stored fully, and the rest is within our control. On 
 this circumstance, mainly, then, will rest our judg- 
 ment as to the probable result of our efforts, though 
 all the concomitant circumstances of the case must 
 be taken into the account." 
 
THE CHOLERA. 209 
 
 Dr. Kirk, of Greenock, whose account of the symp- 
 toms of the cholera asphyxia we have already quo- 
 ted, and who appears to have been indefatigable in 
 his inquiries as to the best method of treating the dis- 
 ease, thus alludes to the subject : — 
 
 u The question as to the general propriety of blood- 
 letting, is at the same time a very difficult and impor- 
 tant one. A great proportion of British practition- 
 ers, who have treated the disease, have shown a par- 
 tiality to it. The reasoning leading to the practice 
 is specious, but I fear superficial. We are told, take 
 away a portion of the circulation, and you relieve 
 it of a part of its load, and give nature freer play ; we 
 unload the system, and induce the surcharged ves- 
 sels to put on a new and livelier action. Now, in 
 accordance to the theoretical views 1 have ventured 
 to adduce upon the disease, it will be seen, that a re- 
 turn to healthy circulation will not result from ab- 
 stracting, or adding, a portion of the circulating mass. 
 The cessation of arterial action is not dependent on 
 the state of the fluids, but on determinate derange- 
 ment in the sensorial power ; the result of a morbid 
 poison, by which the machinery of the circulation has 
 been impaired in its healthy action. I speak of the 
 stage of collapse, or the period which immediately 
 precedes it. In that stage, 1 can see no advantage to 
 result from withdrawing a small portion of blood ; and 
 in 99 out of a hundred cases, a small portion can only 
 be withdrawn. The sensorial derangement will not 
 be relieved by the evacuation, and the system, already 
 depressed by excessive discharges of the most debili- 
 tating kind, will be plunged still deeper into that fatal 
 weakness which is the principal characteristic of 
 this disease. The evacuations of advanced cholera, 
 18* 
 
210 TREATMENT OF 
 
 are not the discharges of alvine matters, or of the or- 
 dinary fluids of the bowels. They are largely compo- 
 sed of the serous and saline parts of the blood ; and 
 consequently produce a destruction of the strength, as 
 swift as it is complete. 
 
 1 entertain the highest respect for some of the em- 
 inent supporters of bleeding ; but, after conscientious 
 attention to the subject, and watching the practice in 
 various hands, I feel myself bound to declare my con- 
 viction. If the patient is attended within an hour or 
 two of the attack, and the pulse is strong, and the ar- 
 terial system in a state of excitement, and he is yet un- 
 reduced by the debilitating dejections of choleric di- 
 arrhoea and vomiting, bleeding is demanded by the 
 ordinary rules of our art, which indicate venesection 
 as the best mode of relieving arterial irritation and high 
 action. But when was it proposed till the present 
 day, to relieve a condition of the extremest depression, 
 and of no arterial excitement, by the abstraction of the 
 principal vital fluid? The blood is unnaturally thick- 
 ened, to be sure, grumous and probably carbonized ; 
 but will the removing of a small column of venous blood 
 change the condition of the rest of the sanguineous 
 fluid, or give energy to those nerves which, under a 
 poisoned influence, have ceased to perform their im- 
 portant functions, of giving life, action, and energy to 
 the whole system ? 
 
 1 grant, most freely, that in the first and second pre- 
 monitory stages, bleeding may do good ; for then the 
 arterial system is in a state of excitement, and the poi- 
 son has not fixed its deadly fangs on the powers of life 
 itself. But then, even, I would be cautious. A de- 
 pressing influence is in the constitution, which may 
 every hour develope itself as most deadly in its power 
 
 
THE CHOLERA, 211 
 
 and tendencies. Let there be withdrawn only so 
 much as to diminish somewhat the energy of the cir- 
 culation ; but do not trench on the vis vitas. Ever 
 recollect that a poison is within which nature is strug- 
 gling to oppose, and by instituting increased action, 
 seeks to free herself from her insalubrious oppressor. 
 Nor is this the language of theory only. I have seen 
 many attempts at bleeding in collapse, but never to 
 any other purpose but apparent harm : and in numer- 
 ous instances of the last stage of the premonitory symp- 
 toms, 1 have thought collapse induced by injudicious 
 bleeding. I was favored w T ith the perusal of a case 
 by a medical friend near Musselburgh, which, under 
 appropriate treatment, and without bleeding, I have 
 no hesitation in saying would have done well ; but 
 from the apparent success of another, and a published 
 case, which had excited a good deal of attention, my 
 friend thought proper to repeat the practice, and lost 
 his patient. But this solitary case need not be quoted ; 
 for in the practice I have seen, I have bitterly to la- 
 ment the injudicious use of the lancet in severe pre- 
 monitory cases. 
 
 There is still a question among practical men, if a 
 state of excitement always precedes the attack. I 
 think it does. In all cases I have had it in my power 
 to observe from the first, it has done so. The poison of 
 cholera in this country does not seem sufficiently 
 energetic to destroy the constitution in a moment, as 
 it is said it sometimes does in India. Nature struggles 
 for emancipation, generally for days together, and in- 
 stitutes new actions, and various discharges, to relieve 
 herself of her load. It is in this condition that the in- 
 judicious practice of giving a mustard emetic is fre- 
 quently resorted to. If an emetic is indicated, the 
 
212 TREATMENT OF 
 
 symptoms giving reason to suppose that sordes are to 
 be discharged from the stomach, common salt and wa- 
 ter will be the best emetic ; it will not irritate and 
 stimulate. But in general, copious draughts of warm 
 water will answer the purpose better. Upon the 
 whole, I entertain much doubt of the propriety of 
 emetics in the advanced stages of cholera. 
 
 I come now to consider the important subject of the 
 use of calomel in this disease. All British practition- 
 ers, who have treated the complaint, have resorted to 
 this chymical preparation. I am not sure that in gen- 
 eral, calomel is prescribed upon any principle ; but 
 rather empirically, and without very definite conclu- 
 sions. I entertain no doubt of the propriety of its use, 
 and have for the advantage of those who have not seen 
 much of cholera, given in the appendix f numerous ca- 
 ses illustrative of the use of it. Perhaps, in our present 
 knowledge of the nature of the disease, we must speak 
 with caution in endeavoring to explain the rationale of 
 its beneficial action. But this is clear, that scarcely any 
 substance will lie more agreeably on the stomach than 
 calomel, in this disease ; for I have been surprised to 
 see repeated doses of calomel retained, when all other 
 things were vomited. Dr. Lawrie says that he knows, 
 from personal experience, that calomel will remain on 
 the stomach when nothing else will ; and my experi- 
 ence of it has been exactly to the same purpose. 
 
 Thus there is no objection to its use, on the score of 
 local irritation ; and from its action on the system as 
 an active mercurial, we may expect it to expedite the 
 return of the secretions of the bowels, liver and kid- 
 neys — which, when obtained, our patient is safe. In 
 England, I seldom saw ptyalism produced by calomel ; 
 but here, where we have the advantage in our hospit- 
 
THE CHOLERA. 213 
 
 als of a capital system of heating, our collapse wards 
 being seldom under 75 deg. Fahrenheit, all the cases 
 which recover are decidedly under the influence of 
 mercury. Thus does the effect of this excellent appli- 
 cation of heat not only act mechanically in restoring 
 that which nature has ceased to supply, but it also gives 
 increased effect to the appropriate medicines. Even 
 after enlarged experience in this disease^ I think calo- 
 mel will retain its place among the remedies used for- 
 ks removal. 
 
 Opium is the next remedy of importance to which 
 we have to allude. This powerful drug has been too 
 indiscriminately used, in the treatment of cholera ; and 
 the scientific practitioners with whom I have had inter* 
 course, now use it with much greater caution than 
 they did when they commenped the treatment of this 
 disease. In the appendix will be found several cases, 
 explaining the mode in which the English practition- 
 ers now use it. 
 
 Several considerations press upon us in reflecting 
 on the use of this drug in cholera. With what inten- 
 tion do we administer it ? It is a stimulant. But have 
 we not pure stimulants of a kind which do not par- 
 take of its narcotic nature, and which will give excite- 
 ment, and act as cordials, without either a depressing 
 or narcotic effect upon the nervous system? Upon 
 the whole, it is my opinion that the use of opium ought 
 to be confined to its effects in obviating spasm, and 
 w T hen spasm does not exist, if a stimulant is indicated, 
 the pure vinous diffusible stimuli seem more appro- 
 priate. We must not forget, however, how useful it 
 may be, from its soothing and astringent qualities, in 
 moderating the discharges ; but let us also remember, 
 that more than half the deaths of cholera are in its final 
 
•214 TREATMENT OF 
 
 congestive fever, and that the principal symptom of 
 that fever is congestion of the head : and consequent- 
 ly that the accumulated effects of a narcotic stimu- 
 lant is much to be dreaded and avoided. 
 
 I would then, very earnestly expostulate against 
 any thing like a liberal use of this drug in the disease ; 
 and would only recommend it in cautious doses, for 
 the purpose of moderating the discharges and subdu- 
 ing spasms. 
 
 Brandy comes next in the list of the remedies em- 
 ployed in cholera ; and as in all cases of collapse I 
 have seen treated by others it has been employed, I 
 must inquire into the propriety of its use, with some 
 caution and accuracy. Does the pathological histo- 
 ry of this disease indicate the propriety of the free 
 use of a diffusible stimulant ? 1 appeal to all those 
 who have witnessed dissections of cholera, if I am 
 not correct in stating that the great and leading facts 
 elicited on the examinations, w r ere, that the import- 
 ant viscera, and even the brain, showed most demon- 
 strably that they had been subjected to high action. 
 I have witnessed the dissection of six bodies in the 
 disease. In all of these, demonstrations of inflam- 
 matory action were most clearly evinced, and inflam- 
 mation, too, of the nerves, plexuses, and membranes, 
 which could not be disputed ; and that man must be 
 hardy indeed, who can look at these details, and say 
 that in its early stages, this is not a disease of inflam- 
 matory action. In the early stages, this action can 
 be subdued; and it is this important fact to which 1 
 have labored to call the attention of the country. But 
 the organs principally affected, the gastric ones, it is 
 known to every tyro, most unhappily do not bear 
 such free bleedings as other important inflammations. 
 
THE CHOLERA. 215 
 
 I make this remark, because it may be urged, why 
 do you give us so many cautions about blood-letting, 
 when you acknowledge with the same breath, that it 
 is a disease of inflammation ? I answer to this, that 
 it is only so in its early stages. Pass the bourne of 
 the second premonitory stage, and the evil is consum- 
 mated, You have no longer a case in which inflam- 
 mation alone is to be considered, but one in which 
 all the functions of nature have lost their powers ; and 
 where, alas ! you can only temporize, and look on, 
 and watch for, and assist the healing power of na- 
 ture. 
 
 Is brandy, then, a remedy in any stage of this dis- 
 ease ? In the report, I have permitted its use in small 
 quantities, not venturing to make an innovation on 
 the established practice by avoiding it altogether ; but 
 it is now my duty to say decidedly, that the cup of 
 brandy you perpetually see at the head of the chole- 
 ra patient, cannot be given him innocuously. His 
 bowels are in general in a state of positive high action 
 and inflammation ; so are his brain and spinal mar- 
 row, and so are even the vascular systems of the 
 greater nerves. What do we gain by brandy ? We 
 obtain a temporary diffused excitement from its sti- 
 mulant powers, and a kind of soothing of the sensa- 
 tions from its narcotic influence ; and can these effects 
 produce any change in that morbid condition of the 
 system, which we have seen, is cause of cholera ? 
 I will be told that brandy, by the mouth and by ene- 
 mata ? have often and evidently done good. Let, then, 
 this be its restricted use. Never give it, either in the 
 one mode or the other, but in those extreme cases of 
 disease where even the temporary fillip to nature, 
 whichit can give, maybe courted ; and though it is 
 
216 TREATMENT OF 
 
 to come into contact with and irritate diseased tis- 
 sues, still perhaps, in these extreme circumstances, 
 its use may be indicated. But in the premonitory 
 stages, while action, sometimes high action, still ex- 
 ists, — and when we know many vital parts are high- 
 ly irritated, and that our business is to subdue that 
 action,— I never see the glass of brandy at the pa- 
 tient's head without a shudder/ It is a fact that in- 
 telligent practitioners are every day becoming more 
 and more cautious of the use of this stimulant. I 
 feel that I have ventured far in this wholesale con- 
 demnation of it; but I confidently anticipate the 
 decision, in my favor, of those who are to come after 
 me, inasmuch as my views are certainly founded in 
 the ascertained pathology of the disease. When 1 
 think a cordial strongly indicated, I am in the habit 
 of preferring the pure wines, the irritation to the in- 
 flamed tissues, from their use, being less to be dreaded 
 than the sharp and naked points of alcohol. 
 
 The next great remedy employed in the cure of 
 this disease, is the application of heat. The restora- 
 tion of the natural heat, so totally lost in the collapsed 
 stage, is suggested by the most natural and evident 
 reasons. The only question is, what is the best 
 mode of effecting this object ? I shall first allude to 
 the most approved modes of applying heat in hospital 
 practice. In this respect I thought the English hos- 
 pitals very deficient. One of the Edinburgh hospi- 
 tals is admirably managed, by a plentiful supply of 
 heated air, and by steam heated mattresses. The 
 Vennel hospital of Greenock is heated by flues com- 
 municating with two furnances, which keep the 
 whole wards constantly at a temperature of from 65 
 to 15 degrees Fahrenheit. We have also a plentiful 
 
THE CHOLERA. 217 
 
 supply of tin vessels, fitted to the shape of the various 
 parts of the body — the abdomen, the arms, the legs, 
 and the chest — by which the heat of warm water is 
 easily conveyed to any of these parts. We have 
 also always in readiness a plentiful supply of heated 
 sand for sand bags. The sand bags are in general 
 made too large, in consequence of which they are 
 heavy and oppressive. They should be flattened 
 bags, and contain only a thickness of an inch and a 
 half of sand. 
 
 The advantage of the general heating of cholera 
 wards is prodigious. 1 have already explained how 
 much more efficient it makes the operation of the 
 mercurial medicines. We have never used the air 
 baths here — perhaps because 1 entertain the idea that 
 ■the application of heat by this slow conductor is not 
 the most efficient mode of communicating it, and 
 that the necessary machine is inconvenient during the 
 frequent dejections and vomiting of the patient. But 
 in all hospitals a ward should exist, removed from the 
 influence of the stoves, in which to place the patients 
 when the stage of consecutive fever has effected 
 them. In private we have only in our power to use 
 the sand bags, tins, and bottles, which c.an be pro- 
 cured ; and to take care to procure a plentiful supply 
 of bed-clothes, and as large fires as possible in the 
 grates. The arms, which are apt in jactitation to be 
 ^perpetually exposed, should be covered to the shoul- 
 j ders with worsted stockings. In the country, where 
 ' hospitals cannot be procured with stoves, it is aston- 
 ishing what perseverance will do in accomplishing 
 our purpose by very slender means. In the Appen- 
 dix will be found a case, by Dr. Morson, which oc- 
 
 rred in a pitman's house, near Newcastle : and 
 19 
 
218 TREATMENT OF 
 
 which shows very well how much can be done by 
 the anxious application of ordinary domestic means. 
 
 All practitioners agree that rubbing is of the great- 
 est importance. The excitement which it gives to 
 those extreme vessels, which, in this disease, seem so 
 peculiarly to lose their tone, indicates its utility, and 
 wherever assistance can be procured it should not be 
 neglected. When Dr. Mollison of Edinburgh was 
 in Newcastle, he cured many cases by energetic and 
 continued rubbing, which in all probability would not 
 have recovered without it. 
 
 We must next take into consideration the claims 
 of counter irritation, to the rank of a valuable reme- 
 dial agent in this disease. It is evident from the views 
 given, and the facts stated, that counter-irritation is 
 clearly indicated in this disease. 1 regret exceeding- 
 ly that none of the dissections I have been enabled to 
 give, show the condition of the spine in cholera, 
 Several friends of mine, who have examined the 
 spine, say that the membranes of the spinal marrow 
 were inflamed. If this is the case, undoubtedly a 
 mode by which inflammatory action will be subdued. 
 in this immensely influential part, without at the 
 same time debilitating the genera! frame, is of the 
 utmost consequence. With this view, I have three 
 times used the actual cautery to extremely bad cases, 
 but I regret to say in none of them was I successful. 
 They were, however, the worst description of cases, 
 and do not stagger my belief in the utility of the re- 
 medy, if applied to a curable case. The best place 
 to apply the cautery seems the lower part of the back 
 of the head, particularly where it joins the spine, and 
 along the spine itself. Dr. Barry says that Dr. Lange, 
 at Cronstadt, by the cautery cured 12 cases out of 
 
THE CHOLERA. 219 
 
 -14. I am skeptical of this, but am willing to believe, 
 L that much advantage may spring from this very de- 
 ed mode of counter-irritation. 
 The next effectual and most efficacious mode of 
 applying a violent irritant, is by placing on the skin 
 a cloth newly wrung out of boiling water. This 
 mode 1 am in the habit of regularly practising, and 
 often with benefit. The blister is raised instantane- 
 ously, and in the pains of the hypogastric region, so 
 common in this disease, it in general gives relief in a 
 few minutes. The next speediest mode is the infu- 
 sion of cantharides in strongest ascetic acid, which 
 will raise an effectual blister on the scalp, or other 
 part of the skin, in a few minutes. 
 
 I know 7 nothing of the effects of galvanism, never 
 having seen it adequately applied in this disease. I 
 confess that, from the nature of this agent 5 I do not 
 expect it will be eventually found useful. The desi- 
 deratum in this disease is, not the restoration of vital 
 or nervous power, but the cure or alteration in the dis« 
 eased state of the nervous power. Now, the proved 
 effects of galvanism are only, that it is able, for a 
 time, to act as a substitute for the nervous power. 
 That it can change unhealthy actions of that pow r er 
 we have no fact to convice us. In Ceylon, I under- 
 stand, a successful case took place from its use, 
 though it was only directed through the lungs ; 
 and 1 have sent to the neighborhood of Mussel- 
 burgh a powerful galvanic battery, which, 1 un- 
 derstand, they have put to use, and speak fa- 
 vorably of the results. But 1 have heard of seve- 
 ral unsuccessful experiments in this neighborhood 
 lately. The remedy seems, at first sight, adapted to 
 the disease ; but even Dr. Philip, who might have 
 been pardoned though he had hoped too much from 
 
220 TREATMENT OF 
 
 galvanism, says — ' 1 cannot overlook two circum- 
 stances-, which seem, in some degree, to render the 
 expectations from it less sanguine. That when the 
 nervous power is merely withdrawn, it can supply its 
 place, rendering the functions of the organ as perfect 
 as when that power was entire, has been ascertained; 
 but in the disease before us, we have reason to fear 
 that the failure does not consist in the mere loss of 
 nervous power, but that the operation of the poison, 
 or the organs of that power, diffuses the influence of 
 the poison itself throughout the system. The other 
 circumstance is, that if it be capable of counteracting 
 the offending cause, it is doubtful whether the degree 
 in which it can be safely employed is sufficient for 
 this purpose. In supporting the function of a vital 
 organ, when it is deprived of its nervous power, a 
 very considerable galvanic power is necessary. It is 
 not to be supposed, in our clumsy mode of applying 
 it, that the same degree of power will be sufficient, 
 as when applied by nature herself. This objection, 
 however, only relates to the degree of benefit to be 
 expected from it. The way in which it was employ- 
 ed in my experiments, is not the proper mode of ap- 
 plying it in the disease before us. Wires, from the 
 positive end of the trough, should be applied to vari- 
 ous parts of the head, and along the whole course of 
 the spine, and wires from the negative end t© various 
 parts of the chest and abdomen.' 
 
 Other remedies have been lately proposed, some of 
 them by high authority. A distinguished foreigner, 
 who visited this country lately for the purpose of at- 
 tending to this disease, proposed, and carried into 
 effect, the process of injecting the veins with a solu- 
 tion of opium. I am not sure of the theory on which he 
 
THE CHOLERA. 221 
 
 expected relief from this process ; but I have heard 
 that he had experienced great benefit from it in te- 
 tanic and other violent nervous affections. It totally 
 failed, his patients having sunk as if no remedy had 
 been used. In Newcastle, where 1 had the pleasure 
 of visiting him, I predicted to my friends that this 
 would certainly be the result of the experiment. 
 The narcotic effect of opium was not to be expected 
 to have power to change the altered state of fluids to 
 that of health, nor to banish the distressing and mor- 
 bid influence settled on the nerves, and slow as the 
 circulation is in collapse, it was hardly to be expect- 
 ed that his remedy was ever to reach the heart and 
 vital parts of the system. In my report to the Board, 
 I have stated my conviction of the utility of the tobac- 
 co enema ; and I have given in the Appendix a series 
 of cases by Mr. Baird, and an essay illustrative of 
 his theory in using it. He prescribes it under the 
 conviction that cholera is a disease of spasm of the 
 important viscera, particularly the gall bladder; and 
 that the relaxing effect of the tobacco subdues this 
 spasm, gives free play to the powers of life, enables 
 the circulation to recommence, and the secretions to 
 flow, 
 
 1 am not prepared to dispute this doctrine of spasm 
 to a certain extent. It may be one of the effects of 
 the poison to cause spasm of the important vicera. 
 We see the bladder contracted, even in death, in 
 every dissection of cholera ; and in two cases I have 
 found the gall duct impervious (in four cases it was 
 patent.) This closure must have taken place from 
 effusion of coagulable lymph shutting it up iri the first 
 high action of the disease. 1 do not think this closure, 
 
 in the dead state, could have been from spasm'. But 
 
 19* 
 
222 TREATMENT OF 
 
 1 am disposed to attribute the good effects of the to- 
 bacco, rather to some specific power in this peculiar 
 drug, by which it counteracts the poison of cholera, 
 and reduces, by its depressing influence, the high ac- 
 tion of the vessels, thus inducing a new and salutary 
 action. But be the theory as it may, the practice is 
 good, and 1 earnestly invite the profession to give it a 
 fair trial. I am convinced, that, after the first stage 
 of this disease, the bile ceases to be formed. No 
 doubt, we always find the gall bladder full. But I 
 believe this filling to have taken place at the com- 
 mencement of the disease. There never appears any 
 yellowness of the skin in any of the secretions, during 
 the progress of cholera, in the perspiration, the urine, 
 or the saliva. There is no proof of bilious absorption, 
 which infallibly would have existed if bile had been 
 formed. 1 believe, in the advanced stages of cholera, 
 that a total suspension of bilious secretion takes place 
 as well as urine ; and that the reason w^e generally 
 find the gall bladder full, is, that the debilitated organ 
 cannot propel its contents. The urinary bladder is 
 differently situated. It is a voluntary organ to a great 
 extent : and 1 have already explained that the volun- 
 tary muscles do not seem much under the influence 
 of this poison. The last formed portions of urine, in 
 the state of health, are thus expelled, and afterwards 
 none forms. 1 have stated that coagulable lymph is 
 in all probability the cause of the occasional closure j 
 of the gall duct. That, in the early stages of this dis- 
 ease, this part of the blood (the lymph) is largely sep- 
 arated, is proved by the dissection of M'Millan, nar- 
 rated in the page 132 of this work, where a lengthened 
 polypus was found in the whole course of the longitu- 
 dnal sinus, and one in each ventrical of the heart. 
 
THE CHOLERA. 223 
 
 Iirthe Appendix to Dr. Kirk's practical observa- 
 tions on Cholera Asphyxia, the following important 
 note is found. 
 
 Sketch of the Practice of three eminent and excellent 
 Practitioners of Newcastle. 
 
 1 shall now lay before the public a short summary 
 of what I understood to be the treatment of this dis- 
 ease, by a very eminent and excellent practical sur- 
 geon, Mr. John Fyfe, of Newcastle. At the time I 
 was in Newcastle, he had attended 579 cases of 
 cholera ; and in all these, he says that collapse never 
 came on till after profuse serous discharge from the 
 bowels. Mr. Fyfe relies very much on stimulating 
 enemata ; and he says that they seldom fail to pro- 
 duce reaction in its most salutary form, attended by 
 iess congestion than that which followed collapse of 
 longer duration, in which stimuli had been withheld, 
 or when the most diffusible stimuli had been given by 
 the mouth. When watery diarrhoea exists, tinged 
 with healthy secretions, he has arrested it often at 
 once by opium; and in nineteen cases out of twenty, 
 convalescence has followed. But if the disease has 
 advanced, he then gave repeated doses of calomel : 
 moderated the discharges by opium, and softened the 
 pulse by bleeding, if , necessary. If the disease pro- 
 ceeds to vomiting, purging, and cramp, Mr. Fyfe pre- 
 scribes a mustard emetic, followed by copious 
 draughts of warm w 7 ater, friction, and the proper reg- 
 ulation of heat. If the pulse is firm, blood is taken 
 to the extent the pulse can bear. Calomel and opium 
 are then used, and diluents allowed. In collapse, 
 Mr. Fyfe objects to large opiates, and also to general 
 
224 TREATMENT OF 
 
 bleeding ; but, in general, he gives relief by throwing 
 into the intestines three pounds of very hot water, six 
 ounces of brandy, and occasionally two drachms of 
 laudanum. It will be frequently necessary to with- 
 draw these injections by a tube — they come off cold 
 — and to repeat them either with hot water alone, or 
 with laudanum, if the irritability of the stomach con- 
 tinues. In this stage Mr. Fyfe uses brandy liberally. 
 He treats the reactive fever in the same way Mr. 
 Frost does, as stated below, and I have already al- 
 luded to some of his ingenious adaptations in my re- 
 port. Mr. Fyfe thinks the period of the incubation 
 of the morbific germ of cholera seems to vary from 
 four hours to eight days. Mr. Fyfe is also of opinion 
 that the effluvia, from the excretions of an individual 
 having diarrhoea cholerica, may communicate to an- 
 other predisposed the most developed form of the 
 disease. 
 
 Mr. Frost, of Newcastle, treated 500 cases of 
 cholera, and is a person of high qualifications, a calm 
 thinker, and an excellent practioner. I think the 
 profession will be glad to hear his opinion and prac- 
 tice in the disease, which 1 will give as accurately as 
 1 can recollect a conversation held with that gentle- 
 man at Newburn. He said that he conceived it a 
 malignant congestive fever, — and if English physi- 
 cians had seen this disease without reading Barry, 
 Bell, Orton, and Lefevre, they would have treated it 
 on scientific principles, and according to the rules of 
 British art. They would have given no astringents. 
 The catch-word of ' stop the diarrhoea' would never 
 have existed. He stopped it, but in a far different 
 method, viz., by calomel, castor oil, and very minute 
 doses of opium ; say five grains calomel, one opium, 
 

 THE CHOLERA. 225 
 
 and two antimonial powder to begin with, several 
 times repeated. If there is headach, and giddiness, 
 and the pulse is of sufficient tone at the commence- 
 ment, — if the pulse is from eighty to a hundred, bleed 
 moderately. But the bleeding must be cautious ; for 
 in this, as in all cases of intestinal irritation, bleedi 
 cannot be largely practised with safety. If the stom- 
 ach is much loaded, or there is nausea, give a draught 
 of warm water to excite vomiting. If that does not ef- 
 fect it, you may give salt and water, or ipecacuanha, 
 or a, dose of castor oil, which mayTSe succeeded by a 
 diaphoretic. This will open the skin. Next day 
 calomel and castor oil again. If the castor oil will 
 not stay on the stomach, the best substitute is magne- 
 sia and rhubarb. If "the patient gets colder, then fill 
 the large intestines with warm water from the forcing 
 pump 5 and if you have any idea that the bowels are* 
 not discharged, then put salt in the water. After 
 this invariable stage of diarrhoea comes that of col- 
 lapse. In every case where correct information 
 could be obtained, diarrhoea hajf^eceded it- He 
 gives warm water to induce vomiting"; injections of 
 hot water ; the careful regulation of heat ; twenty 
 drops of laudanum to allay irritation ; -two grains of 
 calomel, and one-sixth of a grain of opium, evey three 
 hours, for three times, and then castor oil In one 
 case, for instance, under this treatment, the pulse rose 
 to eighty, and the patient became warm. Eight 
 ounces of blood were taken from the arm. He passed 
 no urine for 48 hours. Mr. Frost went on with the 
 calomel, and next day the urine returned, and he re- 
 covered after a mild consecutive fever. He has never 
 practised stimulation. The consecutive fever of chil- 
 dren is almost always attended with the same symp- 
 
226 TREATMENT OF 
 
 toms as hydrocephalus acutus. The hydrargyrus cum 
 creta is the best remedy for them. He has seldom 
 been able to induce ptyalism. Worms are very fre- 
 quently vomited. They are always dead. The in- 
 jesta of cholera seem poisonous to them. At New- 
 burn, a village where Mr. Frost conducted a great 
 part of the practice, two hundred and seventy-three 
 cases of the disease occurred up till the day en which 
 1 visited Newburn with Mr. Frost. Fifty of these 
 cases were fatal. The whole inhabitants of the village 
 were five hundred and fifty, one hundred and forty- 
 one families, and one hundred and thirty-four houses. 
 This is truly appalling. In general, even w 7 hen the 
 cold stage is incomplete, consecutive fever sets in — 
 there is much giddiness, pain ofthe head, and stupor. 
 He has always treated this stage with laxatives. 
 Mustard sinapisms applied to the neck, relieve the 
 head ; to the epigastrium, the stomach. They have 
 often been costive, but it has not been difficult to 
 manage the bowels. Leeching to the head was fre- 
 quently resorted to. Now, I ask the reader to com- 
 pare the success of this treatment with that in the vil- 
 lage of Hartly, where brandy and opium were used, 
 and where, out of thirty four cases, thirty-two died. 
 
 1 beg now to give the experience in this disease of 
 an excellent friend, Mr. D. M'Allum. His acute- 
 ness and talent are only equalled by the excellence 
 of his heart and the soundness of his principles. 
 
 Dear Sir, — Imperfect as naturally must be, from 
 my limited opportunities, my capability of replying to 
 your queries respecting cholera ; yet so far as my in- 
 formation can contribute, in the slightest degree, to- 
 wards the furtherance of your laudable object, 1 am 
 happy to afford it. 
 
 1 
 
THE CHOLERA. 22t 
 
 In looking over the list of queries pioposed, 1 do 
 not see that my individual experience can afford any 
 information worth recording, but upon the last, viz., 
 the treatment found most successful. In reference to 
 treatment, I would divide this disease into three 
 stages. 1 st, That of excitement, or irritation, wherein 
 the patient throws or purges freely, generally accom- 
 panied by severe spasmodic action of the muscles of 
 the legs and bowels : the pulse distinctly perceptible, 
 quick, sharp, and, in some subjects, full. This stage 
 does not last beyond a few hours, passing on to, 2dly, 
 The stage of collapse ; wherein the pulse becomes 
 imperceptible, the extremities cold, the breathing 
 more laborious, the countenance more sunk, espe- 
 cially the eye, which assumes a leaden hue ; and, 
 3dly, The stage of reaction. He who is happy enough 
 to be called in during the first stage, will not hesitate, 
 if the patient have any vigor of constitution, to bleed 
 freely, premising, or using simultaneously, a gentle 
 emetic of ipecacuanha, or salt and water, following 
 this by an anodyne injection. I then administer a 
 pill of two grains of calomel, and one-sixth of a grain 
 of opium, every half hour, with chalk mixture, or sa- 
 line julap, in a state of effervescence for a few hours, 
 until we have dejections evidently combined with 
 bile. To assist this operation, and especially if the 
 vomiting be still severe, I administer warm emollient 
 injections, and afterwards treat as in ordinary con- 
 tinued fever In this stage of collapse, or approach- 
 ing to it, I give a tea-spoonfui of mustard in a little 
 warm water, every five minutes, till 1 produce vomit- 
 ing; at the same moment I order enemata of very 
 warm w 7 ater and soap, without reference to quantity, 
 ^endeavoring to throw up as much as ever I can. 
 
228 TREATMENT OF 
 
 These means 1 find more successful in restoring heat 
 than any external means ; but which I do not, never- 
 theless, neglect, ordering hot applications to the feet, 
 hands, and arm-pits, and that the patient be well 
 rubbed with a stimulating liniment of spirits of tur- 
 pentine, tincture of capsicum, mixed with camphorat- 
 ed oil ; I then apply the hot air, both which I con- 
 tinue at a temperature about 84, for two hours or more. 
 In the mean time, as soon as the emetic has operated, 
 I give six grains calomel, one-fourth of a grain of 
 opium, every quarter of an hour, with two table - 
 spoonfuls of a mixture containing compound spirit of 
 ammonia three drachms, spirits of mindererus three 
 drachms, mixed with hot coffee, giving warm liquids 
 very freely and frequently. In this stage I have tried 
 bleeding repeatedly, but without benefit ; indeed, it 
 seemed to me to precipitate the fate of the patient. 
 The enemata ought to be repeated frequently until 
 reaction takes place. The third stage, viz., of reac- 
 tion, requires no difference of treatment from that of 
 our usual typhus mitior, excepting that bleeding 
 should be had recourse to with very great caution, as 
 I believe, by its too free use in improper cases, the 
 stage of collapse has returned, and the patient sunk. 
 There is generally a tendency to congestion, either 
 of the brain or liver, which requires the application of 
 leeches and blisters. The mortality in my own prac- 
 tice was during the first three w r eeks — -exactly two to 
 one recovered ; but since January commenced T have 
 had seven cases, most of them applying early ; six 
 of them are convalescing, and one dead. In Wall- 
 send township, amid a population of 3000, there have 
 hitherto occurred 15 cases and 4 deaths. 
 
