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THE UNIVERSITY 
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 | UNIVERSITY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN 
 
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THE UNIVERSITY 
 
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 Won VT a 18 | 
 
A Compact and Practical Handy-Book. 
 
 EPIDEMIC CHOLERA: 
 
 f 
 
 ITS MISSION AND MYSTERY, HAUNTS AND 
 HAVOCS, PATHOLOGY AND TREATMENT. 
 
 . With Remarks on the Question of Contagion, the Influence of Fear, and 
 Hurried and Delayed Interments. 
 
 BY A FORMER SURGEON IN THE SERVICE OF THE 
 HONORABLE EAST INDIA COMPANY. 
 
 NEW YORK: 
 Carterton, PustisHeR, 413 Broapway. 
 
 M DCCC LXVI. 
 
Entered, according to Act of Congress, in the year 1866, by 
 GEO. W. CARLETON, = 
 
 In the Clerk's Office of the District Court of the United States for the 
 Southern District of New York. 
 
 Toe New York Printing ComMPANy, 
 81, 83, and 85 Centre Street, 
 New YorK. 
 
To 
 FRED. LAW OLMSTED, ESQ, 
 
 ARCHITECT-IN-CHIEF OF THE CENTRAL PARK, AND LATE 
 
 GENERAL SECRETARY OF THE U. 8. SANI-. 
 TARY COMMISSION, 
 
 . Obese Pages are Dedicated 
 IN RECOGNITION OF HIS 
 
 SAGACIOUS, HONEST, AND LIBERAL BENEFICENCE. 
 
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CONTENTS. 
 
 PAGE 
 I.—The Mission and the Havocs of Cholera.......... 7 
 II.—Symptoms of Cholera—Premonitory Stage and 
 COQU ESO tare etmaier aie sha wtaca) acosbbcea in a0 os eat eee ki 
 III.—Variations in the Symptoms........0...eceeuees 26 
 EV =a TheiStage. Ob W6yOt 2 ci sce kena s tus uclte s sco sian 33 
 V.—Recovery—True and Fallacious................. 38 
 Vi.—Appearances on Dissection... ........eceneerces 41 
 VIl.—Helps and Hints towards a Pathological Definition 46 
 VIII.—Pathological Conclusions..... b Mansanaeets Agus cubits 54. 
 1X.—Epidemic Cholera and Cholera Morbus—The Differ- 
 CCE. i siaia gi aipiwiite dele shen ¢ ov carci asia » « sheaiers 62 
 Poser lL POAUMOTIY « oue sin sin aes 6 stained aie do ov pie'ss.0 Mars g 94 66 
 In the Premonitory Stage... 2.0... ee cece 71 
 In the Stage of; Collapse sie... Sie ne vee os 76 
 OUTITIG re reer Cah alate Me Cale’. Sales s «a hae & 78 
 AMS TLeROtOliatns ete acide ate, «1s ok a 3 died suegigtss 84. 
 Jo thesstare ol every co ys .un's +0 as s,s 0) "s 86 
 Mi —16 Cholera Contagious) i acs os cs0.c tee oss ceca e's 88 
 XII.—The Influence of Fear... ...cscces sc aces Fara woe 101 
 XIII.—Hints to the Sanitary Boards................0.. 10m 
 PSD Vise tO DORA ecaattstertels = tuitetals alate gine s'atce Scere @icees 108 
 Talia er chats Mie ecbich din «151 altel aie mo @ on af ovals neato 109 
 APPENDIX: 
 Cholera—Its History and Localizing Causes......... 11] 
 
 Cholera and Common Sense..... LE Ne catare a dieters 115 
 
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EPIDEMIC CHOLERA. 
 
 I. 
 THE MISSION AND THE HAVOCS OF CHOLERA. 
 
 Epripemic CHoimra, like the Plague and the Yellow 
 Fever, is a main branch of the Universal Sanitary 
 Commission of Almighty God—armed with Herculean 
 powers to turn a river of death through the Augean 
 stables of the World’s filth and lewdness and drunk- 
 enness and ignorance and waste; and in the name 
 of the King of Terrors, to compel from purple and 
 fine linen and sumptuous fare a trembling recognition. 
 of their mortal brotherhood with nakedness and 
 starvation and pitiful squalor. For, as Scott says, 
 “the Beggar had no surgeon to dress, or ointment to 
 mollify, or even a garment to hide his sores, so that 
 the dogs, for very pity, came and licked them ”— 
 but his name, Lazarus, signified God my Helper. So 
 Epidemic Cholera is a famous scourer of consciences 
 as well as sinks, a masterly whitewasher of hearts as 
 well as sewers, a potential disinfectant of “shoddy” 
 and “ petroleum” as well as garbage—moral as well 
 as medical Inspector-General to the King of kings. 
 
8 THE MISSION AND THE HAVOCS OF CHOLERA. 
 
 But it has had, in its time, some awfully heavy 
 contracts on its hands, which, for the stubbornness, 
 Stupidity, and stench to be removed, we can compare 
 with no known anti-nuisance movement, unless, per- 
 haps, a job of New York street-cleaning in the dog- 
 days. 
 
 For instance: in 1762, according to Lebegue de 
 Presle, the Cholera, in a visitation to Upper Hin- 
 dostan, removed a nuisance consisting of 30,000 
 natives and 800 Europeans. 
 
 From 1774 to 1781, it scoured the Coromandel 
 Coast, and ‘at one period destroyed above 60,000 
 people, from Cherigam to Pondicherry. As every- 
 where else in the world, the Pariahs were its first 
 and favorite victims. : 
 
 In April, 1783, about a million and a half of de- 
 votees had assembled on the banks of the Ganges at 
 Hurdwar, to celebrate a religious festival of peculiar 
 popularity. Upon this frantic herd the Cholera 
 burst in fury, and literally “cleaned out” 20,000 
 hysterical heathens in eight days. 
 
 On the 19th of August, 1817, Dr. Robert Tytler, 
 who practised medicine at Jessore, about a hundred 
 miles north-east of Calcutta, was called to visit a 
 Hindoo who had been attacked the night before 
 with violent paims in his bowels, accompanied by 
 purging and vomiting. Dr. Tytler found the man 
 dying, and was about to report the case to the town 
 authorities as one of poisoning, when he learned 
 that, in the same part of the Bazaar, ten other 
 natives had died with the same symptoms, and in 
 
THE MISSION AND THE HAVOCS OF CHOLERA. 9Q 
 
 another Bazaar, seven more, and that the disease 
 had attacked many persons in the street. This was 
 Asiatic Cholera, and in two months it had swept off 
 more than 10,000 of the inhabitants of Jessore. 
 Such was the origin of the “new pestilence,” as it 
 used to be called, which, after overrunning all parts 
 of India, where it has prevailed endemically every 
 year, and extending to Birmah, China, and Austra- 
 lia, Arabia, Persia, Russia, and the heart of Europe, 
 finally reached this Western Continent by way of 
 Quebee and Montreal, in June, 1882, J essore has 
 been styled ‘the cradle of the Cholera,” because it 
 was not until its irruption there in 1817, that the 
 disease attracted anxious attention in Europe. Be- 
 sides, Cholera did not appear as an epidemic at Cal- 
 cutta until September, 1817; and for the ten years 
 preceding, not a single case had been treated at the 
 general hospital for Europeans in that busy mart. 
 But that year it raged throughout the “City of 
 Palaces,” and 86,000 persons were attacked in the 
 first three months of its visitation. It extended in 
 almost every direction around Jessore, to the dis- 
 tance of 250 miles, and it has been computed that at 
 least 600,000 persons died of Cholera in thirty-two 
 cities, in 1817. At some of the towns and military 
 stations, the invasion was so sudden that the roads 
 were covered with the dead and dying, who had not 
 time to regain their tents or houses. Men mounted 
 on horses were seen to fall from the saddle, unable 
 to rise again. ‘The first week in November it 
 
 broke out in the grand army under the command of 
 
10 THE MISSION AND THE HAVOCS OF CHOLERA. 
 
 the Marquis of Hastings, composed of 10,000 English 
 and 80,000 Sepoys, and encamped on the right bank 
 of the Betoah. On the fifth and sixth days, the 
 mortality became so great that despair seized the 
 bravest. To the usual uproar and gayety of a camp, 
 succeeded a mournful silence, only broken by the 
 groans of the dyimg and the lamentations of the 
 survivors. The principal roads and fields around 
 the camp were strewed with the dead bodies of 
 those who had thought to escape by flight. No ex- 
 pressions can truly describe the spectacle of desola- 
 tion which this army, but lately so brilliant, now 
 presented. In twelve days, 9,000 men had died, 
 and a still greater number had fled. Those who 
 remained, overwhelmed by so frightful a disaster, 
 disregarded the voice of their chief, and sought only 
 to save their lives, or stun their fears by debauchery.” 
 We recall here the dreadful revelries of Captain 
 Dowling’s reckless verse—“ The Song of the Dying :” 
 
 “There’s many a hand that’s shaking, 
 
 There’s many a cheek that’s sunk; 
 
 But soon, though our hearts are breaking, 
 They'll burn with the wine we’ve drunk. 
 
 So! stand to your glasses, steady ! 
 "Tis here the revival lies; 
 
 A cup to the dead already, 
 And hurrah for the next that dies! 
 
 “There’s a mist on the glass congealing, 
 "Tis the hurricane’s fiery breath ; 
 And thus does the warmth of feeling 
 Turn ice in the grasp of Death. 
 
THE MISSION AND THE HAVOCS OF CHOLERA. 11 
 
 So! stand to your glasses, steady ! 
 For a moment the vapor flies, 
 
 A cup to the dead already— 
 Hurrah for the next that dies!” 
 
 Happily the Marquis of Hastings marched his 
 army across the Betoah, and pitched his camp on 
 dry and elevated ground, where the disease soon 
 subsided. ; 
 
 In 1819, the pestilence advanced from Madras 
 towards the south; all along the coast numerous 
 towns which had escaped the preceding year were 
 now desolated by a frightful mortality: Hardly 
 fewer than 150,000 people died in the Presidency of 
 Bombay in 1819, from Cholera alone. Entire vil- 
 lages were depopulated, and so great was the panic, 
 that the crews of many vessels, laden with cotton, 
 deserted and fled in the night. At Bombay, nearly 
 20,000 persons were attacked. Bankok, the capital 
 of Siam, lost more than 40,000 of its inhabitants. 
 As the people attributed the calamity to the influ- 
 ence of an Evil Spirit, which, under the form of a 
 fish, had sought refuge in the Gulf of Siam, the Sove- 
 reign authority ordered the celebration of solemn 
 religious rites on the coast, in order to exorcise the 
 finny demon; but the gathering at one place of so 
 dense a throng of human beings, redoubled the fury 
 of the pestilence, and the mortality was frightful. 
 The same year the island of Sumatra was devastated, 
 and so terribly did the disease ravage the capital, 
 that the King fled to the mouth of the river, where 
 
12 THE MISSION AND THE HAVOCS OF CHOLERA. 
 
 he formed acamp. But the Angel of Death followed 
 them thither; and before the year was out had 
 flapped his black wings over forty degrees of latitude 
 and fifty of longitude. 
 
 In 1820 the Cholera inspired the inhabitants of 
 Manilla with so wild a terror that they broke out 
 in an insurrection, In which many Europeans and a 
 great number of natives perished. 
 
 In 1821 it appeared at*Jaggurnah on a missionary 
 expedition. So furiously did it rage among the 
 heathen during the annual monstrosities in honor 
 of Juggernauth, that there were not left maniacs 
 enough to drag the car of the idol around the temple, 
 and that year not asingle devotee enjoyed the luxury 
 of being crushed under its wheels. 
 
 The same year the scourge invaded Bassora on, 
 the Persian Gulf, and slew 17,000 out of a popula- 
 tion of 60,000. Thence it passed to Bagdad, and 
 destroyed one-third of the population. At Shiraz 
 the mortality was awful; Batavia lost 17,000 inha- 
 bitants, and the entire island of Java 102,000. The 
 scourge traversed forty-three degrees of latitude and 
 seventy of longitude, sweeping and garnishing the 
 unclean places. 
 
 In 1822 the progress of the pestilence was in the 
 direction of Europe. The Prince Royal of Persia, 
 having attacked the Turkish army, saw his own 
 array, a few days after the victory, swept away by 
 the epidemic. 
 
 In 1823 the Omnipotent Scavenger swept the Bir- 
 man Empire, and not even the name of the heir to 
 
THE MISSION AND THE HAVOCS OF CHOLERA. 13 
 
 the crown, worn as an amulet around the neck, was 
 awful enough to arrest its progress, or diminish the 
 number of its victims. In China, also, the disease 
 raged everywhere, “ in consequence of the innumera- 
 ble canals,” and a population as the sands on the 
 sea-shore. The Russian authorities urged the Man- 
 darins to adopt preventive or preservative measures ; 
 but the Mandarins (self-possessed philosophers !) 
 replied that the deaths would allow more room in the 
 world for those who survived ; and besides, that the 
 Cholera chose its victims from among the filthy and 
 the intemperate, and that no person of courage, who 
 lived with moderation and cleanliness, would die of 
 it. The Emperor, they declared, had said to his 
 subjects, ‘‘ Do not believe that the disease is strong- 
 er than yourselves. It only kills the scared people.” 
 Sagacious Emperor! 
 
 The same year the Cholera marched northward, 
 as far as Orenbourg, on the confines of Asia and 
 Kurope, where numerous caravans arrive yearly 
 from China and Hindostan ; it also made its appear- 
 ance on the eastern shores of the Mediterranean, 
 and created a lively alarm in Europe. 
 
 In 1825 the Cholera returned to Bombay, and 
 compelled the authorities to build hospitals, and 
 burn great quantities of wood, tar, and gunpow- 
 der. 
 
 In 1827 the epidemic again attacked Calcutta, and 
 this time horses, cattle, elephants, swine, and dogs 
 shared the fate of human pariahs. The Hindoos at- 
 tributed the prolongation and universality of the 
 
14 THE MISSION AND THE HAVOCS OF CHOLERA, 
 
 scourge to the anger of the God of the Cemeteries, 
 provoked by the absence of human sacrifices. “ At 
 Paleal, a Hindoo woman resolved to burn herself on 
 the body of her husband, who had died of Cholera, 
 but the Rajah refused to patronize, or even permit, 
 the performance. ‘The widow, however, was urgent 
 in her suit, and declared that the pestilence would 
 cease in five days if she were allowed to sacrifice 
 herself’ The Rajah yielded, and the woman 
 burned—but it made no difference to the Cholera. 
 
 In 1830 the epidemic prevailed all along the shores 
 of the Caspian Sea, and on the 27th of July ap- 
 peared at Tiflis, the capital of Georgia, nearly de- 
 populating it by death and flight. Impatient of the 
 limits within which it had hitherto been confined, it 
 had, the year before, crossed the Ural Mountains, 
 which separate Europe from Asia. On the 19th of 
 July it reached Astrakhan, at the mouth of the 
 Volga, and thence spread up that river, reaching 
 Nischnei Novgorod about the last of August. On 
 the 15th of September it appeared at Moscow, where 
 it created a senseless panic, and 50,000 persons fled 
 the city in a few days. The consternation was gen- 
 eral throughout the Russian Empire, and the Czar 
 offered a'reward of 25,000 roubles for the best dis- 
 sertation on the nature, causes, prevention and cure 
 of Cholera. A Council of Health was convened at 
 Moscow, composed of physicians from Paris, Berlin, 
 GOttingen, and other cities. 
 
 In 1831 it appeared at St. Petersburg—on the 
 26th of June—having previously visited Archangel, 
 
THE MISSION AND THE HAVOCS OF CHOLERA. 15 
 
 Warsaw, Riga, Polangen, and Dantzic. The Czar 
 retired in dismay from the imperial city, and sur- 
 rounded himself and his court with a cordon mili- 
 taire, permitting no approach from without. In 
 May it broke out in Mecca, among the innumerable 
 pugrims to the shrine, and “abated ” thousands upon 
 thousands of the foulest of those pious nuisances, 
 with whom “it isa point of religion that no pilgrim 
 shall change his clothes during the whole period of 
 his pilgrimage, and that each pilgrim shall sacrifice 
 at least one sheep, and leave the skins and offal to 
 rot under an Arabian sun.” 
 
 Berlin was visited by the Cholera in the last week 
 of August, and from the 1st of September to the 
 middle of December, when it had nearly disappeared, 
 the number of cases was 2,230, of which more than 
 half died. On the 16th of August, the scourge en- 
 tered Vienna from Hungary, in defiance of a double 
 cordon, though the authorities refused to recognize 
 its presence until the 15th of September, by which 
 time it was raging with violence. It was remarked 
 that, in Vienna, the Cholera destroyed more of the 
 nobility and people of the higher classes than at 
 any other time or place; and here, likewise, was a 
 most extraordinary fatality among physicians and 
 other attendants upon the sick. 
 
 The Cholera also prevailed this year (1831) at 
 Constantinople. The Turkish Government declined 
 to establish quarantines, but distributed gratuitously, 
 throughout the empire, small pamphlets giving a 
 history of the disease, and the most approved me- 
 
16 THE MISSION AND THE HAVOCS OF CHOLERA. 
 
 thods of prevention and treatment. Their good 
 sense was rewarded with a mild visitation. 
 
 “On the 26th of October, the Board of Health of 
 Sunderland, in England, officially announced the 
 presence of Cholera in that town. A few cases had 
 been noticed in August, but it did not prevail epi- 
 demically until the last of October.” On the 27th 
 of January it appeared in Edinburgh, and soon 
 afterwards reached London, where, contrary to all 
 expectations, its ravages were inconsiderable. On the 
 24th of March it appeared for the first time in Paris, 
 where it prevailed with great severity ; and shortly 
 afterwards broke out in Dublin. Thenit crossed the 
 Atlantic, landed at Quebec on the 8th of June, was 
 in Montreal by the 14th and New York by the 25th 
 since when its marches and its operations have 
 been traced, observed, and reported with such 
 anxious interest, both in Europe and America, as to 
 call for no recapitulation here. 
 
Hi. 
 SYMPTOMS OF CHOLERA. 
 
 Tue Diagnosis of Epidemic Cholera, especially in 
 the stage of collapse, is, fortunately, as easy to ac- 
 quire as the pronunciation of Italian. It has its 
 peculiar features—its characteristic expressions, mo- 
 tions, signs, and sounds—which are the same, to be 
 readily recognised all the world over. One case 
 may differ from another in certain modifications and 
 “accidents ” proper to the individual, according to 
 temperament, habits, and state of health, as one 
 Chinaman differs from another in looks and ways; 
 but there will be no mistaking the Cholera or the 
 Chinaman in either subject; for there are the high 
 cheek-bones, the flat nose, the pig-eyes, the perpe- 
 tual cunning twinkle, and the “tail”’; and here are 
 the listless, sunken eye, the corpse-like features, the 
 appalled expression, the plaintive whine, the blue, 
 brown, or lead-colored skin, the cold, clammy, 
 *‘ doo’s-nose”’ feel, the rice-water evacuations, the 
 cramps, the “dead ineat ” tongue, and the chilled 
 breath. That physician would indeed be eminently — 
 ignorant or stupid who should fail to recognize a 
 case of Asiatic Cholera in the stage of OU oem 
 Hydrophobia is not plainer. 
 
 But let us imagine a case, and trace it from its 
 
18 SYMPTOMS OF CHOLERA. 
 
 commencement to its close, which, since we shall 
 “leave it to nature,” will surely be death; no man 
 ever heard of an instance of true Cholera curing 
 itself, after spasms, and the clammy blueness, and 
 ‘“‘ washer-woman’s fingers,” and that ominous sink- 
 ing, had set in. Nature, appalled and paralyzed by 
 the stunning stroke of the fierce Angel of Reform, 
 seems to slink away and leave the field to him, retir- 
 ing, like Achilles, to supineness and despair; and 
 .only the hopeful, patient, and sagacious calls of 
 Science can rouse her to arms again. 
 