 In the above observations I have merely referred 
 
THE CHOLERA. 229 
 
 to my own individual practice, and its results. Al- 
 though T have had three patients in one house, I have 
 met with no fact that could confirm the doctrine of 
 contagion. 
 
 Yours, respectfully, 
 
 D. M'ALLUM, 
 Blackett Square, Saturday, Jan. 14th, 1832. 
 
 £0 
 
230 TREATMENT OF 
 
 TREATMENT OF THE CHOLERA IN CANADA AND 
 THE UNITED STATES. 
 
 The first appearance on this continent of the epi- 
 demic cholera, was in Canada, at Quebec and Mon- 
 treal. 
 
 At these places, it was noticed early in June, 1332. 
 The first case published as epidemic cholera, occur- 
 red at Quebec the 8th of June, and in a day or two 
 after, several cases occurred at Montreal, and in the« 
 course of a very short time, it raged in both places 
 with a violence unknown in Europe, and unprece- 
 dented in Asia. 
 
 It ought, however, to be remarked, that according 
 to the testimony of many of the physicians in Cana- 
 da, a similar disease was noticed there early in the 
 spring, and before any arrival of vessels from Europe. 
 So malignant were these cases that occurred early in 
 the spring at Montreal, that some of the medical men 
 believed them to be cases of real Asiatic cholera, and 
 expected to see that disease prevail, but it disappear- 
 ed in a few days. When it did appear as an epi- 
 demic, it came unexpectedly, and so sudden and vio- 
 lent was the attack, and so numerous were its vic- 
 tims, and so wretchedly circumstanced were the em- 
 igrants from Ireland, among whom it most prevailed, 
 that at first, but little was done, and but little could 
 be done, as respects the administration of remedies. 
 Hundreds died without any medical aid whatever. 
 After awhile, better accommodations were obtained 
 for the sick, and when the disease attacked the native 
 inhabitants of the place, a more systematic course of 
 treatment was adopted, and according to the state 
 
THE CHOLERA. 231 
 
 mentsofthe physicians of Montreal, with very great 
 success. 
 
 A few of the medical men of Montreal have pub- 
 lished brief statements of the practice they adopted in 
 .the cholera, and which they found on trial, and on 
 comparison with other methods of treatment, to be 
 most successful. Their plans of treatment, I shall give 
 in their own words. 
 
 Dr. Caldwell, an eminent physician of Montreal, 
 thus writes respecting the cholera, to Dr. Mc 
 Naughton, of Albany : — 
 
 " Montreal, June 24, 1832, 
 Dear Sir,— 
 
 i am just recovering from an attack of spasmodic 
 cholera, and am still so weak as to be unable to enter 
 into a minute detail ; but so far as my strength will 
 permit, will answer the queries you have put. 
 
 And with regard to the first, have to remark, that 
 although it first appeared amongst the emigrants, the 
 inhabitants have since suffered in much greater 
 ratio. 
 
 2d. In the first instance, it was principally confi- 
 ned to the lower orders, but for the last ten days it 
 has seized, indiscriminately, all classes. 
 
 3d. If you are acquainted with the localities of 
 Montreal, you will recollect a small creek or rivulet 
 that runs immediately in the rear of the town, and 
 very nearly throughout its whole extent from east to 
 west ; it has undoubtedly confined itself in a great 
 measure to the line of that channel, and the small al- 
 leys running up from it ; so much so, that I think I 
 am perfectly correct in stating, that 90 cases out of 
 the 100 have occurred on the contiguous banks or al- 
 leys running from them. 
 
232 TREATMENT OF 
 
 4th. Two-thirds of the medical men have been at- 
 tacked, and I believe all have felt its influence more 
 or less. There has been only one deaths but that is 
 accounted for from their being enabled to seize the 
 first moment of attack, and not to any immunity they 
 otherwise enjoyed. 
 
 5th. The duration of the disease has been from 
 four to twenty-four hours; the most frequent termin- 
 ation, however, from seven to twelve. Adult age has 
 exhibited a much greater susceptibility to the disease 
 than early life, and this may be accounted for from 
 the apprehensions of the latter not being so easily ex- 
 cited. Fear unquestionably predisposes most pow- 
 erfully, and such is the effect of the epidemic influ- 
 ence on the nervous system, that ail are more or less 
 affected by it 
 
 6th. We have not had it in our power to carry the 
 post mortem examinations to any great extent ; in 
 the first place f from the increasing demand for medi- 
 cal assistance, night and day, and latterly from the 
 great number of medical gentlemen being laid up. In 
 the few cases that have been examined, great venous 
 congestion has existed throughout the abdominal vis.- 
 cera, more particularly the stomach, intestinal canal, 
 and mesentery ; and in several instances where the 
 disease has been protracted for 24 or 36 hours, spha- 
 celus had taken place. I have not had an opportuni- 
 ty of seeing the head opened- 
 
 With regard to the treatment, you will see an arti- 
 cle in the Gazette of last week, by Dr. Arnoldi, which 
 strikes me as being the most rational. There is an- 
 other by Dr. Stephenson, in the Courant of yesterday, 
 but there is this objection to the means he suggests, 
 that in genuine spasmodic cholera* the irritation of 
 
THE CHOLERA. 233 
 
 the stomach is so great, that liquids of no kind will be 
 retained for an instant. 
 
 In my own practice, I confess to you, and 1 would 
 strongly impress it on your mind, that I have derived 
 more advantage from what may be called prelimina- 
 ry treatment, than from that during the actual attack. 
 Cholera is invariably preceded by symptoms of gas- 
 tric derangement, such as constriction or obstruction 
 of the prsecordia, or a sense of corrugation of the up- 
 per orifice of the stomach, loss of appetite, white fur- 
 red tongue, nausea, occasionally slight diarrhoea, thril- 
 ling sensations of heat through the bowels and differ- 
 ent parts of the body, These symptoms may continue 
 from a few hours, to a day or two, according to the 
 degree of predisposition and susceptibility of the indi- 
 vidual, and also the degree of concentration that may 
 exist in the atmospherical influence at the time. The 
 moment these symptoms showed themselves, I direct- 
 ed the patients instantly to send to me, and gave them 
 fromgr. x to xv of hydrag. cum creta, according to 
 the age and strength of the patient, and in two hours 
 followed it by tart, potassse dr. ii. in a little warm vea! 
 or chicken broth, and repeated it every second hour, 
 until it operated freely. Nothing seemed to allay the 
 gastric irritation so well as the soluble tartar. In 
 many instances it seemed to act as a charm, and I 
 do not know a single instance of any one who went 
 through the influence of this treatment that was sub- 
 sequently attacked with cholera. In some instances 
 it was necessary probably to repeat it once or twice ; 
 and where the tongue was much loaded, I added two 
 or three grains of the submuriate to it. 
 
 In the convalescent stage, if much disposition to 
 
 spasmodic action remained, I have derived great ad- 
 
 20* 
 
234 TREATMENT OF 
 
 vantage from the cajuput oil, in doses of from 15 to 
 25 drops, particularly in females, mixed with lauda- 
 rium, magnesia, &c. according as circumstances in- 
 dicated. > These hints will, 1 trust, enable you to 
 meet the disease, should it unfortunately find its way 
 to your city, with more confidence than 1 did at the 
 outset. The epidemic has for the last two days com- 
 pletely subsided, and has been succeeded by fever of 
 a low synochus form. 
 
 Believe me, dear sir, very truly yours, 
 
 W. CALDWELL." 
 
 Dr. Nelson, Member of the Medical Board and 
 Commissioner of Health of Montreal, thus describes 
 the treatment which he found most successful. 
 
 Treatment. — First Symptom. The principal me- 
 dium through which remedial means can be applied, 
 is the stomach. We are therefore compelled to look 
 to this organ first ; and as no remedy can be of ser- 
 vice there unless it be retained, we must, before all 
 other things, arrest the vomiting, if there be any, and 
 suffer the stomach to become perfectly calm before 
 any other medicine or substance be introduced, lest 
 by so doing we arouse the evil just subdued. As re- 
 lates to the stomach, there are two distinct stages in 
 the disease, and on a just appreciation of these will 
 the success of the practitioner depend. The first is 
 the vomiting, the second is the stage of collapse, or 
 sinking, when all vomiting shall have ceased. Now, 
 as the only known means to stop vomiting in this dis- 
 ease, and many others, is to paralyse the stomach, 
 we must carefully bear in mind, while prescribing for 
 the first, not to overdo the thing, lest when we re- 
 
THE CHOLERA. 235 
 
 quire the energies of the stomach, in the second stage, 
 we find them irrevocably lost in a collapse, which is 
 joined to the common sinking of all parts of the 
 body into death, (the sensorium excepted). Here 
 resides the first and greatest secret in prescribing for 
 a cholera patient ; and which, to the unobserving 
 multitude, has occasioned so much apparent discrep- 
 ancy in the treatment of different practitioners. In 
 the first stage, the most sedative treatment is essen- 
 tial 5 while in the second, the very opposite, that of 
 excitation. 
 
 How to paralyse the stomach, and consequently to 
 arrest the vomiting. Three very particular circum- 
 stances are to be borne in mind, — 1st, the remedy, — 
 2d, how to be administered, — 3d, comportment of the 
 patient. After all that has been said, it will be found 
 that every practitioner from the Ganges to the Vistu- 
 la, has been forced, whatever his preconceived no- 
 tions may have been, to look to opium as his anchor 
 of hope ; but it is to be regretted that a remedy so 
 good, so perfect from mal-administration, should have 
 been turned into a two* edged sword, at once curing 
 and killing the patient. Opium has been given in ev- 
 ery form, and in various combinations ; this last is 
 the error, as the pathological state of the stomach will 
 readily account for. There is such an inordinate 
 sensitiveness at this stage, in this organ, that it will 
 not suffer scarcely the smallest bulk of any substance ; 
 how T injudicious then to augment the size of the rem- 
 edy, by the addition of medicated waters, in them- 
 selves useless ; and how much more unscientific to 
 add a stimulant to your sedative, when the latter ef- 
 fect is the object of the prescription. Let the reme- 
 dy then be a sedative, and not a stimulant ; give opi- 
 
236 TREATMENT OF 
 
 um, and let the dose be concentrated to the smallest 
 size ; give one grain of solid opium, it must be swal- 
 lowed dry : if that be rejected, give a second, and so 
 on to a third ; it will rarely happen if the 3d circum- 
 stance be observed, that a fourth dose shall be requi- 
 red. One grain of opium is so small a body, that 
 the stomach can easily bear it, while the same reme- 
 dy, given in form of a draught, from size alone shall 
 be injurious. 
 
 3d. The patient is naturally restless, and any mo- 
 tion of the body is more or less communicated to the 
 stomach, and it has been observed, times out of num- 
 ber, that the mere turning round of the patient has so 
 acted on the stomach as to set it again in operation. 
 Motion of the body may so act on the abdominal sur- v 
 face of the stomach, as to affect the internal with a 
 sensation of foreign substance, and thus account for 
 the effect. To sum up, for the vomiting stage, give 
 one grain of opium, and give it dry ; give nothing else 
 till vomiting shall have ceased for several hours, and 
 keep the patient in the most quiescent state possible. 
 During all this time, the patient suffers intolerable 
 thirst ; this he must bear with. Drink will be re- 
 turned almost before it reach the stomach, and can- 
 not relieve the symptom for which it was given, 
 whilst it gives the patient one more dreadful convul- 
 sion, each of which hurries him to his end with a ten- 
 fold degree of velocity. Bear in mind, that one grain 
 of opium is as effectual in arresting the irritability of 
 the stomach, as ten grains, while the latter dose would 
 not only do the same, but also paralyse the stom- 
 ach beyond the term of resuscitation. The abuse of 
 opium too frequently occurred at Montreal." 
 
THE CHOLERA. 287; 
 
 Second Stage. — All is now quiet, and now is the 
 time to give stimuli. Small doses of warm brandy^ 
 warm punch, aether or ammonia \ but be careful to 
 choose such as are palatable to the patient. 
 
 The second symptom to be analyzed is the asphyx- 
 iated state of the extreme parts of the body, and also 
 the apoplectic state, as the French call it, of the more 
 central viscera. This asphyxia is known, as the term 
 implies, by the cessation of circulation, and blueness 
 and coldness of the surface. Fortunately it is not 
 difficult to appreciate the indication, though one may 
 not be so sure of its success. The cause is perhaps 
 internal:, but unknown : but the wet state of the sur- 
 face, by evaporation, contributes more rapidly to cool 
 down to the term of death. While you are calming 
 the stomach, take also in charge this last symptom, 
 and treat it thus : Dry the surface of the body by nap- 
 kins, and then still further dry it, by rubbing the pa- 
 tient over with powdered chalk ; and by previously 
 heating the chalk, you will render it doubly useful. 
 For this purpose chalk was recommended by a gen- 
 tleman of Quebec. If chalk cannot be had, the best 
 article as a substitute is flour ; but be careful in heat- 
 ing it not to suffer it to grow brown., lest by the 
 change of color its intransmissibility of caloric be 
 diminished. By fomentations and moist heat, we are 
 undoing with one hand what we are attempting with 
 the other. Moist heat is in the very teeth of natural 
 philosophy, and he who uses it, publishes his deficien- 
 cy in the collateral branches of his profession. 
 
 3d. The third symptom is spasm. In attending to 
 the two first as recommended, we do all that is re- 
 quisite for the third. Opium, as an antispasmodic, 
 and frictions. 
 
238 TREATMENT OF 
 
 AH other remaining symptoms are unworthy of no- 
 tice in this hasty sketch. They are mere concomit- 
 ants, or sequels of the former, and require to be pre- 
 scribed pro re nata. 
 
 P. S. I am induced to add the present postscript, 
 seeing that some persons have not fully comprehended 
 xny meaning when I referred to pro re nata prescrip- 
 tions. 
 
 I have purposely avoided speaking of the mustard 
 emetic, a remedy in this disease so nauseously absurd. 
 The idea of bleeding in cholera has its origin based 
 on an hydraulic theory, totally inadmissible in this 
 disease ; and we have seen its warmest supporters 
 abandon the child of their creation or adoption ; it 
 has been tried here a few times, and not found to an- 
 swer. 
 
 Calomel, a remedy without which an English phy- 
 sician could not live, has, in its place, a good effect, 
 but its place is more rarely found than the Briton im- 
 agines ; in whose practice it forms as invariable, as 
 constant, and often as annoying, an adjunct, as pins 
 do in a lady's dress ; in a lady's dress, pins must form 
 the tie ; in a gentleman's, buttons. The British will 
 have pins, the Continental European, buttons ; they 
 are both good ; on occasions, one is preferable to the 
 other." 
 
 The treatment adopted by Dr. Arnoldi and son, 
 and which has received the approbation of most of 
 the physicians in Montreal, is as follows : — 
 Statement of the Doctors Arnoldi. 
 
 Having now so many data to go by, of the efficacy 
 of our practice, in this most direful disease, (cholera) 
 and knowing that the members of the medical pro- 
 

 THE CHOLERA. 239 
 
 fession are not agreed upon a decided or uniform mode 
 of treatment, we take the liberty of announcing to 
 the public, through the medium of your types, that 
 our practice consists in ordering a total abstinence 
 from all liquids, (and solids of coiirse) from the mo- 
 ment the person feels himself under the influence of 
 any symptom threatening cholera, by which suffi- 
 cient time is gained to obtain medical advice. Our 
 prescription is simply one pill, containing one grain of 
 fresh opium and seven of calomel, which is to be 
 swallowed dry, without the aid of any liquid, if pos- 
 sible. The use of all beverages, we then insist upon be- 
 ing most strictly abstained from, until every symptom 
 has subsided, and something like hunger has returned. 
 In few instances have we had occasion to repeat the 
 pill, unless the patient's stomach did not retain the 
 first (and which was uniformly occasioned by the 
 fluids present in the stomach at the time,) and in the 
 course of a few hours, we generally followed up by 
 an ounce of Epsom salts, dissolved in half a pint of 
 water, and a wine-glass full taken every hour. The 
 subsequent treatment varied according to the pecu- 
 liarities of the case, and could be regulated by the 
 judgment of any practitioner/keeping strictly in mind 
 the yet remaining irritability of the stomach as to flu- 
 ids. Our exertions have been too frequently paralys- 
 ed by the absurd practice of taking laudanum or opi- 
 um pills previous to sending for advice. The pecu- 
 liarity of our plan, and to which we ascribe our whole 
 success, consists in obtaining the arrest of the urgent 
 symptoms by the least possible dose of opium, and 
 absolutely doing nothing. The plan is too simple to 
 be generally credited, but hundreds have experienc- 
 
S40 TREATMENT OF 
 
 ed the efficacy of it ; and we would strongly recom- 
 mend, at least, the first trial to every medical man. 
 
 The plan of sweating the patient we have had too 
 frequent occasions to lament and discountenance, but 
 we nevertheless do every thing in our power to re- 
 store heat to the extremities, by the -application of 
 bottles of boiling water, hot bricks, &c. &c. in the 
 usual manner ; frictions with hot dry flannels, (some- 
 times in desperate cases, sprinkled over with mus- 
 tard.) In short, dry heat in any manner whatever, 
 and this we find most speedily successful when the 
 body itself is but slightly covered. The spasms are 
 best relieved by keeping the patient in one posture, 
 the slightest motion being apt to induce them. We 
 candidly acknowledge that where the blue stage, co- 
 pious sweats, and cold extremeties have set in, before 
 medical aid is called for, we consider the case hope- 
 less ; but even under the most appalling circumstan- 
 ces, the perseverance in the above injunctions has oc- 
 casionally been attended with favorable results. 
 
 Our injunctions therefore, are, that no medicine be 
 kept in the possession of any individual for the pur- 
 pose of being taken, either as a precautionary step, or 
 before calling in medical aid. 
 
 That no person feeling indisposed, take medicine 
 from any but a professional man. 
 
 That a correct detail of all the symptoms be given 
 by any intelligent messenger to the doctor. 
 
 That no person should rely on the efficacy of any 
 of those drugs that are vended as specifics; everyone 
 of our fatal cases hasbeen preceded by the exhibition 
 of these drugs, or the opium pills so generally sup- 
 posed to be the first step towards the cure, the folly of 
 which cannot be too strongly reprobated. 
 
tTHE CHOLERA. 241 
 
 That when a person has once put himself under the 
 are of a medical man, he should continue to follow 
 his prescriptions solely. The interference of friends 
 has been attended by the most fatal consequences, 
 and that of professional men not less so, exclusively of 
 the indelicacy and want of consideration that should 
 subsist between the members of the profession ; as it 
 is but right that he who has the responsibility, should 
 at least have the management. 
 D. ARNOLDI, 
 FRANCIS C. T. ARNOLDI, M. D." 
 
 It is, however, important, though humiliating, to 
 add, that neither the above methods of treatment, nor 
 any other, adopted at Montreal, appeared to be of any 
 service in innumerable instances. I have been as- 
 sured by intelligent eye witnesses who attended upon 
 the practice of Dr. Arnoldi, that they saw it of no 
 avail in very many cases. 
 
 One medical gentleman who saw much of this 
 practice at Montreal, writes me that a it failed in all 
 the cases he saw in the stage of collapse." It was 
 however as beneficial as any other course pursued, 
 and in the less violent cases, proved highly service- 
 able. 
 
 When it was known that the cholera actually pre- 
 vailed in Canada, it excited universal alarm through- 
 out the United States. Many of the large towns sent 
 deputations of medical men to Montreal, to witness 
 the disease, and to obtain all the information in their 
 power, from personal observation, respecting this new 
 pestilence. All the large cities entered very actively 
 upon sanitory measures, such as cleansing the streets, 
 and the filthy parts of the town. In some places, 
 
 21 
 
242 TREATMENT OF 
 
 cholera hospitals were provided, and fitted up for the 
 reception of the sick. Quarantine regulations were 
 adopted and enforced, to prevent the disease being 
 brought from Canada and from Europe. But not- 
 withstanding all these precautions, the disease actual- 
 ly appeared in New York, towards the last of June, 
 1 82£, It appeared in different parts of the city at the 
 same time, and no one has yet attempted to show that 
 it was imported, or to point out the origin of the dis- 
 eass at New York. 
 
 The disease, however, found the Board of Health 
 at New York unprepared to meet it at first with that 
 care and attention which is requisite in order to give a 
 fair trial to the efficacy of remedies. A sufficient num- 
 ber of hospitals, with medical and other attendants, 
 and apparatus necessary for the sick, had not been 
 provided, and for a few days, no conclusions could 
 be drawn respecting the influence of remedies upon 
 the disease. In a short time, however, hospitals, &c. 
 were provided, and more order prevailed, and great- 
 er efforts were directed to the vigorous prosecution of 
 measures calculated to cure those attacked by the 
 disease. 
 
 Almost every remedy which had been tried else- 
 where, has been resorted to at New York, and yet it 
 is a lamentable fact that they have all failed in severe 
 cases. 
 
 The most successful treatment as yet adopted at N. 
 York has been pursued to the greatest extent at Green- 
 wich hospital. It consists chiefly in the use of exter- 
 nal means, such as the application of cayenne pep- 
 per, mustard cataplasms, frictions, &c. &c. — giving 
 but little, and in the stage of collapse no medicine by 
 the mouth. 
 
THE CHOLERA, 243 
 
 In this deplorable stage the patients were nibbed 
 ! with the following ointment : — 
 
 R. Ung. Hyd. fort, ife.j. 
 Pulv. camphor g viii. 
 cayenne g iv. M. 
 
 [ This ointment when diligently rubbed upon the 
 : body and limbs, generally produced some reaction, 
 and often produced slight salivation in six or eight 
 hours. When it did so, the patients were considered 
 safe. 
 The consecutive symptoms were successfully met, 
 L and treated like those of inflammatory fever, by lo- 
 cal bleeding, blistering, &c. 
 
 A few have been cured in New York by the in- 
 jection of saline solutions into the veins. 
 
 Dr. Rhinelander stated to the Board of Health of 
 New York the case of Margaret Mehan, who was 
 Li cured at the Crosby street hospital, by injecting into 
 . the veins, twenty four ounces of a solution composed 
 I of one drachm of carb. soda, and two drachms of 
 a muriate of soda (common salt) dissolved in six pints 
 of water. The operation was performed at 1 P. M. 
 L July 21st. 
 
 jj Several other cases of cholera have been cured in 
 
 a similar manner, both in this country, and also in 
 
 England, where the practice 1 believe originated. 
 
 This practice is undoubtedly founded upon the 
 
 . fact, said to have been discovered by analysis ; that 
 
 the blood drawn from a patient affected with chole- 
 
 - ra, has lost a portion of its watery and albuminous 
 
 « parts, arid also most of its natural saline ingredients. 
 
 According to Dr. Reid Clanny, of Sunderland, in 
 
756 
 
 644 
 
 121 
 
 31 
 
 59 
 
 253 
 
 32 
 
 66 
 
 18 
 
 6 
 
 244 TREATMENT OF 
 
 a communication which he made to the editor of the 
 London Lancet, the blood drawn from a patient who 
 had been five hours affected with cholera, had no 
 taste nor any particular smell. It contained no gases 
 of any description, and was as black as tar. For 
 comparison Dr. C. gives the analysis of the blood of 
 a healthy person. 
 
 This last contained one cubic inch of carbonic 
 acid in the sixteen ounces. 
 
 Health]/ Blood. Cholera Patient. 
 Water, 
 
 Albumen coagulated, 
 Coloring matter, 
 Free carbon, 
 Fibrine pressed and dried, 
 Muriates of soda and"^ 
 
 potassa, carbonate I -. 
 
 of soda and animal [ 
 
 extraction, J 
 
 1000 1000 
 
 Dr. O'Shaugnessy, instituted experiments on the 
 blood of cholera patients and obtained the following 
 results. 
 
 " 1. The blood drawn in the worst cases of chole- 
 ra is unchanged in its anatomical or globular struc- 
 ture .2. It has lost a large portion of its water : 1000 
 parts of cholera serum having but the average of 850 
 parts of water. 3. It has lost also a great proportion 
 of its natural saline ingredients. 4. Of the free al- 
 kali contained in healthy serum, not a particle is pre- 
 sent in some cases, and barely a trace in others. 5. 
 Urea exists in the cases where suppression of urine 
 has been a marked symptom. 6, All the salts defi- 
 cient in the blood, especially the alkali or carbonate 
 
. 
 
 THE CHOLERA. 245 
 
 f soda, are present in large quantities in the peculiar 
 white dejected matters." 
 
 These facts are exceedingly curious, and if con- 
 firmed by other cases and experiments, may lead to 
 new views of the pathology of the disease, if not to 
 new and more effectual methods of treating it. 
 
 The following communications from Dr* Lewins, 
 to the Secretary of the Central Board of Health, Eug- 
 3and, will serve to show the effect of injecting sal«ne 
 solutions into the veins, and the method of perform- 
 ing the operation. 
 
 " Sir,— I conceive it to be my duty to let you know, 
 for the information of the Central Board of Health, 
 that the great desideratum of restoring the natural 
 current in the veins and arteries, of improving the 
 color of the blood, and recovering the functions of the 
 lungs in cholera asphyxia, may be accomplished by 
 injecting a weak saline solution into the veins of the 
 patient. To Dr. Thomas Latta, of this place, is due 
 the merit of first having recourse to this practice. He 
 has tried it in six cases, three of which I have seen 
 and assisted to treat. The most wonderful and sat- 
 isfactory effect is the immediate consequence of the 
 injection. To produce the effect referred to, a large 
 quantity must be injected — from five to ten pounds in 
 an adult — and repeated at longer or shorter intervals, 
 as the state of the pulse, and other symptoms, may 
 indicate. Whenever the pulse fails, more fluid ought 
 to be thrown in, to produce an effect upon it, without 
 regard to quantity. In one of the cases I have refer- 
 red to, 120 ounces were injected at once, and repeat- 
 ed to the amount of 330 ounces, in twelve hours. In 
 another, 376 ounces were thrown into the veins, be- 
 tween Sunday, at 11 oVlock, A. M., and this day 
 21* 
 
246 TREATMENT OF 
 
 (Tuesday) at 4 P. M., that is, in the course of 53 
 hours, upwards of 31 pounds. 
 
 The solution that was used consisted of two 
 drachms of muriate, and two scruples of carbonate 
 of soda, to sixty ounces of water. It was at the tem- 
 perature of 108 or 110 degrees. 
 
 The apparatus employed in injecting was merely 
 one of Reid's common syringes, (the fluid being put in- 
 to a vessel rather deep and narrow), with a small pipe 
 fitted, that it might easily be introduced into an incis^ 
 ion in the veins of the usual size that is made in 
 bleeding. It may, however, be well to keep in mind* 
 that, in the event of the operation being frequently re^ 
 peated, it may be advisable to inject by different 
 veins. 
 
 I forbear at present to enter further into the par* 
 ticulars ; nor have we had sufficient experience to 
 speak decisively on the subject. I may, however, 
 mention that the idea of having recourse to this reme- 
 dy in cholera, occurred to Dr. Latta, from being con- 
 vinced (which I am also) that the evacuations up- 
 ward and downwards, are, in reality, the serum of the 
 blood ; that it is the duty of the physician to replace 
 it, as speedily as possible, by injecting a fluid, as sim- 
 ilar to the serum as can be formed artificially, direct^ 
 ly into the veins, which has been done here with won- 
 derful, and, so far as we can yet judge, excellent ef- 
 fect. An immediate return of the pulse, an improve- 
 ment in the respiration and in the voice, an evolution 
 of heat, an improvement in the appearance of the pa- 
 tient, with a feeling of comfort, are the immediate ef- 
 fects. The quantity necessary to be injected, will 
 probably be found to depend upon the quantity of se- 
 rum lost— the object of the practice being to place the 
 

 THE CHOLERA, 247 
 
 patient in nearly his ordinary state, as to the quanti- 
 ty of blood circulating in the vessels. 
 I have, &c. 
 (Signed) ROBERT LEVVINS, M. D, 
 
 To W. Maclean., Esq. 
 
 Secretary to the Central Board of Health. 
 
 Sir, — I did myself the honor to address a letter to 
 you lately, on the effects of injecting a saline solution 
 into the veins of a patient laboring under cholera. 
 We have not frequent opportunities of trying this, 
 which I denominate admirable remedy, as the dis- 
 ease is decidedly less frequent here ; but I have seen 
 it employed in two other cases, in the course of the 
 last two days, with the same excellent effect. Sixty 
 ounces are generally thrown in at once, and repeat- 
 ed at the end of three or four hours. In a case to* 
 day, where I saw fifty-eight ounces injected, (being 
 the third time of performing the operation), the pa- 
 tient's pulse, at the commencement was 1 80, very 
 small, and very feeble. She was excessively rest- 
 less, with a feeling of great weakness and tormenting 
 thirst. Before twelve ounces were injected, the pulse 
 began to "improve ; it became fuller and slower, and 
 it continued to improve, until, after 58 ounces had 
 been injected, it was down to 1 10. Before I left the 
 patient, (a woman) her condition was altogether ama- 
 zingly amended. There was a fine glow, and a 
 slight perspiration on her face ; the veins on the back 
 of her head were well filled ; the restlessness was re- 
 moved, the feeling of excessive weakness gone, and 
 the thirst ceased. The pulse was under 100, free, 
 full and soft. Verily, Sir, this is an astonishing meth- 
 
248 TREATMENT OF 
 
 od of medication, and I predict will lead to wonderful 
 changes and improvements in the practice of medi- 
 cine. I have addressed you upon the subject, as the 
 organ, from your high official station, of dissemina- 
 ting a knowledge of the extraordinary facts referred 
 to. It will, of course, give me great pleasure to enter 
 further into particulars upon any particular point on 
 which you may require information, in reference to 
 the cases which have come under my observation. 
 I have, &c. 
 (Signed) ROBERT LEWINS, M. D. 
 To W. Maclean, Esq., 
 
 Secretary to the Central Board of Health. 
 
 In the hands of a man of ordinary dexterity, the 
 common injecting apparatus alluded to in my last, 
 will be found to answer the purpose perfectly well ; 
 but if the practice I recommend is, as I hope it will 
 be, generally adopted, it will, I conceive, be expedi- 
 ent to advise that a regular and perfect transfusion ap- 
 paratus be used ; at all events, to warn those who in- 
 ject to beware of allowing air to get into the vein, The 
 tubesj of course, must be filled with fluid, as well as 
 the pipe in the vein, before commencing, and conside- 
 rably more fluid than it is intended to use ought to 
 be in the vessel from which it is pumped. 
 
 R. L." 
 
 I understand that a work upon the efficacy of in- 
 jecting the veins, is now publishing at New- York, and 
 as this practice has been much resorted to in that 
 place, its full value as a remedy in cholera,'will soon 
 be known. 
 
 I ought also to state, that the exclusive camphor 
 
THE CHOLERA. 249 
 
 treatment has been employed at the Park Hos- 
 pital, at New- York, and I am informed, with 
 success. The practice consists of giving small doses 
 of spirits of camphor very frequently, and withhold- 
 ing all other medicines. Dr. William Channing, of 
 JNew-York, is a warm advocate for this practice. 
 He believes camphor in small doses to be a specific 
 for the cholera. He states that of 250 patients at- 
 tacked by cholera, and many of them violently, and 
 who have been treated exclusively by camphor, on- 
 ly five have died. He recommends from one to three 
 drops of unmixed spirits of camphor to be given in a 
 little water every hour or two, and every other medi- 
 cine, especially opium, to be withheld. 
 
250 LECTURES ON 
 
 TWO LECTURES 
 
 ON THE 
 
 CHOLERA MORBUS, 
 
 DELIVERED AT THE B1ILITARY HOSPITAL OF 
 VAL-DE- GRACE, BY 
 
 J. F. V. BROUSSAIS, M. D. 
 
 Officer of the Royal Order of the Legion of Honor, 
 Physician in Chief and First Professor of the 
 Military Hospital of Instruction of Paris, fyc. 
 
 Delivered during the prevalence of the disease in 
 Paris, April 18, 1832. 
 
 Prof. Broussais had announced to his class that his 
 lecture for this day, would be upon the epidemic 
 which had caused of late, great ravages, and still 
 greater terror in the capital of France. The. amphi- 
 theatre was filled at an early hour, by a crowd of 
 auditors more eager than usual to hear the Profes- 
 sor. 
 
 At 8 o'clock, Broussais appeared, and delivered 
 the following lecture, to an attentive and silent au- 
 dience. 
 
 " Gentlemen, — Before commencing, I desire to 
 know if you wish me to deliver ail I have to say upon 
 the epidemic, in one lecture, or in two." 
 (All the class, in two— in two lectures.) 
 " Very well, gentlemen, I will give you two lec- 
 tures. In the lecture of to-day, I will speak of the 
 
THE CHOLERA. 251 
 
 disease, and in that of to-morrow, 1 will dwell upon 
 the treatment." 
 
 Gentlemen, 
 
 The disease, the nature of which we are now to 
 investigate, is called the Cholera Morbus,* The 
 name comes from another malady, so called, be- 
 cause those affected with it vomit a great deal of bile, 
 The denomination was given to it in the times when 
 the humoral doctrines were in vogue ; at which peri- 
 od, diseases were attributed to humors, when their 
 evacuation was most apparent, or seemed to explain 
 the nature of the disease. Thus, in the sporadic 
 cholera, there is always a large secretion of bile ; and 
 thence the name of cholera morbus^ from the Greek 
 word cholos, bile, and the Latin word morbus, disease ; 
 so that the etymological signification of the word is, 
 disease of the bile. This name has been applied on 
 account of the number of symptoms belonging to the 
 epidemic which has long been known in the equato- 
 rial regions, and which now rages within our walls. 
 
 This epidemic has doubtless prevailed at several 
 different epochs, and probably is the same as the 
 frightful pestilence which made its appearance in the 
 year 1348, and carried off nearly a third part of the 
 existing population ; and it has in effect a very great 
 affinity to what is told us of the black fever or black 
 plague. But whatever may have been its nature, it 
 w r as forgotten in our region. We read, from time to 
 time, numerous articles in the papers, upon the rava- 
 ges which the cholera morbus had made at Calcutta 
 and other cities of India or the Levant, but it was still 
 
 * These two lectures have been translated and published by John 
 S. Bartlett, M. P., Albion Office, Cedar street, New York. 
 
252 LECTURES ON 
 
 nothing more than a matter of curiosity. The 
 English, who have considerable establishments in the 
 East Indies, had never introduced the disease into 
 their own countiy, and the small number of French 
 who have visited those places, never spread its conta- 
 gion at home. Whether this was owing to the cir- 
 cumstance that the communications between these 
 countries have always been by sea, to the kind of food 
 taken during the voyage, or to the fresh winds which 
 blow over the water, and thus destroy the causes of 
 the malady, whatever they may be, 1 cannot say ; 
 but certain it is, that the disease had never left the 
 place of its origin. 
 
 The Russians first introduced the cholera into Eu- 
 rope, by means of their communications over land 
 with Persia, India, and countries of the east, where 
 the English have settlements, the disease having fol- 
 lowed their armies. They brought it to Warsaw, and 
 thence it has spread over various parts of the con- 
 tinent. It has appeared in different districts of Ger- 
 many, in the provinces bordering upon Turkey, in 
 Hungaria, and Austria ; in short, it has been propa- 
 gated to a great extent in the north and east of Eu- 
 rope, and has manifested the same violence as in the 
 tropics. This circumstance constitutes an essential 
 difference between the cholera and the yellow fever, 
 which never appears, or at least, never prevails to 
 much extent in cold climates. In fact, the yellow 
 fever is supported by heat, and by emanations from 
 low and marshy grounds; but the cholera needs no 
 such aliment ; it respects neither country nor season. 
 
 The cholera morbus, arriving in our latitude, mani- 
 fested itself first in England, and hence it appears 
 that an intervening sea cannot arrest its progress. 
 
THE CHOLERA, 253 
 
 though the distance, it is true, from the continent to 
 England is very trifling in comparison with that to 
 India. I only allude to the circumstances as impor- 
 tant considerations in our researches, and not as tend- 
 ing to establish, with any certainty, the manner by 
 which the disease may be propagated. 
 
 The malady was preceded in many of the cities in 
 the north and east of Germany by a sort of convul- 
 sive catarrh, which was called grip ; the year follow- 
 ing this scourge appeared in all the places which had 
 been previously visited with the grip, and persons 
 who had made accurate observations and calcula- 
 tions of its progress, predicted from the appearance 
 of the grip here last year, that the cholera would 
 follow it the next. In this hospital we certainly dis- 
 covered the forerunners of this event, (not the grip, 
 for I acknowledge that during the last year we had 
 very few cases of the convulsive catarrh, and I hard- 
 ly believed in the existence of the grip, so rare were 
 its instances,) but we observed some weeks before 
 the appearance of the cholera, a great susceptibility 
 in the digestive organs, so that we were obliged to 
 reduce the aliment of many of our convalescent pa- 
 tients, and to renounce some means of internal revul- 
 sions which w r e were employing in cases of catarrh and 
 and peripneumony. Some experiments which we 
 made of the use of tartar emetic in cases of inflam- 
 mation of the lungs, were attended with remarkable 
 success in the winter \ but we observed, all at once, 
 that it had become impossible to introduce this medi- 
 cine into the digestive canal of certain of our patients 
 without producing the most disagreeable effects. 
 Many threw up the tartar emetic and experienced 
 
 violent convulsions of the stomach. In two cases, 
 
 22 
 
254 LECTURES ON 
 
 which I particularly remember, the pulse was scarce- 
 ly perceptible for the space of sixteen days ; the 
 patients were in the same situation as those who are 
 now affected with the cholera, except that the pulse 
 was not quite extinct ; they were in a state of ex- 
 treme stupor ; the eyes red; the extremities cold, and 
 the pulse at times imperceptible; their evacuations 
 and vomitings frequent. This malady, treated upon 
 the system of antiphlogistics, yielded to the medicine, 
 but the patients were for a long time cold ; but I 
 confess that this observation was not of sufficient im- 
 portance to decide me upon following the same sys- 
 tem in cases of the cholera when it appeared with 
 such violence in this hospital at first. Some time af- 
 ter a patient was brought, whose pulse had nearly 
 ceased ; he was bled profusely, and we then disco- 
 vered that he had an inflammation of the lungs, 
 which nothing would have led us to suspect when his 
 pulse was nearly extinct. Here, then, are symptoms 
 which seem to indicate an increased irritability of the 
 organs of digestion. Under the influence of what 
 causes, then, has this increased irritability taken 
 place ? A question by no means easy to determine. 
 Let us proceed to the development of the actual epi- 
 demic. It broke out all at once among the poorest 
 and most miserable classes of the people in Paris, and 
 those first attacked were carried to the Hotel Dieu ; 
 three days after we had cases of it attheValde 
 Grace ; it had also made its appearance at the Gros 
 Caillou, nearly at the same time as at the Hotel Dieu. 
 The precise epoch of its appearance, was, I believe, 
 the 26th of March : we had no case of it at this hos- 
 pital, however, till the 29th. 
 
 Let us now recall what has been said of the man- 
 
THE CHOLERA. 255 
 
 ner in which it is propagated. The disease had 
 scarcely any appearance of being contagious, since 
 the persons who were first attacked, certainly had?no 
 communication with those who might have been in 
 England ; at least, this was the most probable sup- 
 position. However this may be, I will proceed to lay 
 before you whatever facts I am in possession of re- 
 garding the manner of propagation. Doubtless the 
 disease showed itself first in persons who had never 
 been in contact with those affected by it It is too 
 strongly marked to have been brought in any vessel 
 coming to France, for this would have immediately 
 been discovered. Some person attacked with the 
 cholera, arriving at Calais, or some other sea-port, 
 would have communicated it to those about him, 
 Nothing of the kind, however, is known to have 
 happened. But although those first seized did not 
 appear to have taken the infection from any 
 one else, it is a well established fact, that when the 
 malady had once declared itself in a house, it almost 
 always happened that a number of persons were at- 
 tacked in the same house, and 1 know of no instance 
 where it has been confined to a single individual un- 
 der one roof ; I have no doubt there may be such in- 
 stances, but 1 know many to the contrary ; and in 
 general, upon being called to visit a patient seized 
 with the cholera, I have noticed that several cases 
 ensued the following two or three days. This fact 
 gives rise to the suspicion that there is a species of 
 infection by which the patient communicates the dis- 
 ease to those who have charge of him. But, on the 
 other hand, the inmates of the same house may be 
 regarded as exposed to the same influences, and thus 
 contracting the disease independently of all conta- 
 
256 LECTURES ON 
 
 gion. This is possible 5 but still cases of the cholera 
 are known to occur in different stories, and different 
 families living in the same house, with various modes 
 and habits of life ; so that it would seem that in these 
 houses there is some peculiar cause which multiplies 
 its ravages. 
 
 We must, however, make a great allowance for 
 the moral affections ; those persons who are struck 
 with terror at the sight of choleric patients, are doubt- 
 less very strongly predisposed to the disease. I will 
 mention to you the example of a very distinguished 
 person, an eminent foreigner, whose name, however, 
 I am not at liberty to make public. This gentleman 
 had traced upon the map the whole progress of the 
 cholera ; he conversed with his physician several 
 times a week upon the route it had already taken, 
 and was continually occupied in calculating the time 
 w T hen it would appear in such and such a place, and 
 finally when it would reach France. The cholera 
 having broken out here, " Behold,' 5 said he, "the dis- 
 ease is now at Paris ; there is no doubt I shall feel its 
 effects." He took pains to be informed every day 
 of the number taken, and the number dead, but at 
 first discovered no symptom of the disease in himself 
 He at length however experienced the diarrhoea 
 which usually precedes the cholera, and though it was 
 carefully treated from the first, nothing could arrest its 
 progress. This is a case under my own eyes, for I was 
 called to the patient by his attending physician. I 
 could mention several similar cases. I found one 
 yesterday of the same nature. A patient whom I 
 had cured of an extremely obstinate inflammation of 
 the stomach and bowels, was in great fear of the cho- 
 lera. He went to pay a visit to one of his friends. 
 
THE CHOLERA. 257 
 
 who was attacked, but did not venture into the cham- 
 ber, as he found the whole family in tears and deeply 
 afflicted ; he had hardly entered the house when he 
 was seized with the cholera ; and I think he will die 
 this day. Thus it appears that the disease is propa- 
 gated by the most extraordinary means. 
 
 From some circumstances, it would appear that 
 the disease is carried in the air ; but this supposition 
 is contradicted by the fact, that the cholera, thus re- 
 gularly distributed over the same plain, attacks one 
 village while it spares another ; that it is not com- 
 municated by the inhabitants who are continually 
 passing from one to the other; and that the same per- 
 sons who had ventured with impunity into the midst 
 of the sick, were attacked when the scourge at length 
 arrived to their own place of residence. There is 
 something so extraordinary in the manner in which 
 the malady advances, that it merits the attention of 
 physicians. After all the facts I have cited, 1 am in 
 doubt if 1 ought to admit the idea of infection asjit is 
 generally understood. It is certainly impossible to 
 allow that the disease is contagious, at least in the 
 same way as the small pox or the itch •, for this epi- 
 demic is not communicated by inoculation* Persons 
 have inoculated themselves with the blood of choleric 
 patients ; others have even swallowed it ; and others 
 have impregnated their garments with it ; some have 
 had the courage to sleep in the same bed with the 
 sick; and, in short, every experiment of the kind 
 has been made, and the disease has in no instance 
 been thus contracted. These experiments were 
 doubtless made by men of courage ; for, had timid 
 persons been forcibly inoculated, 1 have no doubt that 
 
 22* 
 
258 LECTURES ON 
 
 they would have taken the disease. I am of opinion 
 that courageous and devoted men could alone have 
 made- these experiments with impunity ; a circum- 
 stance well worthy of novice. The author of a re- 
 cent work on the subject, speaks of a choleric atmos- 
 phere which is confined to a city, a village, or to a 
 single house even : but the existence of this atmos- 
 phere cannot be demonstrated. It is certain, how- 
 ever, that there exists a strong predisposition to chole- 
 ra, and it is to this point that our researches must be 
 directed at present. 
 
 [Here the attention of the audience was re- 
 doubled.'] 
 
 It is proved by the reports of French physicians, 
 who have visited other countries to study the nature 
 of cholera, that every remarkable derangement of the 
 gastric system may be followed by this malady when 
 it prevails in the country. There are instances, how- 
 ever, of persons being seized with it, who were in 
 good health, and with no other previous symptoms 
 than those of the disease itself; but these cases are 
 very rare. The malady is generally first announced 
 by a slight relax, unattended by any disagreeable 
 symptoms : when this ordinary relax already exists, 
 that produced by the cholera discovers itself in a 
 manner not to be mistaken. Thus, the first predis- 
 posing causes are diarrhoea and indigestion, and 
 chronic irritations of the gastric system, which may 
 have existed for a longer or shorter period : but, 
 above all, a disposition to diarrhoea. Another pre- 
 disposition to cholera is terror, one of the most pow- 
 erful causes, undoubtedly. I have already mention- 
 ed one of the numerous instances I have met with of 
 this. 
 
THE CHOLERA. 259 
 
 Predisposing Causes. 
 Intoxication. — Men who were in good health, hav- 
 ing been intoxicated, have been seized the day follow- 
 ing with cholera, though they had experienced no pre- 
 vious indigestion ; with the last exception, this case 
 would be ranked among the first class of predispo- 
 sing causes. Another predisposition is the inter- 
 course between the two sexes. One of my colleagues, 
 a professor in this institution, has mentioned to me 
 numerous examples of students who were seized with 
 the cholera after having visited a brothel. All those 
 who have studied the disease at Warsaw, in Russia, 
 and other places, have observed the same fact. Con- 
 valescence is another predisposing cause ; persons 
 convalescent from disorders pertaining to the gastric 
 system, or on the point of becoming convalescent, are 
 always exposed to the cholera ; but we have not ob- 
 served that this was one of the most powerful 
 predispositions, or, at least, we have been able to 
 elude it, by subjecting our patients to a severe regi- 
 men. I think, therefore, that such persons are not in 
 danger unless they commit some excess which causes 
 indigestion ; a thing, indeed, which happens too often. 
 To these predispositions, I will add that of patients 
 who have for a long time been suffering from some 
 severe malady. 1 am led to this conclusion, because 
 numbers of my old patients who had been completely 
 cured of intermittent fevers or of inflammation of the 
 bowels, have been returned to me now. 1 have ta- 
 ken particular pains to ascertain with what diseas- 
 es they had been afflicted before, and ascertained al- 
 most uniformly that the)' were affections of the gas- 
 tric system. 1 have also remarked, that numerous 
 persons who had been attached to the army of the 
 
260 LECTURES ON 
 
 north, having passed some time itl the hospitals, 
 where they took sulphate of quinine, some of them in 
 very large doses, easily became victims to the chole- 
 ra; but I have not been able to ascertain whether 
 these caes were attended with the previous diarrhoea, 
 or with accidental indigestions. These are the princi- 
 pal predisposing causes. 1 will here add, that persons 
 in apparently good health, and who had experienced 
 none of these predisposing causes, having been attack- 
 ed suddenly, 1 have endeavored to investigate the mat- 
 ter thoroughly, without contenting myself with the first 
 details given me by the patients. I observed that 
 they voided worms, and 1 discovered a great quantity 
 in those who died. I believe we have had seven or 
 eight cases of those attacked by cholera, w 7 hen they 
 believed themselves perfectly well ; but I cannot con- 
 sider a person, who is troubled with worms, as en- 
 joying good health. 
 
 Manner of Attach 
 I here divide the malady into primary and secon- 
 dary. There are, as you know, three great sections 
 of the digestive canal ; the upper consisting of the 
 stomach, which contains the duodenum : the middle 
 containing the small intestines ; and the lower sec- 
 tion, in which are found the colon-, coecum, and the 
 rectum. You know that all inflammations of the in- 
 testines predominate sometimes in one, sometimes in 
 another of these sections. The cholera, then, is not 
 exempted from these laws ; we have observed the 
 commencement of the malady in one or the oth- 
 er of these three sections of the digestive canal. I 
 shall speak first of the attack in the lower section, 
 these being the most frequent. The patients experi- 
 ence slight attacks of colic, or sometimes nothing 
 
THE CHOLERA. 261 
 
 more than a slight pain in the abdomen, which pre- 
 cedes an evacuation ; many are seized all at once with 
 an inclination to go to the privy, and there dischar- 
 ges are made promptly and without pain. The canal 
 empties itself at once ; and some persons, habitually 
 constipated, are much pleased to find their passage 
 open. As soon as the intestine becomes empty, the 
 characteristic results of the cholera take place. The 
 matter voided has a milky appearance, and some- 
 what resembles a decoction of rice or oatmeal \ it is 
 often tinged with bile, and I have constantly noticed 
 that it contains particles of mucus. After this, all the 
 symptoms and characteristics peculiar to the malady 
 which I have just described, make their appearance, 
 The patients are seized with cramp ; the extremities 
 become cold ; nausea succeeds, and is rapidly follow- 
 ed by vomiting, as we recently observed in the case 
 of a patient, who, though he experienced only a 
 slight nausea at the commencement of our visit, 
 vomited abundantly before we left him. I proceed 
 now to the attacks of the disease in the middle section, 
 and the small intestines. The patients experience 
 flatulence, violent workings and heat in the intestines 
 for several days ; they have also slight colic, and a 
 sort of uneasiness which they find it difficult to de- 
 scribe. They, however, preserve their appetite. Soon- 
 er or later the diarrhoea ensues, and the symptoms 
 already noticed as occurring in the lower section, 
 manifest themselves here. The attack of the mala- 
 dy commences less frequently in the upper section ; 
 in this case the patients are constipated ; they experi- 
 ence some nausea and irritation of the stomach; they 
 are forced to vomit, which they do at first without 
 pain, unless there have been previous predispositions 5 
 
262 LECTURES ON 
 
 after this, the vomiting becomes painful ; cramp takes 
 place in the upper extremities ; the throat becomes 
 dry, hot, and sore; the muscles of the jaw are also 
 affected with cramp ; and after this, the other symp- 
 toms of cholera appear. 
 
 There is still another way in which the disease at- 
 tacks the patient : this is by the nervous system. In 
 this case there is no derangement of the digestive ca- 
 nal ; the persons thus seized, experience a dizziness 
 and fall senseless. Many soldiers have been at- 
 tacked in this way ; and there have been cases of it 
 also among the citizens. Persons thus taken with 
 the cholera, fall as if struck by lightning, and in nu- 
 merous instances have died immediately. A ques- 
 tion here arises, — Does the disease, in these cases, 
 really commence in the nervous system. Was there 
 not previously a general irritation in the digestive 
 canal, which produced a reaction on the nervous 
 system ? I am inclined to this last opinion. It is 
 certain, at any rate, that numbers who are seized at 
 first with dizziness, sudden loss of strength, relaxa- 
 tion of the muscles, and fall, recovering from these 
 attacks, are taken with vomiting, the first sign of the 
 malady, and then experience severe colic. These 
 are the facts I have been able to gather respecting 
 the manner in which the disease first declares itself. 
 
 When the malady is secondary, it appears towards 
 the close of a violent inflammation, or even in a con- 
 valescent person. In a patient suffering from some 
 acute disease, the cholera commences ordinarily by 
 diarrhcea, and after that the other symptoms appear. 
 The pulse is feeble, and the remains of fever, which 
 would probably have disappeared in two or three 
 days, are at once extinct ; the patient becomes cold, 
 

 THE CHOLERA. 263 
 
 and the symptoms of cholera declare themselves in a 
 manner too evident to be mistaken. Convalescent 
 persons are usually attacked in the lower section, and, 
 by looseness of the bowels, and having no fever, slow- 
 ness of the pulse and coldness of the extremities take 
 place the sooner. Inflammatory diseases of the lungs 
 seem to be a preservative ; and it has been remarked? 
 that persons troubled with asthma escape the cholera ; 
 this must not, however, be entirely trusted in, as there 
 are phthisical patients who have a sort of diarrhoea, and 
 if they had this predisposition in the time of cholera, 
 they would doubtless be attacked. Thus it appears, 
 that persons suffering from diseases of the stomach or 
 bowels, are most strongly predisposed to the chol- 
 era. 
 
 Symptoms. 
 
 The better to explain the symptoms and character- 
 istics of this malady, 1 shall make the following divis- 
 ions of them ; 1st, Those w T hich come to our knowl- 
 edge by the information of the patients themselves ; 
 2d, Those inferred from the exterior aspect of the pa- 
 tients ; 3d, Those resulting from the nature of the evac- 
 uations. First series — Those patients who are able to 
 describe their condition, give us an accurate detail of 
 what passes within them. They experience an inver- 
 sion or upturning of the lower part of the abdomen, 
 with violent heat and burning concentrated near the 
 epigastrium. Those who are physicians, say that they 
 feel all their blood rushing to the interior of the abdo- 
 men ; such are their expressions ; others imagine that 
 they feel electric sparks, which occasion much pain, 
 and which are followed by uncommon heat ; then 
 comes an extreme heaviness, with a weakness of the 
 
264 LECTURES -ON 
 
 muscles, so that the~patients cannot move. With 
 the exception of complete apoplexy, there is no dis- 
 ease which renders the body so heavy and so lifeless, 
 as the cholera ; the patients have no power of motion ; 
 they seem to be a mass of lead or stone ; they can 
 only stir the feet and hands, but cannot raise the trunk. 
 This is easily conceived, for the principal point of irri- 
 tation is in the digestive canal, and must react on the 
 spinal marrow and muscles of the body. Their dis- 
 charges are not very painful, for they are not accompa- 
 nied by tenesmus, or desire of going to stool, as in ca- 
 ses of ordinary dysentery, but are made with ease, and 
 almost without the volition of the patient. The col- 
 ics exist, nevertheless, but do not seem to occasion the 
 discharges which sometimes take place even when the 
 colic is not felt. The discharges and colic are gene- 
 rally accompanied by cramp. These cramps are al- 
 ways very painful, and it is these which especially ex- 
 haust the patients, and are by them the most dreaded. 
 The pain is manifested by the shrieks of the sufferer. 
 The cramps do not affect the members alone ; they 
 also manifest themselves in the muscles of the back, 
 which are placed along the vertebral column. The 
 patient always feels a considerable irritation in the re- 
 gion of the stomach and the epigastrium, which is, 
 perhaps, felt more than the colics ; it oppresses the 
 patient, and prevents respiration ; and he seeks to be 
 relieved from it by placing a cushion under him, so 
 as to make the breast prominent. A strong contrac- 
 tion appears in the face. Vomiting gives relief, and 
 many of the patients desire and provoke it. The vom- 
 itings go on, continually increasing, with compression 
 of the epigastrium, and difficulty of breathing ; and, 
 with these symptoms, come cramps in the limbs and 
 
THE CHOLERA. 265 
 
 jaws, and sometimes in the muscles of the eyes- The 
 knowledge of most of these symptoms is due to the 
 declarations of the patients themselves. 
 
 Let us proceed now to the symptoms entirely ex- 
 terior. You observe, in the first place, signs which 
 the patients do not speak of. The muscles are 
 strongly marked under the skin ; the eyes are hollow, 
 dry, and sunken ; after some hours, the consistence 
 of the eyeball seems to be dissolved ; and one would 
 say the eyes were turned inward by means of a thread. 
 The aspect of the patient is hideous ; the face very 
 soon loses its fulness, and is contracted in a manner 
 peculiar to these affections : but what causes the 
 greatest astonishment, is the livid hue which spreads 
 -itself over the countenance as the disease advances. 
 The extremities are cold ; the tongue is usually pale, 
 chill, broad, and flat; the breath cold, and the pulse 
 feeble; the words are rather breathed than pronoun- 
 ced. The patient remains motionless, on the back ; if 
 you force them to lay upon the side, they cannot con- 
 tinue so long, but beg to be laid on their back, so that 
 the breast may be raised. While the body thus remains 
 -still, they move the feet and hands, uncover the breast, 
 complain of a fire within, and tear off the poultices 
 and other warm applications placed on the stomach ; 
 they turn from one side to the other, but are not able 
 to rise up. The color becomes darker and darker, 
 and is soon livid. It varies, however, according to 
 vthe natural complexion of the patient. Dark com- 
 plexions become black or bluish ; but those which 
 are more transparent turn yellow, taking the color of 
 bad gilding. This is followed by cessation of the 
 .pulse, which 1 shall call asphyxy. The pulse grows 
 
 ..weak -rapidly, and sometimes disappears in three 
 23 
 
266 LECTURES ON 
 
 hours, or even less. As soon as the pulse begins to 
 grow feeble, the patient falls into the heaviness 1 have 
 referred to : there are cases, however, in which he 
 still preserves his strength when the pulse is extinct, 
 and is even able to raise himself up, and go from one 
 place to another $ but this strength is soon lost, and the 
 unhappy person falls powerless. After the cessation 
 of the pulse, the black hue manifests itself with vari- 
 ous rapidity, sometimes at the end of two or three 
 hours, sometimes even in less ; this depends upon the 
 promptitude with which circulation ceases. When a 
 patient thus affected is examined with a stethoscope, 
 a slight tremor is perceived, similar to that in a dying 
 person, or a pregnant woman. These are the char- 
 acteristics by which this affection is discovered. 
 When the patient throws up nothing but the aliment 
 he has taken, this vomiting cannot be said to be caused 
 by cholera ; neither is the voiding of local matter any 
 bign of it ; but when these symptoms are followed by 
 that kind of matter 1 mentioned before, there can be 
 no doubt of the existence of cholera, whatever pains 
 the patients may experience beside. I insist upon 
 this point. A more foetid smell arises from this mat- 
 ter towards the last, than at the commencement of 
 the malady. The matter changes its character du- 
 ring the progress of the disease : it grows thick when 
 the sickness is long continued ; but is, at first, ex- 
 tremely thin. A noise is heard in the intestines, and 
 the matter, tinged with bile, is rapidly voided. In 
 some cases, this appearance of bile continues to the 
 last. It is important to pay attention to this circum- 
 stance, in order not to be deceived. The cholera may 
 be always recognized by the appearance of whitish 
 gelatinous particles in the evacuations. Attention 
 
THE CHOLERA. 267 
 
 must be paid rather to the affections than the pains, 
 for nothing is more variable generally and in particu- 
 lar cases, than the sensibility of our interior organs. 
 There are persons who suffer much from the slightest 
 inflammation ; others undergo severe diseases with- 
 out suffering. Among those attacked with cholera 
 some pass through all the different stages without 
 pain ; others are agitated, and suffer in the limbs, or 
 have very distressing cramps. The pain of the cramps 
 varies according to the sensibility of the individual ; 
 some are attacked without moving a muscle ; others 
 utter horrible shrieks. Hence the importance of at- 
 tending to the fundamental characteristics of the dis- 
 ease, and these cannot be inferred from the sensibili- 
 ty of the patient. Slowness of circulation, extinc- 
 tion of the pulse, coldness of the extremities, livid 
 color of the face, are the characteristics which it im- 
 possible to mistake, and are the symptoms upon which 
 we must fix our attention. When called to a patient^ 
 if you find his evacuations white, and a diminished 
 circulation, be sure the cholera has commenced. 
 This is the object of my first lecture. To-morrow I 
 shall occupy myself with the progress and treatment 
 of the malady. 
 
268 LECTURES ON 
 
 BROUSSAIS' SECOND LECTURE ON THE CHOLERA 
 MORBUS. 
 
 This second lecture, in which the learner! Profes- 
 sor proposed to develope his doctrines in full, drew 
 together a larger crowd than attended the preceding, 
 (19th April) 
 
 Gentlemen, 
 
 In the lecture of yesterday, I imparted to you 
 some ideas, which I had collected, upon the cholera 
 morbus. I shall recall, in a few words, the most im- 
 portant parts of that lecture. 
 
 We have seen that the cholera is probably a very 
 ancient malady, since the name of sporadic cholera 
 has been given to it, although it differs greatly from 
 that disease in its character of an epidemic ; for the 
 sporadic cholera is scarcely ever developed, except in 
 the summer, under the influence of irritating causes 
 very easily averted, and is neither propagated by in- 
 fection, nor contagion. On the other hand the chole- 
 ra morbus is certainly propagated by a kind of infec- 
 tion which it is difficult to characterise. Still it is 
 proved to exist, as I showed you in my first lecture, 
 and we are forced to admit it. I mentioned next the 
 predispositions to cholera, which reduce themselves 
 to an uncommon irritability, or a morbid irritation of 
 the digestive canal. I also pointed out to you the de- 
 termining causes, which are, all kinds of violent sti- 
 muli that cause any considerable derangement in the 
 act of digestion. I then directed your attention to 
 the manner in which the disease commences its at- 
 tacks. You undoubtedly remarked that there was ? 
 
THE CHOLERA. '269 
 
 almost always, as the patients themselves avowed, 
 some disorder of the digestive canal ; but that the 
 malady sometimes commences in the nervous system 
 by loss of the power of motion, or of the intellectual 
 faculties. I added, however, that 1 was by no means 
 convinced that those patients, in whom the disease 
 made its appearance under the latter form, had not 
 already experienced some derangement of the diges- 
 tive canal : I was therefore obliged to leave this ' 
 point undecided. 1 next showed how the attacks 
 commenced in the three principal sections of the di- 
 gestive canal. There are, then, four different ways 
 in which the disease commences ; by the three prin- 
 cipal sections of the digestive canal, or by the nervous 
 system ; which last, I am of opinion, may be the ef- 
 fect of some previous but undiscovered affection of 
 the digestive canal. After this, we examined the 
 characteristic symptoms of the malady. That you 
 might the better remember them, and to avoid all 
 mistake, 1 classed them in the following order: 1st. 
 The symptoms, which came to our knowledge by the 
 declaration of the patient of what he has perceived 
 in himself; for this malady always commences by 
 some derangement, and these are the atfections of 
 which the patient is able to give an account. 2d. 
 The symptoms discovered upon examining the body 
 of the patient. 3d. The nature of the evacuations. 
 1 fixed your attention with care upon this point, be- 
 cause it is of great importance in recognising the dis- 
 ease. 
 
 We will now proceed to the question, it in case 
 the cholera be arrested in its earliest stages by a pro- 
 per and well directed medical treatment, this can be 
 considered according to the rules of good logic to 
 
 23* 
 
270 LECTURES ON 
 
 constitute a particular disease in every case ; I am 
 of opinion it cannot be, and these are my reasons. 
 For example, if a man is running to throw himself 
 into a river, and is met by a friend who removes the 
 cause of his sorrow, would you say that this man has 
 been pulled out of the river ? Certainly not. Still 
 it is not the less true that he would have been drown- 
 ed, but for the intervention of his friend. This is pre- 
 cisely the case of those in whom the progress of the 
 cholera has been arrested ; they were hurrying on to 
 death, and you have stopped them. Still their pro- 
 gress had already commenced. We must consider, 
 then, 1st. The progress of these affections ; 2d. The 
 examination after death; 3d. The prognostics ; 4th. 
 The treatment. These will form the subject of the 
 present lecture. 
 
 Progress of the Malady. 
 
 It is difficult to discover any absolute, independent, 
 and unvarying progress in the cholera. It is worthy 
 of remark, in the first place 7 that the spontaneous chol- 
 era is always the most dangerous. M. Gravier, phy- 
 sician of the King, at Pondicherry, having observed the 
 disease at Calcutta, was the first person educated at 
 the physiological school, who applied the principles of 
 this school to the investigation of the cholera. M. Gravi- 
 er lamented the bad result of a treatment by stimuli, 
 composed of pepper, brandy, cinnamon, musk, and 
 ginger, applied in such cases ; and he proved that a 
 greater number of cures could be effected by keep- 
 ing the patients upon rice-water, after having bled 
 them. He could obtain neither leeches, nor ice, nor 
 any of the means which you have seen employed here ; 
 
THE CHOLERA. 271 
 
 and besides this, the malady discovered itself in thou- 
 sands of individuals, so' that he was only able to em- 
 ploy two or three general means against this devasta- 
 ting scourge. The same embarrassment recurs in ev- 
 ery instance of a great epidemic. It is evident, then, 
 that by this anti-phlogistic treatment, of which the 
 basis was copious bleeding, and by adopting rice-wa- 
 ter for the beverage instead of brandy and other 
 stimulating drinks, M. Gravier cured more than half 
 his patients, while scarcely one per cent was saved by 
 the method adopted before. Still M. Gravier has con- 
 fessed, with an extremely laudable candor, that bad 
 treatment was better than to abandon the disease to 
 itself; for there was no case on record of the cholera, 
 thus abandoned, terminating otherwise than fatally. 
 This fact was noticed in a communication by M. Gra- 
 vier on the subject, which was showed me in manu- 
 script, for my opinion, in 1823, or 1824 . 1 forget the 
 precise epoch, but the article will be found in the ar- 
 chives of the Faculty of Medicine. M. Gravier has, 
 since then, sent me a great number of notices upon the 
 cholera, from which an article was formed , which ap- 
 peared in the ' Annals of Physiological Medicine,' for 
 the year 1827. The observation of M. Gravier, is 
 conformable to our experience ; this terrible malady, 
 when abandoned to itself, is uniformly mortal, while it 
 is curable in different degrees, according to the treat- 
 ment, and the conditions by which it may be modified. 
 There are three different ways, then, in which the dis- 
 ease may be treated. 1st. By pure stimulus. 2d. By 
 a stimulating and debilitating treatment, employed si- 
 multaneously or alternately. 3d. The physiological 
 treatment. 
 
 The disease, abandoned to itself, is always fatal. 
 