 We will suppose that the Cholera, having flanked 
 all the quarantine defences, has entered New York, 
 and that its presence has been honored by official 
 recognition. You have a friend with Cholera on 
 the brain—nervous, anxious, scared—the eyes of his 
 imagination continually turned inward upon his 
 stomach and bowels, with a morbid fascination suf- 
 ficient, by its very magnetism, to conjure a “cramp” 
 there. Perhaps he has been dyspeptic, subject to 
 indigestions and troublesome alternations of consti- 
 pation and looseness. Perhaps he has domestic or 
 business anxieties, that keep his spirits depressed. 
 Perhaps his occupation is unwholesome—confining, 
 exposing, or overtasking him, invading his hours 
 of natural and necessary rest. Perhaps he is an in- 
 - temperate man, given to spells of excess, followed 
 by corresponding spells of “shakes,” with loss of 
 appetite and sleeplessness and vague alarms, and all 
 the other reproachful shapes of nervous prostration. 
 Perhaps, by habit or necessity, he is a keeper of 
 
SYMPTOMS OF CHOLERA. 19 
 
 bad hours—out in the chilly and damp air of night ; 
 a man, too, familiar with wet feet and irregular and 
 hurried meals. Perhaps, on the other hand, he is a 
 pampered, gouty gourmand—committing slow sui- 
 cide with the entire catalogue of French crudities, 
 and flourishing in the face of Providence, cucum- 
 bers, radishes, and hard-boiled eggs. Perhaps—a 
 hundred peradventures, all ending in the certainty 
 that he is a ready-made case for Cholera, and that 
 he is scared. 
 
 Well, this cut-and-dried victim, who is neither 
 filthy, nor lewd, nor naked, nor starved, nor house- 
 less, nor squalid, but only respectably unfortunate, 
 or a fool, “does not feel well this morning ”?—in 
 fact his sensations are exceedingly queer, not to say 
 alarming. ‘ Do you know anything about Cholera? 
 and what are the premonitory symptoms?” And 
 then he goes on to describe them to you with an 
 unconscious accuracy, impressive as a diagnosis, and 
 touching by its melancholy portent. 
 
 For several days, he says, he has had a vague feel- 
 ing of uneasiness, accompanied by a sense of heat 
 and disorder in the stomach and bowels, with loose- 
 ness—a simple feculent diarrhcea, with little or no 
 griping, the “‘ movements” steadily increasing in 
 frequency day by day. At first there were but 
 three, yesterday there were a dozen. He has occa- 
 sional nausea, with more and more lassitude and 
 languor.. He is giddy, too, at times, and very weak, 
 especially just after purging. ‘Has he headache?” 
 Rarely, and never: much. But he has an empty, 
 
20 SYMPTOMS OF CHOLERA. 
 
 hollow feeling, and this morning, at daybreak, he 
 vomited thin, watery stuff, mixed.with a little bile, 
 and some undigested food. ‘How did he pass the 
 night?” Badly. ‘He shivered some, his stomach 
 and bowels were distended, and he was calied to 
 stool three or four times, passing a thin sort of 
 whitish water, like whey, or the “ rice-water” that 
 his Cholera-book—he has been reading “ Cholera- 
 books,” you perceive—so often mentioned. There 
 were starchy-looking flakes floating in it, with some 
 bile at first, but that grew less. He was very rest- 
 less, had some ringing in his ears, and a tingling 
 sensation in his hands and feet, first in one and then 
 the other, as if they were asleep; and once or twice 
 his foot was cramped. You feel his pulse—per- 
 haps it is somewhat accelerated and weaker than in 
 health; you look at his tongue—not much altera- 
 tion there—it is moist, and slightly furred; but he 
 says his mouth is dry, and he feels thirsty. You 
 observe particularly that his features are sharp, and 
 that his countenance wears an apprehensive, anxious 
 expression. You advise him to go straight to bed, 
 and send for adoctor. But he doesn’t. Jones, who 
 is also his friend, much “ bosomer” than you; 
 Jones, who has all the common sense, and is such 
 a practical, strong-headed fellow, you know; Jones, 
 who never felt uncomfortable an hour in his life, 
 and don’t believe in doctors and their nasty truck ; 
 Jones says, ‘ Nonsense; youre only scared!” Half 
 right, Jones! That sort of people are always 
 half right. ‘ Keep yourself quiet, and don’t eat 
 
SYMPTOMS OF CHOLERA. 21 
 
 anything—then your bowels will have nothing to 
 purge about. Guess conundrums, and leave this 
 little shake to nature, and you'll do.” Between 
 Jones and nature, let us see what he comes to. 
 
 An interval of twenty-four, or perhaps forty-eight 
 hours, has elapsed before you see him again. Can 
 this be the same man? Ah, Jones, what have you 
 done, with your conundrums and your nature? 
 The hand of death is on him? You read his doom 
 in his cadaverous countenance ; in the livid circles 
 around his mouth, and his dull, sunken eyes; in the 
 sharp, contracted features; in the blue lips, and the 
 leaden, brown, or even purple, face and neck— 
 according to the shade of his complexion, and the 
 intensity of the attack; in the wrinkled, sodden, 
 ‘¢washer-woman’s” fingers, from which the rings 
 have dropped off; in the bluish pearl-whiteness of 
 the nails; in the almost blackness of the lines 
 tracing the larger superficial veins; in the labored, 
 irregular, and broken respiration—“‘inspiration ap- 
 pearing to be effected by an immense effort of the 
 chest; while the nostrils, instead of expanding, col- 
 lapse, and stop the ingress of the air, and expiration 
 is hurried and convulsive.” 
 
 You call him by his name, and he answers with 
 a helpless, wild, terror-stricken stare. You read his 
 doom in that; and that look, if you are a doctor, 
 you will never forget; it is the very catastrophe 
 of forlornness. You read his doom in his incessant 
 tossing from side to side, and his agonizing travail 
 and struggle for breath—the throes of a woman 
 
22 SYMPTOMS OF CHOLERA. 
 
 in the fierce pangs of labor. You read it in the 
 shrunken toes, in the spreading, ‘dead-body” dis- 
 coloration of feet, and legs, and thighs, and arms, 
 and presently of chest and abdomen also. You read 
 it in the withered hand laid piteously, appealingly, 
 on stomach and breast. You feel it in the pulse, 
 small as a thread, and hardly vibrating, soon to be 
 totally extinct. You feel it in the deadly coldness 
 and clammy dampness of the skin; in the tongue, 
 perhaps white and loaded, but always moist and 
 flabby, and chilled, “like a bit of dead flesh ’—the 
 *¢ dog’s-nose feel.” You hear it in the almost gone 
 voice ; in the plaintive whisper of that eternal ‘ wa- 
 ter, water, water!” in the occasional weak, suffering 
 whine; in that dreadful low wail “which no man 
 who has once heard it can ever forget—the lowest 
 moan of the most wretched mendicant goes not to 
 the heart more poignantly.” If he tries to speak, 
 it is by only one word at a time; his lungs cannot 
 retain air enough for even the shortest sentence; 
 and oh, the weight and anguish at his heart; and 
 oh, the fire in stomach, and bowels, and throat! 
 Strange, too, that with skin so deadly cold, and 
 almost insensible to the action of chemical cauteries, 
 he should yet complain at times of feeling too warm, 
 and offer to throw off the bed-clothes; his very 
 sensations are beside themselves. If you could only 
 feel him, you would surely thik he had been dead 
 a day or two; and yet, from first to last, he has had 
 nothing like a well-marked chill, only now and then 
 a sort of nervous shivering. 
 
SYMPTOMS OF CHOLERA. yas 
 
 The attendants tell you that after you saw him 
 last, the purging became more and more frequent— 
 abundant, sudden, and “shot out”? with force— 
 nothing but watery stuff, Sir,—sometimes dirty, 
 sometimes with flaky, starchy matter floating in it— 
 but always like barley-water. Lvery time he was 
 purged his pulse would sink, and he would have a 
 spell of cramps in his feet and legs, and get bewil- 
 dered, and stagger like a drunken man, or fall down 
 like a helpless child. Since he grew so weak he has 
 not purged so often or so much—‘“ seems like he 
 hadn’t life enough in his body even for that.” The 
 vomiting has not been in proportion to the diarrhea 
 —not so frequent or sudden or abundant—and now 
 it has quite ceased; what he did throw up was like 
 the stools—barley-water or whey ; only once or twice 
 it was quite green. eit 
 
 ‘* How did the spasms grow upon him, and in what 
 form did they manifest themselves?” Well, first 
 of all, there was the thrilling and tingling im the toes 
 and fingers, as if they were asleep ; then a quivering, 
 rather strange than painful—a “funny feeling,” he 
 called it—in the hands and feet; then a sudden 
 twitching and stiffening and twisting of toes and 
 fingers which seemed to alarm him greatly ; he held 
 up his deformed hands in a helpless, pitiful way, and 
 cried. Next the calves of the legs, and the muscles 
 of the arms and thighs and loins were drawn up in | 
 excruciating knots—as if only particular sets of fibres 
 were in spasm, and the tendons stood strongly out ; 
 then, “the integuments of the abdomen were raised 
 
24 SYMPTOMS OF CHOLERA. 
 
 in irregular folds, and the belly itself violently drawn 
 backward toward the spine, the diaphragm upward 
 and inward toward the chest ;” here, too, were hard- 
 ness and constant pain, and the parts felt sore to the 
 touch. But though the cramps (which were inva- 
 riably increased on moving) were agonizing, there 
 was no convulsion. 
 
 No urine appeared now—the kidneys were already 
 dead; no bile—the function of the liver was abolish- 
 ed; he had ceased to expectorate—the salivary 
 glands. were withered; and, touching climax! the 
 fountain of his tears was dry: surrounded by all 
 that is endearing and heart-rending, wrung with 
 anguish, unnerved, undone—he could not even weep. 
 
 But the end is upon him. Colder, colder! That 
 horrible clammy, corpsy sweat, smelling of the vault, 
 burst forth afresh ; his lips and cheeks puff out and 
 flap, in expiration, “ with a white froth between them, 
 asin apoplexy.” ‘The spasms have cramped his very 
 vitals; his pulse is gone forever; fewer and fainter 
 grow the broken heavings of his chest; if you could 
 draw blood from him now, it would ooze drop by 
 drop, black and sluggish, tarry and cold. Now there 
 is a quivering among the tendons of his wrist, and 
 his weary breast is almost still. His mind has re- 
 mained clear through all the rack and agony, and he 
 is conscious yet; yet he makes no sign—only a long, 
 weary, convulsive sob, but no “rattle.” It is pain- 
 lessness and sleep that the lovely Angel Death has 
 brought him, and the most delicious moment of his 
 life is—the last. 
 
SYMPTOMS OF CHOLERA. 25 
 
 So that’s what “Common Sense” and “ unassisted 
 Nature ” did for a case of Cholera Asphyxia. As for 
 us, all that we can do for it is to see that the dead 
 body is not buried alive. 
 
 2 
 
IT. 
 VARIATIONS IN THE SYMPTOMS. 
 
 THE general features—what one may term the con- 
 tour—of Cholera Asphyxia, that compendium of 
 the prominent phenomena from which, in all latitudes, 
 seasons, localities, and classes, the disease may be 
 easily and certainly made out, being sharply defined 
 and uniform, the same symptoms, nevertheless, vary 
 
 infinitely in the degree of their intensity, “ according 
 
 to circumstances” internal or external to the indivi- 
 dual—from the simplest diarrheea, with little pain and 
 no cramps, and no graver derangement of the circu- 
 lation and temperature of the surface than occurs 
 from the operation of an ordinary purgative, up to 
 the overwhelming attack of a prostration so paralyz- 
 ing that the person stricken has scarcely become 
 sensible of pain when the secretions are suppressed 
 and the heart’s action sinks suddenly. 
 
 Sometimes the premonitory symptoms are pro- 
 tracted, and the patient has a week or more of warn- 
 ing, in the form of diarrhcea, uneasiness, and a sense 
 of heat and “ thrill” in the stomach and bowels; in 
 some cases, not diarrhea, but obstinate costiveness, 
 prevails. Sometimes he “ falls dead in his tracks,” 
 like the men in the army of the Marquis of Hastings. 
 At Bellamy, in India, a tailor was attacked while at 
 
 ee. | 
 
VARIATIONS IN THE SYMPTOMS. 27 
 
 work, and died in his working attitude, cross-legged 
 on his mat; and a merchant, concluding a bargain, 
 vomited twice, and instantly expired. At Mecca, 
 individuals in perfect health were suddenly stricken 
 to the earth, vomited, turned cold, and died. Be- 
 tween these two extremes the merciful admonitions 
 are of various duration, from a few hours to a few 
 days; in the large majority of cases the disease takes 
 from six to thirty-six hours to fully develop itself, 
 and terminates by death or convalescence in from one 
 to two days from the inception of collapse. 
 
 Sometimes the patient sinks at once, after discharg- 
 ing a small quantity of colorless fluid by vomiting 
 and stool; sometimes the vomiting and purging are 
 preceded by the spasms. Sometimes the matter 
 vomited, instead of being colorless or whey-like, or 
 like seething of oatmeal, is green, and the dejections 
 instead of being thin, and whitish and muddy, are 
 red and bloody; or they may even consist of a green- 
 ish pulp, like halfdigested vegetables. 
 
 We have described the cramps as usually beginning 
 in the extremities, and thence creeping gradually to 
 the trunk; but in some cases they are simultaneously 
 in all; and sometimes the order of succession is re- 
 versed, the abdomen being first affected, and then 
 the hands and feet. Generally, neither the vomiting 
 nor the purging is a symptom of long continuance ; 
 either they are checked by art, or the enfeebled body 
 is no longer able to perform those violent motions ; 
 so that they, together with the cramps, usually dis- 
 appear some time before death. After the first 
 
28 VARIATIONS IN THE SYMPTOMS. 
 
 emptyings of the bowels, the stools have been ob- 
 served to be yellowish, turbid, or frothy like yeast, 
 and though generally inodorous, they sometimes emit 
 a rank, fleshy smell. The dejections are seldom at- 
 tended with much griping, and sometimes they are 
 effected without effort or uneasiness, though generally 
 the calls are suddén and irresistible, and the dis- 
 charges expelled with alarming force. Tenderness 
 of the belly, on pressure, is not among the most 
 common symptoms, nor, we repeat, are the vomiting 
 and purging by any means the most important or 
 dangerous; in a great number of fatal cases they 
 have not been profuse, and have ceased, even with- 
 out remedies, early in the attack. 
 
 The cramps sometimes precede the vomiting and 
 purging ; but in the low and most dangerous form 
 of cholera, spasm is often absent, or is present in a 
 very slight degree. Tetanic spasms of the legs, 
 thighs, and loins have been observed, but there is 
 no general tetanus (lock-jaw) or even trismus. Hic- 
 cough in Cholera is not indicative of danger; on the 
 contrary, when it occurs in the interval of struggle 
 between death and reaction, it is a favorable sign, 
 and generally announces the return of circulation. 
 The spasm at the pit of the stomach is often very 
 acute, and the belly is almost always drawn toward 
 the spine by aremarkable permanent contraction of 
 the abdominal muscles. 
 
 The pulse oceasionally, though rarely, keeps up 
 tolerably for several hours after the disease has 
 plainly declared itself. Generally it becomes small 
 
VARIATIONS IN THE SYMPTOMS. 29 
 
 and accelerated at an early stage, and on the acces- 
 sion of spasm or vomiting, suddenly disappears from 
 the extremities. On the cessation of the vomiting 
 or spasin, and sometimes, apparently, from the ex- 
 hibition of remedies, the pulse will return to the 
 extremities for a short time, and then again be lost. 
 In the less severe cases it is not wholly extinguished, 
 though much reduced in volume, and a thread of 
 pulse, however small, is almost always felt at the 
 wrist, where recovery from the blue or cold stage is 
 to be expected. The sinking of the pulse in Cholera 
 is a symptom not less characteristic than the ca- 
 daverous countenance, or the hoarse, plaintive whis- 
 per (vow cholerica), or the discolored skin, or the 
 chilled breath ; when it can be felt, it is generally 
 regular and extremely feeble, ‘“‘ sometimes soft, not 
 very quick, usually ranging from 80 te 100.” 
 
 In the state of the skin, as in the other symptoms 
 of Cholera, striking variations are found. The sur- 
 face is sometimes observed to be dry, though cold ; 
 and in a few rare cases, natural—‘‘ nay, of preter- 
 natural warmth.” Arise of temperature has been 
 repeatedly observed to take place just before death ; 
 but the development of heat under such circum- 
 stances appears to be confined to the trunk and 
 head, and in almost all cases may be regarded as a 
 fatal symptom. It is not indicative of any restora- 
 tion of the diffused energy of the arterial system, or 
 of any improvement in the function of respiration. 
 The heat, in such instances, has continued well 
 marked for seme hours atter death. The skin, in 
 
30 VARIATIONS IN THE SYMPTOMS. 
 
 complete collapse, is generally insensible even to the 
 action of chemical agents, and hence the usual vesi- 
 catories fail to blister. The application of mineral 
 acids or of boiling water, in this condition of the 
 skin, produces little or no effect, and now and then 
 a patient is found who is insensible to the operation ; 
 nor can leeches draw blood, from an early period of 
 the attack. 
 
 The dlueness, so characteristic of Cholera in the 
 East, has by no means been found an invariable, or 
 even avery common phenomenon in England or the 
 United States. Dr. White, one of the physicians 
 to the Gateshead Dispensary and Cholera Hospital, 
 states that in scarcely one case in ten, in his prac- 
 tice, did the discoloration assume that form; but 
 there is often a deep, brownish hue of the face and 
 hands. This plueness or brownness can often be 
 temporarily dissipated by energetic friction. Ab- 
 sence of the peculiar “cold sweat” is a rare, and, 
 we believe, a decidedly unfavorable sign. 
 
 The urine, from having been limpid and free, will 
 become more and more scanty, and its passage will 
 sometimes be attended with such difficulty as almost 
 to amount to strangury; but as the collapse ad- 
 vances, this condition gives place to that in which 
 the kidneys have eeased to perform their office, and 
 there is no more secretion. Some patients complain 
 of an urgent and painful desire to empty the bladder ; 
 but the bladder is empty already, and after death is 
 found to be dwindled to the smallest size ; the desire 
 may arise from the contraction of the posterior disc 
 
VARIATIONS IN THE SYMPTOMS. 31 
 
 of the bladder, hard against the internal meatus, as 
 disclosed in post-mortem examinations. 
 
 The pains of Cholera are agonizing to the sufferer, 
 and at times so pitiful as to move the attendants to 
 tears. The patient tosses incessantly from side to 
 side, and complains of intolerable weight and 
 anguish at his heart. As he struggles for breath, 
 his imploring looks and gestures make you almost 
 feel the horror that is burning and gnawing, and 
 wrenching and rending at his stomach and chest. 
 At times, especially when the cramps are most 
 severe, he rolls about and screams—and then there 
 is that weary, weary cry for “‘ water, water, water,” 
 and that heart-rending, haunting wail when the cold, 
 bony grip of death is on him. 
 
 Violent headache is far from being a common 
 symptom in cholera—a neuralgic pain over one eye 
 is less rare. The cramp is invariably increased on 
 moving. In some cases the patient declares himself 
 free from pain and uneasiness, just when the dead- 
 cold skin and the sharpened, anxious features, and 
 the absence of pulse at the wrist, most surely por- 
 tend speedy dissolution. 
 
 During all this mortal struggle and commotion in 
 the body, the mind remains clear and the perceptions 
 unimpaired, almost to the final moment of existence. 
 “The patient, though sunk and overwhelmed, list- 
 less, averse to speak, and impatient of disturbance, 
 still retains the power of thinking and of expressing 
 his thoughts, so long as his. organs are obedient to 
 his will.” The mortal lies all down-beaten and dis- 
 
32 VARIATIONS IN THE SYMPTOMS. 
 
 traught, but the immortal is still master of itself. 
 Dr. Lawrie, Professor of Surgery in the Andersonian 
 University, who closely observed the epidemic as it 
 appeared at Sunderland, Newcastle, and Gateshead, 
 in 1832, commenting upon the declaration of the 
 majority of medical men, that the mind is always 
 unimpaired, says it appeared to him, in many cases, 
 affected to a degree little short of what we find in 
 concussion of the brain. He remarked this particu- 
 larly in several children ; when undisturbed, they lay 
 in a dull, sleepy, semi-comatose state, breathing with 
 perfect calmness; when roused, they thought only 
 of relieving their distressing sensations, and called 
 - vociferously for cold water. But he does not say 
 that he found them irrational or incoherent, or that 
 their condition was other than that which should 
 attend upon congestion of the vessels of the brain. 
 