272 LECTURES ON 
 
 and appears with the following symptoms : — When 
 the affection has discovered its peculiar characteristics, 
 the patients have continual vomitings and evacuations ; 
 the pulse grows feeble by degrees, and finally disap- 
 pears ; as soon as the pulse has become extinct, the 
 blue color appears, proceeding from the extremities to 
 the centre ; the evacuations cease, and the irritability 
 disappears throughout ; the intellectual faculties, which 
 had been preserved in a wonderful manner, for a long 
 time, &in spite of the sinking of the patient, are now lost. 
 Of these unhappy persons, some die in a sort of agony 
 of short duration, which is announced by a strange res- 
 piration, which 1 should rather term a laborious heav- 
 ing of the stomach ; others expire suddenly in endeav- 
 oring to move themselves, or in the moment of being 
 placed upon a seat, or raised up to change the posi- 
 tion. Such is the termination of the malady. As to 
 its duration, the term varies a little, but not much, for 
 the disease is circumscribed within very narrow limits ; 
 it is scarcely ever known to last longer than three days 
 when left to itself; and often terminates fatally in two 
 or three hours ; that is to say, the phenomena of vom- 
 iting, evacuations, feebleness of the pulse, coldness of 
 the extremities, blackness, and agony, advance some- 
 times with great rapidity, sometimes with a degree of 
 slowness, which is generally confined to the space of 
 three days. The disease is modified in the first place 
 by pure stimuli, I mention this method first, because 
 it has been adopted in India, at Calcutta, and in the 
 English settlements generally, for the simple reason, 
 that Brown's system had absorbed the whole English 
 practice, and the physicians who came from England 
 were necessarily obliged to apply their theory to the 
 patients, in every possible climate ; still, this method 
 
THE CHOLERA. 2735 
 
 was more injurious in the tropics, than elsewhere. 
 This method, purely stimulative, consists in administer- 
 ing spirituous liquors, such as brandy, rum, gin, not 
 only pure, but impregnated and saturated with aro- 
 matics and irritating substances, such as cinnamon, 
 nutmegs, cloves, &c. Madeira wine is every where 
 employed, having been brought by land, and being ex- 
 tremely powerful, as the chemists know, since its fer- 
 mentation is not finished ; and there remains a consid- 
 erable quantity of sugar ;> besides this, it is found in ev- 
 ery part of the world. Some narcotics are also used ; 
 but the Madeira wine and brandy are always impreg- 
 nated with aromatic substances, such as musk, pepper, 
 ginger, and cloves. The mortality under the influence 
 of this treatment, is frightful.- There are, however, a 
 few instances of a happy termination of the malady ; 
 such are the resources of human nature, that the pa- 
 tient sometimes owes his safety to the very circum- 
 stance w r hich seemed about to put an end to his life, 
 and this by means of revulsions. 
 
 It must be confessed, that our information respect- 
 ing the phenomenon of revulsions, is much too limit- 
 ed ; because these revulsions depend upon the sym- 
 pathies or co-operation which exist between the or- 
 gans ; and this study has been abandoned entirely in 
 favor of experiment. In this, there is nothing aston- 
 ishing ; it is natural to the human mind. Whenever 
 any new method comes greatly in vogue, it is easily 
 seized upon by men of science and of high reputation, 
 and they must be satiated with it before they can 
 perceive the inconveniences which result from it. 
 Hence, great numbers became victims to the system 
 of Brown, before its dangers were discovered. 
 
 It is then proved that those who are treated by ex- 
 
274 LECTURES ON 
 
 eessive stimuli may experience a favorable crisis of j 
 their disease, and this crisis is brought about by 
 sweating, and it is particularly that kind of sweating 
 which is induced by wine, punch, spirituous liquors, 
 and brandy, which saves the life of the patient. 
 
 These are the advantages of this treatment. I shall 
 now mention its inconveniences. The first is, that 
 this method, compared with another which I shall 
 speak of, is infinitely more dangerous, since it is at- 
 tended with a much greater number of deaths. An- 
 other is, that those who are cured by the stimulating 
 method, still preserve a morbid state c? the digestive 
 canal, and even of the whole system, which continues 
 through the rest of their life. 
 
 The eclectic or mixed method of treatment, is ad- 
 vised by erudite, but timid persons, and is adopted by 
 the mass of physicians, because their ideas upon the 
 nature of the disease are not well determined. It 
 consists in first bleeding the patients, and after that, 
 in provoking either upwards by ipecacuanha or tar- 
 tar emetic, or downwards by calomel, or other pur- 
 gatives ; and in endeavoring to produce perspiration 
 by means of sudorifics, baths externally applied, or 
 heat applied internally. .Narcotics are then admin- 
 istered for the pain or movement of the nerves ; but 
 they are given before the inflammatory state has been 
 sufficiently reduced. This method is attended with 
 more favorable results than the former ; and it has 
 prevailed in Paris among those physicians who were 
 not educated at the physiqlogical school, and who 
 have not been accustomed, as we have in this school, 
 to compare continually the effect of the modifications 
 in the different maladies with the progress of the 
 symptoms, and the results obtained from examina- 
 
THE CHOLERA. 275 
 
 tion after death. 1 shall not enter into any farther 
 details of this method ; it is much employed, and it 
 is sufficient to refer to it. I ought to remark, how- 
 ever, that its results are more favorable than those 
 of the first method. I hardly know, indeed, if a com- 
 parison can be drawn between the two ; for the re- 
 sults of the first have been attended with hardly any 
 success ; none, indeed, unless in comparison with 
 the ravages of the cholera when left to itself, which 
 is known to be almost uniformly fatal, it is better, 
 in effect, to expose the patient to extreme stimulus, 
 than to leave him to perish ; but it is better still to 
 weaken him by bleeding before resorting to stimulus, 
 
 [Patients die by this treatment a little more slowly 
 than by the preceding method. (Lively sensation)] 
 
 The physiological method, which consists in the 
 use of emollients and relaxants, and of stimulus ap- 
 plied externally, in proportion to the susceptibility of 
 the patient, appears to us preferable to the others ; 
 and I shall proceed to describe its rules of application. 
 I wish you to take particular notice here, that 1 am 
 not speaking of the treatment of the disease, but only 
 of its progress. I simply wish to explain to you, that 
 there is a great variety in the progress of the malady ; 
 that it is subjected to modifying circumstances ; that 
 when abandoned to itself, it has not the same result 
 as when treated medically ; and that its result differs 
 according to the manner in which it is treated. I 
 wish to fix your attention upon these points without 
 going into any further details ; for you have all the 
 same opportunity for examining the disease as my- 
 self. 
 
 Examination of the body after death. 
 
 When these attacks prove fatal to the patient, it 
 
276 LECTURES ON 
 
 is very natural to open the body in order to discover 
 the first, or, at least, the secondary cause of the dis- 1 
 ease, which has extinguished life. 1 make a distinc- 
 tion here between the examination of those who I 
 were not subjected to any treatment, and those who 
 were treated in a manner to delay death a little with- 1 
 out finally preventing it When we examined the I 
 bodies of persons who died after having exhibited j 
 symptoms of the cholera morbus, it was necessary to l 
 take account of their former maladies and the traces j 
 they had left upon the organs. We have here, as in j 
 all the hospitals, many instances of the patients who 
 are brought in alive, but who die before they can be | 
 subjected to any treatment. These patients are black 
 when first presented to us — generally completely j 
 black. The muscles are very prominent in the body | 
 after death, and in a state of contraction, like those j 
 of a wrestler who is making an effort to rise from the 
 ground ; and they have been thus described with 
 great accuracy in a work just published. On open- 
 ing the body, we find in the brain a considerable in- 
 jection in the menynges or membrane, The injec- 
 tion of the cerebral substance is not generally in pro- 
 portion to that of the menynges ; that is to say, the 
 membranes which envelope the brain. This is near- 
 ly all that is worthy of remark in the brain ; there is 
 almost always a little waterinessin the cavity of this 
 membrane ; but, in general, this is not abundant; 
 but, on the contrary, a very considerable quantity is 
 found in those patients who have been treated for a 
 certain time, and who have been bled. We remark 
 very disagreeable symptoms in the throat also, when 
 these congestions of the blood in the head are form- 
 ed.; .there is a stiffness, dryness, and sometimes a 
 
THE CHOLERA. 277 
 
 choaking up of the ganglions ; otherwise there is no 
 increased softness, nor dissolution of the mucous 
 membrane of the mouth, or of the oesophagus. The 
 stomach is ordinarily very much disordered, some- 
 times black, sometimes brown, and sometimes red- 
 dish. Its vessels, extremely developed, exhibit rami- 
 fications of a black color; and between these vessels 
 the mucous membrane is softened, and almost dis- 
 solved. Meanwhile, it is always necessary to take 
 notice of the previous diseases. We have noticed 
 that habitual drinkers, or those who have exposed the 
 stomach to any habitual excess, exhibit frequently a 
 softness and even a very considerable destruction of 
 the mucous membrane ; and this alteration does not 
 exist in persons of sober habits. The duodenum is 
 rarely disordered to any great degree, unless the pa- 
 tient had been previously affected with complaints of 
 the stomach and bowels. The small intestines are 
 very much filled up; but here occurs a very remark- 
 able circumstance ; for we must make our distinc- 
 tions, and speak of the symptoms in reference to the 
 appearance of the body after death. Those patients 
 who had very abundant evacuations, (and these take 
 place to a frightful degree both by vomiting, and go- 
 ing to stool, in those w 7 ho have no medical treatment, 
 so that their strength is exhausted and life passes 
 away,) those patients exhibit the redness of the mu- 
 cous membrane of the intestines less apparently; it 
 exists, however, from the commencement to the end 
 of the canal, but not very distinct. An immense 
 quantity of the liquid which is evacuated, is found in 
 the interior of the digestive canal. There is an en- 
 tire analogy between the matter vomited and voided 
 downwards, after the fecal matter and bile have 
 24 
 
278 LECTURES ON 
 
 passed away, and this liquid which is found in the 
 cavities of the digestive canal. We have had an op- 
 portunity of examining patients in whom these secre- 
 tions produced by cholera had not been repressed by 
 the efforts of art, in consequence of the physicians 
 not having discovered, during the first moments of 
 the disease, the malignity of certain evacuations. which 
 might be mistaken from slight accidents or from de- 
 rangement of the gastric system ; these patients ar- 
 rived here in the last extremities before they could 
 receive any treatment. We were much surprised 
 at these examinations, to discover a sort of mucous 
 formation, and a large quantity of fluid resembling a 
 fuliginous solution which filled the intestines. The 
 mucous membrane appeared a little paler than usual, 
 a slight redness merely pervading its whole extent. 
 From the upper orifice of the stomach, down to the 
 anus, no part discovered this redness ; and we have 
 only been able to ascertain that when the patient had 
 experienced a previous irritation cf the digestive 
 canal, the stomach and bowels had the appearance 
 of greater redness and alteration. The bladder was 
 contracted and gathered into the pubis, a circum- 
 stance not at all surprising, since the abundance of 
 the intestinal evacuations must, of necessity ; have 
 exhausted the sources of urine: but there was no 
 appearance of inflammation. 
 
 Those subjects in whom the malady had been 
 treated in such a manner as to prolong it without fi- 
 nal success, exhibited appearances a little different, 
 These affections commonly cease, or, at least, are 
 modified, when the patients are subjected to medical 
 treatment. When they are well treated, the cessa- 
 tion is followed by their cure, but when treated less 
 
THE CHOLERA. 279 
 
 advantageously, they are sometimes cured, sometimes 
 not. When they are not cured, it is found that the 
 inflammation is. more strongly marked. The redness 
 which was a slightly pale, and resembled in some de- 
 gree the color of the flower called hortensia, is here 
 very bright ; it is scarlet, or even bordering upon 
 black ; there are portions, even in the digestive canals 
 which appears gangrenous. Thus, when the disease 
 made its first attacks in the gastric region, a frightful 
 derangement is found in the stomach, the mucous 
 membrane of this organ appearing entirely destroyed 
 and very black. When the disease commenced in 
 the small intestines, the mucous membrane is some- 
 times gangrenous ; in other patients it is completely 
 destroyed. The liquid contained in the digestive ca- 
 nal, is less fluid, less white, less opaque, adheres to 
 the mucous membrane, and approaches the condi- 
 tion of a false membrane. The intestines are less 
 humid, less black, and more difficult to separate from 
 each other. The glands of Peyer and Brown, some- 
 what more swollen, present the appearances of ileo 
 colic. 
 
 In a word, the ordinary symptoms of disease of the 
 stomach and bowels appear. The brain is crowded 
 not with blood, because the patients have often lost 
 much by bleeding. It is more humid, and fewer 
 drops of blood are discovered when its substance is 
 cut ; the ventricles are more moist, and sometimes 
 abundantly supplied with watery matter* We have 
 never found it inflamed, nor have we ever remarked 
 any arachnitis, properly so called. We have seen 
 congestions of blood and watery effusions, but nev- 
 er distinct inflammation. As to the heart, we found 
 it in the first subjects, choaked up with thick blood, 
 
280 LECTURES ON 
 
 its partitions thickened, and upon being cut. blood, 
 less coagulated than we expected, followed the knife 
 in drops, and even in a stream ; but there was no 
 marked inflammation in the internal membranes of 
 the heart and of the large vessels. When the patients 
 lived for some time after the secretions of the digest- 
 ive canal had ceased to be so abundant, the bladder 
 was not so much contracted as in the case of those 
 who had died during the evacuations. It was entire- 
 ly filled with urine, without inflammation, a circum- 
 stance which throws much light upon the cause of the 
 cessation of urine, which must be attributed to the 
 deviation of the watery fluids which go to the intesti- 
 nal surface instead of following their course as in the 
 healthy condition. The muscles are sticky, dry, and 
 emaciated. The lungs present no remarkable ap- 
 pearance. 
 
 I repeat here, we must give attention to the previ- 
 ous diseases. What are we to conclude from all this? 
 That the cholera morbus is essentially an inflamma- 
 tory affection. This is my conclusion. This inflam- 
 matory affection attacks the whole extent of the di- 
 gestive canal, from the throat to the anus. When- 
 ever it is intense, when it is very red, as it commonly 
 is when the malady has lasted a long time and the 
 evacuations have ceased, when it is less bright in col- 
 or, as is the case when death takes place in the midst 
 of abundant evacuations, it is always genera), and 
 there is no part of the canal which is exempt from it. 
 I insist upon this proposition, which is in oppo- 
 sition to many reports upon the cholera. I in- 
 sist upon it, because it is true, and serves to verify 
 many important points. Some persons maintain that 
 there is no inflammation in the digestive canal, and 
 
THE CHOLERA 281 
 
 they rest their position on the fact, that some patients 
 have died during abundant evacuations, in which case 
 the external membrane of the digestive canal is not 
 scarlet ; but the inflammation does not the less ex- 
 ist, and the abundance of the secretions and evacua- 
 tions explain sufficiently its want of redness. Do not 
 conclude from this, however, that I only consider the 
 disease in relation to inflammation. I set aside here 
 that unknown cause referred to in my first lecture, 
 and which I compare with that of the small pox, 
 which is equally unknown ; what we see in the 
 small pox, as in the cholera, is the inflammation 
 which these maladies produce. 
 
 Thus, in a word, the cholera morbus, as we believe, 
 is a general inflammation of the internal membrane 
 of the digestive canal, of which the first determining 
 cause is unknown, while the predominating and sub- 
 sequent causes may be comprehended. And there is 
 an advantage in this ; for if the first causes cannot be 
 discovered, we can, at least, distinguish the seconda- 
 ry causes, a circumstance of great importance, and 
 which ensures us much success. 
 
 Prognostics. 
 
 These are, 1st, The previous health of the patient. 
 Persons in good health are easily cured, when the dis- 
 ease is treated in time. The age of the patient, — 
 Young persons are cured more easily than the aged. 
 The sex — Upon this point, it has been impossible to 
 make any positive or satisfactory comparisons. The 
 moral condition — I have already made some remarks 
 on this point, and all" our observations tend to confirm 
 them. The prognostics depend, 2dly, upon the na- 
 ture of the commencement of the disease. If it be- 
 24* 
 
282 LECTURES ON 
 
 gin in a downward direction, by a gentle diarrhoea, 
 there is time to treat it, and arrest its progress. And 
 at this moment a vast number of these affections are 
 stopped at their commencement, by the skill of the 
 physicians in Paris. The disease, when thus arrest- 
 ed, is called cholerine. Thus, some trifling consola- 
 tion is offered to the public. The physician says to 
 the patient, e you have the cholerine ; you have a 
 slight diarrhoea, but you have not the cholera.' And 
 when it is checked, he does not say, ' you have had 
 the cholera.' Thus he avoids terrifying the patients, 
 who are satisfied without being made to understand 
 that they were victims devoted to the cholera, had 
 not the necessary succour been lavished upon them. 
 When the disease attacks the middle parts, the re- 
 sult is the same. If it be confined to a slight relax 
 and tension, it is easily checked. When the symp- 
 toms predominate in the upper parts, and the diarrhoea 
 has ceased, I venture the opinion, that the disease is 
 more easily cured. When, on the contrary, it has 
 lasted a long time, and the cramps, which are a proof 
 that the inflammation of the intestines has extended 
 to the spinal marrow, have commenced, when the 
 patients are seized with great anxiety, agitation, and 
 uneasiness through the whole extent of the abdomen, 
 they are in much greater danger. When these symp- 
 toms have disappeared, and there remains nothing 
 more than vomiting and distress of mind, there is 
 much more hope of recovery, 
 
 All the symptoms have not the same importance. 
 The congestions of the brain scarcely ever manifest 
 themselves during the violence of the disease. The 
 patients may appear to be in such a state of sinking 
 and exhaustion as to cause the belief that there is a 
 
THE CHOLEHA. 283 
 
 congestion of the brain ; but if you excite them, if 
 you speak to them, they answer very well ; so that, if 
 you have let fall any indiscreet expressions, you may 
 have cause to repent it, when you see that the pa- 
 tients have the full use of their faculties. On the con- 
 trary, when the symptoms of the attack have ceased, 
 and the moment when you flatter youself that the 
 cure is about to commence, a very severe congestion 
 of the brain may take place, unless measures are 
 adopted to arrest its progress. 
 
 When the malady is prolonged, when the pa- 
 tient is revived from the state of asphyxia, and 
 the dark color has disappeared, the tongue red, and 
 the skin hot, the disease has changed its nature ; the 
 patients exhibit all the symptoms of the diseases of 
 the stomach and bowels, which we are called to treat 
 every day. We here make this distinction : it is al- 
 ways necessary in the treatment we adopt, to have 
 reference to the modifications of the disease. When 
 the patient has been revived from a state of stupor, 
 asphyxia, and blackness, by means of stimulus, this 
 disease of the stomach which ensues, is severe, and 
 resolves itself into typhus. 
 
 At this very moment, indeed, it is said that the ty- 
 phus reigns in Paris, with the cholera, and the same 
 thing is repeated upon the subject that was said in 
 Germany, Poland, Russia, and the Levant. But if 
 you wish to appreciate justly this pretended typhus, 
 this typhoid fever which succeeds the cholera, and 
 of which the most dangerous symptoms have been 
 suppressed, you will perceive that this same fever 
 should be subjected to the same treatment as the 
 ordinary complaints of the stomach and bowels. In 
 our hospitals, for instance, there is no typhus ; there 
 
284 LECTURES ON 
 
 is nothing else than slight complaints of the stomach 
 and bowels, which pass off in three or four days, and 
 the patients call for food. In those halls, on the con- 
 trary, where the patients have been revived by means 
 of stimulants, such as punch and brandy, they perish 
 in great numbers, after having been carried into an- 
 other hall as cured of the cholera. They are report- 
 ed in the bulletin as cured of cholera, and placed in 
 a separate room as affected with typhoid fever, and 
 nothing farther is said about them ; the attention of 
 the physicians is given to the new subjects of cholera 
 who arrive, and the first are forgotten. 
 
 1 now pass to the treatment, which, for the sake of 
 perspicuity, 1 divide in the following manner : — 
 
 The Ancient Treatment or treatment of the spora- 
 dc cholera. — Treatment after the manner of Brown. — 
 Mitigated treatment, or eclectic, or vacillating (bascule) 
 (laughter) ; I make use of a word which ex- 
 presses my meaning, without intending to make any 
 application. — Finally, Physiological treatment, such 
 as we employ here. These are the four divisions we 
 have made. 
 
 Let us examine first the ancient treatment. In all 
 the standard treatises, the following receipts are 
 found. We are directed to administer abundantly to 
 the patient a decoction which favors vomiting, that 
 the bile may pass off, and after that when every thing 
 that was wrong in the digestive canal is evacuated, 
 the cramps and irritation must be allayed by narco- 
 tics. This treatment has saved some individuals, but 
 has not been so successful as to be generally adopted ; 
 besides this, the practice of the middle ages has fallen 
 into disrepute, and Brownism has taken its place, par- 
 ticularly in those countries where the cholera prevails, 
 
THE CHOLERA. 285 
 
 for the English physicians have carried there the ideas 
 of Brown. 
 
 Brownian treatment, — This consists in the use 
 of stimulus. I have little to say on this head, having 
 already referred to it before. I shall only add, that it 
 cures very few patients. I will not say it kills them> 
 because, when the cholera is left to itself no one es- 
 capes ; and this treatment, in a vast number of cases, 
 is succeeded by typhus, or disease of the stomach and 
 bowels, which extends to a degree of typhus. 1 do 
 not wish to accuse any one, but only to do justice to 
 all. As to the means of treatment, I have pointed 
 them out. 
 
 The mitigated treatment consists of the following 
 means. The physician seeks to restore heat to the 
 patient, at the period of asphyxia, or if you wish tg 
 go back to the diarrhoea which precedes, he seeks to 
 remove it by means of rice-water, diascordium and 
 opium. Sometimes, indeed, the force is moderate^, 
 but it is impossible to prevent the malady from break- 
 ing out. After the asphyxia and the blackness have 
 made their appearance, the physician endeavors to 
 warm the patient by external and internal applica- 
 tions. For exterior, hot baths are used, and dry fric- 
 tion, with aromatic and stimulating substances, hot 
 bricks and flannel. The skin is irritated and stimula- 
 ted continually, in the hope of recalling circulation. 
 For the same purpose, hot drinks are internally ad- 
 ministered. Some practitioners have no fear of the 
 drinks being too strong. Like the followers of Brown? 
 they give brandy and punch. Others, more timid, 
 make use only of borage, or balm, and above all, of 
 camomile, which has lately obtained a great credit. 
 After that, they give something fortifying, acetate 
 
280 LECTURES ON 
 
 of ammonia, ether, or substances containing alcohol 
 If the patient experience nausea, opium is sometimes 
 added. When a reaction is produced by these 
 means, which does not always happen, the patient 
 grows warm ; some hours afterwards, he becomes 
 cold again ; the same methods are again employed, 
 but he grows cold continually. 
 
 But persons w 7 ho manage well, hasten to profit by 
 the first appearance of warmth, and send the patient 
 into another hall. Thus 1 saw, at a boarding school, 
 a number of scholars who had been attacked, warm- 
 ed again for the moment, and sent home to their pa- 
 rents, where the disease immediately returned. It 
 is possible, however, to maintain this warmth ; and 
 when a continued reaction has been obtained, an in- 
 tense irritation occurs ; less violent, however, than 
 that produced by the hyper-stimulants of the Browni- 
 ans. Others think that evacuations should be pro- 
 moted by emetics. As soon as they see the quantity 
 of liquid which inundates the digestive canal, they 
 say, ' evacuations must be aided, 1 without reflecting 
 that they will arrive at the absolute exhaustion of the 
 strength, and that the irritation will be augmented. 
 English and Polish physicians have been known to 
 give, alternately, calomel to promote evacuation, and 
 brandy to stimulate. Some cures have resulted from 
 the treatment. 
 
 1 cannot say what is the proportion of cures effect- 
 ed by these different methods ; it would require many 
 years of research to ascertain. It will perhaps be 
 known at some future day, but at present, I can only 
 state to you the most general facts. When, by the 
 means 1 have spoken of, the patient is revived from 
 
THE CHOLERA. 2&^ 
 
 his stupor, if these physicians discover much fever, 
 they bleed, either with the lancet or by leeches ap- 
 plied to the epigastrium : then, if the patient be too 
 much weakened by loss of blood, they give him ether 
 or seltz water ; in a word, the medicine is suggested 
 by the symptom. 
 
 These results are more favorable than those of 
 Brown's treatment. It is the prevalent method in this 
 capital, and to this we owe a great advantage in the 
 mortality over other countries where the disease has 
 appeared. 
 
 We come now to the physiological treatment, which 
 we employ. 1 wish to describe, and if possible, to 
 j ustify it. We made, at first, some experiments with 
 hot drinks and stimulants, moved, as we were^ by 
 the coldness of the patients : but as these means did 
 not succeed, we abandoned them, and have not re- 
 curred to them. I watched the patients carefully; I 
 gave them, not camomile, for I dared not go so far, 
 but mallows, and similar things. They said to me, 
 ; I beg you to give me something cold ; I am tortured 
 by the hot drinks ; I have a terible burning in the 
 throat, and I beg you to cool it in some way.' Their 
 countenance brightened in saying this, but they after- 
 wards fell into a still greater dejection. I concluded, 
 from examining the bodies, and from the confession 
 also of the patients, that stimulants were of no use. 
 1 then administered cold drinks ; the patients drank 
 freely, but the evacuations redoubled in consequence. 
 I recollected that ice had been employed to advan- 
 tage in Germany ; but I only had a vague and unsat- 
 isfactory idea of the manner in which it had been 
 used. It occurred to me to diminish the drinks and 
 give them ice. When the patients had copious evac- 
 
 
■288 LECTURES ON 
 
 uations both ways, I caused ice to be given them to 
 eat, with the injunction to swallow it. They took 
 the ice with delight : the tongue was cold, the pulse 
 extinct, and the body chilled. When the tongue is 
 observed to become red, the skin to resume its color, 
 and the blackness to disappear, the ice may be dis- 
 continued and the drinks given ; but while the phy- 
 sician is endeavoring to restore the moisture of the 
 mouth and the interior of the body, the gastrite is de- 
 veloped, reaction is going on, the nature ofthe inflam- 
 mation is changed, and consists in a rapid congestion 
 towards the digestive canal. The vomitings and 
 stools continue, and the pulse is accelerated ; from 
 being slight and hard, it becomes fuller and softer, 
 the brown color of the skin passes gradually away, 
 and one is surprised, the next day, to see the patient 
 with the signs of commencing inflammation of the 
 stomach and bowels, la the mean time, when he is 
 troubled with thirst you may give him some drinks, 
 which you may be sure he will absorb. The dan- 
 ger is of filling the intestinal canal at the moment it 
 is choaked up. When the asphyxia and blackness 
 have disappeared, and the patient has recovered his 
 strength, you conduct him slowly without stimulus, 
 waiting till he has become slightly cold, and till the 
 tongue, which had become a pale red, but not more 
 pale than when it first grew cold, has recovered its 
 ordinary color. This is the substance ofthe treat- 
 ment for the interior. For the exterior, heat may be 
 applied ; it should be directed to the lower extremi- 
 ties. It is not well to accumulate heat upon tha 
 breast : the patient cannot support it ; they have, on 
 the contrary, a desire to uncover themselves, which 
 seems to aid their respiration, and they derive sensi- 
 
THE CHOLERA. 289 
 
 ble benefit from it, and express their satisfaction. If 
 on the other hand, you force them to have the breast 
 covered, if you place them under a blanket or down 
 covering, they appear to suffer extremely, and beg 
 you to uncover the breast a little. The public is still 
 the dupe, in this respect, to prejudices which have 
 been brought from Germany. I will speak here of 
 friction : it is certain that there are establishments at 
 Paris, where the persons employed in rubbing, sweat 
 themselves, before they excite any perspiration in the 
 patients. On the contrary, this stimulus only increas- 
 ed the anguish of the sick, and chilled them after the 
 first few moments, by leaving them uncovered. It is 
 not enough to apply cooling substances internally, and 
 heating ones without ; the inflammation must be com- 
 bated ; and for this purpose we employ leeches. 
 Bleeding can be rarely resorted to, the blood being 
 very thick, and having somewhat the appearance of 
 jelly. Its fluidity may be momentarily restored by 
 rubbing the arm of the patients, or by plunging it 
 into hot water ; but all this produces no essential re- 
 sult. In order that the bleeding may be of any use, 
 the patient must be taken in the earliest stages of the 
 disease. I then cause leeches to be applied to the 
 epigastrium and the lower part of the abdomen. The 
 leeches draw nothing at first, but in proportion as 
 circulation is promoted by the ice, and at the same 
 time by emollient poultices placed upon the abdomen. 
 A quantity of blood is taken by the leeches, so as to 
 aid the cure. You will ask me, perhaps, how the 
 want of ice may be made up? I answer, that nothing 
 is so good as ice. Nevertheless, i think that small 
 draughts of cold water may be of use. Besides this, 
 
 there are in almost all places, persons who understand 
 25 
 
290 LECTURES ON 
 
 how to produce ice by artificial means, by using ox- 
 ide of manganese, sulphuric acid, or muriate of soda. 
 Ice must be procured, if possible 5 but if it cannot be 
 obtained, the want of it must be supplied by taking 
 small quantities of fresh water. Blisters and mus- 
 tard seed poultices should be employed afterwards to 
 prevent congestion of the brain. Leeches may be 
 applied with advantage to the temples, and upon the 
 jugular vein ; poultices and warm applications of 
 mustard-seed should be placed upon the extremities ; 
 and hot vapor baths should be used, at the same time 
 applying ice and cold water. 
 
 It may be said, perhaps, you are exclusive then. 
 Will you allow us to give neither iEther nor Seltz- 
 water to the patients who fall into syncope after 
 bleeding ? I beg pardon ; I think this may be done : 
 i would have the physician use stimuli when he per- 
 ceives the pulse of the patient growing weak, pro- 
 vided he has ice in readiness to calm its effect, I 
 have done this myself, and believe it advantageous, 
 and 1 have done this, though very seldom, in this 
 hospital, since I cannot be here at all moments of the 
 day, nor can I choose my attendants, to watch the 
 patients without interruption. But, in spite of this, 
 I have obtained very remarkable success, since at 
 present we do not lose more than one patient out of 
 thirty or forty, while at first we lost about one out 
 of six. The proportion of cures has been since aug- 
 mented, because the patients have been brought to 
 lis before they had reached the last stages of the dis- 
 ease. Thus, you observe, I do not absolutely reject 
 any system of treatment. Some persons have pro- 
 posed narcotic glysters with laudanum. I will now 
 express my opinion upon this. In the commence- 
 
THE CHOLERA. 291 
 
 ment of the disease, if a stifled sound ensues when 
 you touch the abdomen, this proves that it is not air 
 which prevails in its cavity, but that it is full of the 
 mucous matterpf which I have spoken. If, in these 
 circumstances, you administer glysters of rhatany, 
 and other astringent substances, you will produce ir- 
 ritations; the matter will not be detached, but will 
 mount up again ; congestion of the brain will ensue 3 
 and you will be in danger of witnessing very disa- 
 greeable results : this practice must therefore be re- 
 nounced. But when the patients have been bled, 
 and their evacuations have been abundant, if they 
 continue to experience pain in the lower part of the 
 abdomen ; if they are effected with terror, agitation 
 and uneasiness, it is time to administer narcotic glys- 
 ters. You will then obtain remarkable success, 
 while, if you administer the glysters prematurely, the 
 result will not be satisfactory. As to the quantity of 
 opium, this depends upon the system adopted by the 
 physician. There are some who reject opium and 
 stimulants ; others administer them in large doses* 
 I prescribe but from five to ten drops of laudanum, 
 I have given even forty drops when the patients were 
 very much convulsed, but never any greater quanti- 
 ty. This, then, is the substance of my treatment. 1 
 allow no kind of warm drinks. The only time that 
 I think them admissible, is when the patient begins 
 to have an appetite. 1 then prescribe a cup of soup 
 diluted with water, which revives the patient in an 
 astonishing manner, so that he fancies himself cured. 
 As to the length of time, we have had patients in this 
 hospital, who have remained four or five days in a state 
 of asphyxia and blackness; we expected, every mo- 
 ment, that they would die, but still they have recover- 
 
292 LECTURES ON 
 
 ed to the great astonishment of the assistants. We 
 have had instances of the recovery of patients who 
 had become black or dark colored, and this has been 
 owing to the use of ice and cold drinks. 
 
 I now proceed to the treatment at the time of pre- 
 disposition. When a person, affected with irritabili- 
 ty of the digestive canal, sees that the cholera has 
 broken out in the place where he lives, he should 
 commence by diminishing the quantity of this food 
 at least one half. This is called the prophylatic treat- 
 ment. Only a small quantity of vegetables must be 
 eaten : I do not say that they should be entirely given 
 up, but used very sparingly. You should eat eggs, 
 veal, and poultry, and not drink much between 
 meals ; and not at all, unless you are thirsty. Great 
 moderation must be used in this respect. All kinds 
 of uncommon and violent fatigue must be avoided ; 
 and also sexual intercourse, which easily fixes the 
 disease in feeble subjects ; the regular habits of life 
 must be kept up, and not deserted for any invitation, 
 nor upon any occasion. I have known many persons, 
 who, after preserving themselves a long time from 
 the malady, fell into some excess, and were attacked 
 the next day, and some died in a few hours. All per- 
 sons, or, at least those who have not uncommon 
 courage and firmness of character, should avoid the 
 sight of patients suffering with cholera, as there is 
 something very frightful in the contortions of their 
 countenance ; and one must be accustomed to attend 
 patients, in order to behold, with indifference, so ter- 
 rible a spectacle. Fruit and milk must be given up ; 
 there are persons, however, who digest milk perfectly, 
 and these need not renounce it. There are others 
 who are constantly disordered by milk, which occa- 
 
THE CHOLERA. 293 
 
 sions in them an almost continual diarrhoea ; besides 
 this, there are others who regard coffee and milk as a 
 daily purgative and such persons should abstain from 
 it. I know there are some who say, " If I do not 
 take coffee with milk, I shall have no stool," 1 an- 
 swer them, " Give up your coffee and milk, should 
 nothing pass you for a week." All passion must be 
 avoided, as this gives rise to great inconveniences. 
 Above all, a resource against terror must be sought 
 in the moral powers ; for this malady, so terrible when 
 suffered to progress, can, by attacking it in the very 
 commencement, be made one of the least injurious 
 from which human nature suffers. The cholera mor- 
 bus, in fine, is one of those diseases which best 
 prove the power of medicine. Had all the physi- 
 cians in Paris agreed as to the manner of treating it, 
 you would have seen wonders performed, and 
 France would have been distinguished among the 
 nations for effectually arresting the cholera ; but this 
 is impossible ; the idea of uniformity of thought is a 
 chimera, an utopia, to which no reasonable man can 
 yield himself up. 
 
 When the disease commences with some precurso- 
 ry symptoms, this is truly the moment of triumph. If 
 a man who has commonly one stool a day, perceives, 
 all at once, a relax, in the middle of the night, with- 
 out cause or motive, and that the evacuation of ordi- 
 nary matter is followed by a white mucous substance, 
 depend upon it, this man is attacked with the first de- 
 gree of cholera. In this situation, it is very easy to 
 cure him, as 1 have already ascertained. There are 
 physicians w 7 ho are satisfied with prescribing brandy, 
 astringents, diascordium, simarouba, and rhatany, 
 
 with glysters and other things of the kind* They re- 
 25* 
 
294 LECTURES ON THE CHOLERA. 
 
 commend* also, a diminution of nourishment. Bi>t 
 these are only half means. Go at once to your ob* 
 ject, cut off the food, apply leeches to the anus, if the 
 pain be in the lower part of the abdomen, and to the 
 epigastrium if it be in the stomach. Make free use 
 of the leeches, and of ice, and you are sure of suc- 
 cess, unless you have to deal with patients whose vis- 
 cera were previously disordered , and we must always 
 except such cases. 
 
 I repeat what I have already told you 5 it is an 
 eternal truth — if your patients have organic affec- 
 tions of long standing, above all, if they be aged, 
 you must not flatter yourselves that a cure will be so 
 easily effected 5 but when success is possible, you will 
 obtain it. It is much more prudent to impose this re* 
 gimen upon them, for two or three days, than to give 
 them chicken and rice, with soup. Be severe, and 
 make no change in your prescriptions, for if you au- 
 thorise three mouthfuls, the patient will be sure to 
 take fiv^e, and the whole fruit of your labor will be 
 lost. 
 
 This is all, gentlemen, that the actual state of my 
 knowledge, and my ideas on the cholera morbus, al- 
 low me to say to you, and I shall be extremely happy 
 if you can derive any advantage from my remarks." 
 
 [This discourse was followed by lively, and long 
 continued applause.] 
 
CAUSES OF THE CHOLERA, AND METHODS 
 OE PREVENTION. 
 
 In commencing an inquiry as to the causes which 
 produce the cholera, the first question that requires 
 an answer, is, whether the disease is contagious or 
 epidemic. Upon this delicate and difficult subject, med- 
 ical men are much divided. They may be divided 
 into three classes, who hold to different opinions. 
 
 1. The first, though least numerous class among 
 the intelligent medical men, are the exclusive conta- 
 gionists, who believe that the cholera is communica- 
 ted from an unhealthy body to a sound one, by ap- 
 proximation, or actual touch. To this class belong 
 also the great mass of the non- medical community — 
 the civil authorities of towns and those who have the 
 power to make and enforce quarantine regulations 5 
 regulations which, as regards the prevention of chol- 
 era, have been of no use, but, on the contrary, as 
 facts fully exhibit, have been productive of immense 
 evils. 
 
 2. A larger class are the anti-contagionists, who 
 believe that the cholera depends either on a general 
 cause every where existing, or arises from numerous 
 causes, the most powerful of which are, exposure to 
 cold and humidity at night, and burning heat during 
 the day, the abuse of stimulating liquors, bad food, 
 want of cleanliness, &c. &?c. 
 
 Some, like M. Schnurrer, suppose it is produced by 
 a cause every where existing — the magnetic influence 
 of the earth, which he calls the telluric power. 
 
 Mr.Loder, of Moscow, thinks the disease is primi- 
 
296 CAUSES OF THE CHOLERA, 
 
 tively nervous, and depends on an electro-magnetic 
 cause. 
 
 Dr. Hahneman, a distinguished German physician, 
 asserts that the miasmata of cholera arises from very 
 small insects, too minute to be seen, but which attach 
 themselves to all parts of the body. But these last 
 opinions are now but guesses at truth, if true they 
 should prove to be, and are undeserving of attention 
 so long as they are not supported by facts. 
 
 3. A third, and probably an increasing class, are 
 those who keep to a middle course, between the con- 
 tagionists and the anti-contagionists, and believe in 
 what is called the doctrine of contingent contagion. 
 These say, that although the disease arises from some 
 aerial or terrestrial influence, of which we at present 
 know nothing, and over which we have no control, 
 yet in the filthy hovels of the indigent, in the impure 
 air of crowded apartments, the disease may, and 
 sometimes does acquire a character of communica- 
 bility, which it did not at first possess, and of which 
 it is deprived, when these circumstances are not pres- 
 ent, or when it occurs in well ventilated and cleanly 
 situations. 
 
 Let us now inquire which of these opinions are sup- 
 ported by the most numerous and best authenticated 
 facts. 
 
 The exclusive contagionists, in support of their 
 opinions, advance the following facts : — 
 
 1. The disease was imported into Calcutta, and 
 other places in Bengal, from Jessore, in 1817. 
 
 2. It has always followed the great travelled routes, 
 such as the large roads, navigable rivers, &c, and 
 has been transported from one country to another by 
 vessels, armies, and caravans. 
 
AND MEANS OF PREVENTION. 297 
 
 3. The nurses and attendants in cholera hospitals 
 have frequently been attacked by the disease. 
 
 4. Several cities, fortresses, and private dwellings 
 have established rigorous sanitory measures, and the 
 cholera has not been manifested among them. 
 
 5. Individuals coming from places where the dis- 
 ease raged, have sickened of the cholera in a healthy 
 town ; and soon after, several of their attendants have 
 died of the same disease. 
 
 6. The cholera was imported into Mauritius by the 
 Topaze frigate, which sailed from Calcutta while the 
 disease was raging there. 
 
 7. The disease was imported into Orenburg, by 
 caravans, from central Asia. 
 
 8. It was brought to Dantzic, by a vessel from 
 Riga, the captain of which ship, died the day of his 
 arrival, and afterwards the disease spread to the 
 town. 
 
 9. The cholera was imported into Sunderland from 
 Hamburgh, or from some of the ports on the conti- 
 nent of Europe. 
 
 10. It was brought into Canada by vessels and 
 emigrants from Ireland. 
 
 To these strong and striking facts, the Anti-conia- 
 gionists reply, in general terms, that many of the 
 facts alledged, will not bear investigation. That 
 many of them are not true ; and that all can be ex- 
 plained without resorting to the belief that the dis- 
 ease is contagious. 
 
 They say the inhabitants of every town, and coun- 
 try, are exceedingly averse to admitting that a pesti- 
 lential disease has originated among themselves, and 
 are ever ready to lend a willing ear to tales of its im- 
 portation, and easy credence to any facts that tend 
 
298 CAUSES OF THE CHOLERA, 
 
 to sustain their opinions. That during the prevalence 
 of any general epidemic, some facts will undoubtedly 
 occur, which may be brought to support the conta- 
 giousness of the disease, while the general course of 
 the malady demonstrates that it is not so. This is 
 strikingly true of the influenza as will hereafter be 
 shown. 
 
 But to the facts adduced by the contagionists, their 
 opponents reply in detail : 
 
 1. That it was not imported from Jessore into Cal- 
 cutta and Bengal, as on full investigation it was 
 proved by the most conclusive testimony, that it oc- 
 curred nearly at the same time, in various parts of 
 the province, between which there had been no im- 
 mediate intercourse. Further, — in India, the conta- 
 gious nature of cholera is denied by 99, out of every 
 100 medical men in that part of tho world. {Dr. 
 James Johnson, 
 
 2. If it was true that the cholera has been restrict- 
 ed to great roads and rivers, it might be accounted for 
 from the fact that there, men collect in the largest 
 masses, where they are most exposed to all the 
 causes which the anti-contagionists say produce the 
 disease, such as filth, intemperance, want of food, 
 pure air, &c. &c. But the fact is doubted. Sur- 
 geon Mitchell, in his report from Palmacottah, says, 
 ' as far as I can learn, the cholera appears to have 
 made its approach by neither of the great roads. 
 Commencing its ravages here, to the eastward, a lit- 
 tle north of the fort, it spread pretty generally through 
 the small, low, dirty houses, in every direction. The 
 hospital seems to have escaped, probably because the 
 building stood upon high and open ground.' 5 
 
 But the following statement from Mr. Bell, author 
 
AND MEANS OF PREVENTION. 299 
 
 of one of the best works on the cholera, and who 
 served in India from 1818 to 1829, where he saw 
 much of the disease under every possible aspect, is a 
 triumphant argument against the exclusive contagion- 
 ists: 
 
 ;i But it has been said to accompany troops, in 
 marching into a district where it had not previously 
 prevailed, and into which it has thus been introduced. 
 This statement is so much at variance with the well 
 ascertained habits of the disease, that it would re- 
 quire the most minute inquiry, and unquestionable 
 evidence, to entitle it to credit. It has been repeatedly 
 ascertained, that cholera patients may be carried 
 into hospitals crowded with patients laboring under 
 other diseases, without these, or numerous hospital 
 attendants, having the disease communicated to 
 them. Yet it is asserted, that a regiment, travelling 
 at the rate of six or ten miles a day, has carried the 
 disease along with it a hundred miles or more, com- 
 municating it to the inhabitants as it passed on ! We 
 have seen that a camp, by shifting ground a short dis- 
 tance, has put a stop to the ravages of the disease. 
 And is it to be believed, that a regiment cannot get 
 rid of it, with no cause but contagion for its continu- 
 ance, by ten or twenty marches ? 1 conceive, that 
 this supposed proof of a contagious quality in cholera 
 may be otherwise accounted for. When travelling 
 on circuit, I have found the disease prevailing in a dis- 
 trict, before any report had been made of the fact, not- 
 withstanding the most positive orders on the subject ; 
 and 1 am persuaded, that were any of the instances 
 adduced in support of the statement under consider- 
 ation, strictly inquired into, it would be found that the 
 usual apathy of the natives of India had prevented 
 
300 CAUSES OF THE CHOLERA, 
 
 their noticing the existence of the disease, until the 
 fact was brought prominently forward by the pre- 
 sence of Europeans. It should also be borne in 
 mind, that cholera asphyxia is not a new disease to 
 these natives; but seems to be in many places almost 
 endemical ; whilst it is well known, that strangers, in 
 such circumstances, become more obnoxious to the 
 disease than the inhabitants of the country. More- 
 over, travellers have, superadded to the remote causes 
 of the disease, fatigue and road discomforts, which 
 are not trifling in a country where there are neither 
 inns nor carriages. 
 
 The following extract from the Journal of my first 
 journey in India, is illustrative of some of the peculi- 
 arities, in this disease, to which I have adverted. In 
 July 1819 1 marched from Madras in medical charge 
 of a large party of young officers, who had just 
 arrived in India, and who were on their way to join 
 regiments in the interior of the country. There was 
 also a detachment of Sepoys, and the usual numer- 
 ous attendants and camp-followers of such a party in 
 India. 
 
 The cholera prevailed at Madras when we left it. 
 Until the fifth day's march, (50 miles from Madras,) 
 no cases of the disease occurred. On that day seve- 
 ral of the party were attacked on the line of march ; 
 and, during the next three stages, we continued to 
 have additional cases. Cholera prevailed in the 
 country through which we were passing. In consul- 
 tation with the commanding officer of the detach- 
 ment, it was determined that we should endeavor to 
 leave the disease behind us ^ and as we were informed 
 that the country beyond the Ghauts was free of it, 
 marched without a halt, until we reached the high 
 
AND MEANS OF PREVENTION. 301 
 
 table land of Mysore. The consequence was, that 
 we left the disease at Vellore, 87 miles from Madras, 
 and we had none of it until we had marched 70 miles 
 farther, (7 stages,) when we again found it at one of 
 our appointed places of encampment- But our camp 
 was, in consequence, pushed on a few miles, and only 
 one case, a fatal one, occurred in the detachment. 
 The man was attacked on the line of march. We 
 again left the disease, and were free from it during 
 the next 115 miles of travelling. We then had it 
 during three stages, and found many villages desert- 
 ed. We once more left it, and reached our journey's 
 £nd, 260 miles farther, without again meeting it. 
 Thus, in a journey of 560 miles, this detachment was 
 exposed to, and left the disease behind it, four differ- 
 ent times 5 and on none of those occasions did a 
 single case occur beyond the tainted spots." 
 
 3. That some of the attendants on cholera patients 
 have been attacked by the disease is undoubtedly 
 true, yet facts from all countries where the disease 
 has prevailed, abundantly exhibit that they are no 
 more liable to the disease than other classes in the 
 same community, who are engaged in laborious em- 
 ployments. Reports from India, Russia, Poland, 
 England, France, Canada and New York, all con- 
 cur in the fact of the remarkable exemption of the at- 
 tendants upon cholera patients. The proof of this 
 statement will be found in another part of this work. 
 
 4. That some cities and fortresses which establish- 
 ed rigorous quarantine regulations, have escaped the 
 disease, is very true •, but it is also true, that other 
 places immediately adjoining those which were at- 
 tacked, have escaped, notwithstanding every precau- 
 
 26 
 
302 CAUSES OF THE CHOLERA, 
 
 tionary measure had been omitted. Jt is further true 
 that numerous countries, cities, and fortresses have 
 adopted and enforced the most severe preventive regu- 
 lations ; they adopted them early, and executed them 
 with rigor, and yet the disease appeared among them. 
 AH that quarantine enactments can do towards pre- 
 venting the spread of a disease from one country to 
 another has been done in Russia, Austria and Prussia. 
 In Russia immense lines of troops were formed for 
 arresting its progress : St. Petersburg was entirely 
 surrounded by cordons sanitaires \ but all these regu- 
 lations enforced by a powerful and despotic govern- 
 ment were unable to prevent the approach and the 
 spread of the cholera throughout the Russian Em- 
 pire. The efforts of Austria were equally unavailing, 
 for in a short time the disease passed her triple cor- 
 dons and invaded the country from Poland. Prussia 
 employed sixty thousand of her best troops to en- 
 force her rigorous restrictions, and travellers bear tes- 
 timony to the severity with which they were enforced. 
 "And what have been the results ? An immense ex- 
 penditure of money, the suspension of commerce, a 
 stop put to industry, multitudes deprived of the means 
 of acquiring subsistence, and whole families plunged 
 into misery, and rendered favorable subjects for the 
 disease ; but no stop to the extension of the disease, on 
 the contrary its progress was rendered more fatal. 
 As an instance of this, Breslau may serve as an illus- 
 tration ; and a warning to other cities. That city con- 
 tains 90,000 inhabitants, active, commercial and in- 
 dustrious, many of them manufacturers and artisans. 
 A quarantine of twenty days, with difficulties almost 
 insurmountable which it entailed, was established at 
 the borders of the province and maintained with a ri- 
 

 AND MEANS OF PREVENTION. 303 
 
 gor, which might serve as a model to other nations. But in 
 the midst of this apparent security, a woman living in 
 a damp part of the town was attacked by the cholera, 
 and in a few days the disease spread. The most 
 minute researches on the part oj the public authorities 
 could not discover any communication between this wo' 
 man and any stranger or goods suspected of being in- 
 jected. But when the disease spread, the authorities 
 saw too late the deep injury which their sanitary 
 measures had inflicted ; a multitude of families, and 
 thousands of individuals were plunged in extreme 
 misery, for the sudden cessation of commerce, and 
 consequent suspension of labor, had deprived them of 
 the means of subsistence"* 
 
 Taught by sad and lamentable experience, Russia, 
 and Austria, and Prussia have withdrawn their cor- 
 dons and acknowledge not only their inutility, but 
 that they are productive of immense evils. Indeed 
 all the nations of Europe are abandoning severe 
 quarantine regulations^ and it is hoped that the cities 
 of this country will not adopt them, but place all 
 their reliance for the prevention of the disease, on the 
 removal of those causes which in all countries have 
 appeared to produce it 
 
 5. Individuals coming from infected districts, and 
 becoming sick with the cholera in a town where the 
 disease had not before prevailed ; appear to have 
 communicated the disease to their attendants, who 
 have soon sickened and died. Such instances are 
 not numerous though they have been witnessed in all 
 countries. Thus the Bombay report says, that a 
 man left Pan well, whilst the disease prevailed there, 
 arrived at Bombay and was attacked and died ; the 
 
 * American Journal of Medical Sciences, May 1832. 
 
304 CAUSES OF THE CHOLERA, 
 
 next day his wife, and the wife of the man who lived 
 next door, and soon several of the neighbors died of 
 the same disease. 
 
 Scouttetten, relates the following instance. An 
 European left Madras, where the cholera existed in 
 Oct. 1818; fell sick on his journey and died at St 
 Thomas-du-Mont, where the disease had not appear- 
 ed. The next day his wife died ; two days after- 
 wards the landlord perished, and in two days more 
 the landlady and domestics were attacked. Several 
 cases of a similar kind are furnished by the Russian 
 official documents. In this country we have had a 
 few similar cases. Thus a woman and child, from 
 New York, where the disease prevailed, arrived at 
 New Haven, Con. in the steam boat ; they were ex- 
 posed to the wet on landing and fatigue by walking. 
 They both sickened ; and were reported by the phy- 
 sician who attended them to the Board of Health as 
 cases of Asiatic cholera, of a mild character. These 
 two cases recovered. But soon after the parents of 
 the woman that had recovered, and who were intem- 
 perate persons, sickened and died of the disease. It 
 is said the family were in a destitute and filthy condi- 
 tion. 
 
 Cases of the same character and accompanied by 
 like circumstances occurred at Hartford, in the same 
 state. A colored man went from Hartford to New 
 York while the disease prevailed there. He com- 
 plained of ill health before he left Hartford, and on 
 his return from New York was attacked by diar- 
 rhoea which continued several days, and greatly re- 
 duced him. July 20th he took castor oil which re- 
 duced him still more and increased his diarrhoea. 
 The afternoon of the same day, he was attacked by 
 
AND MEANS OF PREVENTION. 305 
 
 vomiting of a light colored fluid resembling rice wa- 
 ter, and the discharges from the bowels were of the 
 same character. He had cramps of the extremities 
 and other symptoms which induced his attending phy- 
 sicians to report the case to the Board of Health as 
 one of Asiatic cholera of a mild character. This 
 man recovered, but his parents, said to have been in- 
 temperate, and who had attended upon their son, 
 had lodged in the same room, and had been deprived 
 of their usual rest, and who immediately took cath- 
 artic medicines : sickened two days after the attack 
 of the son, and both died, with the symptoms of cho- 
 lera. 
 
 Instances like these, though they are not numerous, 
 have convinced many of the contagious nature of the 
 disease. But do facts warrant this conclusion ? Are 
 we bound to believe, from the facts presented, that 
 these cases were produced by some specific poison 
 brought from New- York, and emanating from the 
 body of the sick person, affected those that were well ? 
 Were none of the causes present which in every oth- 
 er country, have, in alliance with the general epi- 
 demic influence, sufficed to produce the disease, or 
 are they in these cases to be deemed inoperative, and 
 to pass for nothing ? Is the natural anxiety of pa- 
 rents, — intemperance, night-watching, the terror ari- 
 sing from the assurance that the first case was Asiat- 
 ic and malignant cholera, brought from a place wheie 
 it was daily destroying great numbers, — the injudi- 
 cious use of cathartic and preventive medicines, ac- 
 cumulated filth, crowded, ill ventilated rooms, to be 
 considered wholly inert in producing the disease 
 in Connecticut, although all these causes existed 
 26* 
 
306 CAUSES OF THE CHOLERA, 
 
 there, and are the very causes that we are assured by 
 medical men, and by the evidence of innumerable 
 facts, have served to produce the disease in all other 
 countries ? 
 
 The medical authorities of Orenburg, of Dantzic, 
 of Moscow, of St. Petersburg, of Sunderland, of 
 Quebec and Montreal, of New- York and Philadel- 
 phia, and most other places where the disease has 
 prevailed, have stated that it was impossible to trace 
 its introduction from abroad into any of these places, 
 but that the disease developed itself spontaneously in 
 all of them. 
 
 In reply to the arguments in favor of contagion, 
 derived from the cases at New-Haven, Hartford, &c. 
 the anti-contagionists say, that other cases of a more 
 malignant character have been witnessed in different 
 parts of the country, and yet none of the attendants 
 on these fatal cases have had the disease. Is a mild 
 case of cholera more likely to be contagious than a 
 severe and fatal one ? A man from New-York died 
 of cholera on board of a steam-boat at Hartford. 
 Many individuals attended upon him, and the crew 
 of the boat, consisting of more than 20 persons, were 
 exposed. They took care of him when sick, and as- 
 sisted in burying him, and were confined on board 
 the same boat for several days, and yet not a single 
 individual has been affected by the disease. 
 
 A man left New-York when the disease prevailed 
 there ; sickened and died of the cholera at Brook- 
 field, Mass. Not one of his attendants have had the 
 disease. 
 
 But the occurrence of the cholera at Providence, 
 R. I. affords, say the anti-contagionists, a triumphant 
 
AND MEANS OF PREVENTION. 307 
 
 reply to the arguments of the contagionists, and is in 
 accordance with the general facts respecting the oc- 
 currence of the cholera inmost of the places where 
 it has appeared. 
 
 All the facts connected with the first appearance of 
 this disease at Providence, are so important, that I 
 shall insert the whole of the Report of the Special 
 Medical Council of the Board of Health. 
 
 Report. — "It has become our painful duty to an- 
 nounce to the public, the occurrence of four cases of 
 epidemic cholera, in this city. 
 
 The following is a brief statement of the most im- 
 portant facts relative thereto, viz. 
 
 John Thurber, (aged about 50,) the first individual 
 attacked, has enjoyed unusually good health, for some 
 time past, until Wednesday, July 25th, when he was 
 seized, (as persons often are, in summer,) with vomit- 
 ing and purging, which the family endeavored to com- 
 bat until Monday morning, when their efforts not 
 proving successful, Dr. Utley was sent for, who, by 
 the use of ordinary means, succeeded in relieving the 
 patient ; he afterwards appeared to be in a fair way 
 to recover, until last evening, (July 31st,) when, as 
 was supposed, from the mental excitement produced, 
 by hearing of his wife's seizure, he relapsed, and was 
 also attacked with violent spasms of the hands and 
 feet, which have continued in a milder form to this 
 time ; but from the presence of other symptoms, his 
 situation now is extremely critical. 
 
 The second individual taken sick was Mrs. Thur- 
 ber, as above noted. She first complained yesterday 
 forenoon of a slight uneasiness in the bowels ; this, 
 however, did not attract particular attention. About 
 
308 CAUSES OF THE CHOLERA, 
 
 3 o'clock, P. M. she was seized with violent vomit- 
 ing, purging, and cramps, that continued at intervals 
 until a few hours previous to her death, which took 
 place at 7 o'clock this morning. 
 
 The third patient was a young girl by the name of 
 Slocum, aged 3| years. She went to school, appa- 
 rently in perfect health, yesterday afternoon. At a 
 quarter before 5, she complained to the instructress 
 of feeling sick, and was in consequence sent home. 
 Soon after reaching home, vomiting and purging set 
 in, which were shortly followed, according to her 
 mother's account, by coldness of the surface, and a 
 cessation of the pulse at the wrist. The usual symp- 
 toms noticed in this disease shortly ensued, and con- 
 tinued to increase until her decease, which happened 
 at three o'clock this morning. 
 
 The fourth case is a sister of the preceding one, 
 aged 5 ; she first began to complain about half past 
 3 this morning, with pain in the bowels ; which was 
 soon aggravated and followed by the symptoms al- 
 ready alluded to ; she is now in a state of collapse. 
 
 The attending physician thought it advisable to call 
 in, in the course of the night, (of the 31st July) the 
 following gentlemen in consultation, viz : — Doctors 
 Fuller, Mauran, Miller, Webb and Hartshorn ; who, 
 after a careful examination of the patients, gave it 
 unanimously as their opinion, that they labored un- 
 der the same disease as has extensively prevailed in 
 New- York, and elsewhere. 
 
 At the time of the consultation, Mrs. Thurber was 
 in a confirmed state of collapse ; there were the pe- 
 culiar appearance of the countenance, the change of 
 voice, coldness of the tongue and breath, impercepti- 
 
AND MEANS OF PREVENTION. 309 
 
 bility of the pulse, corrugated appearance of the 
 hands, &c. 
 
 Post mortem examinations were made of the two 
 deceased patients, in the presence of a large majority 
 of the medical faculty. The appearances presented 
 were such as to convince all of the correctness of the 
 opinion previously formed of the cases, and corres- 
 ponded precisely with what had been witnessed in 
 New- York by several of the physicians. 
 
 All of these cases occured in the same house, 
 which is situated in Field Street, on Eddy^s Point, on - 
 the west side of the river, and its location, as far as 
 we are enabled to judge, is a healthy one. 
 
 Upon enquiring, we were informed that there had 
 been no communication between the inmates of the 
 house, and any individual from New-York, or other 
 places where the cholera prevails, or has prevailed. 
 Mr. Thurber and wife resided in New- York, with 
 their son-in-law, until the 11th of June, when they 
 removed to this place, and have, previous to the at- 
 tack now described, enjoyed their usual health. The 
 date of their quitting the city of New- York, was 
 three weeks previous to the official announcement of 
 the cholera in that place, and two days subsequent to 
 its first appearance on this continent. 
 
 The preceding brief account is respectfully submit- 
 ted for the information of the public, by order, and in 
 behalf of the medical gentlemen of this city. 
 
 LEWIS L. MILLER, 
 LEANDER UTLEY, 
 THOMAS H. WEBB, 
 ISAAC HARTSHORN 
 
 Providence, Aug. \,one d* clock, P. MP 
 
310 CAUSES OF THE CHOLERA, 
 
 The above facts are very deserving of considera- j 
 tion. The first case appears to have been like ordi- 
 nary seizures of vomiting and purging, and yielded 
 to ordinary treatment, until the mental excitement 
 produced by the seizure of his wife aggravated 
 all his symptoms, and produced a relapse of 
 which he died. It serves to show the close connec- 
 tion between the common cholera of our country, 
 and what is called Asiatic cholera, and how easily 
 fear, and other causes may transform the one into the 
 other. The influence of fear in producing and ag- 
 gravating the cholera, has been acknowledged by al- 
 most all writers upon the disease, but its influence, it 
 appears to me, has been underrated and misunder- 
 stood ; I shall therefore recur to it in another place. 
 
 6. It has been said the cholera was imported 
 into Mauritius, by the Topaze frigate, from Ceylon. 
 To this, it is replied, that Dr. John Kinnis, who resi- 
 ded at Mauritius, and had charge of a hospital there, 
 in a report addressed to Sir James M'Grigor, and 
 published in the Edinburgh Medical and Surgical 
 Journal for 1821, says, that 2 cases of the disease oc- 
 curred 3 weeks before the arrival of the Topaze, and 
 when the vessel did arrive, the surgeon of the frigate 
 stated, that not one of the crew were affected by the 
 cholera ; and Dr. K. from personal observation, as- 
 sures us that not one of the patients sent from the 
 Topaze to the hospital, labored under symptoms of 
 cholera ; and further, that the disease did not break 
 out among the attendants on these men, but among 
 the African slaves and Indian convicts. 
 
 The disease soon run its course in this island, and 
 then appeared at Bourbon, in defiance of a most rig- 
 orous quarantine. 
 
 
AND MEANS OF PREVENTION. 31 { 
 
 7. The disease was imported into Orenburg, say 
 the contagionists, by caravans from Asia. To this 
 their opponents reply, that the last caravan that arri- 
 ved at Orenburg, reached that place thirty-five days 
 before the first case of cholera appeared, and that 
 the individuals composing it, were all in good health, 
 and had not imparted the disease to any of the fron- 
 tier towns through which they had passed. 
 
 3. It was brought to Dantzic by a vessel from Ri- 
 ga, it has been said. But Dr. Dalmas, a member of 
 the Medical Commission, sent by the French Govern- 
 ment to Warsaw 7 , investigated the subject himself at 
 Riga ; and states, as the result of his investigations, 
 the following facts, which have not been denied. 
 
 1 . That the cholera did not exist at Riga, at the 
 time of the sailing of the vessel mentioned. 2. That 
 the cholera did not appear on board the ship du- 
 ring the voyage. 3. That the cholera appeared 
 at Dantzic before the arrival of the vessel ; that 
 it broke out in the town before it appeared at the 
 port ; and lastly, the cordon sanitaire did not protect 
 the neighboring places. These assertions Dr. D. 
 supports by proofs, too abundant to detail. 
 
 9. The advocates of contagion say, the chole- 
 ra was imported into Sunderland by vessels from 
 Hamburgh, or from some port in the north of Europe. 
 Such an origin of the complaint at Sunderland, was 
 widely circulated in the newspapers ; but on investi- 
 gation, it has proved to be wholly without foundation. 
 The disease first manifested itself in a part of the 
 town more than two miles distant from where the 
 vessels were lying, and among those who had no 
 communication with the port. Besides, both Dr. 
 Bvown, and Dr. White, of Sunderland, state, that the 
 
312 CAUSES OF THE CHOLERA, 
 
 same disease, accompanied by all the symptoms as- 
 cribed by observers to the Asiatic cholera, prevailed 
 there in August, two months before the arrival of the 
 vessels that are charged with having brought the dis- 
 ease from the continent 
 
 10. Again, it is said, the cholera was imported 
 into Canada by vessels and emigrants from Ire- 
 land. The board of health at Quebec are in pos- 
 session of no facts calculated to show that the disease 
 was imported into that city, and the most eminent phy- 
 sicians of Montreal, and the most enlightened citizens 
 in that city are satisfied that it is an epidemic, and 
 not a contagious disease. They say that many cases 
 of cholera occurred six weeks before the vessel and 
 emigrants arrived. 
 
 I have thus given some of the most important facts 
 produced in justification of their belief, by those who 
 say that the epidemic cholera which now prevails in 
 this country, and many l other parts of the world, is a 
 contagious disease. I have also given what many of 
 their opponents upon this subject, call a complete re- 
 futation of them. And upon a review of all the facts 
 and arguments which have been adduced by both 
 parties, upon this difficult subject, surely, the consci- 
 entious enquirer after truth, will be oliged to confess 
 that if the cholera is at all, or under any circumstan- 
 ces a contagious disease, it is so but in a trifling de- 
 gree, and that generally, it is propagated by other 
 means than by the transmission of some poisonous 
 substance from the diseased to the healthy. 
 
 The anti-contagionists say, the cholera has al- 
 ways been an endemic disease in India, but that in 
 1817 it assumed an epidemic character. The cause 
 which produced thischaracter, like the origin of most 
 
AND MEANS OF PREVENTION. 313 
 
 general pestilences, is still a mystery. Probably, 
 however, it is some atmospheric phenomenon. Mr. 
 Scott, Dr. Jameson, and Mr. Annesley, say that the 
 seasons preceding the appearance of the epidemic in 
 India, were remarkable for atmospheric vicissitudes, 
 and the disease appeared at the commencement of a 
 rainy season, so excessive as to convert the whole 
 delta of the Ganges into a sheet of water. 
 
 But what that epidemic influence is, which has 
 made cholera prevail so extensively since then, and 
 diffused it over the world, we do not know, any more 
 than we know the cause of any epidemic. We do, 
 however, know that there are predisposing and exci- 
 ting causes, which, if avoided, even when the gene- 
 ral epidemic influence prevails, will, for the most part, 
 serve to protect people from the cholera, or transform 
 the disease from a highly malignant and incurable dis- 
 order, into a mild one, over which medicines have 
 great control. 
 
 These causes so necessary to be known, and to be 
 avoided, are exposure to cold and moisture, or sudden 
 changes from heat to cold, a scanty, poor, or bad di- 
 et, lodging in crowded, damp, or ill-ventilated rooms, 
 or upon the ground, fear and mental anxiety, accumu- 
 lations of filth among a crowded population, excesses 
 of all kinds, especially intemperance in the use of 
 stimulating drinks, &c. &c. &c. 
 