EVs 
 THE STAGE OF FEVER. 
 
 A patient, having once fairly entered the stage of 
 collapse, is rarely restored to health without passing 
 through a fever closely resembling the typhus mitior 
 of Great Britain. The system, under the influence 
 of the peculiar and mysterious poison by means of 
 which the Asiatic Cholera does its work, has been 
 sunk into the lowest state of human existence. 
 Those vessels that had ceased to pulsate, and all 
 those muscular fibrils that had been for days con- 
 vulsed, contracted, and, as it were, knotted and 
 twisted in spasm, cannot at once resume their 
 healthy action. The vis medicatrix nature, mn 
 resuming its efforts, seems over-eager for the resto- 
 ration of the functions, and consequently sets up an 
 exaggerated and dangerous action in every artery. 
 After the “blue” cold period has lasted from 12 to 
 24, seldom to 48 hours, the vital powers begin to 
 rally, the circulation and animal heat to be restored, 
 the cramps to relax, and the vomiting and purging 
 to diminish, if they have not already ceased. The 
 warmth returns gradually, the pulse rises in strength 
 and fullness, and then becomes sharp, and sometimes 
 hard. The patient now complains of headache, with 
 ringing in the ears. The tongue becomes more 
 D* 
 
34 THE STAGE OF FEVER. 
 
 loaded, redder at the tip and edges, and dryer; 
 thirst continues, but there is less nausea. High- 
 colored urime is passed with pain, and in small quan- 
 tities. ‘The pupil is yenerally dilated, and soreness 
 is felt on pressure over the liver, stomach, and 
 bowels. The stools are no longer like water ; they 
 first become brown and thin—then dark, or black, 
 and pitchy ; and for some days the bowels continue 
 to discharge immense loads of vitiated bile. A pro- 
 fuse critical perspiration may appear, on the second 
 or third day, and leave the sufferer convalescent, but 
 more frequently the quickness of pulse, and heat and 
 dryness of skin are aggravated, the tongue becomes 
 deeply furred, brown and dry, and sometimes hard, 
 the eyes suffused and drowsy ; there is a dull flush 
 on the face, with stupor and heaviness. Commonly, 
 at this time, there is low muttering delirium, or 
 other marked disorder of the brain; dark sordes 
 collect on the lips and teeth, the patient is pale, 
 squalid and low, catches his breath, is extremely rest- 
 less, and moans “solemnly.” The pulse becomes 
 weak and tremulous; on the skin rigors alternate 
 with flushes of heat. Then comes a blessed insensi- 
 bility, and the patient soon sinks under the prostrat- 
 ing effects of frequent pitchy alvine discharges— 
 death arriving on the sixth, eighth or tenth day, or 
 even later, to the very individual whom the most 
 assiduous attentions had barely saved in the cold 
 stage. Constipation is not an uncommon symptom 
 in the febrile stage, and the urine is often secreted 
 abundantly—in fact, dangerous retentions are to be 
 
THE STAGE OF FEVER. 35 
 
 guarded against. It is probable that the duration 
 of the consecutive fever is, in the majority of Euro- 
 pean cases, commensurate with the duration and 
 severity of the collapse, and not materially depend- 
 ent on the kind of remedies employed. But some- 
 times a very mild case precedes a dangerous fever, 
 especially in Europe ; and sometimes after the seve- 
 ‘rest collapse, there is no fever at all, especially in 
 India.! In England the consecutive fever has been 
 regarded as more frequently fatal, unless strictly 
 watched, than collapse itself; and in cases of recov- 
 ery from even mild forms of fever, relapses, more or 
 less alarming, have not been very uncommon there. 
 
 The points of difference between the phenomena 
 of the European and the Indian forms of the epi- 
 demic, were intelligently stated by Drs. Russell and 
 Barry, in a joint report to the British Government, 
 dated “St. Petersburg, July 27, 1831,” and by Dr. 
 Lawrie, of Sunderland and Newcastle, in a commu- 
 nication to The Medico-Chirurgical Review, in 1832. 
 We believe that the same points of difference will 
 be observed in the epidemic now advancing towards 
 these shores: 
 
 First.—“ The premonitory stage occurs in a much 
 larger proportion of cases in the English than in the 
 Indian disease. In the latter it is the exception, in . 
 the former it is the general rule.” 
 
 [The writer of the present article can verify, from 
 personal observation, so much of this statement as 
 relates to the phenomena of Cholera in Malacca, 
 Burmah, and Hindostan.] 
 
36 THE STAGE OF FEVER. 
 
 Secondly.— The evacuations, both upward and 
 downward, seem to have been much more profuse 
 and ungovernable in the Indian than in the Kuro- 
 pean Cholera, though the characteristics of the evac- 
 uations are precisely the same.” 
 
 Thirdly.—* Restoration to health from the cold 
 stage, without passing through consecutive fever 
 of any kind, is far more frequent in India than in 
 Russia or England, nor does the fever in India 
 assume a typhoid type.” 
 
 [Recovery directly from the cold stage, without 
 the fever, is the rule in India; whereas, in England 
 or in the United States, we believe that few, who 
 have been once fairly Seat will escape the con- 
 secutive fever. | 
 
 Hourthly.— The borne of deaths in the cold 
 stage, compared with those in the hot, is far greater 
 in India than in Western Europe.” 
 
 Fifthly.—* The head is more frequently affected 
 in the British than in the Indian form of Cholera— 
 as shown by greater mental oppression and insensi- 
 bility during collapse.” 
 
 Siathly.—According to Dr. Lawrie, “the discol 
 oration of the surface is neither so frequent nor so 
 extensive in India as in England.” 
 
 [The dfuve is the common discoloration in India, 
 the drown in Europe; though in many cases, in both 
 England and this country, there has been a well- 
 marked purplish change. | 
 
 When we come to consider the pathology of Cho- 
 
THE: STAGE OF FEVER. ay 
 
 lera, the reader’s mind will revert to some of these 
 variations and phenomena, as confirming our views 
 of the nature and process of the morbid changes, 
 and of the treatment scientifically and logically indi- 
 cated. 
 
Y; 
 RECOVERY—TRUE AND FALLACIOUS. 
 
 Wuen the more formidable symptoms of collapse 
 have set in with severity, the chances of recovery 
 are in all cases precarious; and if the constitution 
 has been impaired by previous disease, or has failed 
 by reason of age, the case has always been regarded 
 as nearly hopeless. But in childhood, youth, and 
 the vigor of life, a well-instructed, sagacious, cou- 
 rageous and persevering use of remedies will often 
 be rewarded with complete success. 
 
 A thread of pulse, however small, is almost always 
 felt at the wrist where recovery from the “blue” or 
 cold stage is to be expected. In much less formidable 
 cases, it is never wholly extinguished, though much 
 reduced in volume; the respiration, too, is less embar- 
 rassed, and the oppression and anguish at the chest 
 are not so overwhelming, although vomiting, purg- 
 ing, and cramps may have been more intense. Just 
 where the favorable turn is taken, in the first feeble 
 efforts at reaction, the return of circulation is often 
 curiously announced by hiccough. Then the surface 
 begins to grow warm, the pulse reappears at the 
 wrist, and increases in strength and volume, and the 
 natural hue of the skin is restored. Next, the vom- 
 iting and purging cease, or rapidly diminish (in 
 
RECOVERY—TRUE AND FALLACIOUS. 39 
 
 certain cases of recovery from extreme collapse 
 they even return for a time, after having quite dis- 
 appeared) ; the cramps are relaxed; fecal matter 
 reappears in the stools; bile, urine, and saliva are 
 once more secreted and discharged; the voice 
 becomes stronger and more natural—the racked 
 and broken wretch sighs, weeps, and lives. 
 
 When the vital forces have begun to rally, the 
 physician cannot be too vigilant; he must watch 
 nature warily, suspiciously, to prevent the recur- 
 rence of collapse on the one hand, to repel conges- 
 tions of the head and viscera on the other. Where 
 the strength of the patient’s constitution, or the 
 curative means employed, are, although inadequate 
 wholly to subdue the disease, sufficient to resist the 
 violence of its onset, nature makes various efforts to 
 rally, and holds out strong but fallacious promises 
 of returning health. Or when the restorative efforts 
 are opposed by previous organic disease, general 
 feebleness of constitution, or the worn-out energies 
 of age, we must not calculate too confidently on any 
 imperfect reaction that may be induced. In all 
 such cases, the lost heat may be wholly or partially 
 restored; if only partially, the chest and abdomen 
 will become warm while the limbs remain deadly 
 cold—a most evil omen; the pulse may return, 
 erowing moderate and full; the vomiting and 
 cramps may cease; the stools may become green, 
 pitchy, and even feculent; there may be a partial 
 restoration of the natural excretions; and yet the 
 patient will suddenly relapse and sink, “not from 
 
40 RECOVERY—TRUE AND FALLACIOUS. 
 
 violent reaction or the development of any local 
 inflammation, but from want of energy in the vital 
 powers to carry forward the attempts at restoration 
 which seemed go happily begun.” ‘The sufferer may 
 have fallen into a flattering slumber ; but now anxiety 
 and sleeplessness will return, and all the alarming 
 symptoms be reéstablished. These ignes-fatuc of 
 rallying sometimes flicker for two or three days, 
 and all that time life and death will be poised in a 
 sensitive balance. In some of the most rapidly fatal 
 cases, warmth has partially returned to the surface, 
 and the pulse has fluttered and flattered immediately 
 before death. Be it remembered that the real dan- 
 ger is by no means in proportion to the quantity of 
 matter discharged from the stomach and bowels. 
 In some of the most trying cases this is not very 
 considerable, and in some of the most successful it 
 has been very great. Neither is cramp or spasm a 
 sure criterion. The great danger arises from sus- 
 pended or imperfect circulation. Restore and equal- 
 ize this, and you have “ cured the Cholera.” 
 
VI. 
 APPEARANCES ON DISSECTION. 
 
 THE appearances disclosed on post-mortem inspec- 
 tions of the bodies of those who have died of Cho- 
 lera, vary according to the duration and intensity 
 of the attack, the age, constitution, and previous 
 health of the “ subject,” and the remedies adminis- 
 tered; but enough of uniformity is found in the 
 reports of the most instructed and careful observers 
 —especially as to the points most significant, and 
 of the first pathological importance—to serve the 
 purpose of a description addressed to the unprofes- 
 sional multitude ; enough, too, we think, to afford an 
 accurate definition of the disease, in place of the 
 bewildering guess-work of the text-books. In the 
 language of the Medico-Chirurgical Review, “The 
 man who would treat disease successfully, must not 
 consider his only aim and object to be the knowl- 
 edge of the various 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 directed beyond this—to the 
 laws of vital actions, to the manner in which they 
 are disordered, and to those agents capable of re- 
 storing them to their healthy state.” 
 
 The bodies of those who have sunk in the earlier 
 
42 APPEARANCES ON DISSECTION. 
 
 stages of Cholera exhibit hardly any unhealthy ap- 
 pearance; the stomach and intestines are apt to be 
 paler, and more distended with air than usual, and 
 some explorers have discovered, fancifully perhaps, 
 a ‘characteristic feetor” from the abdominal cavity. 
 But in the more protracted cases, a greater or less 
 degree of injection of the mucous membrane, with 
 occasional ecchymosis, is the most frequent appear- 
 ance. It has also been observed, in cases where the 
 violence of the spasms proved the most prominent 
 symptom, that the mucous membrane presented 
 that appearance which approaches nearest to inflam- 
 mation. The large intestines are sometimes filled 
 with whitish and flaky-turbid fluid, sometimes with 
 greenish, yellow, or tarry matter—in other words, 
 with the characteristic discharges, or with vitiated 
 pile, just as the patient may happen to have died in 
 the earlier or later period of the attack, in collapse, 
 or in the struggle for reaction. In like manner the 
 stomach contains either the ingesta in an unaltered 
 state, or the same “veal-soup-like” stuff that the 
 patient has been vomiting; or its contents may be 
 green or dark. So, likewise, as to the vascular ap- 
 pearances presented by the alimentary canal, the 
 varieties seem to correspond, with instructive regu- 
 larity, to the duration, the stage, and the intensity 
 of the attack. The mucous membrane is generally 
 somewhat softened ; sometimes of an unusual pale- 
 ness throughout, “but oftener having various por- 
 tions tinted of various hues,” from the pale rose to 
 the dark brick-dust and slate-colors, as venous or 
 
APPEARANCES ON DISSECTION. 43 
 
 arterial injection predominates; patches of ecchy- 
 mosis and arborizations of the larger branches are 
 frequent; but the most common appearances have 
 been a red or purplish speckling of the mucous 
 membrane, generally over the whole surface, but 
 more apparent in some parts than in others. Some- 
 times these different appearances are scattered 
 throughout the entire extent of the alimentary canal ; 
 at other times the stomach alone is colored and the 
 intestines pale, or the stomach pale and different 
 portions of the intestines darkly injected. The 
 venous trunks of both stomach and intestines are 
 generally found remarkably engorged. The rule, 
 divested of its numerous exceptions, or rather modi- 
 fications, dependent upon circumstances and condi- 
 tions which the intelligent physician will not fail to 
 take into the account of each individual case, is: 
 Where the patient has not lingered, but succumbed 
 early to a rapid attack—no striking vascular change, 
 beyond general venous congestion, and turgidity of 
 the prominent vessels. Where collapse, in its com- 
 pletest form, has been developed, repelling and dam- 
 ming the current of the blood—universal dark en- 
 gorgement, with deep discoloration of the internal 
 surface of the stomach and intestines. Where the 
 disease has been protracted, and has reached the 
 stage of consecutive fever—every degree of arterial 
 injection, in addition to the congestion, from the 
 lightest blush to the angry flush of exaggerated action 
 and incipient inflammation. These are the keys to the 
 stages ; the mad malady rings many a change on them. 
 
44 APPEARANCES ON DISSECTION. 
 
 The liver is commonly found enlarged and gorged 
 with blood, but not always. In some cases it is 
 soft and light-colored, and not very turgid; in 
 others it is even collapsed and flaccid. The gall- 
 bladder is, almost without exception, full of dark 
 green or black bile. The spleen and kidneys are 
 not always surcharged with blood; quite frequently 
 they present a perfectly natural and healthy appear- 
 ance. The bladder is always empty and contracted. 
 The lungs have often been found in a natural state, 
 even in cases where there has been much oppression 
 of respiration. Much more commonly, however, 
 they are either gorged with dark blood, so that 
 they have lost their characteristic appearance and 
 have rather assumed that of the liver or spleen, or 
 they are remarkably collapsed, their bulk so much 
 reduced that they lie in the hollow on each side of 
 _ the spine, leaving the cavity of the thorax nearly 
 empty. In the majority of cases the heart and its 
 larger vessels are distended with very dark blood. 
 All the cavities of the heart are filled with a thick, 
 blackish treacle; and blood so dark that, when ex- 
 tended on a white surface, it resembles in color the 
 juice of the darkest cherry, is often found in the 
 arch of the aorta and in the other great arterial 
 trunks. The principal venous vessels are usually 
 found engorged—the most forcible injection could 
 not have more completely filled them—and the con- 
 tained blood is dark and sirupy. The vessels and 
 membranes of the brain are frequently turgid with 
 blood, particularly towards the base. <A fluid is 
 
APPEARANCES ON DISSECTION. 45 
 
 sometimes found effused into the convolutions in 
 considerable quantity, with more or less serum in 
 the lateral ventricles. The blood-vessels of the 
 vertebral column and spinal cord may be noticeably 
 congeste.!, and in some cases there are marks of in- 
 flammatory congestion in the larger nerves. But 
 the cases in which the brain presents a natural ap- 
 pearance, and those in which the sinuses and the 
 veins leading to them are stuffed with almost black 
 blood, are of equally common occurrence. 
 
VII. 
 
 HELPS AND HINTS TOWARDS A PATHOLOGICAL 
 DEFINITION. 
 
 THE consecutive fever of Cholera is not an integrant 
 and necessary part of the disease. It cannot be 
 distinguished from an ordinary continued fever, 
 except by the rapidity and fatality of its course. 
 It is the result of nature’s effort to recover herself 
 from’ the stunning shock that has prostrated her, 
 and the oppression that keeps her down. 
 
 Cholera is only cognizable with certainty during 
 the cold or “blue” period; of the three stages, the 
 collapse alone is true Cholera. 
 
 Where medical measures have been promptly, 
 energetically and successfully employed, the essen- 
 tial and diagnostic symptom, sudden sinking of the 
 circulation, has often not developed itself; and 
 there are cases where an excited vascular action has 
 accompanied the first tumult of the system in Cho- 
 lera. ‘These are precisely the cases which yield 
 most certainly and promptly to the remedial meas- 
 ures. In India it has been observed that these 
 favorable indications chiefly appear among the 
 European soldiers, who usually imbibe spirits freely 
 at the commencement of the attack. During an 
 - invasion of Cholera in Malacca and Burmah, in 
 
A PATHOLOGICAL DEFINITION, 44 
 
 June and July, 1852, the writer of this had medical 
 charge of an East India Company’s war steamer in 
 the Bay of Bengal and the Straits of Malacca. The 
 ship’s company was composed of Europeans and 
 natives— Malays and Mohammedans—in about 
 equal proportion. Under the peculiar treatment, 
 to be described further on, not a single case of col- 
 lapse occurred among the Europeans, all of whom 
 “indulged ” liberally, the officers in wine and toddy, 
 the men in their regular grog, twice or three times 
 a day, and in irregular “drinks” as often as they 
 could get them; whereas, among the natives, most 
 of whom were abstemious by reason of “ piety” or 
 vows, every case was collapsed; but the recoveries, 
 even from the cold stage, amounted to eighty-five 
 per cent. 
 
 If the superficial veins and arteries be opened in 
 the cold stage, the contained blood may flow out ; 
 but their walls then collapse, and no more blood 
 can be drawn. There is no authentic fatal case of 
 Cholera on record where the circulation has not 
 been arrested, in the extremities at least, long be- 
 fore death. 
 
 An increase of temperature is often observed, just 
 before dissolution; but the development of heat in 
 such instances is partial, being confined to the 
 trunk and head, and is a fatal symptom. This 
 mocking warmth is generally appreciable. for some 
 hours after death. 
 
 The application of boiling water to the skin, in 
 the worst cases of collapse, produces little or no 
 
48 A PATHOLOGICAL DEFINITION. 
 
 effect, and some patients are insensible to the opera- 
 tion; but it is certain that in a body but just dead 
 of some other disease, boiling water will vesicate 
 readily. So extreme is the diminution, or so com- 
 plete the destruction, of the nervous energy of the 
 skin in the cold collapse of Cholera, that there is 
 less vitality there in such cases, the patient being 
 still alive, than in the skin of a body recently dead 
 of a different disease. The writer has applied boil- 
 ing water to the feet and legs of patients in India, 
 without eliciting a tone or gesture of complaint. 
 
 The change in the condition of the blood—“ dark, 
 black or tarry, thick, ropy or sirupy”—is fully 
 proved to be in the ratio of the duration of the 
 disease, the blood more or less rapidly changing 
 from a natural to a morbid state as the disease 
 advances; such is the general rule. Observe that 
 the blood is usually found to be less changed in 
 those cases of Cholera which are ushered in with 
 excitement, than where collapse has occurred at an 
 early period of the attack. 
 