 These causes have ever been sufficient to produce 
 sporadic cases of cholera, in all countries, and when 
 more powerful, they may cause the disease to be 
 epidemic. If it is asked why these causes have never 
 before produced the disease in the United States, we 
 reply by asking, why it did not appear at Jessore in 
 
 1800, or in 1820, or some other time, instead of 1817, 
 
 27 
 
314 CAUSES OF THE CHOLERA, 
 
 All we can infer from the facts given us respecting 
 the disease, is, that exactly the same causes could nev- 
 er have been in operation before, in either place. In 
 proof that the causes assigned, serve to produce and 
 aggravate the disease, we are told they were all in ope- 
 ration in the towns of India, when the disease prevailed. 
 The population in most parts of India, is very dense, 
 and in the large towns, exceedingly so. The following 
 account of Calcutta, from the correspondence of the 
 lamented Bishop Heber, is applicable to most of the 
 cities and towns in India : — 
 
 " Calcutta, Dec. 15, 1823. 
 Of the country, we have as yet seen little, except 
 in one voyage up the river, and in the vicinity of Cal- 
 cutta. But all Bengal is described to us as like those 
 parts which we have seen, a vast alluvial plain, inter- 
 sected by the innumerable arms of the Ganges, over- 
 flowed once a year, but now covered with fields of 
 rice, divided by groves of tall fruit-trees, with villages 
 under their shelter, swarming with a population be- 
 yond any thing which Europe can show, and scarcely 
 to be paralleled in China. Calcutta, when seen from 
 the south, on which side it is built round two sides of 
 a great open plain, with the Ganges on the west, is a 
 very noble city, with tall and stately houses, ornament- 
 ed with Grecian pillars, and each, for the most part, 
 surrounded by a little apology for a garden. The 
 churches are not large, but very neat, and even elegant 
 buildings, and the government house is, to say the 
 least of it, a more showy palace than London has to 
 produce. These are, however, the jront lines ; be- 
 hind them ranges the native town, deep, black, and 
 dingy, with narrow crooked streets, huts of earth ba- 
 ked in the sun, or of twisted bamboos, interspersed 
 
AND MEANS OF PREVENTION. 315 
 
 here and there with ruinous brick bazars, pools of 
 dirty water, coco-trees, and little gardens, and a few 
 very large, very fine, and generally very dirty houses, 
 of Grecian architecture, the residence of wealthy na- 
 tives. There are some mosques of pretty architect- 
 ure, very neatly kept 3 and some pagodas, but mostly ru- 
 inous and decayed, the religion of the people being 
 chiefly conspicuous in their worship of the Ganges, 
 and in some ugly painted wooden or plaster idols, with 
 all manner of heads and arms, which are setup in dif- 
 ferent parts of the city. Fill up this outline with a 
 crowd of people in the streets, beyond any thing to 
 be seen even in London ; some dressed in tawdry silks 
 and brocades, more in white cotton garments, and most 
 of all black and naked, except a scanty covering round 
 the waist, besides figures of religious mendicants, with 
 no clothing but their long hair and beards in elf locks, 
 their faces painted white or yellow, their beads in one 
 ghastly lean hand, and the other stretched out like a 
 bird's claw to receive donations ; marriage processions, 
 with the bride in a covered chair, and the bridegroom 
 on horseback, so swathed round with garlands as hard- 
 ly to be seen ; tradesmen sitting on the ground in the 
 midst of their different commodities, and old men, 
 lookers on, perched naked as monkeys on the flat roofs 
 of the houses; carts drawn by oxen, and driven by 
 wild looking men, with thick sticks, so unmercifully 
 used as to undeceive perfectly all our notions of Brah- 
 minical humanity; attendants with silver maces, pres- 
 sing through the crowd before the carriage of some 
 great man or other; no women seen, except of 
 the lowest class, and even these with heavy silver or- 
 naments on their dusky arms and ankles ; while coach- 
 es, covered up close with red cloth, are seen convey- 
 
316 CAUSES OF THE CHOLERA, 
 
 ing the inmates of the neighboring seraglios to take 
 what is called the i air ;' a constant creaking of cart 
 wheels, which are never greased in India ; a constant 
 clamor of voices, and an almost constant thumping 
 and jingling of drums, cymbals, &c., in honor of some 
 of their deities ; and add to all this a villainous smell 
 of garlic, rancid coco-nut oil, sour butter, and stag- 
 nant ditches, and you will understand the sounds, 
 sights, and smells of what is called the ' Black Town* 
 of Calcutta. 
 
 The singularity of this spectacle is best, and least 
 offensively enjoyed on a noble quay which Lord Has- 
 tings built along the shore of the river, where the ves- 
 sels of all forms and sizes, Arab, Indian, Malay, Amer- 
 ican, English, the crowds of Brahmins and other Hin- 
 doos washing, and saying their prayers ; the lighted 
 tapers which, towards sun-set, they throw in, and the 
 broad, bright stream which sweeps them by, guiltless 
 of their impiety, and unconscious of their homage, af- 
 ford a scene such as no European, and few Asiatic cit- 
 ies, can at all parallel in interest and singularity ." 
 
 Mr. Kennedy, in his history of the cholera, says, it 
 w 7 as amongst the swarming population of these filthy 
 receptacles, who barely subsisted on a meagre diet of 
 bad rice, who worked hard in the sun during the day, 
 and who lodged in their small mud hovels, and not un- 
 frequently with cows and other animals, that the chol- 
 era run a long and wide career of destruction. 
 
 Dr. Young, in his remarks upon the cholera morbus, 
 as it prevailed in the villages around Calcutta, says, 
 there are in the lowest and most thickly inhabited quar- 
 ters, many ditches of stagnant, filthy water, on the 
 margins of which, the natives sleep, during the hot and 
 
AND MEANS OF PREVENTION: 317 
 
 sultry nights. In such situations, he says, the cholera 
 raged with double and dreadful fury, while the dryer, 
 better drained, and more thinly inhabited parts of the 
 town, suffered comparatively but little, 
 
 Every wliere, the disease has not only been most se- 
 vere in crowded, dirty towns, but has generally been 
 confined to those parts of towns that are most so, and 
 that are inhabited by the poor and suffering portion of 
 the population. 
 
 For instance, the merchants of the town of Gun- 
 toor, who occupy spacious dwellings, in a wide, dry 
 street, almost entirely escaped the disease, which ra- 
 ged with great violence among the people who resided 
 in the close damp alleys of the town. 
 
 Multra, a filthy place, containing many dirty and 
 crowded bazars, suffered severely, whilst Argra, a clean 
 airy town, almost entirely escaped. 
 
 In Tripoli, a very clean town in Syria, only thirty- 
 one were attacked, and five died, out of a population 
 of 15,000, and the disease disappeared in a few days ; 
 whilst at Antioch, and other low and badly ventilated 
 places, it prevailed for a long time, and raged with 
 great violence. 
 
 The disease has, in all countries, manifested the like 
 partiality for the most dirty and crowded cities ; and 
 for low and damp situations. 
 
 The following interesting observations on the statis- 
 tics of Sunderland, from the work of Mr. Parsons, as 
 published in a late number of the Medico Chirurgical 
 Review, fully confirm the above statement : — 
 
 ' The town of Sunderland consists of three parishes ; 
 viz. Monk Wearmouth, with a population of about 
 6,000, — Bishop Wearmouth, with 14,000, — and 
 
 Sunderland with 20,000 inhabitants. In Bishop 
 
 27* 
 
318 CAUSES OF THE CHOLERA, 
 
 Wearmouth nearly all the wealthy inhabitants of the 
 town reside, and the number of its pauper popula- 
 tion is very small ; the streets are generally sufficient- 
 ly wide and clean, and their elevation above the le- 
 vel of the river is from 110 to 120 feet. In Sunder- 
 land, which is a continuation of Bishop Wearmouth, 
 there are very few streets of proper width, and their 
 general elevation above the level of the river is from 
 70 to 90 feet lower than in the adjoining parish. The 
 bye-streets are extremely narrow, several not being 
 broad enough for the passage of a common cart, and 
 during my residence in the town they were rarely 
 cleansed from the dirt, and other impurities allowed 
 to accumulate in them, for many days together. The 
 houses in these bye-streets or lanes commonly had no 
 yards or courts attached to them ; the rooms w T ere 
 dark, ill ventilated and dirty ; the passages and stairs 
 were dirty through the great number of persons living 
 in each house ; and very often each room, from the 
 cellars to the attics, was occupied by a whole family ; 
 Dr. Barry found 120 individuals living in one of these 
 houses. In the parts bordering on the river, Monk 
 Wearmouth closely resembles Sunderland in the 
 crowded state of its poor inhabitants. For several 
 years past it has been the custom in Sunderland for 
 the parish managers to contract with some individual 
 for the maintenance, &c. of the whole poor of the 
 parish. When this plan was first adopted, now about 
 seven years since, the annual expense for t hi spur- 
 pose amounted to upwards of 9000/., the number of 
 persons contributing to the poor-rates being at that 
 time, as it is at present, rather more than five hun- 
 dred, and consisting almost entirely of the shop-keep- 
 ers and others necessarily resident in the place ; but, 
 
AND MEANS OF PREVENTION. 319 
 
 by means of the farming system, the annual expense 
 has been gradually reduced to its amount in the pre- 
 sent year, of between three and four thousand pounds, 
 with, it is believed, a considerably increased number 
 of claimants on the parochial funds. A necessary 
 consequence of this cruel economy, was the state of 
 great destitution in which the poor existed at the time 
 of the appearance of cholera amongst them ; and, 
 although much was done towards improving their 
 condition, by giving them clothes, bedding, fuel, &c, 
 still it was found that individual exertions were man- 
 ifestly unequal to counteract the ill effects, on the 
 public health, of extreme and widely diffused poverty, 
 and its too frequent consequences, a neglect of clean- 
 liness, drunkenness from the immoderate use of ar- 
 dent spirits, and the gratification of other depraved 
 propensities. The death, by cholera, of Mr. Middle- 
 brook, the late contractor for the poor, has released 
 the parish from its engagement to him, and the sys- 
 tem of farming the paupers is now, though late, abol- 
 ished.' 
 
 The ravages of the disease were chiefly confined 
 to the parish of Sunderland ; in Bishop Wearmouth, 
 which contains at least one-fifth of the whole popula- 
 tion, but only a small portion of the pauper inhabi- 
 tants of the town, a few cases occurred in the middle 
 of November, and again in the beginning of Decem- 
 ber ; but up to the 12th of that month the number of 
 deaths in this parish did not exceed 20. In the pa- 
 rish of Monk Wearmouth but few cases occurred, 
 not more than 15 deaths having taking place from 
 the disease up to the same date. 
 
 With regard to the parish of Sunderland itself, the 
 disease was almost exclusively confined to the low, 
 
320 CAUSES OF THE CHOLERA, 
 
 dirty, and confined lanes in thickly populated dis- 
 tricts, not more than 12 cases having occurred in the 
 upper and more widely-built portion, although the 
 freest and most unrestrained communication existed 
 with those places where the disease raged. 1 " 
 
 From the accounts which we have received from 
 Quebec, Montreal, New York and other places 
 where the cholera has appeared on this continent, 
 we learn, that it has manifested the same tendency to 
 prevail mostly in confined, low and dirty streets, 
 where the population is crowded, and suffering for 
 want of food, clothing, pure air, &c. &c. 
 
 But as 1 have said, there is another class of medi- 
 cal men who are neither contagionists, nor fully anti- 
 contagionists, but who believe in the doctrine of con- 
 tingent contagion. 
 
 They say that the cholera has for its essential and 
 general cause some serial or terrestrial influence, the 
 nature of which we know nothing ; but that in gene- 
 ral this influence will not produce severe cholera un- 
 less aided by other causes, such as exposure to cold, 
 want of proper food, and clothing, and pure air ; or 
 by intemperance, debauchery, &c. &c. In this 
 way they believe the disease is generally propagated, 
 but still they say, there are facts too numerous to be 
 disregarded, or to be explained in any way, but by 
 admitting that under certain circumstances, such as 
 concentrated filth, bad air, and crowded rooms where 
 the sick are confined, the disease may and does as- 
 sume a contagious character, although it is not so es- 
 sentially or generally. This party are however stren- 
 uous opposers of quarantine and other regulations, 
 
AND MEANS OF PREVENTION. 321 
 
 of a rigid character, which have been imposed upon 
 towns and countries, and which the whole progress 
 of the disease has shown to have been of no utility 
 whatever. The only practical use of this doctrine 
 which its advocates wish to make, is a very desirable 
 one, — to thoroughly cleanse the apartments of the 
 sick, and remove from the same all individuals except 
 necessary attendants. When this course is pursued 
 they do not believe the disease possesses the charac- 
 ter of communicability. 
 
 Among the innumerable facts, which they, in com- 
 mon with the anti-contagionists, adduce in justifica- 
 tion of their disbelief in the contagious nature of 
 cholera, the following, are but a very small part. 
 
 1 . That the cholera is not a contagious disease, but 
 arises from some atmospheric distemperature, is evi- 
 dent from the fact that its appearance in a place is 
 usually preceded by sporadic cases of cholera, and 
 the general prevalence of disordered digestion ; and 
 when the disease does appear as an epidemic, scarce- 
 ly a single individual in the same town escapes 
 having some disorder of the stomach and bowels. 
 Almost every individual complains of diarrhoea. This 
 statement is confirmed by all the accounts we have 
 received from India, Russia, Poland, England and 
 France, and ii has been noticed in all the places 
 where the cholera has prevailed in this country. The 
 fact is so well known, that reference to authorities is 
 unnecessary. 
 
 2. This atmospheric distemperature is, in many 
 places, so powerful as to affect animals. Cattle and 
 dogs died of cholera in India, goats and camels in 
 Persia, chickens, turkeys, &c. in Moscow, and in 
 Prussia, multitudes of fish died during the prevalence 
 of the epidemic. 
 
322 CAUSES OF THE CHOLERA, 
 
 3. The sudden invasion of the disease, or the small 
 space of time that elapses between perfect health and 
 the full development of the disease, is very different 
 from the slow progress of contagious diseases. At 
 Bellamy in India, a tailor was attacked while at work, 
 and died with his work in his hands, in the attitude 
 in which he was sitting. A merchant while making 
 a bargain was seized, vomited twice, and instantly ex- 
 pired. At Mecca, the invasion of the disease was 
 almost instantaneous ; individuals in perfect health 
 were suddenly stricken to the earth, vomited, became 
 cold, and died.— American Jour. Med. Sciences, 1 832. 
 These are, to be sure, rare instances, as the disease 
 does not usually terminate fatally in less than from 
 six to twenty hours, and not unfrequently it lasts se- 
 veral days. 
 
 4. The great numbers attacked simultaneously by- 
 cholera, and who had previously no intercourse with 
 the sick, a fact which all writers on the disease admit, 
 cannot be accounted for without supposing the disease 
 to be epidemic. 
 
 5. The general exemption from the disease of me- 
 dical and other attendants on the sick, goes to prove 
 that the disease is not propagated from the sick to the 
 healthy. 
 
 6. Dr. Jameson says, that of between 250 and 
 300 medical men engaged in practice in Bengal, but 
 three took the disease. 
 
 7. At Bombay, none of the hospital attendants 
 were attacked, though they were assisting the pa- 
 tients day and night. Kennedy. 
 
 3. The Madras Report says, in the hospital of the 
 Royals' only one individual out of 101 attendants was 
 attacked ; and at the receiving hospitals for cholera 
 
AND MEANS OF PREVENTION. 328 
 
 patients at Trichinopoly, St. Thomas du Mount and 
 Madras, the attendants were numerous, and some- 
 times shared the same bed with their patients, yet not 
 one took the disease. 
 
 9. At Berhampore none of the native attendants on 
 the cholera hospitals were affected. Trans. Med, 
 fy Phys. Soc. of Calcutta. 
 
 In Europe the same general immunity of the atten- 
 dants on cholera patients has been witnessed. 
 
 10. A letter addressed to the medical council of 
 Moscow, signed by eight chief physicians to the hos- 
 pitals of Astrachan, says, 
 
 " We have all without any precaution touched and 
 rubbed the sick. We have daily visited the hospitals 
 crowded with cholera patients, where we have respi- 
 red their breath, and yet we have neither contracted 
 the disease nor conveyed it to our families. The at- 
 tendants who nursed and applied frictions to the pa- 
 tients — who put them into the baths, changed their 
 linen, and performed other offices for the sick, remain- 
 ed free from cholera." 
 
 1 1 . The same letter adds, " In the military, as well 
 as in the civil hospital, the linen and clothes of chole- 
 ra patients, were transferred to other patients without 
 being previously fumigated or ventilated, and never- 
 theless, those who wore these garments did not become 
 affected with cholera." The same letter also states 
 that " Several nurses and mothers affected with chole- 
 ra, suckled their children, both during and after the 
 disease, without the latter being attacked with chole- 
 ra." 
 
 12. Dr. Lefevre, physician to the British embassy 
 at St. Petersburgh, reports as follows : — 
 
 u I knew four sisters watch anxiously over a fifth. 
 
324 CAUSES OF THE CHOLERA, 
 
 severely attacked with the cholera, and yet received 
 no injury from their care. 
 
 " In one case, 1 attended a carpenter in a large 
 room, where there were at least thirty men, who 
 slept on the floor among shavings ; and though it was 
 a severe and fatal case, no other instance occurred 
 among his companions. 
 
 " In private practice, among those in easy circum- 
 stances, I have known the wife attend the husband, 
 the husband attend the wife, parents their children, 
 children their parents, and in fatal cases, where from 
 long attendance and anxiety of mind, we might con- 
 ceive the influence of predisposition to operate, in no 
 instance have 1 found the disease communicated to 
 the attendants." 
 
 13. During the prevalence of the epidemic at Mos- 
 cow, 587 patients affected with cholera were admitted 
 into a hospital with 860 patients, laboring under other 
 diseases, yet, not a single one of the latter became af- 
 fected with cholera. 
 
 Dr. Zudkoff of Moscow, w T ho had been formerly a 
 contagionist, says, that he saw to his great astonish- 
 ment, that all the attendants, and all the soldiers han- 
 dled the sick, and supported their heads whilst they 
 vomited, without using any precaution, and yet with- 
 out being attacked by the cholera, 
 
 14. Mr. Searie, who attends a very large number 
 of patients in Warsaw, having charge of a hospital 
 for the reception of the poor, writes, that not one of 
 the hospital assistants— not one of the hospital at- 
 tendants — not one of the nurses — not one of those 
 who handled the dead, fell a victim to the disease. 
 
 15. During a period of the late epidemic cholera in 
 Berlin, 409 houses were visited by the disease, and 
 
AKD MEANS OF PREVENTION. 325 
 
 in 273 of these, only one individual in each house 
 was affected, while in the remaining 136, four or five 
 suffered in each mansion. Such is the density of the 
 population, in the parts of Berlin affected with the 
 cholera, that the calculation assigns 4,200 families, 
 making an average of four persons to each family, in 
 the above number of houses, being an aggregate of 
 16,800, who lived in the immediate contact with chol- 
 era. Of this mass, 803 only were stricken with the 
 disease, or about one in eighteen persons. 
 
 16. Dr. Albers, in his official report to the King of 
 Prussia, states, that during the epidemic, it is certain 
 that about 40,000 inhabitants quitted Moscow ; not- 
 withstanding which, no case is on record of cholera 
 having been transmitted to other places. 
 
 17. In the marine hospital of St. Petersburg, of 43 
 attendants on cholera patients, not a single one w 7 as 
 affected : and in the temporary hospital at the same 
 place, of fifty -eight attendants, one only was affect- 
 ed with cholera, and he after drinking kwass, when 
 very warm. — Amer. Jour. Med. Sciences, 1832. 
 
 18. Those engaged in post-mortem examinations 
 of cholera patients, have not been attacked by the dis- 
 ease. ' Such examinations,' say the physicians of 
 Astrachan, i were made at our hospitals, without any 
 precautions, with perfect impunity.' 
 
 19. Dr. Foy, at Warsaw, and ten others, inocula- 
 ted themselves with the blood of patients laboring 
 under the cholera, tasted their dejections, and inha- 
 led their breaths, without receiving the disease. — Ga- 
 zette Medicale, 1831, 
 
 20. As to the capability of merchandise to convey, 
 
 and afterwards communicate the infectious germ of 
 28 
 
326 CAUSES OF THE CHOLERA, 
 
 cholera, the Central Board of Health, in a commu- 
 nication to the Privy Council, remark : — 
 
 ' There is perhaps no question in the whole range 
 of sanitary police, on which so many and such irre- 
 fragable facts can be brought to bear as on this ; de- 
 rived too, from the most authentic and recent sour- 
 ces. 
 
 Seven hundred and thirty ships loaded with hemp 
 and flax, from infected parts of the Baltic, arrived at 
 the different quarantine stations in this country, be- 
 tween the 1st of June and the 31st of December, 
 1831. 
 
 Many vessels also arrived laden with wool and 
 hides, yet not a single case of cholera occurred on 
 board any of these ships outside theCattegate Sea, nor 
 amongst the people employed in opening and airing 
 their cargoes in the lazarets. 
 
 At the hemp and flax wharfs in St. Petersburgh, 
 where several thousand tons of these articles arrived 
 during the spring and summer of this year, from pla- 
 ces in the interior, where the cholera existed at the 
 time of their departure for the capital, the persons em- 
 ployed in bracking or sorting, and who generally pass- 
 ed the night among the bales, did not suffer so early 
 in the season, nor so severely, as other classes of the 
 general population. 
 
 The same observation holds good with respect to 
 all the rope walks of St. Petersburgh, and the impe- 
 rial manufactory of linen cloth at Alexandrofsky, 
 where all the yarn is spun from flax bracked and 
 hackled on the spot.' 
 
 21. In England, we find still further proof of the 
 non-contagious nature of the disease : — 
 
 ■" Down to the 29th of February, 1832, agreeable 
 
AND MEANS OF PREVENTION. 327 
 
 ib the statement made to our government, by Mr. As- 
 pinwall, American consul at London, but one medi- 
 cal practitioner had died of cholera in England, al- 
 though at a moderate computation, 1 ,000 or more have 
 been in constant attendance on choleric patients." 
 
 According te the Medico Chirurgical Review for 
 April, 1832, ; not a single medical man has been af- 
 fected by the cholera in Sunderland, Newcastle, or 
 Gateshead. 5 
 
 22. The cholera has not appeared to be contagious 
 in France. ' From the medical officers of the Paris 
 hospitals, Hotel Dieu and St. Louis, we have state- 
 ments that, within those hospitals, the cholera has not 
 shown itself to be contagious.' — Report of Mass. 
 Med. Soc. on cholera* 1832. 
 
 23. In this country, we find the like general ex- 
 emption from the disease among the attendants upon 
 cholera patients. Some, to be sure, have had 
 the disease, but they have, more than others, been 
 exposed to all the exciting causes of the complaint. 
 Most of the physicians of Quebec and Montreal are 
 satisfied that the disease is of an epidemic character, 
 and not contagious. 
 
 24. The following report bears testimony to the non- 
 contagious nature of the cholera at New York. 
 
 * Board of Health, July 24, 1 832. 
 The Special Medical Council presented the follow- 
 ing report, which was read and directed to be pub- 
 lished : — ■■ 
 
 <s To Walter Bowne, Esq., 
 ( President of the Board of Health. 
 Sir, — I beg leave to address you upon the unne- 
 cessary haste with which the bodies of persons who 
 
328 CAUSES OF THE CHOLERA, 
 
 have died of cholera, have, in some instances, been 
 interred. 
 
 The council are of opinion that the dead may, with 
 perfect safety to the living, remain unburied for at 
 least six hours, even during the present warm seasorr, 
 and, under proper precautions, for a much longer pe- 
 riod. 
 
 They also deem it expedient that the public should 
 know that the neighborhood of the hospitals and bury- 
 ing grounds has not been found, upon enquiry, to 
 be peculiarly liable to the disease. At the pub- 
 lic burying ground called the Potter's Field, where 
 nearly one hundred bodies have been buried daily, 
 during the past week, none of those engaged in the 
 work have been taken ill ; and of the one hundred 
 persons living in the Asylum for the Deaf and Dumb? 
 within 200 yards of the same, not one is known to 
 have been attacked. 
 
 The medical and other attendants of the hos- 
 pitals, not predisposed to the disease by their previous 
 habits, have, also, so far as is known to the council* 
 escaped its attack. 
 
 In behalf of the Special Medical Council. 
 ALEX. H. STEVENS, M. D. Pre*. 
 
 By order of the Board of Health, 
 
 3, MORTON, Sec%" 
 
 25. Finally, if the facts which have been adduced 
 by the contagionists are sufficient to prove the chole- 
 ra to be essentially and generally a contagious disease, 
 then every other epidemic which the world has ever 
 known, may be proved to be so ; for, as 1 have said, 
 whenever any disease becomes general, some circum- 
 
AND MEANS OF PREVENTION. 329 
 
 stances will unquestionably occur, to favor the idea 
 of the contagious nature of the complaint. Take for 
 example, the Influenza, which, I believe, is not con- 
 sidered at all contagious, at the present time ; cer- 
 tainly it is not supposed to be propagated by conta- 
 gion ; yet as striking, and well authenticated, and nu- 
 . merous facts, and facts of the same kind, can be pro- 
 duced to prove that it is so, as has been produced to 
 convince the world that the cholera is contagious, and 
 therefore quarantine regulations are necessary, &c. 
 &c. I will refer but to a very few. 
 
 Dr. Hamilton, describing the Influenza of 1782, 
 says, " The first who were seized with the Influenza 
 at Norwich, were two men lately arrived from Lon- 
 don, where it then continued to rage. A sergeant in 
 a regiment of foot, went to London on furlough ; the 
 disease then raged in the capital. He returned in a 
 few days to St. Albans, affected, and communicated 
 it to the people in whose house he had his billet. 
 This was the first of its appearance there, and from 
 thence it spread rapidly all over the town." 
 
 In 1803, tho Influenza prevailed very generally in 
 England, Ireland, and other countries. The London 
 Medical Society, wishing to collect materials for a 
 complete history of the epidemic, addressed letters to 
 more than fifty distinguished medical men, in various 
 parts of the country, requesting answers to certain 
 questions. Among the questions proposed, were the 
 following : Has the present epidemic differed from 
 former ones which you have seen? Has the present 
 epidemic influenza appeared to you to be contagious ? 
 Those who recollected former epidemic influenzas, 
 generally answered that the diseases were similar ; 
 
 but r^ore than one fourth of the physicians from whom 
 
 28* 
 
330 CAUSES OF THE CHOLERA, 
 
 answers were received were of opinion that the In- 
 fluenza then prevalent was. contagious, the others, or 
 about forty who returned answers, were of a contrary 
 opinion. Among the facts stated by those who be- 
 lieved the influenza to be contagious, I find the fol- 
 lowing: Dr. Robert Percival, of Dublin, says the In- 
 fluenza is " contagious, for it travelled from place to 
 place, prevailed in London before it came to Dublin, 
 &c. &x." Dr. Longfield, of Cork, says, "it appear- 
 ed to be very contagious, as some boarding schools 
 remained free until visited by some persons who 
 brought it from the neighboring towns." Dr. Binns, 
 of Ackworth, says, "that a school of 300 pupils in 
 that town escaped the disease, and adds that at Crof- 
 ton, another school of 60 young ladies wholly escaped 
 the influenza, though it prevailed in the same village^ 
 and the young ladies were much in the open air, but 
 care was taken to prevent communication with the 
 infected." 
 
 Dr. Bardsley, physician to the Manchester Infirm- 
 ary, states that "agentleman of Manchester returned 
 from London, while laboring under influenza, found 
 his family all w r ell, but next day three of them sick- 
 ened of influenza, and two more on the following 
 day. He further states, that the nurses of the House 
 of Recovery fell sick soon after the reception of the 
 first cases of influenza."* 
 
 It will be unnecessary to multiply similar instan- 
 ces ; no doubt they are to be found wherever influen- 
 za or any other epidemic becomes general ; and as 
 numerous and striking in proof of the contagious na- 
 ture of the disease, as any that serve to convince 
 
 * See Memoirs of the Medical Society of London, vol. d. 
 
AND MEANS OF PREVENTION. 331 
 
 people that cholera is so ; and therefore quarantine 
 regulations will be just as serviceable to prevent the 
 spread of the influenza, as they can be, to stop the 
 progress of the present epidemic cholera. 
 
 Means of Prevention. 
 The best method of preventing the cholera may be 
 learned by attending to the causes which in all coun- 
 tries have appeared to produce the disease. These 
 causes, and which are of course to be avoided, are 
 impure air, low and damp dwellings, crowded and 
 filthy houses and cities, poor diet, intemperance, fear 7 
 &c &c. 
 
 Most countries and cities have published directions 
 which have emanated from medical men, respecting 
 the prevention of the disease. Such directions have 
 undoubtedly been of great service. The following 
 were published at Paris, by the Central Commission 
 of Health. 
 
 Course to he pursued to prevent the Cholera. 
 " 1st. The little danger there is of being attacked by 
 the cholera, should keep up the spirits. We should? 
 therefore, not disturb ourselves, nor should we think 
 of the disorder, but to adopt the precautions neces- 
 sary to guard against it. The less fear, the less ha- 
 zard. But as tranquillity of mind is a great preser- 
 vative, we must avoid every thing which excites 
 strong emotions, anger, fear, great exhilaration, &c» 
 
 2d. It has been observed, that the purer the air, 
 the less is the liability to cholera. 
 
 Too much attention therefore, cannot be paid to 
 the salubriousness of our dwellings. Care must be 
 taken that many do not occupy, much more sleep in, 
 the same apartment, that the premises be ventilated 
 in the morning, and in the course of the day, by 
 
332 CAUSES OF THE CHOLERA, 
 
 opening the windows and doors as often, and keeping 
 them open as long as possible. It is proper also to 
 place in dwelling houses, large earthen vases, con- 
 taining chlorured water, (made by pouring upon one 
 ounce of chloride of lime, one quart of water.) The 
 purification of the air may be also produced by a 
 clear and bright fire kept in the fire-place for a short 
 time. 
 
 Care must be taken that the doors and windows are 
 not opened until after one is entirely dressed, so as 
 not to be exposed to chills. It will be best to pass 
 into another apartment during this operation, 
 
 There should be no curtains about the beds, nor 
 should any utensils be suffered to remain dirty, but be 
 cleansed as soon as used, and always contain a little 
 water. The humid air of dwellings, unhealthy at all 
 times, becomes very dangerous when the cholera pre- 
 vails, no clothes therefore should be dried in the sit- 
 ting rooms, and especially not in the bed-chambers. 
 Not only must the bed rooms be aired, but the utmost 
 salubrity must be preserved in houses and out-houses. 
 It is also important to cleanse privies with the great- 
 est care> to purify them once a day with chlorured 
 water, or water only. All their conduits should be 
 closed except when in use. 
 
 Every one should take care that house slops are 
 emptied as soon as produced, that they do not remain 
 between the pavements of the courts and allies, and 
 that they pass off rapidly by the conduits and gutters 
 which carry them to the streets. It is necessary in- 
 deed to keep up this flowing by copious washings if 
 the descents are not sufficiently rapid. 
 
 The window panes should be washed at least once 
 a week ; for the action of light is useful to health. 
 
AND MEANS OF PREVENTION. 338 
 
 Every species of garbage both animal and vegetable 
 requires great attention, their accumulation should 
 therefore be prevented by the earliest possible re- 
 moval of them. 
 
 Useless domestic animals should be expelled. 
 Swine, rabbits, fowls, and pigeons, &,c. should not be 
 kept in confined places, or even in spacious courts 
 where there is little air. The inhabitants of houses, 
 particularly in the populous quarters, should in this re- 
 spect watch mutually ; they should besides contribute 
 each one his part, towards the cleanliness of the 
 streets especially where they are narrow. It is the 
 interest of all. 
 
 3d. Chills are thought, by those physicians who 
 have observed the cholera, to be among the causes 
 most favorable to the development of the disease. 
 Care should therefore be taken to dress warmly, and 
 to guard the abdomen, and keep the feet from the 
 action of cold. For this purpose it will be well to 
 wear a woollen girdle, woollen or flannel under vests 
 next the skin, and to use woollen socks, to be changed 
 or washed when they become moist or dirty. The feet 
 should be often washed in warm water. Overshoes 
 should be worn when necessity obliges one to remain 
 where it is damp or cold ; in a w 7 ord, people should 
 so warm themselves that the feet should be protected 
 from cold and moisture. 
 
 Many persons, particularly of the lower classes, 
 have the very bad practice of standing with their 
 naked feet upon the cold ground when they go to bed 
 and more so when they rise, and even walk upon it, 
 This custom cannot be too much censured, as it be- 
 comes particularly dangerous during the prevalence 
 of the cholera. 
 
334 CAUSES OF THE CHOLERA, 
 
 The fear of chills, even in summer, should prevent 
 people from sleeping with their sashes raised. There 
 should be a moderate temperature within doors ; for 
 rooms that are kept too warm, render their occu* 
 pants, more susceptible to the cold to which they are 
 exposed on going out. 
 
 For the same reason it is proper to keep early 
 hours and not pass part of the night in promenading, 
 going to meetings, to the coffee houses, ale houses, 
 taverns, &,c. above all when the nights are very cold 
 and damp. 
 
 4th. To endeavor to lead an active life, shunning 
 as much as possible, excess of fatigue, is one of the 
 best means to insure tranquillity. Occupations which 
 involve men in disputes are injurious. The same 
 may be said of labors which occasion a deprivation 
 of usual sleep at night. 
 
 Mention has already been made of the usefulness 
 of woollen girdles and socks; but these vestments 
 should always be kept clean. Cleanliness is always 
 necessary to health. They who have the means of 
 taking occasional tepid baths, will do well to use 
 them, but must remain in them no longer than may 
 be necessary to clean their persons ; care should be 
 taken to wipe with warm linen, and to avoid imme- 
 diate exposure to external air on leaving the bath. 
 This precaution is specially useful when the season is 
 cold. 
 
 Dry frictions are beneficial. They are easy to be 
 administered by rubbing or having rubbed, in the 
 evening, or better morning and evening, the body, 
 arms, thighs, and legs, for a quarter of an hour, with 
 a soft brush or a piece of woollen cloth. 
 
 In reference to dress, the season will best deter- 
 
AND MEANS OF PREVENTION. 335 
 
 mine its character, but in no case should people dress 
 too slightly. 
 
 6th. When the cholera prevails, the mode of living 
 is a matter of great importance. Sobriety cannot be 
 too strongly recommended. Very many cases are 
 known in which the cholera followed the excesses of 
 the table, and it is proved that the intemperate are 
 particularly exposed to this malady. 
 
 Well cooked provisions, roasted and not too fat, 
 fresh fish, eggs for those who have good digestion, 
 and light and well baked bread, should form the chief 
 nutriment. 
 
 Among vegetables, the least aqueous and lightest 
 should be preferred. We do not think of excluding 
 from these last, potatoes of good quality. We even 
 approve of dry haricots, lentils, peas and beans plain. 
 Crudities, such as salads, radishes, &c. are injurious. 
 Salted provisions and salt fish should be avoided, and 
 swine's flesh used as little as possible. Heavy and 
 rich pastry are altogether prohibited. 
 
 In the season of fruits, it is necessary to be very 
 cautious in their use, above all, when they are not per- 
 fectly ripe, for they may prove very dangerous. Cook- 
 ed fruits are less exceptionable, but they should nev- 
 er be eaten in great quantities ; and still less should 
 they form the chief part of the meal. There is some 
 food, healthy in general, but which, by a peculiar 
 state of the stomach, is of difficult digestion with some. 
 Every one, in this respect, should consult his stom- 
 ach. 
 
 Beverages do not require less circumspection in 
 their use. Very cold drink, taken when one is warm, 
 is dangerous. There is no necessity for quenching 
 
&36 CAUSES OF THE CHOLERA, 
 
 thirst, except when perspiration ceases ; that is, no 
 necessity for cold drink when one is in a sweat. 
 
 The consequences of this abuse are fatal, in pro- 
 portion to the coldness of the drink. The water 
 should be clear ; filtered water is preferable to all 
 other. It should be whetted with a very little vinegar 
 or brandy when we wish to drink it pure, (two spoon- 
 fuls of brandy, or one of vinegar to a pint of water) 
 especially if the season is warm, and one is obliged to 
 do corporeal labor, which, by exciting perspiration, 
 provokes thirst, and makes it necessary to drink often. 
 Reddened water, that is, water to which a little good 
 wine is added, is also beneficial. In short, water 
 slightly aromatic may be successfully used, that is, 
 having a stimulant infusion of peppermint, or camo- 
 mile (a pinch of mint, or six heads of camomile to a 
 half pint of boiling water, to which add, after cooling, 
 half a pint of cold water). 
 
 Nothing is more pernicious than the abuse of strong 
 liquors. It has been proved by a great number of 
 cases, that the cholera attacks the intemperate, and 
 even those who without making an habitual use of 
 strong drinks, commit occasionally by enticement, a 
 single excess of this kind. 
 
 The use of ardent spirits, taken alone and before 
 breakfast, a habit so common among the lower class 
 of work-people, and so hurtful at all times, becomes 
 particularly fatal when cholera prevails. Persons 
 who have this habit should eat something, at least a 
 piece of bread, before swallowing the brandy. White 
 wine should not be taken before breakfast, without 
 the same precaution ; and then only in the smallest 
 quantities. 
 During the prevalence of the cholera, bitter brandy, 
 
AftfD MEANS OF PREVENTION. 337 
 
 that is, brandy into which bitter and aromatic plants 
 are infused, or rather Absynth brandy, is preferable 
 to common brandy. Wine taken in moderate quan- 
 tity, is a proper beverage during and at the end of a 
 meal 5 but it should be of good quality. It is better 
 to drink half the quantity and have the quality superi- 
 or. New and sharp wines are more hurtful than 
 beneficial. Red wine is preferable to white. The}? 
 who have the means of mixing it with gaseous water, 
 such as Seltzer water, natural or manufactured, will 
 do well to supply themselves with this salubrious and 
 agreeable drink. 
 
 Beer and cider, especially when new, when not 
 well fermented, or when sour, dispose to cholics and 
 diarrhoea, and thus become very dangerous. What 
 has been said, applies with stronger force to sweet or 
 new wine. 
 
 (Signed) 
 
 JUGE, 
 
 PAR1SET, 
 
 ESQUIROL, 
 
 CHEVALLIER, 
 
 LEROUX, 
 
 LEGRAND, 
 
 BARON DESGENETTES, 
 
 The Edinburgh Board of Health say, " Experi- 
 ence has shown, that the most essential precaution 
 for escaping the disease is sobriety,— that intoxication 
 during the prevalence of the epidemic is almost sure 
 to be followed by an attack,— and that those addict- 
 ed to drinking are the most subject to take cholera, 
 and the most likely to sink under it. In like manner, 
 
 strict attention to personal cleanliness, — to cleanli- 
 29 
 
338 CAUSES OF THE CHOLERA, 
 
 ness and ventilation of dwelling houses, — to wiarm 
 clothing, — to regularity of hours for sleep, — to keep- 
 ing as much as possible within doors at night, — -and 
 to taking food before going out in the morning, — may 
 be relied on as important means of security." 
 
 The measures adopted in Edinburgh for security, 
 appear thus far, to have been remarkably successful ; 
 but judging from all the facts known respecting the 
 causes and progress of the cholera, it still remains 
 very doubtful whether Boards of Health, organized 
 as they are in this country with very limited powers, 
 especially in small towns, are capable of doing much 
 that is effectual towards preventing the disease, and 
 there is reason to fear they frequently do much inju- 
 ry by exciting alarm, which their frequent meetings 
 are sure to create, and by their assurances to the pub- 
 lic that the very first case of cholera shall be announ- 
 ced, as if some exceedingly contagious disease was 
 expected to arrive.* 
 
 In order to be able to do much good, when a dis- 
 ease similar to cholera is likely to prevail, Boards of 
 Health require the power to change the habits of the 
 sensual, the vicious, the intemperate, and above all, the 
 power to clothe and feed the poor, and to provide cleanly 
 and comfortable dwellings for all classes in community. 
 But they have not this power. The only power which 
 exists in this country to stay the scourge which has 
 ravaged Asia and Europe, and now threatens us, is 
 in the possession of the rich. On them must fall the 
 
 * An agent of a large manufacturing establishment in an inland 
 town, far from any place where the cholera prevailed, told me that 
 the day after a committee from the Board of Health visited his estab- 
 lishment, 30 or 40 of his workmen determined to leave, on account of 
 the cholera, assigning this call from the Board ofHealth, as the only 
 reason for their supposing the cholera was soon to prevail among 
 jrtiem. No fear of the disease had prevailed previously. 
 
AND MEANS OF PREVENTION. 339 
 
 burden of relieving the wants of the suffering, and of 
 thus preventing and mitigating the severity of this 
 dreaded epidemic. 
 
 Is the present epidemic cholera, a different and 
 distinct disease from the common cholera morbus ? 
 
 Sydenham described an epidemic cholera morbus, 
 which prevailed in England in 1669. He calls the 
 disease cholera morbus, and did not suppose the dis- 
 ease differed from the common cholera, except that 
 this year, it prevailed epidemically. The Bombay 
 Medical Board say that this description by Syden- 
 ham, applies exactly to the cholera of India. There- 
 fore, the people of India might attribute their disease 
 to importation from England. 
 
 The Report of the Royal Academy of Medicine, 
 of Paris, says, 'The cholera of India is, as to its 
 symptoms, the cholera of the ancients, and except 
 in intensity and danger, differs but little from ordinary 
 cholera.' The most intelligent physicians in Eng- 
 land, are of the same opinion. 
 
 Dr. Kane, of Plattsburgh^ N. Y. who saw much 
 of the epidemic in Montreal, says that the physicians 
 of Montreal view the present epidemic, or Asiatic 
 cholera, as it is called, ' as differing in no respect from 
 the endemic cholera of the United States and the 
 Canadas, save that now it is epidemic. The same 
 organs are affected, and the same symptoms exhibit- 
 ed.' 
 
 The common cholera morbus of this country is 
 usually considered as not a very dangerous com- 
 plaint ; but most writers mention that it often is so, 
 and frequently terminates life in a few hours. By 
 
340 CAUSES OF THE CHOLERA; 
 
 referring to descriptions of the symptoms of this dis- 
 ease, as found in old medical works, we find the vom- 
 iting, purging, cramps, spasms, and most of the symp- 
 toms which the Asiatic cholera exhibits, all alluded 
 to. It is true, however, that most of the old writers 
 consider the cholera to depend upon a redundant se- 
 cretion of bile. This is, undoubtedly, an erroneous 
 conclusion, and arose, probably, from regarding the 
 effects of the disease as the cause of it. Later pa- 
 thologists have shown, that the secretion of bile, es- 
 pecially an excessive secretion, takes place, only, af- 
 ter the disease has continued sometime, and not until 
 reaction is produced. Sydenham, however, does not 
 allude to bile being present, in the first discharges, but 
 says they are thin and watery ; and Frank says, i at 
 first, the egesta are like water, then, as if flesh had 
 been recently immersed in them, — sometimes they 
 are white,' and adds, ' in the worst cases of cholera? 
 the patients exhausted by profuse discharges, and 
 their torments, become collapsed in five or six hours ? 
 and look no longer like themselves. 5 
 
 No symptoms have been described as occurring in 
 Asiatic cholera, that do not sometimes occur in com- 
 mon cholera. Some insist much upon the dischar- 
 ges being different. In allusion to this opinion^ the 
 Medico Chirurgical Review* says, — 
 
 " Great stress is laid on the nature of the ejected 
 matters in cholera. If the fluids are colorless, it is a 
 proof that the disease is Asiatic — if any bile or other 
 colored fluids appear, the disease is English. Yet 
 the India Boards, and, indeed, all careful observers* 
 have acknowledged that the discharged fluids form 
 no criterion of the disease. The Bengal Board, for 
 example, tells us that fe the fluid ejected from the stom- 
 
AND MEANS OF PREVENTION. 341 
 
 ach was watery ; mostly tasteless, transparent, Or of 
 a whey or ash color. Sometimes it was sour, green, 
 dark, like infusion of tea, starchy, mixed with mucus, 
 and viscid. In very rare cases, pure bile was thrown 
 up. 9 In respect to the alvine evacuations, they were 
 4 generally watery, colorless, white or muddy ; — some- 
 times red and bloody, sometimes greenish and pulpy, 
 like half digested vegetables. 5 Is it not preposterous, 
 after this, to make the distinction between Asiatic 
 and English disease to consist in the color of the 
 motions? Nimium ne crede colori !" 
 
 From these and numerous other facts which might 
 be adduced, it is evident that the Asiatic cholera does 
 not differ from our common cholera, except that the 
 first is epidemic, and far more dangerous and in- 
 tense, than we have been accustomed to witness the 
 latter. This intensity is most strikingly manifested 
 in the immediate sinking of the circulation, which is 
 the most essential and diagnostic symptom of the pres- 
 ent epidemic disease. 
 
 The question is also asked, if a similar epidemic ev- 
 er prevailed before in this country ? If such an epidem- 
 ic has prevailed, I cannot find that any records of it 
 have ever been published. 
 
 Mr. Webster, in his valuable and very erudite 
 work on the history of epidemic and pestilential dis- 
 eases, makes no mention of a similar disease, though 
 his researches have been very extensive. He alludes 
 however to destructive epidemics that have prevail- 
 ed among the Indians, and other inhabitants of this 
 country, which might have been of this character ; 
 but as the symptoms of these diseases are not given, 
 behave no means of judging. 
 29* 
 
042 CAUSES OP THE CHOLERA, 
 
 The Report on Spasmodic Cholera, prepared by a 
 Committee of the Mass. Med. Society, says, ' the 
 pestilential fever of New England, and which pre- 
 vailed in Massachusetts, Connecticut, Vermont, &c, 
 in 1806 — 7, and 1811 — 12, bore more resemblance to 
 the cholera as to its extension and duration than any 
 other disease that has prevailed in this country. Oth- 
 ers have supposed the diseases are the same. But 
 from an examination of the accounts of the New 
 England pestilential fever, written by those who saw 
 much of the latter, it is very evident they are diseases 
 of a dissimilar nature. 1 am confirmed in this opin- 
 ion by a physician* of high qualifications, who saw 
 much of the fever, when it prevailed several years 
 since, in Worcester Co. Mass. and who has recently 
 had abundant opportunity of seeing the cholera at 
 Albany and New York, and who assures me the dis- 
 eases do not resemble each other, neither in the symp- 
 toms, nor in the appearances on dissection. 
 
 Cholera and other bowel complaints have been r 
 however, far more prevalent and fatal some years 
 than others, in this country. During the past year, 
 a very singular and malignant disease prevailed at 
 Warwick, a hilly town, in Franklin Co. Mass. Judg- 
 ing from the description of the disease which I have 
 received from Dr» Jarvis, a very intelligent physician 
 of Northfield, Mass., it bore a striking resemblance 
 to the present epidemic cholera. The disease com- 
 menced in July, and in five weeks, 32 individuals 
 were attacked, of whom 16 died. The disease com- 
 menced by distress at the stomach, extending to 
 the bowels, then nausea, and vomiting, and fre- 
 quent calls to stool, the discharges were white 
 Dr. Flint, Northampton, Mass. 
 
AND MEANS OF PREVENTION. B43 
 
 and watery. If the disease was arrested here, the 
 dejections became bilious, and the patients recover- 
 ed, but if not arrested, the vomiting increased ; 
 nothing could be retained on the stomach but opium ; 
 the discharges from the bowels constant, and of a thin 
 fluid, resembling rice water ; intolerable thirst, cramps 
 of the abdominal muscles and extremities : the skin 
 became cold, shrunken, and of a leaden hue, pulse 
 weak, and often imperceptible \ the mind not weak- 
 ened or disturbed, the patients exhibiting but little 
 anxiety for themselves, but conversed freely until the 
 last. 
 
 Such is an abstract of the brief account of this sin- 
 gular malady which 1 have received from Dr. Jarvis; 
 it is hoped he will soon furnish the profession with a 
 more detailed history of the disease. 
 
 It is very probable that in other parts of the coun- 
 try similar diseases have appeared, and which have 
 borne a very close resemblance to malignant cholera, 
 and have been to a considerable degree epidemic. 
 Such had been noticed in England, previous to the 
 appearance of the cholera at Sunderland. 
 
 In the autumn of 1825, a disease broke out at 
 Leeds, in England, which exhibited all the symptoms 
 of the Asiatic cholera, vomiting and purging of a flu- 
 id resembling barley water, intense spasmodic con- 
 tractions, cold, clammy skin, small, and often imper- 
 ceptible pulse, skin contracted, and of a purple hue. 
 Some lingered for a day or two, whilst others died in 
 two or three hours. — Medico Ckirurgical Review for 
 April, 1832. 
 
 In August, 1831, violent cases of cholera occurred 
 at a school in Clapham, Eng. Of 22 boys 20 were 
 attacked with vomiting and purging, of an alarming 
 
344 CAUSES OF THE CHOLERA, &c. 
 
 character in the course of six hours. The matter 
 vomited was sometimes tinged with bile, but for 
 the most part it was colorless and inodorous. A few 
 died, but most of them recovered. On careful ex- 
 amination of the food they had eaten, nothing was 
 discovered likely to cause the disease ; but it was af- 
 terwards ascertained that a very foul drain in the rear 
 of the school house, had been accidentally opened a 
 day or two before the disease appeared ; and the con- 
 tents of this filthy receptacle were thrown into a 
 yard adjoining the play ground for the boys. 
 
 A disease somewhat similar, though less violent has 
 just occurred among the prisoners in the Mass. 
 State prison, atCharlestown. During the night of the 
 5th of Aug. 115 of the convicts were attacked with 
 disorder of the stomach and bowels, 49 of whom 
 were so sick as to be sent to the hospital. The same 
 day, 15 similar cases occurred at the House of Indus- 
 try, South Boston. The physicians report that the 
 disease is not spasmodic cholera, nor the common 
 cholera of the country, and that they have not discov- 
 ered the cause that produced it. None of the cases 
 iiave proved fatal. 
 
THE INFLUENCE OF FEAR IN PRODUCING AND 
 AGGRAVATING THE EPIDEMIC CHOLERA. 
 
 Almost every person who has written upon the 
 causes that produce the cholera, mentions the fear of 
 the disease, as among the most frequent and powerful. 
 This exciting cause^ has, however, been much more 
 frequently alluded to by the medical men in England, 
 France, and the United States, than by those of In- 
 dia. We are therefore to presume that the fear of 
 the cholera, has been greater, and more manifest, in 
 the above named countries, than it was in Asia. This 
 is not at all surprising, for if the disease had never 
 been known as an epidemic, and was now to appear in 
 this country, or any part of Europe, and be as fatal 
 as it has ever been, the people in general, away from 
 its immediate neighborhood, would not, for some 
 years, be but very little excited or alarmed. But now 
 we have added to the terror created by the daily rav- 
 ages of the disease, the greater terror arising from the 
 knowledge of its great mortality and general preva- 
 lence in other countries. This was not the case in 
 India. 
 
 Again, the people of India are not, in general, a 
 reading people, whilst the Europeans and Americans 
 are so : and by means of newspapers and other pe- 
 riodicals, and the facilities for conveying information 
 rapidly from one part of the country to another, eve- 
 ery man, woman, and child, hears daily of the pro- 
 gress and the ravages of the disease. 
 
 So much has been written upon the disease, and 
 read by the general community, that its history is not 
 
346 CAUSES OF 
 
 only well known to all, but all the symptoms which 
 may or may not be premonitory of cholera, are well 
 understood. The exciting and predisposing causes, 
 the articles of diet to be used or avoided, the remedies 
 to prevent and to cure, are all treasured up, and have 
 had the effect to create a morbid excitement respect- 
 ing the disease, throughout the whole mass of com* 
 munity* 
 
 These are, probably, among the causes that make 
 the fear of the disease to be far greater, and more in- 
 jurious in its effects, and more powerful to excite the 
 disease in this country, and in Europe, than it was 
 in Asia. 
 
 It is, probably, the great influence of this cause 
 alone, that makes the cholera nearly as violent and 
 fatal here as it was in India, although all the other 
 causes are far less powerful* 
 
 But not to take too much for granted respecting 
 the influence of this passion in producing and aggra- 
 vating the cholera, let us inquire if it is true that it 
 has the power ascribed to it. Let us learn what the 
 effect of fear is upon the human system. Let us first 
 enquire of medical men of experience. 
 
 " Fear," says Haller, " diminishes the powers of 
 the body, enfeebles the movements of the heart, 
 and weakens the circulation. Influenced by this 
 passion, the scurvy and other diseases become more 
 fatal, putrid and contagious maladies acquire more 
 malignity, and the body becomes more disposed to 
 be affected by pestilential miasmata." 
 
 "Fear," says Dr. Falconer, (Treatise on the Influ- 
 ence of the Passions on the Diseases of the Human 
 Body) " diminishes the power of the heart, enfeebles 
 
THE CHOLERA. 347 
 
 the pulse, and sometimes to such a degree that the 
 blood does not flow on opening a blood vessel. Fear 
 also arrests the natural secretion, and produces this 
 remarkable effect, which is, to render those who are 
 frightened more subject to be attacked by contagious 
 diseases." 
 
 M. Virey, (Diet, des Sciences Medicales, Vol. xxxix) 
 says, that " fear is engendered when, according to 
 Homer, the mind or soul descends from the body in- 
 to the lower extremities, iofly." It produces de- 
 rangement of the secretions, cold perspiration, a re- 
 cession of the blood from the surface to the hearty and 
 diarrhoea, a coldness and paleness of the skin, and 
 when extreme, arrests the circulation of the blood 
 and the secretions." 
 
 Dr. Burrows (On Insanity) observes that "fear 
 produces embarrassment in the motion of the heart, 
 the blood is detracted from the extreme vessels, as is 
 evinced by a death like paleness. It depresses and 
 enfeebles the action of the heart, diminishes the quan- 
 tity of blood flowing to the brain, and debilitates the 
 nervous power." 
 
 A late writer and distinguished physician, (Alibert, 
 Physiologie des Passions,) says that " Fear is of a 
 contagious nature, and its effect upon the body is to 
 produce a retrocession of the blood from the exterior 
 to the interior, and to derange or suppress all the func- 
 tions of assimilation." 
 
 Other authorities might be produced to show the 
 dangerous effects of fear upon the human system, its 
 influence to produce and spread spasmodic complaints, 
 and its tendency to become epidemic, during great 
 public calamities : but it will be unnecessary to multi- 
 
348 CAUSES OF 
 
 ply them, to demonstrate that this passion not only dis* 
 poses a person to be affected by a contagious disease, 
 but actually produces a disease and symptoms similar 
 to the premonitory symptoms of cholera. Facts innu- 
 merable might be adduced to show that fear alone is 
 sufficient, and often, very often, does produce the 
 same symptoms that are now called premonitory 
 symptoms of cholera. 
 
 1 have seen repeated instances of diarrhoea produ- 
 ced by mental anxiety. 1 knew an instance of a 
 clergyman of great sensibility, who for more than a 
 year had a diarrhoea, from this cause, every Sabbath 
 morning. 
 
 Long continued and anxious attention to the 
 sensations and feelings of the bowels, will tend to dis- 
 order them. A person whose mind is constantly on 
 the alert to detect some symptoms of disease of the 
 stomach or bowels, who anxiously watches the effect 
 of every thing he eats or drinks, upon the organs of 
 digestion, will be very certain to create in them a 
 morbid sensibility, which will be followed by indiges- 
 tion, diarrboea or other disease. 
 
 It may be said the cholera attacks children who 
 have no anxiety, or have no knowledge of the disease. 
 This may be true to some extent, but it should be 
 recollected that children have been remarkably ex- 
 empted from the disease. Besides, according to my 
 observation, most children of five or six years of age, 
 and upwards, have much anxiety respecting this dis- 
 ease, of which, to be sure, they know nothing, except 
 that it is some approaching and fearful calamity. In 
 children, fear, like other passsions, is soon effaced, 
 but it is also more sudden and powerful in them, and 
 far more likely to endanger them by its effects upon 
 
 
THE CHOLERA. 349 
 
 their susceptible and delicate nervous system. A 
 school in the interior of Massachusetts was broken 
 up for the day by the fear of cholera, produced by the 
 sickness and vomiting of one of the children. The 
 cry that the cholera had come, produced the 
 same symptoms in so many of the pupils, that the 
 school had to be dissolved. 
 
 The distinguished physician* of a celebrated insti- 
 tution, situated within a short distance of the house 
 where two persons died of cholera, in Hartford, told 
 me that the day after this occurrence, all the inmates 
 of the institution who had heard of the deaths by chol- 
 era, were affected by diarrhoea, the cause of which, 
 he attributed to the influence of fear and anxiety. 
 
 From such, and many other instances of a similar 
 character which have come to our knowledge, is there 
 not great reason to apprehend that many, very many 
 cases of cholera, if not produced by fear alone, are 
 aggravated by it to a dangerous degree, and cases of 
 common cholera, transformed through the influence 
 of fear, into the malignant and fatal ? 
 
 From several parts of the country, we receive pub- 
 lished reports of Boards of Health, of mild cases of 
 Asiatic cholera. These cases recover. But in a day 
 Or two after, we learn that the anxious and alarmed 
 relatives, and the attendants upon these mild cases, 
 who have been deprived of their usual rest, regular 
 meals, and who are fearful of becoming sick, have 
 sickened and died. Such cases are then attributed 
 to contagion, as if the other causes in powerful opera- 
 tion, and which have produced the disease in all other 
 countries, were not here in operation. 
 
 * Dr. Todd. 
 
 30 
 
350 CAUSES Of 
 
 If the assertions of medical men in all parts of the 
 world, respecting the influence of fear in producing 
 disease, and especially the cholera, are not wholly 
 groundless and false, then it is all important that 
 medical men and public authorities endeavor to allay 
 excitement, and if possible, the panic which univer- 
 sally prevails throughout this country, respecting the 
 epidemic that prevails. Though, to be sure, this dis- 
 ease is a distressing visitation, yet there is abundant 
 reason to believe, that with proper care in avoiding 
 the causes that excite it, it will prove no more de- 
 structive of human life in New England, than Influ- 
 enza has some years been, and far less so than Scar- 
 latina and some other complaints have frequently 
 been. But if the causes which are known to produce 
 it, are not avoided; the disease will undoubtedly pre- 
 vail, for as we have seen, quarantine regulations are 
 worse than useless. 
 
 The general influence which renders certain exci- 
 ting causes so powerful in producing the disease, is 
 above us, and every where around us, and over which 
 we have no control. We might as well attempt to 
 stop the wind, or allay the tempest by quarantine 
 edicts, as to prevent the spread of the atmospheric 
 poison. Our hope is in our general habits of tempe- 
 rate but good living, our cleanliness and thin popula- 
 tion, and above all, in our moral courage, and the in- 
 dulgence, not only of the hope, but the belief 'that we 
 shall escape if we avoid the exciting causes. 
 
 We know how powerful has been the influence of 
 faith and hope, to lessen the ravages of other diseases. 
 
 When the plague prevailed at Messina, in Sicily, 
 in 1743, and at a time when it raged with unabated 
 
THE CHOLERA. 351 
 
 fury, the people took down from the great altar, the 
 ancient image of their tutelary saint, the Holy Mary r 
 the Mother of God, and carried it in procession 
 through the streets. From that day the plague began 
 to decline. — ( Turrianoh treatise onplague at Messina.) 
 
 But we need not seek far back in history, nor 
 among an ignorant race of men, to find instances of 
 the influence of panic in the diffusion of epidemic dis- 
 ease. 
 
 Dr. Stanford, of the Medical staff, communicated 
 the following information to Dr. Ferguson. "In the 
 autumn of 1813, he was stationed, with part of the 
 British army, at Cadiz, when an irruption of yellow 
 fever took place. Some of the medical men were 
 staunch contagionists, and impressed their belief upon 
 the corps to which they belonged ; in all these, the 
 disease was most fatal to great numbers. The men 
 were half dead with fear, before they were taken ill, 
 and speedily became its victims. But in the other 
 regiments, where no alarm had been sounded, the 
 the soldiers took the epidemic with steady courage, 
 and generally escaped an attack, and if not, they re- 
 covered from it in a large proportion." 
 
 At the present alarming time, no duty of medical 
 men, and all those who have influence over the faith 
 of others, as regards the epidemic, seems more impe- 
 rative, than that they should steadily endeavor to quiet 
 public alarm, and constantly abstain from creating 
 any fear as respects the prevalence of the disease, and 
 its contagious nature. Hundreds will die of common 
 cholera, if they are not assured, and made to believe 
 that the disease which affects them, is not the cholera 
 which their fears suggest. In such cases, every look 
 and question and action of a physician, is very impor 
 
352 CAUSES OF 
 
 tant. In such cases, he has it in his power, not only 
 to endanger the sick, but to spread around a far more 
 dangerous contagion than that of cholera, the conta- 
 gion of fear 5 to drive from the bed of sickness, the 
 anxious relatives and useful attendants, palsy the 
 hand of charity, and create in those who are obliged 
 to attend upon the sick, a disposition to a disease, 
 closely allied to, if not the malignant cholera. 
 
 Never before has the world been visited by a dis- 
 ease, in which fear has had so dangerous an influ- 
 ence ; for the passion of fear falls in with, and unites 
 with the disease, and attacks and paralyses the same 
 organs. Both fear and the cholera drive the blood 
 from the exterior upon the heart, arrest or derange 
 the secretions, hinder assimilation, and of course pro- 
 duce indigestion, and disorder of the stomach and 
 bowels. 
 
 Upon this subject, the Medico-Chirurgical Review^ 
 remarks, " Medical men will now see how much they 
 will have it in their power, when the cholera comes, 
 to pronounce or withhold sentence of desolation upon 
 a community. The word contagion will be the word 
 of doom ; for then the healthy will fly their houses, 
 and the sick be deserted ; but a countenance and 
 bearing devoid of fear, will command the aid, and 
 inspire the hopes that are powerful to save in the 
 most desperate cases." 
 
 If any should still be of opinion that the disease is 
 contagious, and rely upon some few facts that have 
 occurred in the progress of the disease in this country, 
 such as the attendants on the sick being attacked by 
 the disease, to justify their opinion, let them reflect 
 that all these cases may have originated from terror 
 and other exciting causes, without contagion having 
 
THE CHOLERA. 353 
 
 any agency. Let them reflect that similar cases 
 have occurred in other countries ; but when the epi- 
 demic has passed away, and sanity upon this subject 
 restored to the community, they have been seen to 
 have originated from other sources than contagion. 
 
 In proof of this, 1 will cite a late resolve of one of 
 the most intelligent Medical Societies in the world, 
 the members of which, from their learning, and from 
 their intimate acquaintance with the disease, were 
 as well qualified to judge respecting its nature, as 
 any other body of men whatever. 
 
 Westminster Medical Society r , April 28, 1832. 
 This being the last meeting of the Society for the 
 session, the discussion " On the nature, character, 
 and treatment of cholera morbus," was concluded by 
 the adoption of the following resolution, Dr. Gran- 
 ville moving, and Dr. James Johnson seconding : — 
 " That the Westminster Medical Society, having de- 
 voted the uninterrupted space of six months to the 
 serious and dispassionate consideration of the mala- 
 dy which has been prevailing in England since the 
 latter end of September last, and especially in the 
 metropolis, and having heard the several arguments, 
 depositions, doctrines and facts of the many mem- 
 bers practically, as well as theoretically engaged in 
 that important enquiry, declare, that, in the opinion 
 of the majority of the society, the evidence brought 
 forward to prove the said malady to be a contagious 
 disease has completely failed ; and that every circum- 
 stance which has come to the knowledge of the So- 
 ciety, shows the disease in question to have begun, 
 progressed, and ended in the ordinary way of every 
 
 other epidemic disorder." 
 
 30* 
 
APPENDIX. 
 
 NOTE A. 
 
 RECENT PROGRESS OF THE CHOLERA 
 IN EUROPE. 
 
 The cholera, whirh first commenced its ravages in the north of 
 England, in Oct. 1831, soon spread to Scotland, and reached 
 London early in 1832. In neither of these places has it yet pre- 
 vailed with great violence \ and by the end of April, had nearly 
 disappeared. The disease extended into Ireland, and prevailed 
 at Dublin and Cork in the month of April. The 24th of March 7 
 1832, it first appeared at Paris, where it increased with great 
 rapidity. Some days, the deaths amounted to nearly one thou- 
 sand. The printed reports give 861 deaths on the 9th of April, 
 It has been calculated that 20,000 died of cholera at Paris be- 
 tween the 24th of March and the end of the following April 
 We look with much interest for accounts from Paris, respecting 
 the causes which rendered the disease so much more violent at 
 this place, than it had been in other towns in Europe. We shall 
 expect from the medical men of Paris, minute and important 
 details relative to the appearances observed on dissection ; and 
 also as regards the age, sex, professions, &c. most affected by the 
 disease. The cholera began to decline in Paris towards the end 
 of April, but has not yet entirely disappeared from that city. The 
 latest accounts received from Paris, state that the disease was 
 again on the increase. During the last six days of June, 271 
 deaths from cholera occurred in that city. We also know that it 
 still prevails in several other towns in France. The cholera also 
 prevailed the 1st of July in Dublin, London, Liverpool, Man- 
 chester, and several other towns in England and Ireland. The 
 following is the latest account received : 
 
 Council Office, July 4. 
 England and Scotland. — New cases, 378 — deaths, 138— re- 
 covered 150 — remaining, 787. Total cases from commencement, 
 14,919— total deaths, 5,54L 
 
356 APPENDIX 
 
 Since the appearance of the cholera in Europe, numerous 
 treatises, lectures, essays, and letters respecting the disease have 
 been published ; and some of them contain the opinions of the 
 most celebrated medical men in Europe. Many of the works, 
 however, suggest no new views of the nature of the disease, nor do 
 they recommend any method of treatment that has not already 
 been alluded to. 
 