 The blood is sometimes found, on dissection, to be 
 of as dark a color in the left as in the right side of 
 the heart, affording reason to believe that in the 
 whole arterial system it is equally changed. In 
 many cases the temporal artery has been opened, 
 after attempts to procure blood from the brachial or 
 jugular veins had failed, and the blood in the artery 
 was found dark and thick, like the venous blood; it 
 flowed in a languid, ropy stream, and then the ar- 
 tery collapsed. 
 
A PATHOLOGIGAL DEFINITION. 49 
 
 {liccough is a favorable sign, and seems to an- 
 nounce the return of circulation, especially when it 
 occurs in the intermediate moments between the 
 threatening of death and the beginning of reaction. 
 
 While burning thirst, pain at the stomach, cramps, 
 asphyxia, clammy sweat, cadaverous coldness, and 
 aphonia, may all be present, vomiting and purging 
 may be absent, and “‘ yet”’ the case will rapidly run 
 to a fatal termination. The fact is, the vomiting 
 and purging are not only “far from being the most 
 important or dangerous symptoms ”—it is not only 
 true that “the danger of the case is by no means 
 dependent on the quantity of matter discharged 
 from the stomach and bowels,” and that “in some 
 of the worst cases this is not very considerable, and 
 in some of the most fortunate it is very great ”’— 
 but it is our conviction that the vomiting and purg- 
 ing are, in their original intention, genuine efforts of 
 nature to relieve the engorged vessels, and restore 
 the equilibrium of the circulation; that they con- 
 stitute nature’s safety-valve to the congestion; that 
 their presence, 77 collapse, is generally a favorable, 
 and their sudden disappearance a very unfavorable 
 sign. ‘They almost invariably cease a short time be- 
 fore death in the cold stage; they frequently return 
 ina notable degree at the beginning of reaction. 
 Mr. John Fyfe, of Newcastle, England, attended 
 579 cases of Cholera; and in all these, he says, col- 
 lapse never came on “until after profuse serous 
 discharges from the bowels.” Was not nature, by 
 those discharges, struggling to prevent the collapse ? 
 
 3 
 
50 A PATHOLOGICAL DEFINITION. 
 
 —in the language of Dr. James Johnson, Physician 
 Extraordinary to the King of England, was she not 
 making “violent, but too often unsuccessful, efforts 
 to restore the broken balance of the circulation, and 
 to reéstablish the secretions, by sickness and purg- 
 ing—the ejected fluids being exudations, not secre- 
 tions ?” Here nature cries to us for help, and shows 
 us how to help her—disclosing to us the inner mys- 
 tery of Cholera. If we do not make haste to aid 
 her in the direction she points out, she will exhaust 
 herself by her own tremendous efforts. 
 
 In Cholera there is every reason to believe that 
 every species of secretion, in all parts of the body, 
 is abolished. No known function of the mucous 
 membrane of the alimentary canal could form 
 matter like that which is discharged ; and as there 
 is no circulation going on in the skin, but rather a 
 complete state of asphyxia there, there can be no 
 secretion of perspiration. The “cold sweat” of 
 collapse is not true perspiration (like the critical 
 perspiration of the consecutive fever), but exuda- 
 tion; and, viewing the skin and the mucous mem- 
 brane as one continuous surface, itis just to conclude 
 that this exudation is homogeneous throughout. 
 “Whence, then, and how, come these discharges? 
 On the skin, certainly not from circulation, for there 
 is none there; and it is more than probable that the 
 capillary circulation of the mucous membrane of the 
 intestines is equally absent. It would seem as if the 
 elements of the body, composing the parts nearest 
 to the surfaces, became subject to new affinities, 
 
A PATHOLOGICAL DEFINITION. 51 
 
 forming a new substance, incapable of being retained 
 by the membranes, but rapidly oozing through them. 
 Two facts go to support such a hypothesis: First, 
 the abundant new formation transuded, where no 
 circulation exists; and second, the rapid amaigrisse- 
 ment of the body. This wasting of the body is not 
 merely apparent, it is real; the usual roundness of 
 the parts is taken off, and tendons and other salient 
 points become strikingly prominent.” We quote 
 from the report of Dr. Robert Nelson, member of 
 the Medical Board, and Commissioner of Health at 
 Montreal. 
 
 Of the two great classes of functions performed 
 by the organs of which man is composed, one only is 
 primarily paralyzed by the poison of Cholera. The 
 operations of the senses, and of the intelligence, are 
 either left untouched or are affected but in a second- 
 ary manner. It is the animal that dies; the intelli- 
 gence, awe-stricken, surveys the scene of death, and 
 trembles and wonders. Those functions by which 
 mere existence 1s preserved—those complicated 
 powers by means of which we are forever appropri- 
 ating, and converting into a part of ourselves, por- 
 tions of the matter around us—are, all at once and 
 all together, deranged and disabled by the blow of 
 this terrible angel. Nutrition is annihilated; respi- 
 ration becomes difficult, irregular, and inefficient ; 
 the involuntary muscles no longer perform their 
 offices; the voluntary are contracted in painful knots 
 by other powers than the will; the blood ceases to 
 circulate ; its physical properties are altered, its 
 
52 A PATHOLOGICAL DEFINITION. 
 
 serous element suddenly thrown out upon the in- 
 testinal mucous surface of the body; the secretions 
 are all arrested, and animal heat is no longer pro- 
 duced. 
 
 After the first, or premonitory stage, bile ceases 
 to be formed. We always find the gall-bladder full ; 
 but this filling has taken place before collapse set in. 
 There are no signs of bilious absorption. 
 
 The victim of Cholera does not die “solely of 
 starvation, caused by vomiting and diarrhea,” as 
 certain doctors hold; but by paralysis of a portion 
 of the nervous system, and consequent chemical and 
 organical decomposition of the blood. 
 
 During the prevalence of Cholera, there are often 
 observed among persons otherwise healthy various 
 anomalous affections of the nervous system—such 
 as cramps, cold sensations of the hands, feet, and 
 legs, a peculiar thrilling in the extremities of the 
 fingers and toes, and an oppressive feeling of anxiety 
 in the region of the heart. 
 
 Adult age exhibits a much more lively suscepti- 
 bility to the Cholera poison than early life; great 
 numbers of children escape it, simply because they 
 are less subject to the predisposing influence of 
 Fear. | 
 
 The idea of bleeding, in the stage of collapse, has 
 its origin in a hydraulic theory totally inadmissible 
 in Cholera. There is not too much blood in the 
 
 ‘whole body, but too much at the centres and too 
 little at the surfaces. A return to healthy distribu- 
 tion and circulation will not result from abstracting, 
 
A PATHOLOGICAL DEFINITION. 53 
 
 any more than from adding, a portion of the dam- 
 med-up mass. ‘The cessation of arterial action is 
 not owing to the state of the fluids, but to determi- 
 nate derangement in the nervous power, by which 
 the machinery of circulation has been stopped. Be- 
 sides, in most cases you cannot bleed; thickened 
 and stagnant in the vessels, the blood cannot be 
 made to flow; and if afew ounces be squeezed from 
 the orifices, it hangs from them in long tarry strings 
 —to no purpose. 
 
 The experiment of galvanizing is a kindred ab- 
 surdity. The desideratum in Cholera is not the ‘sup- 
 ply or restoration of vital or nervous power, but 
 the propulsion of that power to the surface from 
 which it has receded. 
 
NULL 
 
 PATHOLOGICAL CONCLUSIONS. 
 
 “ Not in the world of Light alone, 
 Where God has built His blazing throne, 
 Nor yet alone in earth below, 
 With belted seas that come and go, 
 And endless isles of sunlit green, 
 Is all thy Maker’s glory seen; 
 Look in upon thy wondrous Frame— 
 Eternal Wisdom still the same! 
 
 “The smooth, soft air, with pulse-like waves, 
 Flows murmuring through its hidden caves, 
 Whose streams of brightening purple rush, 
 Fired with a new and livelier blush, 
 
 While all their burden of decay 
 The ebbing current steals away, 
 And red with Nature’s flame, they start 
 From the warm fountains of the Heart. 
 
 “No rest that throbbing slave may ask, 
 Forever quivering o’er his task, 
 While far and wide a crimson jet 
 Leaps forth to fill the woven net 
 Which, in unnumbered crossing tides, 
 The flood of barning Life divides; 
 Then, kindling each decaying part, 
 Creeps back to find the throbbing heart. 
 
 * * * * * * * 
 
 “Then mark the cloven sphere that holds 
 All Thought in its mysterious folds, 
 That feels Sensation’s faintest thrill, 
 And flashes forth the sovereign Will ; 
 Think on the stormy world that dwells 
 Locked in its dim and clustering cells ! 
 The lightning gleams of power it sheds 
 Along its hollow, glassy threads! ” 
 Homes. 
 
 In 1831, Dr. James Johnson, whose clear-sighted 
 deductions have thrown so much informing light on 
 the nature of Epidemic Cholera, and who was at 
 that time editor of The Medico-Chirurgical Review, 
 
PATHOLOGICAL CONCLUSIONS. 55 
 
 and Physician Extraordinary to the King of Eng- 
 land, submitted to the Westminster Medical So- 
 ciety a series of propositions, embodying his views 
 of the pathology of the disease—views that have 
 never since been contravened, and to the convincing 
 completeness of which no later observations have 
 materially added. We extract the essence of those 
 propositions: | 
 
 “J. That in Epidemic Cholera, as in most other epide- 
 mics, a poison or sedative principle—whether emanating 
 from the earth, from animal or vegetable matter on the 
 earth, or engendered in the air—strikes a predisposed in- 
 dividual, and, after an uncertain period of incubation, 
 produces a train of phenomena, forming the subject of sub- 
 sequent propositions. In Sporadic Cholera (that is, common 
 cholera morbus), the general or diffusive cause is absent; 
 but when the common exciting causes are strong, and the 
 subject highly predisposed, severe or fatal cases will occur 
 (even in that less formidable malady), where the symptoms 
 cannot be distinguished from those of the malignant Hpi- 
 demic Cholera.” 
 
 [That ‘ Asiatic” Cholera arises from ‘ atmos- 
 pheric distemperature,” and is diffused through, 
 and conveyed by, the air, is evident from the fact 
 that its appearance in any place is usually preceded 
 by cases of cholera morbus, and the general preva- 
 lence of disordered digestion ; and when the disease 
 does appear as an epidemic, scarcely a single indi- 
 vidual in the same locality escapes having some 
 disorder of the stomach and bowels. Almost every 
 one complains of diarrhea. Morcover, this atmos 
 
56 PATHOLOGICAL CONCLUSIONS. 
 
 pheric distemperature is often so powerful as to 
 affect animals. In January, 1827, in Caleutta, cat- 
 tle, and even elephants, experienced the epidemic 
 influence to such a degree that they died in great 
 numbers. Everywhere in India, cattle and dogs 
 have died of Cholera, goats and camels in Persia, 
 monkeys in Burmah, chickens and turkeys in Mos- 
 - cow, and in Prussia multitudes of fish. Within a 
 week after the outbreak of the pestilence at Con- 
 stantinople, in July last, the birds of all kinds, from 
 the sparrow and swallow to the sea-gull and kite, 
 absolutely disappeared from the capital, and by 
 their return, early in September, announced with 
 reanimating certainty the restored salubrity of the 
 atmosphere. It was also said that the gilding on 
 the caiques in the Golden Horn and the Bosphorus 
 was tarnished, especially in those localities where 
 the Cholera had raged most severely. | 
 
 “IT, This poison manifests its effects according to the 
 evidence of our senses: jist, on the nervous system, as 
 evinced by the prostration of strength, 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 organic life.” 
 
 [Symptoms curiously resembling those of Cholera 
 are frequently observed to attend that sudden pros- 
 tration of nervous energy, that shocking annihila- 
 tion of tone, which follows upon a_ protracted 
 debauch, especially in subjects of highly nervous 
 temperament—that extreme depression into which 
 
PATHOLOGICAL CONCLUSIONS. 57 
 
 persons so constituted usually sink from extreme 
 excitement—that painful nervous back-springing 
 and unbalancing from excessive physical or mental 
 stimulation. In such cases there are often extreme 
 weakness, sudden diarrhea, cold sweats, shiverings, 
 sinking of the pulse, blue discoloration of the nails 
 and lips and around the eyes, excruciating cramps 
 creeping from the extremities to the trunk, distor- 
 tion of the fingers, tingling and thrills in the muscles 
 of the feet and hands, a sensation as if the balls of 
 the fingers were applied to cold metal buttons, agi- 
 tating anxiety about the region of the heart, tones 
 and gestures of imploring helplessness, suddenly 
 altered countenance, an expression of wandering 
 apprehension, and even the hoarsely whispering 
 voice. In like manner, the influence of extreme or 
 prolonged fear upon the nervous system, often mani- 
 fests itself in phenomena strikingly resembling what 
 are called the premonitory symptoms of Cholera. | 
 
 “TIT. The secondary effects of the choleraic poison are 
 shown in the vascular system. The heart acts feebly, the 
 circulation recedes from the surface, and the blood accumu- 
 lates in the vessels of the internal organs; decarbonization 
 and calorification cease, or are greatly diminished; the tem- 
 perature of the body falls to that of surrounding inanimate 
 substances; paleness is changed to blueness; and the influ- 
 ence of the ganglionic system of nerves seems to be nearly 
 suspended, if not annihilated.” 
 
 [The reader has but to revert to what has already 
 been noted in relation to the post-mortem appear- 
 
 9° 
 3*F 
 
58 PATHOLOGICAL CONCLUSIONS. 
 
 ances, and the changes in the distribution, quality, 
 and color of the blood, to appreciate the clearness 
 of this proposition and the accuracy of its state- 
 ment. The recession of circulation from the sur- 
 face, and the utter loss there of all that elasticity 
 which depends upon nervous vitality or tone, are 
 evinced by the peculiar ‘‘ pudginess ” or dough-like 
 quality of the skin, when it is pinched up between 
 the thumb and finger. | 
 
 “TV. 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 reéstablish the 
 secretions by sickness and purging, the ejected fluids being 
 exudations rather than secretions.” 
 
 [It is in this view of their intention or tendency 
 that the vomiting and purging are to be regarded 
 as natural rallying exertions. | 
 
 “V. Weare not, in our present state of knowledge, cer- 
 tain whether the spasms are merely the effect of the poison 
 on the nervous system, or an effort of nature to resist it; 
 but they, like the vomiting and purging, tend ultimately (if 
 not seconded) to exhaust the powers of life.” 
 
 [The writer was led, by his observations in India, 
 to the conclusion that the spasms do constitute such 
 an “ effort to resist” the paralyzing influence of the 
 _ choleraic poison, by restoring the continuity of the 
 obstructed nervous current. | 
 
 “VT. If nature (by which I mean the constitution), whe- 
 
PATHOLOGICAL CONCLUSIONS. 59 
 
 ther with or without aid, be able to resist the first or 
 depressive shock of the poison, and institute a reaction in 
 the system, that reaction, in a great majority of cases, be- 
 comes a fever, exhibiting a new train of phenomena, and 
 demanding a different mode of treatment. If this view be 
 correct, it would lead to the inference that the choleraic 
 symptoms constitute the first or cold state of a choleraic 
 féver.” 
 
 [Or, a more logical definition, that the true cho- 
 leraic symptoms are confined to the cold stage, and 
 that from the moment that reaction is substantially 
 set up, the disease ceases to be Cholera, and becomes 
 continued fever. | 
 
 “VII. 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 often remaining 
 but little impaired till the last glimmer of the lamp of life is 
 extinguished. This has been often witnessed in concen- 
 trated miasmal fevers, both within and without the 
 tropics.” 
 
 “VIII. All the changes which present themselves in the 
 dead body are effects, not causes of the disease; with the 
 exception of the congestion of black blood in the internal 
 organs, which is almost the only phenomenon observable 
 when Cholera terminates fatally in a few hours. The 
 traces of inflammation in various organs after death, indi- 
 cate the causes or effects of the reactive fever rather than 
 of the Cholera which precedes that fever.” 
 
 [This is not so well put. Why the exception? 
 The course of the disease being in three stages— 
 
60 PATHOLOGICAL CONCLUSIONS. 
 
 the premonitory, the cold, and the febrile—the 
 second stage only being true Cholera, and the poison 
 manifesting its effects first on the nervous system, it 
 is clear that the congestion of black blood is the 
 mechanical effect of paralysis of the nervous extremi- 
 ties primarily, and secondarily and consequently 
 of collapse of the superficial vessels, whereby the 
 Whole volume of the blood is suddenly repelled from 
 the surfaces to the centres, from the finer fila- _ 
 ments to the larger branches, and so on to the 
 great trunks, which are found loaded with thick 
 black blood after death. ‘This is the whole process 
 and sequence of engorgement and congestion, and 
 therefore the congestion should be regarded as the 
 effect of the Cholera proper, and the traces of vas- 
 cular excitement and inflammation as the effect of 
 reaction, and the cause of the consecutive fever. | 
 
 “TX. As we have no means of expelling or neutralizing 
 the poison, we can only endeavor to counteract its affects, 
 and to assist nature in her remedial movements.” 
 
 [The primary or essential indication is to restore, 
 not “the equilibrium of the circulation,” as Dr. 
 Johnson has it, but the impaired nervous vitality, 
 the paralyzed nervous energy, whereby that equili- 
 brium was lost. The balance of nervous power 
 restored, the balance of circulation follows, of course, 
 and then— secretion, calorification, oxygenation.” 
 This is the signal that nature makes in the cramps, 
 and the key-word is Revulsion. The galvanizers 
 tried to answer it, but their error was the same in 
 
PATHOLOGICAL CONCLUSIONS. 61 
 
 principle as that into which the bleeders fell; for 
 the galvanizers insisted upon adding something that 
 was not wanted, and which could not have been 
 added if it had been; while the bleeders insisted 
 upon taking away something that could not be 
 spared, and which could not have been removed. | 
 
IX. 
 
 EPIDEMIC CHOLERA AND CHOLERA MORBUS— 
 THE DIFFERENCE. 
 
 British CHoLtERA and Asiatic Cholera, Common 
 Cholera and Malignant Cholera, Sporadic Cholera 
 and Epidemic Cholera, Cholera and Cholera Mor- 
 bus—these are terms commonly employed to mark 
 the distinction between the two diseases. For our 
 own part, we regard it as a fact established that, in 
 their kind, they are one and the same; that the dif- 
 ference is of degree, of intensity and fatality, merely, 
 and the presence or absence of the diffusive cause. 
 In the characteristic phenomena, we find the family 
 likeness very strongly marked: vomiting and purg- 
 ing, pain and cramp in the.stomach and bowels, de- 
 jections at first thin and watery, afterwards bilious, 
 great sickness and distress at the stomach, spasms 
 in the muscles of the abdomen and extremities, in- 
 tense thirst and craving for cold water, sinking of 
 the pulse, cold arms and legs, dead-pale countenance, 
 distressed expression, cold sweat, and extreme pros- 
 tration. 
 
 Sydenham described an epidemic Cholera Morbus 
 that prevailed in England in 1669. In his opinion 
 the disease did not differ from the Common Cholera, 
 except that, that year, it prevailed epidemically. 
 
EPIDEMIC CHOLERA AND CHOLERA MORBUS. 63 
 
 The Bombay Medical Board have declared that 
 Sydenham’s description applies exactly to the Cholera 
 of India. ‘Therefore the people of India might at- 
 tribute their disease to importation from England.” 
 
 A Report of the Royal Academy of Medicine of 
 Paris says, “* The Cholera of India is, as to its symp- 
 toms, the Cholera of the ancients; and except in 
 intensity and danger, differs but little from ordinary 
 Cholera.” The most accomplished physicians of 
 England have indorsed this opinion. 
 
 The physicians of Montreal regarded the epidemic 
 of 1832 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 exhibited.” 
 
 The common Cholera Morbus of the United States 
 is usually considered a not very dangerous malady ; 
 but most writers declare that it often is so, and that 
 it frequently destroys life in a few hours. The de- 
 scriptions of this disease, found in old medical works, 
 always included the vomiting, purging, cramps, 
 sweats, and most of the symptoms of Asiatic Cholera. 
 Sydenham describes the first discharges as thin and 
 watery; and Frank says, “ At first the egesta are 
 like water—then as if flesh had been recently im- 
 mersed 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.” Observe that it is of 
 Cholera Morbus that he is writing. 
 