 Dr. Binaghi witnessed the disease at Warsaw, and has pub- 
 lished his opinion respecting it. This opinion has been transla- 
 ted from the Italian, by Wm. Sampson, Esq., and published re- 
 cently at N. York. Dr. B. thinks the cholera is a disease of the 
 nervous system, and principally of the nerveo-splanchnic sys- 
 tem. The direct cause of the disease he says is unknown. He 
 thinks the cholera is not contagious, but may be an epidemic, 
 produced by the variations of the seasons. He says it prevails 
 longest in soils that are low, flat, humid, and populous. He ad- 
 vises, as preventive of the disease, to avoid exposure to sudden 
 changes of weather, and to keep the skin and feet constantly 
 warm, to eat moderately of nourishing food and avoid the use 
 of unripe and acid fruit. 
 
 His method of cure is as follows. First, establish a point ol 
 counter irritation on some unimportant part of the body, by moxa 
 or the actual cautery to the back, breast, abdomen or limbs, and 
 keep all the surface of the body warm, and moderate the violent 
 internal action by Sydenham's laudanum in large doses, and to 
 give warm drinks. In the first stage of the disease he condemns 
 the use of internal stimulants ; but in the second stage he thinks 
 they may be useful and necessary, and recommends the use of 
 quinine, piperine, bark, &c. &c. 
 
 The opinion of the celebrated Dupuytren respecting the na- 
 ture and treatment of the cholera, has aLso been published. He 
 believes the cholera has its seat in the alimentary canal, and con- 
 sists of an irritation of the secretory apparatus, and especially 
 of the small glands or mucous follicles of the intestines. From 
 these he thinks the superabundant evacuations proceed. To al- 
 lay this irritation, and stop the discharges, he recommends the 
 application of leeches, in the first instance to the abdomen, and 
 the administration of frequent and large draughts of a strong de- 
 coction of poppy heads ; but above all he depends upon the ad- 
 ministration of sugar of lead, either in pills or solution. If the 
 stomach can not retain the medicine, he advises the application 
 of a large blister to the abdomen, and after removing the epider- 
 mis, to sprinkle one half of the wound with sulphate of morphine, 
 and the other half with pulverized sug'ar of lead. 
 
 The following table exhibits the propoportion of deaths, to the 
 population, in some of the large cities of Europe : — 
 
APPENDIX. 35f 
 
 The first column of figures shows the total population, and the 
 second, the number of deaths from cholera, during the prevalence 
 of the disease, up to the 19th of April, at which time it had dis- 
 appeared from many of the places named, and had passed 
 through its worst stages in the rest. 
 
 Moscow, 350,000 4,690 equal to 1 in 74 
 
 Petersburgh, 360,000 4,757 1 74 
 
 Vienna, 300,000 11,896 1 159 
 
 Berlin, 340,000 1,401 1 242 
 
 Hamburgh, 100,000 446 1 224 
 
 Prague, 97,000 1,335 1 72 
 
 Breslaw, 78,000 670 1 116 
 
 Konigsberg 70,000 1,318 1 53 
 
 Magdeburgh, 36,000 346 1 104 
 
 Braun, 33,000 601 1 54 
 
 Stettin, 24,000 250 1 96 
 
 Halle, 28,000 152 1 184 
 
 Bliberg, 22,000 253 1 77 
 
 London, 1,500,000 1,223 1 1,228 
 
 Edinburgh, 150,000 72 1 2,033 
 
 Glasgow, 180,000 395 1 455 
 
 Paisley, 60,000 204 1 294 
 
 Hungary, 8,750,000 188,000 1 46 
 
 Paris, 800,000 20,000 1 40 
 
 If to these be added, 
 
 Montreal, 25,000 1,250 1 20 
 
 Quebec, 22,000 1,790 1 12 
 
 N.York, 200,000 2,000 1 100 
 
 Albany, 24,000 311 1 77 
 
 It should be recollected, however, that the population of Que- 
 bec and Montreal, had been greatly increased by the arrival of 
 emigrants, at the time the cholera appeared at those places. But 
 notwithstanding this, it is a well established fact, that the disease 
 has been full as malignant on this continent as in any part of the 
 world, and even a greater number of those attacked, and who 
 have received medical aid, have died in this country, than in In- 
 dia, among those similarly situated. This will be made evident 
 by referring to the table of recoveries and deaths in India, page 
 149 of this volume, 
 
 The following important facts and tables, are selected from 
 the 'Bibliotheque Universelle,' for Dec. 1831. 
 
 ] . At Posen, a city containing 30,000 inhabitants, more men 
 died than women, of the cholera. Of 541 deaths, 303 were 
 males, and 238 females, and of the following ages :— 
 
35S APPENDIX. 
 
 Under 1 year, 5 
 
 From 1 to 7 38 
 
 8 years to 14 35 
 
 15 to 28 104 
 
 29 to 42 145 
 
 43 to 56 111 
 
 57 to 70 73 
 
 Above 71 30 
 
 Total, 541 
 
 At Berlin, the same facts were noticed, as is evident from the 
 following account of the first 1,500 cases of cholera. 
 
 Men. Women. Total. 
 
 From 1 to 10 years, 145 99 244 
 
 11 to 20 62 60 122 
 
 21 to 30 106 105 211 
 
 31 to 40 175 125 300 
 
 41 to 50 135 116 251 
 
 51 to 60 85 96 181 
 
 61 to 70 65 67 132 
 
 71 to 80 21 28 49 
 
 81 to 90 3 7 10 
 
 Total 797 703 1,500 
 
 2. At Posen. the makers of brick, and the pewterers, suffered 
 more than these who belonged to other professions. 
 
 The table on the following page respecting the first 1,000 ca- 
 ses of cholera, is very curious and interesting. 
 
APPENDIX. 
 
 Employments of the first 1,000 Cholera Patients, 
 at Berlin. 
 
 
 
 
 under 
 
 
 
 
 
 1 
 
 t 
 
 15 yrs. 
 
 H 
 
 O 
 
 © 
 
 
 s 
 
 
 2 
 
 09 
 
 O 
 
 
 
 
 
 
 
 <X> 
 
 
 
 
 
 a 
 
 a 
 
 
 
 S 
 
 QQ 
 
 uT 
 
 • 
 
 PL 
 
 
 
 ■-■- 
 
 
 
 ~_= 
 
 
 ■■■'"■ ' 
 
 • ■ ■ ' 
 
 Those in superior employments and 
 
 
 
 
 
 
 ' 
 
 • 
 
 their families. 
 
 9 
 
 2 
 
 4 
 
 
 15 
 
 4 
 
 11 
 
 Physicians and their families. 
 
 4 
 
 1 
 
 1 
 
 
 6 
 
 1 
 
 5 
 
 Instructers and Instructresses. 
 
 5 
 
 2 
 
 1 
 
 
 8 
 
 3 
 
 5 
 
 Artists — painters — musicians. 
 
 4 
 
 5 
 
 1 
 
 1 
 
 11 
 
 2 
 
 9 
 
 Negociants. 
 
 18 
 
 9 
 
 3 
 
 1 
 
 31 
 
 9 
 
 22 
 
 Artisans — Masters. 
 
 53 
 
 32 
 
 17 
 
 14 
 
 116 
 
 28 
 
 82 
 
 „ Workmen. 
 
 69 
 
 34 
 
 11 
 
 6 
 
 120 
 
 37 
 
 74 
 
 „ Apprentices, 
 
 3 
 
 
 
 
 3 
 
 1 
 
 1 
 
 Weavers. 
 
 31 
 
 16 
 
 20 
 
 9 
 
 76 
 
 25 
 
 48 
 
 Watermen 
 
 29 
 
 2 
 
 
 1 
 
 32 
 
 3 
 
 29 
 
 Boatmen. 
 
 19 
 
 
 
 
 19 
 
 2 
 
 16 
 
 Venders of wine, and Victuallers. 
 
 6 
 
 8 
 
 2 
 
 
 16 
 
 5 
 
 9 
 
 Dealers in old clothes. 
 
 3 
 
 8 
 
 1 
 
 
 12 
 
 . 3 
 
 8 
 
 Tailoresses, Seamstresses, and Laun- 
 
 
 
 
 
 
 
 
 dresses. 
 
 
 11 
 
 
 
 11 
 
 5 
 
 5 
 
 Domestics. 
 
 18 
 
 32 
 
 2 
 
 1 
 
 53 
 
 17 
 
 30 
 
 Laborers. 
 
 95 
 
 39 
 
 21 
 
 12 
 
 167 
 
 30 
 
 119 
 
 Infirmary keepers, and Grave diggers. 
 
 16 
 
 9 
 
 
 
 25 
 
 14 
 
 8 
 
 Guards for the night. 
 
 6 
 
 1 
 
 
 1 
 
 8 
 
 1 
 
 5 
 
 Widows and their families. 
 
 
 75 
 
 3 
 
 6 
 
 84 
 
 19 
 
 56 
 
 Bachelors, and women separate. 
 
 
 23 
 
 4 
 
 3 
 
 30 
 
 7 
 
 19 
 
 Pensioners. 
 
 11 
 
 18 
 
 
 
 29 
 
 11 
 
 17 
 
 Invalids. 
 
 5 
 
 4 
 
 3 
 
 
 12 
 
 1 
 
 10 
 
 Public Women. 
 
 
 6 
 
 
 
 6 
 
 1 
 
 4 
 
 Employments unknown. 
 
 16 
 
 27 
 
 11 
 
 10 
 
 64 
 
 14 
 
 50 
 
 Military men actively employed. 
 
 10 
 
 
 2 
 
 
 12 
 
 3 
 
 8 
 
 „ „ on furlough. 
 
 3 
 
 3 
 
 
 
 6 
 
 4 
 
 2 
 
 Total J 
 
 452* 
 
 373 
 
 108) 
 
 37 
 
 1000 
 
 263 
 
 666 
 
 3. The Jews have wonderfully escaped the cholera. At Po- 
 ser), which contained 6,000 Jews when the cholera raged there, 
 only 37 died of the disease. At Berlin, only six Jews had the 
 disease during the two first months the cholera prevailed there. 
 This exemption they undoubtedly owed to their accustomed so- 
 briety, regularity and habitual prudence. 
 
 4. It is curious to observe that more cases occur on certain days of 
 the week than on others. Usually, the most cases occur on 
 Tuesday, arid the least on Sunday. This probably arises from 
 the excesses committed on Sunday. At Koenipsberg, the fol- 
 lowing number of sick were attacked from the 23d of July to the 
 
360 APPENDIX 
 
 28th of October, and the number of attacks for each day of the 
 week is thus exhibited. 
 
 Sunday ... 276 
 
 Monday ... 282 
 
 Tuesday - - . - 348 
 
 Wednesday - 286 
 
 Thursday - 295 
 
 Friday 249 
 
 Saturday ... 234 
 
 Total, 1970. 
 
 At Berlin, the cases for the first seven weeks of the prevalence 
 of the cholera at that place, occurred on the following days : — 
 
 
 Cases. 
 
 Cured. 
 
 Dead. 
 
 Sundays 
 
 195 
 
 57 
 
 148 
 
 Mondays 
 
 245 
 
 60 
 
 151 
 
 Tuesdays 
 
 272 
 
 72 
 
 153 
 
 Wednesdays, 
 
 260 
 
 58 
 
 142 
 
 Thursdays 
 
 252 
 
 80 
 
 184 
 
 Fridays 
 
 225 
 
 63 
 
 143 
 
 Saturdays 
 
 258 
 
 55 
 
 136 
 
 Total, 
 
 1,724 
 
 454 
 
 1,057 
 
 5. At Berlin, several members of the same family were often 
 affected, one after another, thus from August 29th to September 
 26th, 770 cases were reported. During that period, a second case 
 happened in the same house, 
 
 After one day ... 65 times, 
 
 two days ... 34 
 
 three ... 23 
 
 four .... 16 
 
 five .... 21 
 
 six .... 7 
 
 seven - - - 3 
 
 eight ... 2 
 
 nine 
 
 6. Other diseases were increased at Berlin, during the preva- 
 lence of the cholera. The total number of deaths from the 3d to 
 the 23d of September, 1830, was 436 : but for the same time in 
 1831, was 552, exclusive of cholera cases. These 552 persons 
 died of the following diseases: — Marasmus, 158 — Diarrhoea 
 from dentition, 18 — Convulsions, 52 — Vomiting and Diarrhoea, 
 12 — Apoplexy, 42 — Nervous Fever, 52 — Mucous Fever, 3 — Bil- 
 ious Fever, 3 — Malignant Fever, 1 — Dropsy, 40 — Scarlatina, 
 4 — Inflammation of the brain, 17 — Of the Lungs, 6 — Of the 
 Bowels, 13 — Strangulated Hernia, 1 — Quinsy, 1 — Colic, 7 — 
 Hemoptysis, 2 — Cancer of the Uterus, 3 — Palsy of the Lungs, 
 11 — Scrofula, 9 — Vomiting Chronic, 1 — Disease of Heart, 4 — 
 
APPENDIX. 
 
 361 
 
 Of the Liver, 4— Of the Vertebra 1— Old Age, 52— Still-born, 
 20 — iVbortion, 5 — Suicide, 1 — Deaths unknown, 6. 
 
 7. In Prussia, the order of the victims of the cholera, was as 
 follows : — 
 
 1st. The aged men. 
 
 2d. Drunkards. 
 
 3d. The infirm, and valetudinarians. 
 
 4th. The timid. 
 
 The lower or poor class, furnished the greater part of the ca- 
 ses that terminated fatally. The consumptive generally escaped 
 the cholera at Berlin. 
 
 Number of the cases of cholera that occurred in the Prussian 
 States, previous to the 12th of November, 1831. 
 
 Provinces. 
 
 Cases. 
 
 Deaths. 
 
 Cured. 
 
 Prussia, 
 
 20563 
 
 2231 
 
 7418 
 
 Posen, 
 
 10542 
 
 6037 
 
 3631 
 
 Silesia, 
 
 2045 
 
 1191 
 
 594 
 
 Brandenburg, 
 
 4665 
 
 2827 
 
 1726 
 
 Saxony, 
 
 606 
 
 360 
 
 189 
 
 Pomerania, 
 
 1393 
 
 847 
 
 488 
 
 The cities of Berlin, 
 Kcenigsberg, Dantzic, Po- 
 sen, Breslaw, Magdebourg 
 and Stettin, have furnished 
 
 39814 
 
 23493 
 
 14046 
 
 8411 5269 2797 
 
 [Gasete d'Etat de Prusse.] 
 
 31 
 
362 
 
 APPENDIX. 
 
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NOTE B. 
 
 PROGRESS OP THE CHOLERA IN CANADA 
 AND UNITED STATES. 
 
 The first appearance of the epidemic cholera on this continent, 
 was at Quebec and Montreal. At Quebec, the disease com- 
 menced the 8th of June, and in a few days after, several cases of 
 the same disease occurred at Montreal. 
 
 The influx of emigrants into the Canadas, the present year, 
 had been enormously great, and greater than any preceding 
 year, as will appear from the following memorandum : 
 
 The arrivals, tonnage and emigrants at the port of Quebec, 
 made up from the Exchange Books to the 9th July : — 
 
 Years. Vessels. Tonnage. Emigrants. 
 
 99,961 6,528 
 
 108,659 15,935 
 
 130,051 32,327 
 
 146,112 33,848 
 
 From July 9th, to August 8th, 10,073 
 
 Total in 1832, 43,921 
 
 By some, the emigrants were supposed to have brought the 
 disease, but as I have shown elsewhere, some cases of the same 
 disease occurred before any arrival of emigrants from Europe; and 
 it should be recollected that the lower town of Quebec, or that 
 part of it, called the Cut de Sac, is, in the summer season, one of 
 the most filthy places in the world. 
 
 The following table will show the progress of the disease at 
 Quebec, for the first two weeks of its prevalence there, though it 
 includes only the Hospital cases. 
 
 Quebec. — Cases of Cholera in the two hospitals, from 8 o'clock, 
 A. M. on the 8th, to 8 o'clock, A. M. on the 21st inst. 
 
 1829 
 
 366 
 
 1830 
 
 421 
 
 1831 
 
 497 
 
 1832 
 
 544 
 
364 APPENDIX. 
 
 1 
 
 Remaining 
 from last re- 
 port. 
 
 GO 
 
 G 
 
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 J 
 
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 Eg 2i 
 
 Qg 
 
 H3 
 
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 05 
 
 8th 
 
 none 
 
 3 
 
 none 
 
 none 
 
 2 
 
 1 
 
 9th 
 
 1 
 
 13 
 
 none 
 
 none 
 
 6 
 
 8 
 
 10th 
 
 8 
 
 10 
 
 none 
 
 none 
 
 11 
 
 7 
 
 11th 
 
 7 
 
 13 
 
 none 
 
 none 
 
 11 
 
 9 
 
 12th 
 
 9 
 
 27 
 
 none 
 
 none 
 
 13 
 
 23 
 
 13th 
 
 23 
 
 77 
 
 9 
 
 none 
 
 40 
 
 60 
 
 14th 
 
 60 
 
 48 
 
 8 
 
 none 
 
 41 
 
 67 
 
 15th 
 
 67 
 
 68 
 
 17 
 
 2 
 
 37 
 
 96 
 
 16th 
 
 96 
 
 98 
 
 31 
 
 3 
 
 36 
 
 155 
 
 17th 
 
 155 
 
 47 
 
 62 
 
 5 
 
 37 
 
 160 
 
 18th 
 
 160 
 
 46 
 
 57 
 
 2 
 
 23 
 
 181 
 
 19th 
 
 181 
 
 66 
 
 46 
 
 12 
 
 32 
 
 199 
 
 20th 
 
 199 
 
 60 
 
 44 
 
 20 
 
 40 
 
 100 
 
 21st 
 
 199 
 
 37 
 
 46 
 
 6 
 
 32 
 
 198 
 
 Total 609 507 
 
 On the 7th day after the appearance of the cholera at Que- 
 bec, 143 died of the disease; and on that and the succeeding five 
 days, the deaths from cholera amounted to 711, being an average 
 for the six days of 118 deaths per diem. From the commence- 
 ment of the disease to the sixth of August, a period of fifty-eight 
 days, the number of deaths from cholera at Quebec amounted to 
 1790. — Neilsorfs Gazette, 
 
 At Montreal, the disease raged with great violence, as will be 
 seen from the following statement of the cases and deaths, from 
 the commencement of the disease, to the 13th of July, inclusive : 
 
 
 Daily cases. 
 
 Daily burials. 
 
 Total cases. 
 
 Total deaths. 
 
 June 10th to 15th, 
 
 
 1328 
 
 175 
 
 June 16, 
 
 381 
 
 86 
 
 1709 
 
 261 
 
 17, 
 
 474 
 
 102 
 
 2183 
 
 363 
 
 18, 
 
 261 
 
 128 
 
 2444 
 
 491 
 
 19, 
 
 338 
 
 149 
 
 2781 
 
 640 
 
 20, 
 
 165 
 
 94 
 
 2946 
 
 734 
 
 21, 
 
 15 
 
 76 
 
 3097 
 
 810 
 
 22, 
 
 109 
 
 52 
 
 3206 
 
 862 
 
 23, 
 
 83 
 
 31 
 
 3289 
 
 893 
 
 24, 
 
 51 
 
 21 
 
 3340 
 
 914 
 
 25, 
 
 44 
 
 33 
 
 3384 
 
 947 
 
 26, 
 
 27 
 
 23 
 
 3411 
 
 976 
 
 27, 
 
 21 
 
 25 
 
 3432 
 
 996 
 
 28, 
 
 22 
 
 20 
 
 3454 
 
 1016 
 
 29, 
 
 37 
 
 21 
 
 3491 
 
 1037 
 
 30, 
 
 32 
 
 22 
 
 3523 
 
 1059 
 

 
 APPENDIX. 
 
 
 3 
 
 
 Daily cases. 
 
 Daily burials. 
 
 Total cases. 
 
 Total deaths 
 
 July 1, 
 
 23 
 
 17 
 
 
 3546 
 
 1066 
 
 2, 
 
 13 
 
 20 
 
 
 3559 
 
 1076 
 
 3, 
 
 11 
 
 14 
 
 
 3570 
 
 1110 
 
 4, 
 
 23 
 
 17 
 
 
 3593 
 
 1127 
 
 5, 
 
 22 
 
 13 
 
 
 3615 
 
 1140 
 
 6, 
 
 19 
 
 9 
 
 
 3634 
 
 1144 
 
 7, 
 
 13 
 
 9 
 
 
 3647 
 
 1153 
 
 8, 
 
 14 
 
 11 
 
 
 3661 
 
 1164 
 
 9, 
 
 10 
 
 9 
 
 
 3671 
 
 1175 
 
 10, 
 
 7 
 
 6 
 
 
 3678 
 
 1184 
 
 11, 
 
 14 
 
 10 
 
 
 3692 
 
 1190 
 
 12, 
 
 15 
 
 10 
 
 
 3707 
 
 1200 
 
 13, 
 
 9 
 
 10 
 
 
 3716 
 
 1210 
 
 Since the above statement was made, the disease has contin- 
 ued .to prevail in Montreal. For a few days,, it seemed to cease, 
 but then it broke out again with severity, and since the middle of 
 July to the present time, Aug. 10, it has proved fatal to 10, 15 ? 
 and 20 persons a day. 
 
 The cholera commenced at New York about the 24th or 26th 
 of June, The second day of July, the Board of Health announced 
 that eleven cases had occurred, all of which had terminated fatal- 
 ly, and that three new cases had that day been reported. The 
 progress of the disease since then, has been as follows : 
 
 P- H-J P- 1 hA 
 
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 51 
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 66 
 74 
 94 
 60 
 72 
 202 42 28 12 82 
 
 226 48 42 10 100 
 
 * These include all in the Bellevue Hospital from the 27th of 
 June to the 7th of July, 
 f These include all in Bellevue on the 9th and 9th, 
 
 4th 
 
 7 
 
 
 
 5th 
 
 15 
 
 3 
 
 
 6th 
 
 11 
 
 13 
 
 
 7th 
 
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 13 
 
 30* 
 
 8th 
 
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 10th 
 
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 43 
 
 11th 
 
 45 
 
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 53 
 
 12th 
 
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 14th 
 
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 43 
 
 29 
 
 15th 
 
 60 
 
 53 
 
 20 
 
 16th 
 
 92 
 
 50 
 
 21 
 
 17th 
 
 60 
 
 63 
 
 23 
 
 18th 
 
 65 
 
 59 
 
 14 
 
 19th 
 
 114 
 
 77 
 
 11 
 
 20th 132 
 
 66 
 
 28 
 
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 85 
 
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 105 
 
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 129 
 
 10 
 
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 119 
 
 10 
 
 16 
 
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 101 
 
 10 
 
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 17 
 
 
 115 
 
 15 
 
 29 
 
 22 
 
 
 133 
 
 28 
 
 31 
 
 15 
 
 
 163 
 
 45 
 
 32 
 
 17 
 
 
 146 
 
 19 
 
 29 
 
 12 
 
 
 138 
 
 22 
 
 36 
 
 14 
 
366 
 
 
 
 
 APPENDIX. 
 
 
 
 
 
 
 Cu 
 
 
 
 
 H 
 
 eu 
 
 
 
 
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 21st 
 
 191 
 
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 33 
 
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 104 
 
 22d 
 
 154 
 
 76 
 
 9 
 
 2 
 
 241 
 
 50 
 
 35 
 
 5 
 
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 91 
 
 23d 
 
 163 
 
 42 
 
 26 
 
 
 231 
 
 46 
 
 17 
 
 20 
 
 
 83 
 
 24th 188 
 
 51 
 
 22 
 
 35§ 
 
 296 
 
 57 
 
 22 
 
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 10§ 
 
 96 
 
 25th 
 
 99 
 
 45 
 
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 3t 
 
 157 
 
 21 
 
 32 
 
 5 
 
 3t 
 
 61 
 
 26th 
 
 75 
 
 48 
 
 14 
 
 4 
 
 141 
 
 23 
 
 21 
 
 7 
 
 4 
 
 55 
 
 27th 
 
 73 
 
 46 
 
 3 
 
 IT 
 
 122 
 
 23 
 
 18 
 
 5 
 
 IT 
 
 46 
 
 28th 
 
 93 
 
 49 
 
 1 
 
 2 
 
 145 
 
 37 
 
 26 
 
 4 
 
 HI 
 
 68 
 
 29th 
 
 61 
 
 58 
 
 1 
 
 2 
 
 122 
 
 19 
 
 15 
 
 3 
 
 3 
 
 39 
 
 30th 
 
 62 
 
 35 
 
 3 
 
 3 
 
 103 
 
 14 
 
 19 
 
 3 
 
 3 
 
 39 
 
 31st 
 
 59 
 
 52 
 
 1 
 
 9 
 
 121 
 
 23 
 
 20 
 
 3 
 
 2 
 
 48 
 
 Aug. 1,47 
 
 33 
 
 4 
 
 2 
 
 92 
 
 13 
 
 21 
 
 3 
 
 1 
 
 41 
 
 2d 
 
 47 
 
 24 
 
 
 
 10 
 
 8i 
 
 14 
 
 17 
 
 
 
 3 
 
 34 
 
 3d 
 
 48 
 
 36 
 
 1 
 
 5 
 
 90 
 
 14 
 
 8 
 
 1 
 
 1 
 
 24 
 
 4th 
 
 48 
 
 35 
 
 3 
 
 2 
 
 88 
 
 17 
 
 11 
 
 2 
 
 
 
 30 
 
 5th 
 
 57 
 
 38 
 
 
 
 1 
 
 96 
 
 21 
 
 8 
 
 
 
 
 
 29 
 
 6th 
 
 60 
 
 38 
 
 
 
 3 
 
 101 
 
 21 
 
 15 
 
 
 
 1 
 
 37 
 
 7th 
 
 57 
 
 31 
 
 
 
 1 
 
 89 
 
 19 
 
 12 
 
 
 
 1 
 
 32 
 
 8th 
 
 50 
 
 32 
 
 
 
 
 
 82 
 
 12 
 
 9 
 
 
 
 
 
 21 
 
 9th 
 
 47 
 
 26 
 
 
 
 
 
 73 
 
 18 
 
 10 
 
 
 
 
 
 28 
 
 10th 
 
 60 
 
 34 
 
 
 
 3 
 
 97 
 
 18 
 
 7 
 
 
 
 1 
 
 26 
 
 11th 
 
 33 
 
 41 
 
 
 
 2 
 
 76 
 
 18 
 
 15 
 
 
 
 
 
 33 
 
 12th 
 
 32 
 
 33 
 
 
 
 2 
 
 67 
 
 9 
 
 12 
 
 
 
 2 
 
 23 
 
 13th 
 
 63 
 
 41 
 
 
 
 1 
 
 104 
 
 16 
 
 6 
 
 
 
 1 
 
 22 
 
 14th 
 
 18 
 
 24 
 
 
 
 
 42 
 
 8 
 
 7 
 
 
 
 
 15 
 
 15th 
 
 33 
 
 29 
 
 13 
 
 
 75 
 
 14 
 
 9 
 
 4 
 
 
 26 
 
 16th 
 
 39 
 
 37 
 
 3 
 
 
 79 
 
 14 
 
 11 
 
 1 
 
 
 26 
 
 17th 
 
 28 
 
 25 
 
 10 
 
 
 43 
 
 14 
 
 8 
 
 2 
 
 
 21 
 
 18th 
 
 38 
 
 38 
 
 1 
 
 
 76 
 
 6 
 
 13 
 
 
 
 
 19 
 
 Tot. 2859 1817 556 92 5323 937 789 305 38 2057 
 It is worthy of notice, that during the prevalence of the cholera 
 at New York, the number of deaths from other diseases has been 
 greater than usual, notwithstanding the number of inhabitants 
 has greatly diminished ; the same was observed at Berlin. 
 The whole number of deaths in the month of 
 July, 1830, was 664. 
 " 1831, 512. 
 Exclusive of cholera cases, " 1832, 751. 
 
 The deaths and diseases for the three weeks that the cholera 
 was most fatal at New York, were as follows, from July 7th to 
 the 28th : — Abscess, 1 ; Apoplexy, 9 ; Asphyxia, 2 ; Burns, 1 
 Casualty, 7 ; Cholera, malignant, 1741 ; Cholera Morbus, 34 
 Child-bed, 2 ; Colic, 1 ; Consumption, 83 ; Convulsions, 38 
 
 X Haerlem not heard from. § Including two days. 1T Not heard from. 
 
APPENDIX. 367 
 
 Cramp in the stomach, 5; Drinking cold water, 1; Diarrhoea, 
 13; Dropsy in head, 22; Drowned, 5; Dysentery, 9; Epilepsy, 
 7; Fever, 4; Bilious fever, 3 ; Remittent, 3; Scarlet, 6; Typhus, 
 5; Flux infa utile, 44; Hemorrhage, 1 ; Hemoptysis, 1 ; Croup, 8 ; 
 Inflammation of bowels, 20; Inflammation of brain, 13; Inflam- 
 mation of chest, 5; Inflammation of liver, 1; Inflammation of 
 stomach, 2 : Intemperance, 9 ; Locked Jaw, 2 ; Marasmus, 24 ; 
 Measles, 18 ; Mortification, 3 ; Old age, 17 ; Palsy, 3 ; Peripneu- 
 mony, 7; Rheumatism, 1 ; Smallpox, 2; Stillborn, 25 ; Schir- 
 rus, 2 ; Sore throat, 2 ; Spinabifida, 1 ; Tabes Mesenterica, 4 ; 
 Teething, 7 ; Unknown, 20 ; Whooping cough, 6 ; Worms, 7. 
 
 The disease appeared at Albany, July 3d, and since then, cases 
 have occurred daily. From the commencement of the disease to 
 the present time, August 18th, 1131 cases have occurred at Alba- 
 ny, of which 319 have terminated fatally. The disease appears 
 now to be on the decline in that city. 
 
 A few cases of cholera occurred at Philadelphia, about the mid- 
 dle of July, but the disease soon subsided, until the 27th, when it 
 again appeared, and has thus continued. 
 
 Number of persons attacked with the Spasmodic cholera, and 
 the deaths by that disease which have taken place in Philadel- 
 phia and Liberties, from the 27th of July to the present time. 
 
 
 
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 1610 
 
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 615 
 
368 APPENDIX 
 
 The 5th of July, the cholera appeared at Detroit, where it 
 prevailed for some time. The 17th of July, at Buffalo, and boon 
 after, the disease prevailed in several towns on the banks of the 
 Grand canal in the state of New York. 
 
 It appeared in several towns in New Jersey, about the middle 
 of July, and the 24th of the same month it broke out at Norfolk 
 and Portsmouth in Virginia, where it still continues to rage with 
 great violence, especially among the colored population. 
 
 Several towns in Connecticut were slightly visited by the dis- 
 ease in the course of July. 
 
 It appeared in Rhode Island about the first of August; and the 
 15th of the same month, two cases occurred in Boston, and about 
 the same time it commenced at Baltimore, and within a few days, 
 several cases have occurred at Elizabeth city, North Carolina. 
 
 Since the first of July, more \h%x\ fifty towns have been visited 
 by the Epidemic or Malignant cholera, and the disease appears 
 still to be extending in every direction. Among the towns which 
 have already been visited by the disease, are Newark, Princeton, 
 Trenton, New Brunswick, Elizabethtown, &c, &c. N. Jersey ; 
 Cleaveland and other towns in Ohio ; New T Haven, Hartford, 
 New London, &c. Connecticut ; Troy, Lansingburg, Rochester, 
 Utica, Syracuse, Poughkeepsie, Lockport, Brooklyn, Schenecta- 
 dy, &c. &c. state of New York ; Wilmington and Newcastle in 
 Delaware. It has already appeared in 12 of the U. states, and 
 from the past progress of the disease, we have no reason to hope 
 that any state in the Union will be exempted from a visitation of 
 the epidemic, though we trust it will be, in general, far less violent 
 and fatal in the interior of the country, and in the small towns, 
 than it has been in the large cities where it has already prevailed. 
 Our expectation of a diminution hereafter in the violence of the 
 disease, is founded upon the belief that other places will profit by 
 the sad experience of the towns where it has already prevailed, 
 and by attention to cleanliness, the purification of houses, the di- 
 minution of the inmates in small and crowded dwellings, the 
 clothing and feeding of the poor, and above all, by a general 
 abandonment of vicious, sensual, and intemperate habits, either 
 stay the progress of the evil, or greatly lessen its ravages. 
 
 This universal and mortal epidemic has long called loudly 
 Upon mankind for a reformation in these respects ; it has spoken 
 to them by the voices of millions of their dying fellow creatures, 
 to live temperately and soberly, and to provide for the sufferir g 
 poor, before the disease comes upon them. When, therefore, 
 mankind give attention to the past and present admonitions, and 
 hearken to the voice of reason, and not to that of passion or appe- 
 tite, then may we confidently expect the disease, which is now 
 sweeping over our country with frightful mortality, will be 8Q- 
 tirely arrested, or its violence greatly mitigated. 
 
 Hartford, Adg, 20th, 1832. 
 
 3477