64 EPIDEMIC CHOLERA AND CHOLERA MORBUS. 
 
 No symptoms have been described as characteris- 
 tic of Epidemic Cholera that do not sometimes pre- 
 sent themselves in Common Cholera. Much stress 
 has been laid by certain observers on the difference 
 in the discharges. On this point Zhe Medico-Chi- 
 rurgical Review remarks: “If the fluids are colorless, 
 it is considered 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 dis- 
 charged fluids form no criterion of the disease. The 
 Bengal Board, for example, tells us that ‘the fluid 
 ejected from the stomach was watery, mostly taste- 
 less, transparent, or of:a whey or ash color. Some- 
 times it was sour, green, dark, like infusion of tea, 
 starchy, mixed with mucus, and viscid. In very 
 rare cases, pure bile was thrown up.’ In respect to 
 the alvine evacuations, ‘they were generally watery, 
 colorless, white, or muddy—sometimes red and 
 bloody—sometimes greenish and pulpy, like half- 
 digested vegetables.’ Is it not preposterous, after 
 this, to make the distinction between the Asiatic and 
 the English disease to consist in the color of the 
 motions? Nimium ne crede colori!” 
 
 Dr. Jarvis, a very intelligent physician of North- 
 field, Mass., communicated to Dr. Brigham of Hart- 
 ford, Conn., a description of “a very singular and 
 malignant disease” that prevailed at Warwick, a 
 hilly town in Franklin County, Mass.,in 1831. The 
 disease made its appearance in July, and in five 
 weeks thirty-two individuals were attacked, of whom 
 
EPIDEMIC CHOLERA AND CHOLERA MORBUS. 65 
 
 sixteen died. The malady manifested itself, in the 
 first instance, by distress at the stomach, extending 
 to the bowels; then by nausea, and vomiting, and 
 frequent calls to stool; the discharges were white 
 and watery. If the disease was arrested here, the 
 dejections became bilious; but if not arrested, the 
 vomiting increased; nothing could be retained on 
 the stomach but opium; the discharges from the 
 bowels were constant, and of a thin fluid, resembling 
 rice-water ; there were cramps of the muscles of the 
 abdomen and extremities, with intolerable thirst ; 
 the skin became cold, shrunken, and of a leaden hue; 
 the pulse weak, and often imperceptible ; the mind 
 not weakened or disturbed, the patients manifesting 
 but little anxiety about their condition, and con- 
 versing freely to the last. 
 
 These are but a few from the convincing array of 
 facts that might be marshalled to prove that the Epi- 
 demic Cholera of Asia differs from the Common 
 Cholera Morbus of the United States in intensity 
 and fatality only ; and that when the latter, by reason 
 of its violence and favorable local circumstances, as- 
 sumes an endemic character, there may remain but 
 the difference of a letter between the two diseases. 
 
X. 
 TREATMENT. 
 
 SaLT, mustard, vinegar and oil, pepper, red and 
 black, everything the casters afford, except tomato 
 catsup and Jockey-club sauce—as if Cholera were 
 chicken salad; wine, whisky, rum, and brandy, 
 Apple Jack and Old Tom—everything the decan- 
 ters, and nothing that the pitcher, supplies; rhubarb, 
 senna, and castor-oil; scammony, colocynth, jalap 
 and aloes; ipecacuanha, tartar-emetic, and sulphate 
 of zinc; calomel in all stages and in doses of all 
 sizes, from the homeopathic mite to the allopathic 
 monstrosity; opium in all its forms, and by every 
 imaginable mode of administration ; ether, camphor, 
 musk, castor, aromatic and stimulating tinctures; 
 essential oils of peppermint, clove, and cinnamon; 
 extracts of hyoscyamus and cicuta, prussic acid, sub- 
 nitrate of bismuth, colchicum, cinchona, serpentaria 
 and capsicum ; oil of vitriol, spirits of turpentine, and 
 for all we know, petroleum; brandy injections, soap 
 injections, tobacco injections, warm drinks and ice 
 water; tepid baths, cold baths, hot baths, vapor 
 baths, hot sand, friction with irritating rubefacients, 
 blisters, scalding water, mineral acids, red hot irons, 
 cold water pumped on the spine and the pit of the 
 stomach, bleeding, cupping, leeching, oxygen gas, 
 
TREATMENT. 67 
 
 laughin gas, injections of saline solutions into the 
 veins, electricity, galvanism, chloroform, clairvoy- 
 ance, hasheesh, inhalation, Perry’s Pain-killer, Rad- 
 way’s Ready Relief, Mrs. Winslow’s Soothing Syrup, 
 Phalon’s Night-blooming Cereus, Constitution Life 
 Syrup, and Mrs. Allen’s Hair Restorer. 
 
 For heterogeneousness and promiscuousness, and 
 elaborate and complicated stupidity and nastiness, 
 we know of nothing in the whole range of English 
 literature with which to compare the run-mad list, 
 unless it be Mr. Timothy Tickler’s description of the 
 spots on a steamboat table-cloth, in the Noctes Am- 
 brosiane. Enough, that it represents every degree 
 of “sagacity and energy,” from the most timid im- 
 becility to the most self-sufficient recklessness, from 
 “leaving the disease to Nature,” to murder with 
 ageravating circumstances; and that it stands for 
 the practice of all the gentlemen who have got 
 themselves inoculated with other gentlemen’s theo- 
 ries,—who have ripped with this Euripides of Vene- 
 section, or socked with that Socrates of Vesication. 
 Even if this were the place, and the time and space 
 were ours, to explore and discuss the bewildering 
 budget of notions, the labor were in vain. Our 
 readers will thank us for proceeding at once to our 
 demonstration of the method of treatment at which 
 we long ago arrived, by way of the pathological 
 conclusions already plainly stated, and by which 
 eighty-five out of every hundred of the collapsed 
 cases, and all of the premonitory cases, were reco- 
 vered, in the Bay of Bengal in 1852. ° 
 
68 TREATMENT. 
 
 But first, in this connection, it seems but fair that 
 we should call attention to a fact which has been 
 everywhere observed, and which may serve to ex- 
 plain the honor in which certain remedies have been 
 held in certain localities and seasons, only ta fall 
 into contempt at other times and places. The 
 causes that produce Cholera are always most violent 
 at first; and after an early climax of fury, the dis- 
 ease is observed to become more mild and manage- 
 able. Remedies then appear to have more control 
 over it, and the hope is entertained that the method 
 of treatment adopted has lessened the mortality and 
 triumphed over the scourge; but all such hopes are 
 almost sure to be blasted on a recurrence of the in- 
 vasion, or on trial of the same remedies in other 
 places at the commencement of the attack. Dr. 
 Lefevre, physician to the British Embassy at St. 
 Petersburg, and who enjoyed the amplest oppor- 
 tunities of observing the disease and ascertaining 
 the most successful modes of treatment, remarks: 
 “The Epidemic Cholera, on its first invasion, baffles 
 all attempts to conquer it; but it gradually loses its 
 intensity, and towards its decline, becomes as tract- 
 able as other diseases of the alimentary canal.’ 
 And Dr. David B. White, one of the physicians to 
 the Gateshead Dispensary and Cholera Hospital, 
 says: “ When Cholera first rages, its inveteracy is 
 greater than at any subsequent period, and remedies 
 which utterly fail in the first instance, acquire a re- 
 nown and celebrity when nature herself is at work 
 to assist them.” 
 
TREATMENT. 69 
 
 So, what is true of the period of the invasion is 
 equally true of the stage of the case: thus calomel, 
 before reaction, has been pronounced all vanity and 
 foolishness ; and bleeding, after reaction, has secfhed 
 all wisdom and virtue. Mr. William Scot, in an old 
 Report to the Madras Medical Board, on the treat- 
 ment of Cholera in the Presidency of Fort St. 
 George, says: ‘“‘ The suppression of the excretion of 
 bile being only a link in the common chain of symp- 
 toms, and the partial or occasional removal of that 
 excretion, 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 par- 
 ticular means, may be considered as premature and 
 injudicious. Whenever a favorable change takes 
 place, indicated by a renewal of the ordinary func- 
 tions, then the exhibition of the appropriate stimulus 
 (calomel) seems to be clearly indicated, and not till 
 then.” And Dr. Kinnis, in an account of the treat- 
 ment at Port Louis, Mauritius, in 1820, anticipates 
 the intelligent objections (to blood-letting) of many 
 later observers, in the following words: “The im- 
 pression produced on me is, that when only a few 
 ounces of blood can be obtained, their abstraction 
 accelerates the fatal event; and when bleeding can 
 be carried to syncope, the disease is curable without 
 it.” In other words, it is folly to bleed with the 
 object of “restoring the circulation,” since if you 
 can draw blood, it is because the circulation is 
 already partially or completely restored; and if 
 there is not circulation already, you cannot draw 
 
70 TREATMENT. 
 
 blood, and your cutting and squeezing only weaken 
 more and more the half-dead patient, and thwart 
 and cripple nature. 
 
 The fact is, nature is trying to do her own bleed- 
 ing in her own way, and doing it in excess—by the 
 profuse evacuations, we mean. In the language of 
 Dr. Kirk: “ When was it proposed, till the present 
 day, to relieve a condition of the extremest depres- 
 sion, and of no arterial excitement, by the abstrac- 
 tion of the principal vital fluid? Will the removal 
 of a small column of venous blood change the con- 
 dition of the rest of the sanguineous stagnance, or 
 impart energy to those nerves which, under a poi- 
 soned influence, have ceased to perform their impor- 
 tant functions of giving life and action to the whole 
 system?” No; the practice of bleeding, especially 
 in the stage of collapse, admits not even of that 
 similia similibus defence which may be set up for 
 the tobacco injections, of which it has been said that 
 when dogs are poisoned by them, the symptoms 
 produced are precisely those of Cholera—purging, 
 vomiting, cessation of the pulse, complete collapse. 
 
 But in spite of our promise, we have digressed 
 into debate, and with a thought of apology to the 
 reader, we come back to the treatment which we 
 believe has been conclusively proven to be the logi- 
 cal and natural end to which the true pathological 
 paths infallibly converge, and for which any one 
 must be prepared who has followed us thus far on 
 the trail of clear-sighted and keen-scented explorers. 
 
 There are usually three stages to a case of Cholera 
 
TREATMENT. Tl 
 
 —first, the premonitory or warning stage; second, 
 the “ cold-blue,” or stage of collapse, which alone 
 is true Cholera; and finally, the stage of consecutive 
 fever, which is the result of reaction, and differs in 
 no respect from a common continued fever. The 
 first and last stages may both be absent—that is, a 
 man may be suddenly struck down with collapse, and 
 as suddenly be restored to perfect health, without 
 passing through the stage of fever. The writer has 
 observed this phenomenon in its completeness, again 
 and again, on the coast of Siam; but it is of ex- 
 tremely rare occurrence in Europe or the United 
 States. “The poison of Cholera, in Great Britain,” 
 says Dr. Kirk of Scotland, ‘does not seem suffi- 
 ciently energetic to destroy the constitution in a 
 moment, as it is said it sometimes does in India. 
 Nature here struggles for emancipation, generally 
 for days together, and institutes new actions, and 
 various discharges, to relieve herself of her load.” 
 
 TREATMENT OF THE PREMONITORY STAGE. 
 
 This is simple enough—only be prompt. What- 
 ever you do, waste no time; for Cholera is the time 
 of failing forces, and the tide of circulation that is 
 going out, and it waits forno man. You may have 
 three days of warning—act as if you had but three 
 hours; and from the moment that you take hold 
 of what threatens to be a case of Cholera, keep con- 
 stantly in view the following indications, in their 
 order : 
 
72 TREATMENT, 
 
 I. To allay irritation in the nervous expansion of 
 the stomach and bowels. 
 
 II. To excite the vascular system, and to restore 
 fluidity, motion, and heat to the blood, by restoring 
 the impaired nervous vitality. 
 
 III. To reanimate the suppressed secretions. 
 
 IV. To obtain healthy evacuations from the bow- 
 els and kidneys. 
 
 V. To control and moderate reaction, and ob- 
 viate congestions, local determination, or organic 
 inflammation. 
 
 When the patient comes under treatment in this 
 stage of the disease, before the pulse and animal 
 heat have failed, his recovery may be calculated 
 upon with much confidence—especially if he be 
 young, of vigorous constitution, and with a reactive 
 vitality unimpaired by previous organic disease. 
 Therefore, while the symptoms are confined to sim-: 
 ple diarrhea, nausea, or imperfect vomiting, flatu- 
 lence, vertigo, headache, and pain in the abdomen 
 or pit of the stomach, thrilling sensations of heat 
 through the bowels, and probably occasional cramps 
 or quivering in the legs—to any or all of these 
 symptoms—send him at once to bed, and insist upon 
 strict repose. If he can use a bed-pan for the pur- 
 pose of evacuation, so as to avoid rising from his 
 bed even for that occasion, so much the better. 
 Many persons have experienced the full develop- 
 ment of Cholera, and have even died, for having, 
 in the beginning, refused to take to the bed for a 
 simple looseness ; and a diarrhcea which would surely 
 
TREATMENT. 73 
 
 have degenerated into Cholera has often been cured 
 by the mere repose and warmth of the bed. Keep 
 him warmly covered, and make him wear a flannel 
 band around his belly. An excellent application to 
 the abdomen is a bag filled with ashes, or bran, very 
 warm, and often changed. At the same time, if the 
 weather be cool, let the temperature of the apart- 
 ment be kept moderately high. Administer inter- 
 nally nothing, as yet, except half an ounce of castor 
 oil with 25 drops of Jaudanum, in a cup of strong 
 coffee. 
 
 But if the nausea and diarrhcea continue—espe- 
 cially if the oil and coffee are rejected—if the pain 
 in the abdomen and pit of the stomach becomes 
 more distressing, and the vertigo and flatulence, 
 and thrillings of heat in the bowels increase, apply 
 a large mustard poultice over the whole surface of 
 the abdomen, so as to cover the pit of the stomach, 
 and administer a draught consisting of a tablespoon- 
 ful of salt, dissolved in a large tumbler of warm water. 
 If the pulse has begun to sink, the extremities to 
 grow cold, and the cramps to be painful, repeat the 
 salt and water, doubling the quantity of salt, and 
 adding a teaspoonful of red pepper. This will act 
 as a free emetic, and will probably bring up a con- 
 siderable quantity of dark bile—perhaps thick and 
 vitiated ; but that will depend, to some extent, on 
 the intensity of the attack. The administration at 
 this time of an active emetic is in accordance with 
 the admirably expressed views of Dr. James John- 
 son, who says: 
 
 4 
 
74. TREATMENT. 
 
 ‘Of all the means which nature or art can bring into 
 operation, the act of full vomiting is the most powerful in 
 driving the blood from the trunk to the capillaries—from 
 the internal organs to the periphery of the body. It is 
 also the most universal excitant of secretion in every gland- 
 ular structure of the living machine. Nausea and retching 
 are quite different in their effects from the operation of full 
 vomiting; for they depress the power of the heart and 
 nervous system, and prevent the blood from flowing to the 
 surface; while 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 character, or at 
 least the appearance, of arterial blood.” 
 
 But this is the only time when it is surely an 
 advantage to administer emetics; in the more ad- 
 vanced stages they are of doubtful propriety. 
 
 If these measures prove ineffectual—if the pulse 
 continues to sink, and the surface to grow colder, 
 if the cramps increase in violence, and the dis- 
 charges from the bowels are losing their natural 
 feecal color and odor, and assuming the ‘‘ rice-water ” 
 characteristics, it is quite time to begin with stimuli 
 —equal parts of laudanum and spirits of camphor, 
 a teaspoonful in half an ounce of brandy every half 
 hour; for collapse is almost upon you, and you have 
 no time to spare; but don’t have recourse to stim- 
 uli until the pulse is decidedly sinking, and the sur- 
 face growing cold ; then nature needs them, and their 
 force is expended where it is needed. 
 
TREATMENT. wo 
 
 Cloths wrung out in hot water, and laid on the 
 abdomen, are very useful in alleviating the pain, or 
 any griping that may attend the diarrhea. 
 
 The following is an excellent formula for pills to 
 arrest the diarrhea, especially in persons destitute 
 of the comforts and conveniences of life, or whose 
 occupations keep them stirring or exposed: 
 
 R. Pulv. Opii—er. xv. 
 Hydrarg. Submur.— 3 j. 
 Pulv. Bacc. Capsici— 3 ij. 
 Confec. Rosee—q. s. 
 
 So as to make 40 pills. 
 
 One to be given every two hours, till the diar- 
 rhea is checked. They produce a degree of consti- 
 pation, which, if necessary, may be removed on the 
 second day by any mild laxative. Physicians will 
 find it convenient to carry a box in the pocket, for 
 the way-side emergencies of a cholera invasion. In 
 a few cases, not diarrhea, but obstinate constipa- 
 tion prevails, “after a longer or shorter duration of 
 which the disease suddenly appears.” For these, 
 castor oil, or rhubarb and magnesia, assisted by in- 
 jections of warm water, are to be preferred, whilst, 
 from first to last, drastic purgatives are to be strong- 
 ly deprecated. Active friction of the abdomen with 
 warm flannels, or the bare hand, will materially pro- 
 mote the action of the laxatives. 
 
 If the patient has already begun to suffer from 
 thirst, toast-water, beef-tea, and thin sago, are the 
 safest. drinks—a little at a time; and the diet should 
 
76 TREATMENT. 
 
 be confined to chicken and mutton-broth, and well 
 boiled rice. 
 
 Should recourse be had to the stimuli, of brandy, 
 laudanum and camphor, their action should be sec- 
 onded by the application of steady dry heat, and en- 
 ergetic and persistent friction. Let the upper and 
 lower extremities be surrounded with bags of heated 
 ashes, bran or sand, or with hot bricks and bottles 
 of hot water, wrapped in woollen cloths; heat com- 
 mon platters of metal or earthenware, and lay them, 
 wrapped in flannel, on the pit of the stomach and 
 the abdomen ; at the same time, assiduously rub the 
 legs and arms with warm flannels, sprinkled with 
 dry mustard. 
 
 So much for the treatment of the premonitory 
 stage, down to the point where it begins to pass 
 into collapse. The prompt and vigilant application 
 of these various measures will infallibly ward off the 
 “cold blue”. stage, in ninety cases out of a hun- 
 dred. In this place, by the by, we remember the 
 importance of enjoining cheerfulness, as far as may 
 be, in the attendants and surroundings of a patient 
 in the premonitory stage of Cholera. 
 
 TREATMENT OF THE STAGE OF COLLAPSE. 
 
 We will now suppose that all our efforts to shield 
 the patient from the icy grasp of true Cholera have 
 been unavailing, and that he is fast sinking into com- 
 plete asphyxia—his pulse no longer to be felt, his 
 skin brown or leaden, and doughy and clammy and 
 
TREATMENT. 77 
 
 cold, like that of a dead body, his tongue cold, even 
 his breath cool, his features pinched and shrunken, 
 his expression anxious and woe-begone, his fingers 
 and toes withered and puckered, his eyes sunken, 
 his voice hoarsely, piteously whispering,—wrenched 
 and torn with cramps, and maddened with thirst ; it is 
 a frightful picture; our readers should be shockingly 
 familiar with it by thistime. Well then, what now ? 
 
 Courage and Perseverance /—Heroic treatment 
 and indefatigable pertinacity !—You have this dread- 
 ful encouragement, that the case is clearer than it 
 was before, the ‘situation ” simpler ; you know your 
 foe now, and you confront him face to face ; you 
 have nothing to hope for from nature, and nothing 
 to fear from experiment, and noghing to lose; 
 you may cripple or exhaust your patient in 
 striving to save him, but the Cholera, if it break 
 down your guards, will surely slay him outright. It 
 is a fair stand-up fight between you and your giant ; 
 your patient’s vital subsistence, and your own scien- 
 tific ammunition, are running very low; if you 
 waver or parley, you are lost. Remember—that 
 “ the organs, during the collapse, probably owing to 
 deficient vitality, often give no indication of having 
 been acted upon by repeated doses of certain power- 
 ful medicines, which, under other circumstances, 
 would have produced the most decided effects.” 
 But forget the “ therefore ”’—that it is suggested (by 
 some irresolute and short-sighted practitioners, who 
 do not recognize an analogy even when it is held be- 
 fore their eyes) “that this temporary insensibility 
 
"38 TREATMENT. 
 
 of the system should not inculcate the administration 
 of such quantities as could, by accumulation, when 
 - the organs begin to recover their vitality, give rise 
 to unfavorable results.” If you administer to aman 
 who has been bitten by a rattlesnake, two or three 
 quarts of whiskey or apple brandy, you have no fear 
 that he will die “‘ dead drunk,” as soon as he begins 
 to recover his vitality; nor do you find it difficult to 
 understand why, in cases of Cholera that have been 
 treated with free doses of calomel in quick succes- 
 sion, salivation is so rarely produced. 
 
 Now, then, is the time to bring all your forces 
 into action, and engage them all together, with 
 intrepidity and éan. Begin by giving a large 
 enema—from three to four pints of as hot water as 
 the hand can bear, with six ounces of brandy, and 
 two drachms of laudanum. At the expiration of an 
 hour, withdraw this enema by a tube introduced into 
 the rectum—it will come off quite cold—and imme- 
 diately throw in another, without the laudanum and 
 brandy. At the same time administer by the 
 mouth, every half-hour, the equal parts of landanum 
 and camphor, a teaspoonful in half an ounce of 
 brandy, already prescribed. One hour after the last 
 injection of hot water alone, repeat it—this time 
 adding the brandy and laudanum—and so on by 
 alternate hours. Between the doses of landanum and 
 camphor, give five grains of QUININE, in any mode 
 of administration least disagreeable to the patient ; 
 if it be immediately rejected, immediately repeat it. 
 If the means of injection are not at hand, double 
 
TREATMENT. 79 
 
 the doses of camphor and laudanum, until some 
 simple apparatus can be procured; though it is rea- 
 sonable to expect that, in time of Cholera, every 
 family not absolutely destitute will be provided 
 _with one, and that no physician will go abroad 
 without it; it should also be in the power of every 
 police officer to furnish one at the shortest notice. 
 Still, though a great advantage, and the best of all 
 possible modes for applying heat, the enema is not 
 imperatively indispensable, the patient’s life does not 
 depend upon it; and if you cannot Inject, you may 
 make the double doses of laudanum and camphor 
 serve your purpose, especially if you have your great 
 gun, the Quinine, engaged. If he rejects the lauda- 
 num and camphor, give him a grain and a half of dry 
 opium every hour, until he ceases to vomit. 
 
 All this while it is to be presumed that you have 
 been pursuing your external treatment with re- 
 doubled assiduity and care; that your bricks, your 
 bottles of water, your bags of ashes or bran or sand, 
 are in their places and kept hot, worsted stockings, 
 filled with hot sand constituting a simple and effec- 
 tive appliance; that you are keeping your patient in 
 a strictly horizontal position, and in as complete 
 repose as may be practicable; that you have his 
 chest and arms clad in thick flannel, and his abdo- 
 men and thighs and legs covered with sinapisms, and 
 that you are applymg cloths wrung in very hot 
 water to his feet ; or that you are vigorously rubbing 
 him with dry warm flannels wherever and whenever 
 you can get at his legs or arms or trunk; that you 
 
80 TREATMENT. 
 
 cause his bed-covering, and his warming appliances, 
 to be carefully replaced as often as, in his restless, 
 tossing agony, he may throw them off; and that you 
 have made your assistants sensible of the impor- 
 tance of avoiding all unnecessary disturbance of the 
 patient, and of confining him to the horizontal posi- 
 tion until the heart shall have recovered its action, 
 by reminding them that an erect, or even half erect 
 position during the collapse, has been often observed 
 to produce instant death; indeed, any muscular 
 movement is more or less dangerous. For this rea- 
 son alone, the use of the warm bath, once in decided 
 favor, isto be positively condemned. In its time it 
 probably killed five cases for every one it saved; 
 baths of all kinds are painful and dangerous. 
 
 The patient ought never to be left, for a moment, 
 without an attendant firm enough to guard and con- 
 trol him, and sufficiently well instructed to be capa- 
 ble of acting according to circumstances, and taking 
 advantage of every change. ‘The application of 
 evaporating liquids, or indeed of any moisture, to 
 the general surface, should be forbidden, for obvious 
 reasons. When the frictions with dry warm flannel, 
 powdered with mustard, can be maintained by four 
 persons rubbing all at once the whole surface of the 
 body, the advantage is great. Mustard plasters 
 should be applied to the spine, when that can be 
 done without disturbing the patient too much; and 
 the vomiting is often allayed by linen cloths dipped 
 in hot water and laid on the pit of the stomach. 
 When the cramps are excruciating in the muscles of 
 
TREATMENT. 81 
 
 the arms and legs, the roller bandage, firmly applied, 
 will often afford decided relief; the patient com- 
 monly cries out for extension and pressure, “ strong 
 pressure,” there. For that inappeasable fiend of 
 thirst, the sufferer may suck or swallow whole, smail 
 lumps of ice, the size of a hickory-nut; no drink will 
 afford him such grateful relief; if you are compelled 
 to give him cold water, it should be colored with 
 brandy, and slightly acidulated, and he should be 
 allowed to sip it only. 
 
 And now, if you must be afraid, be afraid of the 
 Collapse, and not of your remedies. 
 
 Not of the stimulants—for if you have understood 
 what we have so conscientiously and particularly en- 
 deavored to demonstrate, as to the true nature of 
 the disease, and the pathological procession of the 
 phenomena, any defence of the stimulant treatment 
 is unnecessary; and if you have not understood that, 
 such a defence were useless. 
 
 Not of the opium—for the vomiting, the purging, 
 the cramps—originally honest efforts of nature to - 
 relieve the engorgement and congestion, and restore 
 the secretions, by giving a new impulse to the circu- 
 lation, and new energy to the insensible nervous ex- 
 tremities, having failed of their intention, have now 
 become simply exhausting, and must be stopped. 
 And who needs an argument to prove that that may 
 best be done by an astringent, an antispasmodic, an 
 anodyne, astimulant, allinone? Only, give enough. 
 When the Cholera first appeared in Russia, the 
 French Government sent an agent to St. Petersburg 
 
 4% 
 
82 TREATMENT. 
 
 to investigate the nature of the disease; and he 
 wrote: “ The brilliant success mentioned by English 
 physicians has been of very rare occurrence, and due 
 only to the very large doses which they have had the 
 courage, or rather the temerity, to administer.” 
 Remember, that collapse almost never comes on till 
 after profuse serous discharges from the bowels. 
 
 Not of the Quinine—for of all the medical agents, 
 whose aid fair science has invoked for the relief of 
 collapsed and congested, stagnant and dried-up 
 humanity, there is not one more direct, more consis- 
 tent, more clear in its great office of distributing and 
 equalizing the circulation, and leading the vital cur- 
 rent back from its bursting dams to its remote, 
 deserted channels, than this simple, faithful, noble 
 tonic. Moreover, you have, in the asphyxia of 
 Cholera, a true tonometer. Watch those puckered, 
 blanched, and withered fingers, and ply your quinine 
 without fear; for so long as they remain withered, 
 blanched, and puckered, you may be sure that the 
 ‘peculiar virtue of the drug fails before the paralyz 
 ing potency of the poison, with the inertness of 
 bread pills; but so soon as they begin to plump out 
 rosily with the returning genial heat— 
 
 Its faintest, feeblest stir 
 Slow-spreading, strengthening long, at last 
 Vibrating full in them,”— 
 
 then stop; so you will have nothing to fear from 
 “‘the accumulative effects of the drug ;” on the con- 
 trary, you will probably find the consecutive fever 
 
TREATMENT. 83 
 
 mildest and briefest in those cases of which the col- 
 ‘apsed stage has been treated with quinine—as from 
 she analogy of its modus operandi in intermittent 
 fever, you might expect. 
 
 It has even been argued in objection to the treat- 
 ment by quinine, that neither that “nor any other me- 
 dlicine” can produce any effect whatever in the col- 
 lapsed stage, because the absorbents are paralyzed. 
 But it must be evident that the remedial measures 
 here recommended to precede, accompany, and co- 
 operate with the quinine, forcibly tend to revive the 
 function of the absorbents, by promptly restoring 
 vitality to that portion of the nervous system from 
 which such functions are derived. 
 
 Of no disease in the whole dire catalogue is it truer 
 than of Cholera, that “while there’s life there’s 
 hope.” Keep on saying ‘‘ Never say die,” with the 
 pertinacious iteration of Barnaby Rudge’s raven. 
 Stick fast to your patient, and fight for him, in spite 
 of extreme unction, almost in spite of a charnel odor ; 
 and never give him up until the coffin-lid is screwed 
 down. Itis not easy to say just when people do die, 
 according to “ Crownners’ ’quest law,” in Cholera 
 asphyxia; for they are often colder and more insen- 
 sible than any dead man some hours before they give 
 up the ghost, and sometimes they are warmer than 
 many a living one, some hours after. At the Mission 
 San Dolores, near San Francisco, where many cases 
 of Cholera occurred in 1849, the writer saw a living 
 Mexican “ laid out.” 
 
84 TREATMENT. 
 
 TREATMENT IN RHACTION. 
 
 Unless your patient’s constitution has decayed with 
 age, or been broken by previous disease or de- 
 praved habits, he will, in a few hours, have rallied 
 under the treatment here prescribed. Now is the 
 time to bring up your “mercury ” reserve. As soon 
 as the pulse returns to the wrist, and begins to 
 acquire volume and strength—as soon as the natural 
 warmth and color begin plainly to return to the skin, 
 and the spasms to abate—at once, without waiting 
 for other signs of reaction, stop the injections, double 
 the intervals between your doses of quinine, and be. 
 tween those of laundanum and camphor; that is, that 
 there may be an hour from quinine to quinine, and 
 an hour from laudanum to laudanum—and tmme- 
 diately give twenty grains of calomel. If, at the 
 expiration of two hours, the evacuations have not 
 become bilious and frecal, repeat the dose. If they 
 have, stop the quinine, laudanum, and camphor, and 
 give ten grains of calomel; which should be followed 
 up, at the expiration of two or three hours more, 
 with a full dose of castor oil. If by this time he has 
 passed urine, and dropped into a restful slumber, as 
 will probably be the case, your patient is saved; the 
 Cholera has passed, and what remains is either com- 
 mon continued fever, or direct convalescence. 
 
 In June, 1852, Tobee, tindal of the Malays, on 
 board the Hon. East India Company’s war-steamer 
 Phiegethon, went ashore at Aracan, at 9 in the 
 morning, in perfect health. At 1 oclock he was 
 
TREATMENT. 85 
 
 brought back completely collapsed—cold and blue. 
 The treatment employed was precisely that which 
 has been prescribed in these pages, especially as to 
 the brandy, camphor, quinine, and calomel. At 7 
 o’clock the sane evening the natural heat and hue 
 had returned to the skin; after passing considerable 
 quantities of thick, black, vitiated bile, his stools had 
 become fecal and nearly natural; he had passed 
 urine, and was sleeping quietly. Twenty-four hours 
 afterwards he was on deck, comparatively well, and 
 on the third day he was discharged from the sick- 
 list at his own request. He was a man of about 
 twenty-five, with an unimpaired constitution, and of 
 great personal strength and courage. He had no 
 fever. 
 
 This case was followed by several others—all 
 natives, and some of them strictly abstemious. -Ad/ 
 were collapsed, all took the quinine, none had the 
 Sever, and ail recovered. Among the European por- 
 tion of the crew not a case occurred; notwithstand- 
 ing that many of these got drunk as often as the 
 opportunity offered, and all took their regular daily 
 allowance of grog. 
 
 In the rallying stage it is important to watch the 
 changes, to prevent recurrence of collapse on the 
 one hand, and to ward off congestions of the head and 
 viscera on the other. The first is averted by repose 
 and external warmth, and by giving warm arrow- 
 root in moderate quantities; the second, when the 
 indications are threatening, by small doses of calomel, 
 and castor oil, with acidulated drinks. 
 
86 TREATMENT. 
 
 TREATMENT IN THE STAGE OF FEVER. 
 
 The eminent Mr. John Fyfe, of Newcastle, Eng- 
 land, who in 1831 attended 579 cases of Cholera, 
 used to say that the duration of the consecutive . 
 fever was commensurate with the duration and 
 severity of the collapse, and not much dependent on 
 the kind of remedies employed. This is certainly 
 far from being true of the Indian form of the disease, 
 especially of those cases which have been treated 
 with quinine; and even in England, and in this 
 country, a very mild case sometimes precedes a 
 dangerous fever; and sometimes after the severest 
 collapse there is no fever at all. In England, under 
 certain circumstances, the fever, unless strictly 
 watched, proved more frequently fatal than collapse 
 itself, though the symptoms were described as differ- 
 ing but little, if at all, from those of ordinary typhus 
 —except, perhaps, in the greater rapidity with which 
 they ran to a fatal termination. 
 
 There is apt to be much giddiness, pain in the head, 
 and stupor. If the case is a mild one, mustard 
 poultices applied to the neck. will relieve the head,— 
 and to the epigastrium, the stomach. Should there 
 be constipation, it may be corrected with simple 
 laxatives. Ifthe cerebral oppression is very serious, 
 the back of the neck should be blistered, and the 
 head shaved and kept cool with wet cloths, or even 
 with ice. Small doses of calomel and castor oil (as 
 in a preceding paragraph) should be given; and 
 great care should be observed to avoid errors of diet 
 
TREATMENT, 87 
 
 The congestion which threatens the head is the chief 
 danger, and it will often be necessary to precede the 
 blisters (which are sometimes applied to the scalp, 
 and sometimes also to the calf of the leg) by leeches 
 behind the ears or on the neck, 
 
 So much for a rational and successful treatment 
 of Cholera, from first to last. Whoever may be 
 disposed to take exception to the method, will surely 
 not deny it the merit of simplicity, procurability, 
 and adaptability. All the means and appliances are 
 within the reach of the poorest man; and in the 
 absence of a physician, any person of fair intelligence 
 and common sense can use them. 
 
 Children, with their fresher constitutions and their 
 purer habits—and, above all, their minimum of sus- 
 ceptibility to the influence of panic—are in infinitely 
 less danger from an invasion of Cholera than their 
 more corrupt and conscience-stricken elders. When 
 attacked, they suffer more from oppression of the 
 brain than adults: and their consecutive fever al- 
 most always assumes the shape of Hydrocephalus. 
 
 Relapse in Cholera—not very common—should be 
 treated on the same principles as the original attack. 
 
XI. 
 _ IS CHOLERA CONTAGIOUS? 
 
 Wiruin the limits of a compact practical treatise, 
 we cannot, with profit to the reader, and for the 
 attainment of that handy usefulness which, from the 
 first, has been our single aim in the preparation of 
 these papers, indulge our zeal by engaging in the 
 irrepressible conflict which this vexed question 
 seems to involve—a wordy, windy warfare, which 
 will not cease to be waged so long as straight facts 
 can be wrenched and twisted to the needs and tricks 
 of mere wrangling ; so long as medical Ephraims are 
 joined to their hobby-idols; so long as those who 
 have the power to establish and enforce quarantine 
 regulations find their personal advantage in the 
 exercise of that authority. But since it is by ‘‘ both 
 houses” conceded that if Cholera is contagious, the 
 most rigid quarantines that sagacity and experience 
 can devise, and firmness enforce, are imperatively 
 demanded for the protection of populations; and 
 that if, on the other hand, it zs noé contagious, such 
 quarantines are not only useless, but infinitely per- 
 nicious, by their tendency to plunge in extreme 
 misery the hundreds of families and thousands of 
 individuals who are dependent upon the commerce 
 they suddenly blockade, and the labor they sud- 
 
IS CHOLERA CONTAGIOUS ? 89 
 
 denly discharge; and so to encourage those condi- 
 tions which most potently invite the disease, 
 while, at the same time, they frighten off the 
 humaner agencies which alone can prevent, con- 
 quer, or mitigate it; therefore, we prefer to take 
 this question sharply by the throat, and to declare 
 our positive conclusion, deliberately reached through 
 careful examination and comparison of all the evi- 
 dence brought forward on both sides, as well as 
 from unusual opportunities of observation in the 
 very laboratories and hot-beds of this atmospheric 
 poison, that not a single case—well attested, and 
 clearly, completely Gemonstrated—of Cholera trans- 
 mitted by contact alone—with the person, clothing, 
 excretions, or effluvia of another “ case ”—has ever 
 yet been cited; and this we say in full knowledge 
 of all the guast “facts and proofs” elaborated by 
 the glorious minority of contagionists, whose doc- 
 trine manifestly tends, first, to make victims, and 
 _then to leave them prostrate and unbefriended ; 
 / for Panic nurses Cholera, and the doctrine of Con- 
 \. tagion patronizes Panic. 
 ~ It is safe to say that in India ninety-nine out of 
 every hundred physicians of any professional respect- 
 ability utterly flout, as a thing preposterous, this 
 “ Contagion” scarecrow, and the majority of them 
 regard it as a nuisance sufliciently noxious to be 
 abated by law. On this subject the present writer 
 conferred, during two years, with numerous medical 
 officers of the most accomplished attainments, and 
 complete experience, in the service of the East India 
 
90 IS CHOLERA CONTAGIOUS ? 
 
 Company, as well as with many of the Surgeons of 
 the Royal Navy, attached to the China and India 
 Squadrons; yet he cannot now remember one 
 who did not scoff the notions of the Contagion- 
 ists; and when we consider that these can, never- 
 theless, show upon their rolls here and there an 
 eminent name, we can only wonder at the common- 
 ness of crotchets and the uncommonness of common 
 sense. 
 
 In this connection we cannot do better than quote 
 from the very thoughtful treatise of Dr. Brigham: 
 
 “That some cities and fortresses, which established rigor- 
 ous quarantine regulations, have escaped the disease, is 
 very true; but it is also true that other places, immediately 
 adjoining those which were attacked, have escaped, not- 
 withstanding that every precautionary measure had been 
 omitted. It is further true that numerous countries, cities, 
 and fortresses have adopted and enforced the most severe 
 preventive regulations—that they adopted them early 
 and enforced them with rigor—and yet the disease ap- 
 peared among them. All that quarantine enactments can 
 do towards preventing 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 drawn, to 
 arrest its progress; St. Petersburg was entirely surrounded 
 by cordons sanitaires ; but all these regulations, enforced by 
 a powerful and despotic government, were unable to pre- 
 vent the approach and the spread of Cholera throughout the 
 Russian Empire. The efforts of Austria were equally un- 
 availing, for in a short time the disease passed her triple 
 cordons and invaded the country from Poland. Prussia 
 
IS CHOLERA CONTAGIOUS ? 91 
 
 employed sixty thousand of her best troops to enforce her 
 rigorous restrictions, and travellers bear testimony to the 
 severity with which they were enforced. And what has 
 been the résult? (turning to The American Journal of Med- 
 ical Sciences for May, 1832)—‘ An immense expenditure of 
 money, the suspension of commerce, a stop put to industry, 
 multitudes deprived of the means of acquiring subsistence, 
 and whole families rendered favorable subjects for the disease ; 
 but no stop to the extension of the disease—on the con- 
 trary, its progress was rendered more fatal, As an instance 
 of this, Breslau may serve as an illustration and a warning 
 to other cities. That city contains ninety thousand inhabi- 
 tants—active, commercial, and industrious, many of them 
 manufacturers and artisans. A quarantine of twenty days, 
 with the difficulties almost insurmountable which it en- 
 tailed, was established at the borders of the province, and 
 maintained with a rigor 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 of the public authori- 
 ties could not discover any communication between the 
 woman and any stranger or goods suspected of being infected. 
 But when the disease spread, the authorities saw too late 
 the deep injury their sanitary measures had. inflicted.’ 
 
 “Taught by lamentable experience, Russia and Austria 
 and Prussia have withdrawn their cordons, and acknowl- 
 edge not only their inutility, but that they are productive 
 of immense evils. Indeed, all the nations of Hurope are 
 abandoning severe quarantine regulations, and it is to be 
 hoped that the cities of the United States will not adopt 
 them, but place all their reliance, for the prevention of the 
 disease, ori the removal of those causes which in all coun- 
 tries have appeared to produce it.” 
 
92 IS CHOLERA CONTAGIOUS ? 
 
 With such darkness as that of the St. Peters- 
 burgs, Moscows, and Breslaus of imbecility before 
 us, is this a time to slip on the goloshes of Conta- 
 gion, as Hans Christian Andersen would say, and 
 step out into the Middle Ages of Fumigation ? 
 
 To. what purpose, save to set up the mare’s nests 
 of certain professional Pickwickians, is all this 
 tedious bewilderment of wrangling, when at every 
 turn the earnest and honest inquirer encounters 
 such facts as these that follow? We shall take 
 them as we find them, plainly and sturdily arranged, 
 in the excellent work already quoted; and we con- 
 tent ourselves with asking any reader who may 
 have previously qualified himself to answer, by 
 learning from a school-boy’s “‘Speller and Definer” 
 the meaning of the word Contagion, whether any 
 one of them could under any circumstances be true 
 of a disease not distinctly non-contagious ? 
 
 I. The great numbers attacked simultaneously, 
 and who had previously had no intercourse with the 
 sick—a fact which all writers on Cholera admit— 
 cannot be accounted for without supposing the dis- 
 ease to be simply epidemic. 
 
 Ii. The general exemption from the disease of 
 medical and other attendants on Cholera cases: 
 
 1. Dr. Jameson says that of between 250 and 300 
 physicians engaged in Cholera practice in Bengal, 
 only three took the disease. 
 
 2. At Bombay none of the hospital attendants 
 were attacked, though they were assisting the pa- 
 tients day and night. 
 
IS CHOLERA CONTAGIOUS ? 93 
 
 3. The Madras report shows that, in the hospital 
 of the Royals, only one out of 101 attendants was 
 attacked, and at the receiving hospitals for Cholera 
 patients at Trinchinopoly, St. Thomas du Mount, and 
 Madras, the attendants were numerous and some- 
 times shared the same bed with patients; yet noé 
 one took the disease. 
 
 4, At Berhampore none of the native attendants 
 on the Cholera hospitals were affected. 
 
 5. A letter addressed to the Medical Council of 
 Moscow, by eight chief physicians to the hospitals 
 of Astrakhan, says: “We have all, without any 
 precaution, touched and rubbed the sick; and we 
 have daily visited the hospitals crowded with 
 Cholera patients, where we have respired their 
 breath; yet we have neither contracted the disease 
 nor conveyed it to our families. The attendants who 
 nursed and applied frictions to the patients—who 
 put them into baths, changed their linen, and per- 
 formed other offices for the sick—remained free 
 from Cholera. In the military, as well as in the 
 civil hospitals, the linen and clothes of Cholera pa- 
 tients were transferred to other patients without 
 being previously fumigated or ventilated ; and, never- 
 theless, those who wore those garments did not be- 
 come affected with Cholera. Several nurses and 
 mothers, having Cholera, suckled their children both 
 during and after the disease; yet the latter were not 
 attacked.” 
 
 6. Dr. Lefevre, physician to the British Embassy 
 at St. Petersburg, reports as follows ; 
 
94 IS CHOLERA CONTAGIOUS ? 
 
 “In private practice, among those in easy circumstances, 
 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 anxi- 
 ety of mind, we might expect the influence of predisposition 
 to operate ; in no instance have I found the disease com- 
 municated to the attendants,” 
 
 7. During the prevalence of the epidemic at Mos- 
 cow, 587 persons, affected with Cholera, were admit- 
 mitted into a hospital where there were already 860 
 patients laboring under other diseases. Vot a single 
 one of the latter took the Cholera. 
 
 Dr. Zudkoff, of Moscow, who had formerly been 
 
 a Contagionist, declares that he saw, to his astonish- 
 ment, that all the attendants and all the soldiers 
 handled the sick, and supported their heads while 
 they vomited, without using the least precaution, 
 and without contracting the disease. 
 -. 8. Mr. Searie, who attended a very large number 
 of patients in Warsaw, where he had charge of a 
 hospital for the poor, writes that not one of the at- 
 tendants, not one of the nurses, not one of those who 
 handled the dead, fell a victim to the scourge. 
 
 9. In Berlin, 409 houses were visited by the epi-. 
 demic, and in 273 of these only one individual in 
 each house was affected, while in the remaining 136 
 four or five suffered in each. Such is the density of 
 the population in the quarters of Berlin so attacked, 
 that the census assigns 4,200 families, with an ave- 
 rage of four persons to each family, to those 409 
 houses, being an aggregate of 16,800 residents who 
 
IS CHOLERA CONTAGIOUS ? 95 
 
 lived in immediate contact with Cholera. Of this 
 mass, only 803 were stricken with the disease, or 
 about one in 18 persons. 
 
 10. In the Marine Hospital of St. Petersburg, of 
 forty-three attendants on Cholera patients, not a 
 single one was affected ; and in the temporary hos- 
 pital in that city, of fifty-eight attendants, only one 
 was attacked, and he after drinking kwass while 
 very warm. 
 
 11. Those engaged in post-mortem examinations 
 of Cholera cases have not been attacked by the dis- 
 ease. Such examinations have everywhere been 
 made without any precautions, and with perfect 
 impunity. 
 
 12. Dr. Foy at Warsaw, and ten others, inoculated 
 themselves with the blood of Cholera patients, tasted 
 their dejections, and inhaled their breath, without 
 receiving the disease. 
 
 13. As to the capability of merchandise to con- 
 vey, and afterwards to communicate the infectious 
 germ of Cholera, the Central Board of Health, in a 
 communication to the Privy Council, remark: 
 
 “There is, perhaps, no question in the whole range of 
 sanitary police on which so many and such irrefragable facts 
 can be brought to bear as on this—derived, too, from the 
 most authentic sources. 
 
 “Seven hundred and thirty ships, laden with hemp and 
 flax, from infected ports of the Baltic, arrived at the differ- 
 ent quarantine stations in this country between the Ist of 
 June and the 3lst of December, 1831. Many vessels also 
 arrived laden with wool and hides; yet not a single case of 
 
96 IS CHOLERA CONTAGIOUS ? 
 
 Cholera occurred among any of these ships outside of the 
 Cattegat sea, nor among the people employed in opening 
 and airing their cargoes in the lazarets. At the hemp and 
 flax wharf of St. Petersburg, where several thousand tons 
 of these articles arrived during the spring and summer from 
 places in the interior, where Cholera existed at the time of 
 their shipment for the capital, the persons employed in 
 ‘bracking’ or sorting, and who generally passed 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. Petersburg and the Imperial manufactory of 
 linen cloth at Alexandrofsky, where all the yarn is spun from 
 flax bracked and hackled on the spot” 
 
 14. Down to the 29th of February, 1832, Mr. 
 Aspinwall, American Consul at London, reported to 
 this Government that only one medical practitioner 
 had died of Cholera in England, although at a mode- 
 rate computation one thousand or more had been in 
 constant attendance on Cholera patients. And, ac- 
 cording to The Medico-Chirurgical Review, for 
 April, 1832, not a single medical man was affected 
 by the Cholera in Sunderland, Newcastle, or Gates- 
 head. 
 
 When the Cholera prevailed in its most virulent 
 form among the armed vessels and transports of the 
 East India Company’s fleet, in the waters of Tennas- 
 serim and Pegu, in 1852, no case occurred among the 
 medical officers or hospital attendants. At that time 
 the writer, having medical charge of a war-steamer, 
 freely handled the persons and clothes of Cholera 
 
IS CHOLERA CONTAGIOUS ? 97 
 
 patients, inhaled their effluvia, and mingled his 
 breath with theirs, with the impunity he expected. 
 So likewise did his assistants. No precautions 
 were taken against contagion, because contagion 
 was never thought of among men who annually re- 
 newed their acquaintance with Cholera. We be- 
 lieve that physicians and nurses are, ceteris paribus, 
 less liable to the disease than other classes of per- 
 sons, because, by constitution as well as habit, per- 
 haps, they are less liable to that sort of anxiety and 
 alarm, because in the midst of the disease their 
 minds are actively and wholesomely employed, and 
 because they are continually impressed with the 
 importance of hygienic care, and necessarily ae 
 to the practice of it. 
 
 Intelligent and impartial observation has erected 
 an iron-clad wall of proof against which the Conta- 
 gionists pop their small shot in vain, and on the 
 face of which the honest medical inquirer may read 
 these truths, for a law to his professional life: 
 
 ~ Cholera is strictly an epidemic, existing by force 
 of a mysterious poison diffused through the atmos- 
 phere. Whether the influences which produce this 
 poison are “telluric,” “ electro-magnetic,” or “ ani- 
 malcular,” we know no better now than we did 
 fifty years ago. 
 
 Cholera moves in the form of a vast volume or field 
 of such poisoned air. Its rate of progress is com- 
 paratively uniform, and its track not more eccentric 
 than may be accounted for by the influence of pre- 
 vailing winds. 
 
 i) 
 
 pe 
 
98 IS CHOLERA CONTAGIOUS ? 
 
 As soon as it reaches any given place, all the per- 
 sons residing in, arriving at, or passing through, 
 that place, who may be predisposed by certain con- 
 
 3 ae hereinbefore stated, become the selected 
 
 _objects of its attack, however widely they may be 
 
 scattered, and without regard to their possibilities 
 
 —of communicating with each other; it is sufficient 
 
 wre 
 v or New York in 1848, “although it had been intro- 
 
 that they are included in the Choleraic atmosphere. 
 
 Cholerais never brought; ¢¢ comes. If passengers 
 sailing from a port of France, where the epidemic 
 prevails, arrive in an American port, whither it has 
 not yet come, bringing with them the germs of the 
 disease alive in their own systems, those germs will 
 not grow and spread in the new and healthy air, but 
 will wither and die out for want of their natural 
 pabulum—the Choleraic atmosphere. 
 
 But if that atmosphere accompanies them, then 
 the germs will flourish and be propagated. This is 
 why the Cholera did not extend to London in 18381, 
 
 duced, and persons had been exposed to its infec- 
 tion.” The cases had been brought, but the epi- 
 demic had not arrived. On the other hand, “ 
 
 spread like wildfire in Paris, in 1832,” because the 
 epidemic brought its own cases along with it. But 
 the presence of the Choleraic atmosphere is an 
 ‘essential condition of the spread of Cholera. With- 
 
 tS it, a few isolated cases of aggravated Cholera 
 
 Morbus, in individuals rendered peculiarly suscepti- 
 
 ble and sympathetic by their local and personal ac- 
 cidents, are the worst that need be feared, and we 
 
IS CHOLERA CONTAGIOUS ? 99 
 
 believe that such examples of Cholera Morbus, oc- 
 curring during the prevalence of an actual epidemic, 
 constitute a large proportion of the whole number 
 of cases counted as true Cholera. Upon a prepared 
 nervous system, it is most natural that the fiercer 
 disease should beget its kind, even though the pro- 
 geny may be of weaker powers. 
 
 All attempts to prove that the disease was im- 
 ported into Sunderland and England, in 1831, failed ; 
 and the opinion that it was not imported at all 
 became very general, not only at Sunderland, but 
 throughout England, and especially among the 
 members of the medical profession. 
 
 On the 28th of April, 1832, at the last meeting 
 for that session of the famous Westminster Medical 
 Society (the members of which, by their profound 
 learning and their intimate acquaintance with the 
 disease, were as well qualified to decide this impor- 
 tant question as any other body of men in the 
 world), the prolonged discussion ‘“‘on the nature, 
 character, and treatment of Cholera Morbus” was 
 concluded by the adoption of the following resolu- 
 tion, Dr. Granville moving, and Dr. James Johnson 
 seconding : 
 
 “That the Westminster Medical Society, having devoted 
 the uninterrupted space of six months to the serious and 
 dispassionate consideration of the malady 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 members practically, as well as theoretically, engaged 
 
100 IS CHOLERA CONTAGIOUS ? 
 
 in that important ioquiry, 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 circumstance which has 
 come to the knowledge of the Society shows the disease 
 in question to have begun, progressed, and ended in the 
 ordinary way of every other epidemic disorder: ” 
 
 —that is, a disorder which falls at once upon great 
 numbers of people. 
 
 Quarantines to exclude the choleraic atmosphere 
 can, therefore, be best appreciated by such as he 
 who complained that he had caught cold by sleep- 
 ing in the Park with the gate open. 
 
 Says The Medico-Chirurgical Review: 
 
 “Medical men will now see how much they will have it 
 in their pywer, 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 will 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.” 
 
XII. 
 THE INFLUENCE OF FEAR. 
 
 Ir anything could render Cholera contagious it 
 would be the enervating influence of Panic—as when, 
 wanting a contagion of its own, it rides on the con- 
 tagion of fear. For fear diminishes the nervous 
 power, depresses and enfeebles the action of the 
 heart, retracts the blood from the extreme vessels, » 
 and deranges the secretions. 
 
 “Fear,” says Dr. Falconer (Zreatise on the Influ- 
 ence of the Passions on the Diseases of the Human 
 Body) “diminishes the power of the heart, and 
 enfeebles the pulse—sometimes to such a degree 
 that the blood does not flow on opening a blood- 
 vessel. Fear also arrests the natural secretions, and 
 renders those who are frightened more liable to be 
 attacked by contagious diseases.” 
 
 M. Virey (Dict. des Sciences Medicales) says: 
 ‘Hear produces derangement of the secretions, cold 
 perspiration, a recession of the blood from the sur- 
 face to the heart, and diarrhcea, with coldness and 
 paleness of the skin.” 
 
 Alibert (Physiologie des Passions) says: “ Fear 
 is of a contagious nature, and its effect upon the 
 body is to produce a retrocession of the blood from 
 
102 THE INFLUENCE OF FEAR. 
 
 the exterior to the interior, and to derange or sup- 
 press all the functions of assimilation.” 
 
 “The tendency of Fear,” says Dr. Brigham, “is 
 to produce and spread spasmodic complaints, and. to 
 become epidemic during great public calamities. It 
 not only disposes a person to be affected by a con- 
 tagious disease, but actually produces a disease, with 
 symptoms similar to the premonitory symptoms of 
 Cholera.” He calls attention to the fact, that an 
 individual 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 sen- 
 sibility, which will be followed by indigestion, diar- 
 rhea, or other derangement; and suggests that there 
 is great reason to apprehend that many, very many 
 cases of Cholera, if not produced by fear alone, are 
 ageravated by it to a dangerous degree; and that 
 cases of ‘common Cholera” are transformed, through 
 the influence of fear, into the malignant and fatal. 
 “ At the present alarming time, no duty of medical 
 men, and of all those who have influence over the 
 faith of others as regards the epidemic, seems more 
 imperative than that they should steadily endeavor 
 to quiet public alarm, and constantly abstain from 
 creating any fear about 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 Oholera which their fears suggest. In such 
 
THE INFLUENCE OF FEAR. 103 
 
 cases, every look and question and action of a phy- 
 sician is very important. He has it in his power, 
 not only to endanger the lives of the sufferers, but 
 to spread around a far more dangerous contagion 
 than that of Cholera—the contagion of fear ; 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 identical with, malignant Cholera; for the pas- 
 sion of fear falls in and unites with the disease, and 
 attacks and paralyzes the same organs.” 
 
 A man was once journeying in the interior of 
 Turkey, when he met the Pestilence. ‘Where are 
 you from?” he asked. ‘From killing 2,000 people 
 in Smyrna,” replied the Pestilence. “ That’s a lie,” 
 said the man, “I know that you have killed 6,000 
 there.” ‘ No,” said the Pestilence, “I killed 2,000, 
 and Fear killed 4,000.” 
 
 Adults exhibit a much more lively susceptibility 
 to Cholera than children, the apprehensions of the 
 latter not being so easily excited. It has been 
 observed that the little ones enjoy a remarkable 
 exemption from the disease; and its attacks are to 
 be looked for, for the most part, among the more 
 intelligent children of five or six years and upward, 
 who have derived from what they have heard or read 
 a depressing anxiety respecting i1t—-as of some invisi- 
 ble, mysterious, and fearful calamity, which is steal- 
 ing upon them and those who are dear to them. In 
 children, fear, like other passions, is soon effaced ; but 
 
104 THE INFLUENCE OF FEAR. 
 
 it is also more sudden and powerful in them, and far 
 more likely to operate dangerously upon their deli- 
 cate and susceptible nervous organizations when, by 
 their intelligence and imagination, they are in a con- 
 dition to entertain it. 
 
XIII. 
 HINTS TO THE SANITARY BOARDS. 
 
 Ir is curious that when the attendants employed 
 about Cholera cases in the febrile state are attacked, 
 they are never seized with ordinary fever, but with a 
 genuine cold blue Cholera. Nothing, therefore, is 
 more certain than that persons may arrive in our 
 ports apparently laboring under common feverish 
 indisposition, who really are suffering under Cholera 
 in the febrile stage. 
 
 Dr. Lefevre observed that the epidemic Cholera, on 
 its first invasion, baffles all attempts to conquer it; 
 but that it gradually loses its intensity, and “toward 
 its decline becomes as tractable as other disorders of 
 the alimentary canal.” Many other observers have 
 particularly noted that the deaths are everywhere 
 most numerous, in proportion to the whole number 
 attacked, at the commencement of an invasion. 
 
 In crowded, filthy, and ill-ventilated places, where 
 the exciting causes are actively combined against the 
 health of all who are exposed to their influence, the 
 disease takes an apparently infectious character, 
 tending still further to propagate it, and aggravate 
 the alarm. 
 
 Those who have practised abstinence from the use 
 of wine, beer, and ardent spirits, should not have 
 
 5 
 
* ae , 
 
 rn 
 
 ve 
 
 106 HINTS TO THE SANITARY BOARDS, 
 
 recourse to them in the hope of “ fending off” the 
 
 Sere Nor should those who have habitually and 
 
 reely indulged in the use of them, suddenly and 
 completely abstain. In either case the experiment 
 is a dangerous one. 
 
 The following remarks of a late writer are espe- 
 cially worthy of attention : 
 
 ““Eixcesses and extremes of all kinds predispose to 
 Cholera. Hxcessive filth does so. So does excessive 
 bathing, with a view to extreme cleanliness; for it reduces 
 the heat of the body, and debilitates the system. The 
 inordinate use of either animal or vegetable food is a predis- 
 posing cause. But so, most emphatically, is fasting or 
 abstinence, especially as regards animal food, The fearful 
 mortality from Cholera in Paris, in 1832, occurred during the 
 fastings of Lent. Nothing like it occurred at any other 
 period. Ina part of Louisiana, where nearly all the people 
 are Roman Catholic, the mortality in a Cholera epidemic 
 was quadrupled during and after a three days’ fast.” 
 
 In public and private, cheerfulness should be pro- 
 moted by every decent device—on the streets, by gay 
 processions—in the parks, by bands of music, and 
 moderately exhilarating pastimes—in dwellings, by 
 music, games, tableaux, &c.—everywhere, by the 
 various attractions of places of rational amusement. 
 Public journals should stand with a hopeful and en- 
 couraging face between the pestilence and the peo- 
 ple, and children and nervous persons should not be 
 permitted to read or talk about the Cholera at all. 
 Food, clothing, warm water, and consolation should 
 
HINTS TO THE SANITARY BOARDS. 107 
 
 be freely distributed among the poor. Soup, soap, 
 flannel and smiles will do as much good as tempe- 
 rance tracts and Cholera bulletins. 
 
 “Ttis 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 that they often do much injury by exciting 
 alarm, which their frequent meetings are sure to create, 
 and by their assurances to the public that the very first 
 case of Cholera shall be announced—as if some exceedingly 
 contagious disease was expected. In order to do much 
 good, Boards of Health require the power to change the 
 habits of the sensual, the vicious, the intemperate; and 
 above all, to clothe and feed the poor, and to provide cleanly 
 and comfortable dwellings for all classesin community. But 
 they have not this power. The only power that 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 burden of relieving the 
 wants of the suffering, and of thus preventing and mitigat- 
 ing the severity of this dreaded epidemic.” —Brigham. 
 
/ 
 
 XIV. 
 | THE DEAD. 
 
 Ir used to be believed, rather fancifully, that the 
 bodies of those who died of Cholera underwent 
 putrefaction sooner than those of persons dying un- 
 der the ordinary circumstances of mortality. There 
 is no evidence of any such tendency to rapid decom- 
 position, and people should beware of the notion. 
 
 In some instances the body—at least the trunk 
 and head—has remained sensibly warm for some 
 hours after death; and spasmodic twitchings of the 
 muscles have taken place and continued for a con- 
 siderable time in the corpse. Dr. Lawrie observed 
 that convulsive movements were common after men- 
 tal life was quite extinct; and that it was almost 
 impossible to say “at what moment the vital 
 motions ceased to vibrate.” A body lies appa- 
 rently lifeless; suddenly a convulsive shudder 
 shakes it; its hands are clenched; if you insert 
 your own within them, and force them open, they 
 shut again with a spasmodic catch. 
 
 Thus, those who cling to the notion that rapid 
 decomposition is peculiar to death by Cholera, are 
 apt to bury with indecent haste; while those, on 
 the other hand, who are ignorant and _ supersti- 
 tious in regard to the fallacious warmth and the 
 
THE DEAD. 109 
 
 convulsive movements, are loath to inter until the 
 remains have actually begun to putrefy. 
 
 On the 24th of July, 1832, the Special Medical 
 Council of the New York Board of Health pre- 
 sented a report in relation to the unnecessary haste 
 with which the bodies of persons who had died of 
 Cholera had, in some instances, been interred : 
 
 “The Council,” they said, “are of opinion that the dead 
 may, with perfect safety to the living, remain unburied at 
 least six hours [why not twelve?], even during the present 
 warm season, and, under proper precautions, for a much 
 longer period. They also deem it expedient that the public 
 should know that the neighborhood of the hospitals and 
 burying-grounds has not been found, upon inquiry, to be 
 peculiarly lable to the disease. At the public burying- 
 ground, called the Potter’s Field, where nearly 100 bodies 
 have been buried daily, during the past week, none of those 
 engaged in the work have been taken ill; and of the 100 
 persons living in the Asylum for the Deaf and Dumb, with- 
 in 200 yards of the same not one is known to have been 
 attacked. ” 
 
 MORAL. 
 
 Epidemic Cholera is a main branch of the Uni- 
 versal Sanitary Commission of Almighty God; and 
 of all the nuisances it is appointed to abate, that 
 which insults with foulest offense the nostrils of 
 the Divine Source of all physical and moral health 
 and healing, is fat, lazy, selfish, imbecile ignor- 
 ance or indifference. Chloride of lime will not 
 heal the sores of Lazarus, nor quarantines quiet the 
 consternations of Dives. 
 
110 THE DEAD. 
 
 “Wealth has no power to bribe, nor Beauty to charm this 
 oppressor ; 
 But all perish alike beneath the scourge of his anger ; 
 Only, alas! the poor, who have neither friends nor at- 
 tendants, 
 Creep away to die in the Alms-house, home of the home- 
 less,” 
 
APPENDIX. 
 
 [From the New York Tribune, Jan. 20, 1866. ] 
 CHOLERA—ITS HISTORY AND LOCALIZING CAUSES. 
 
 CHoteraA and Commerce have this much con- 
 nection, that the former follows the path of the lat- 
 ter, and keeps most easily along water-sides. At 
 Alexandria, it began last May in a filthy suburb 
 occupied by a dense crowd of Arabs, Maltese, and 
 Greeks, and there strengthened itself until it killed 
 two hundred a day. It also travelled to Cairo and 
 other places along the Nile. It passed around the 
 eastern coast of the Mediterrean, reaching Beyrout, 
 Jaffa, Alexandretta, and Smyrna, and by the middle 
 of July was taking a thousand lives daily in filthy 
 Constantinople. The island of Malta, the province of 
 Palermo, the cities of Modena, Ancona, San Paulo, 
 Valentia, Toulon, Marseilles, Gibraltar, Madrid, 
 Odessa, Paris, and Southampton, were reached, 
 proving that the epidemic does follow water-lines. 
 It travelled to Bagdad and the borders of the Per- 
 sian Gulf, and to Damascus and Jerusalem. At the 
 same time, Mecca and Medina, and the caravans of 
 pilgrims, were most severely attacked. Out of 
 700,000 pilgrims visiting Mecca in May, it is esti- 
 mated that 40,000 perished by Cholera. Out of a 
 single shipload of devotees from southern India, 
 arriving at the Arabian port of Moculla, in Mid- 
 winter, eighty died before their companions left the 
 ship. And, generally, it may be remarked, that the 
 relation of human agency in the transportation of 
 
112 APPENDIX. 
 
 the epidemic was unusually marked, and that the 
 epidemic has followed the laws: previously deduced 
 from its history; that the season was exceedingly 
 hot and damp; that the first and chief epidemic 
 centres were by the water-sides and in the most 
 humid localities, and that the epidemic earliest and 
 ost fatally “‘ afflicted the persons and classes who 
 dwell in foul air, and who are most negligent and 
 reckless in their diet, who indulge in excesses and 
 abuses of their appetites, and who are generally most 
 subject to the diseases that arise from bad diet and 
 the neglect of selfcare.” 
 
 This country has had four visitations of Cholera. 
 In June of 1832, it was found in an emigrant vessel 
 in the St. Lawrence river; it reached Quebec a few 
 days later, New York two weeks later than Quebec, 
 and soon afterwards cases were found in Albany and 
 other cities along the water-line of the Middle 
 States. In this city, it then killed 3,513. On the 
 2d of December, 1848, it again reached New York 
 in the emigrant ship “‘ New York,” having killed 14 
 passengers during the voyage of three weeks from 
 Havre. About the same time it arrived at New 
 Orleans, killing there 1,400 during January ; in a fort- 
 night it was at Memphis; another fortnight carried 
 it to St. Louis; and another to Nashville and Cin- 
 cinnati. On the 11th of May it reappeared in 
 New York, finding a home awaiting it at the Five 
 Points; and during that year 5,071 deaths occurred 
 in the city by it; and in the summer of 1854, it 
 claimed 2,509 more. 
 
 Dr. Snow, the Superintendent of Health of the 
 city of Providence—than whom a more careful and 
 efficient health officer is not to be found—in a recent 
 report to the Providence Board of Health, declares 
 that he ‘can point out the precise localities in the 
 city where the Cholera will prevail if it visits us 
 
APPENDIX. 113 
 
 again; can show the houses in which it will do its 
 worst work; can name the families and almost the 
 individuals who will have the disease; can show 
 what there is in those localities, houses, families, 
 and individuals, which will cause the disease; and 
 can show that those causes might be removed, and 
 the disease prevented, by the proper action of the 
 authorities, of the owners of the houses, and of in- 
 dividuals.” The General Board of Health of Great 
 Britain declared that, as was anticipated, in 1849, 
 the “Cholera returned to the same countries, and 
 the same cities and towns, and even the same 
 streets, and houses, and rooms, which it ravaged in 
 1832;” and, furthermore, it is stated that ‘but 
 very few indeed who suffered then have escaped 
 now, except in those instances in which sanitary 
 measures have in the mean time been effected.” 
 The city of Worcester, on the Severn, which had 
 twice been scourged, having performed a thorough 
 cleansing, escaped the following epidemic, which 
 swept the neighboring cities. The Cholera of 1849, 
 with insignificant exceptions, prevailed, out of five 
 hundred towns noted, in those previously known for 
 their local impurities; in sixty-cight towns, where it 
 raged severely, the Committee of the Royal Col- 
 lege of Surgeons found the localizing causes of 
 pestilence prevailing; and in fifty-one out of fifty- 
 three quarters where it first appeared, in as many 
 districts, the well-known and preventable causes 
 were found. Thus the medical officers report that 
 “in the town of Jewksbury the Cholera was first 
 announced in an alley containing a slaughter-house, 
 pig-styes, and a bone-deposit; and for more than a 
 month it lingered there, spreading thence over the 
 town. In the city of Hull it was at first limited to 
 the ill-drained localities. In St. Giles’ Parish (Lon- 
 don) it commenced in Church street, where the 
 
114 APPENDIX. 
 
 drainage and ventilation were bad, cleaning defec- 
 tive, and population dense. In Islington, malaria 
 from bad drainage and ventilation was the general 
 cause. In Chatham the disease was chiefly confined 
 to the narrow lanes and alleys which are crowded, 
 deficient in- cleanliness, and where fever is more or 
 less prevalent. In Liverpool the disease was con- 
 fined for the most part to the worst ventilated, low, 
 and ill-drained courts. Lodging-houses of this 
 character were sometimes alone attacked.” That 
 class of lodging-houses in England that has been 
 brought under sanitary regulations, with an aggre- 
 gate population of eighty thousand, was almost to- 
 tally exempt from Cholera during the last epidemics. 
 The report of the General Board of Health for 
 1849 states, that in the great tenant-house, called 
 the Metropolitan Buildings, in which health regula- 
 tions were complete, with a population of five 
 hundred, not a case occurred, although the ept- 
 demic was very fatal in that district. And the 
 report of the same Board, in 1851, states that “in 
 the Metropolis every efficient sanitary improvement 
 has been followed, as directly as cause and effect, 
 by a corresponding decrease of sickness and mor- 
 tality. There is no exception to this rule. It 
 applies to the courts, alleys, and houses occupied 
 by the industrious classes; it applies to public insti- 
 tutions of every kind—to prisons, to hospitals, to 
 lunatic asylums, and, above all, to establishments 
 specially erected to test the value of sanitary prin- 
 ciples—to the model lodging-houses of the Metro- 
 polis. In a report on Epidemic Cholera, it is 
 shown that only one out of seven hundred and 
 ninety-five persons, inmates of these model build- 
 ings, had been attacked by the disease; whereas, 
 among the population of London generally, one 
 person in seventy-five was attacked. 
 
APPENDIX. 115 
 
 CHOLERA AND COMMON SENSE. 
 BY THE EMINENT DR. JACOB BIGELOW. 
 
 Within the present century, Cholera, a disease in- 
 digenous in hot climates of the East, has at various 
 intervals made its appearance in the temperate lati- 
 tudes of Europe and America. It is now again ex- 
 citing interest from its possible, and, perhaps, proba- 
 ble approach to this country. 
 
 The experience of the last thirty or forty years 
 has led a majority of medical men who had observed 
 the disease, to believe that, as a general law, it is not 
 contagious. In this belief [ must individually remain, 
 until evidence more satisfactory than any which has 
 yet appeared shall justify an opposite conviction. 
 
 The great epidemics of 1830 and 1847 had a re- 
 markable coincidence in the path which they pursued, 
 and in the order and dates of their arrival in different 
 cities. They seem to have followed certain great 
 routes of travel, and to have avoided others equally 
 frequented. According to Lesegue, they both visited 
 consecutively, and in corresponding months, Tiflis, 
 Astrakhan, Moscow, St. Petersburg, and Berlin. In 
 1831, Cholera did not take the most frequented 
 route from Berlin to Paris, but passed along the 
 shores of the Baltic, crossed over to Sunderland, 
 went down to London, and again crossed the chan- 
 nel, and arrived in Paris about six months after its 
 appearance in Berlin. A disease propagated by 
 contagion of any kind would hardly have avoided 
 the most fr equented thoroughfares from Berlin to 
 Paris, while it occupied half a year in going round 
 England. 
 
 The epidemic now or lately prevailing in Europe 
 appears to date back at least nine months, at which 
 time it existed among the caravans of pilgrims visit- 
 ing or returning from the city of Mecca. In the 
 
 nv, 
 
f 
 
 ae ey believe it to be, it ought to have begun, and 
 
 \ 
 
 Noo 
 
 —. 
 
 H 
 
 116 APPENDIX. 
 
 middle of May last it was at Alexandria and Cairo; 
 in June, at Constantinople, Ancona, and Marseilles ; 
 and in November, at Paris, Havre, and other Euro- 
 pean cities. 
 
 Thus it appears that Cholera has now existed in 
 Europe from three to eight months, among cities 
 having constant commercial intercourse with sea- 
 ports of the United States, during which time thou- 
 sands of passengers and tens of thousands of bales 
 and packages have been landed in our maritime 
 cities. If Cholera were as contagious or portable as 
 
 perhaps finished its work, in many of our seaports 
 before this time. , 
 Epidemics require two things for their introduc- 
 
 _in the inhabitants of the place visited; and second, 
 
 j 
 
 ra and extension. These are, first, predisposition 
 | 
 
 e arrival or presence of an existing cause. This 
 
 fd . ° ° ° 
 \__ cause in some epidemics, such as small-pox, 1s conta- 
 
 gion. In others, it is an occult influence, not yet — 
 discovered nor understood, nor known to be con- 
 trolled, except in some instances, by hygienic 
 agencies. No country, I believe, has succeeded in 
 keeping out Cholera by quarantines, and no country, 
 as far as we know, can produce it artificially or re- 
 tain it after the predisposition has disappeared. In 
 its own time it moves on thoroughfares where men 
 are travelling, and spreads in cities where they are 
 stationary, for no better reason known than that 
 mankind are tts necessary food, and that where there 
 are no people there can be no Cholera. But why, 
 of two frequented roads or cities, it selects one and 
 avoids the other, investigators have not yet been 
 able to satisfy us. 
 
 The credit of having introduced the present epi- 
 demic into Europe is, by a sort of popular acclama- 
 tion, assigned to the hosts of squalid devotees who 
 
APPENDIX. 117 
 
 perform an annual pilgrimage to Mecca. Yet we 
 are told that “‘the Cholera exists every year among 
 the caravans of Mussulmans arriving at the holy 
 cities,” so that their supposed mission of forward- 
 ing the Cholera to Europe in most years fails to be 
 performed. 
 
 Cholera, like influenza and some other migratory 
 diseases, has not always advanced from east to west. 
 Of the vehicle in which it travels, or the course it 
 is next to take, we know about as much as mankind 
 knew of the cause of lightning before the discovery 
 of electricity. Its conveyance and propagation have 
 been ascribed to air, to water, to material foci, to 
 electricity, to ozone, or to the want of it. Of late, 
 in consequence of the vast development by the 
 microscope of the existence everywhere of minute 
 living organisms, it has become more common to 
 ascribe the arrival of this and other like epidemics 
 to certain unseen “germs,” which are called seeds, 
 or ova, cryptogamic, or animaleular, according as 
 the fancy of the theorist inclines him to adopt a 
 vegetable or an animal nomenclature. 
 
 But in this, as in many other cases, it is easier 
 to trace an analogy, or to assume a cause, than it 
 is to prevent an effect. Although inquirers have 
 been indefatigable in their attempts to enlighten the 
 world on the means of ridding ourselves of the pre- 
 sence of the various co-tenants of our globe, yet no 
 crusade has succeeded in banishing from our fields 
 and houses the unwelcome swarm of mosquitoes, 
 worms, grubs, and flies, which molest us with their 
 annual presence, nor in suppressing the blight of 
 grain, the potato-rot, or the peach-tree disease. 
 Happily, some, if not most of these, have their 
 periods of abatement or disappearance ; and this 
 rather through the order of Providence than the 
 agency of man. Cholera seems to abide in the same 
 
118 APPENDIX. 
 
 category. We know little of its exciting cause, and 
 not much of its prevention, except that by following 
 in our personal habits the dictates of reason and 
 experience we diminish both the fr equency and dan- 
 ger of its occurrence. 
 
 Whatever may be the cause or vehicle of Cholera, 
 credulous and excitable persons are impatient of 
 suspense, and are prone to cut a knot which they 
 fail to untie. When an epidemic disease first 
 appears, some coincidence is always brought to 
 light which is supposed capable of accounting for 
 it. The arrival of a ship, the opening of a trunk, or 
 the washing of a garment, are among the most fre- 
 quently accepted causes. But as these have hap- 
 pened a thousand times before, and apparently under 
 like circumstances, without any known results, it 
 had been thought necessary by some of our late 
 writers to narrow the compass of actual exposure 
 down to the reception of the morbid excretions of 
 one individual into the digestive canal of another. 
 The first impression made by this announcement 
 must, if true, be one of relief, the danger not seem- 
 ing likely to happen very often. But to the possi- 
 bility of such danger we can never oppose an abso- 
 lute negative, so long as we persist in eating smelts 
 and flounders caught. about the mouth of our drains, 
 or even turnips, salads, and strawberries raised at 
 Brighton. The risk, however, is so small, that most 
 persons will prefer to take it, rather than ‘to deprive 
 themselves of food or luxury. 
 
 Of the many sensation tales printed and reprinted 
 about Cholera, and the supposed instances of remark- 
 able communication or arrestation, it is sufficient to 
 say that they are frequently interesting, being fully 
 as dramatic as they are probable. 
 
 In the same regard we cannot help noticing that 
 credulity, and perhaps private cupidity, have caused 
 
APPENDIX. 119 
 
 much stress to be laid on the supposed preventive 
 efficacy of what are called “ disinfectants ;” a mys- 
 terious word, which implies a thing assumed but not 
 proved to exist. We have deodorizers, such as 
 chlorine, charcoal, ete., which by their combination 
 render certain effluvia imperceptible to our noses. 
 The narrative, then, of the physician of Malta, who 
 covered certain surfaces in vessels with oil, and had 
 them “ disinfected by chlorine gas,” “after which 
 no new cases occurred,” is to be classed with other 
 like results with which the medical press always 
 abounds at the close of epidemics. 
 
 In clean and well-regulated cities of temperate 
 climate, Cholera is far from being the most formid- 
 able of epidemics. A greater part of its victims are > 
 the miserably poor, the worn-out, the ill-provided, , 
 and the intemperate, in whom this disease only anti- 
 cipates the date, but does not greatly crease the 
 annual and biennial number of deaths. Its mortal- 
 ity in our Northern Atlanéic cities rarely amounts 
 to one per cent. of the population in a given place 
 or year, so that a man may reside through an epi- 
 demic in one of these cities with less risk than he 
 can take a pleasure voyage to Europe. After hav- 
 ing witnessed many cases of Cholera in this and 
 other cities, I am further satisfied that it affords one 
 of the easiest modes of exit from the world. 
 
 People who would avoid or prevent Cholera, should 
 cultivate equanimity, regularity of life and habits, 
 cleanliness, salubrious exercise, temperance, and 
 avoidance of all excesses. When they have done 
 their duty in providing for the care of the sick, al- 
 laying public panics, and abating public nuisances, 
 they may safely dismiss their apprehensions. Little 
 good and some harm is always done by the indis- 
 creet agitation of a subject which is toa great ex- 
 tent beyond our control. A single or sporadic case 
 
120 APPENDIX, 
 
 of Cholera occurring in a village of a thousand 
 inhabitants may attract little notice, and pass with- 
 out record; but a hundred cases in a city of a 
 hundred thousand inhabitants, make an aggregate 
 “which generally causes some panic, though the pro- 
 portion is exactly the same, and the panic equally 
 unnecessary. It is possible that the supposed im- 
 “munity of country districts in comparison with cities, 
 may be accounted for by the fact, that in the sparse 
 population of country towns, cases are less liable to 
 be detected and published. 
 
 I may be excused for repeating the following re- 
 mark from among some ‘‘ Aphorisms” published by 
 me about thirty years ago, when the disease was new 
 and little known to us: “Should the Cholera con- 
 tinue to prevail for three years throughout this 
 continent, it would cease to interrupt either business 
 or recreation. Mankind cannot always stand aghast, 
 and the wheels of society at length would be no 
 more impeded by its presence than they are now by 
 the existence of consumption, of old age, or of 
 drunkenness.”— Boston Medical and Surgical Jour- 
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