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THE UNIVERSITY
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|) Medical Library of E. F. WELLS, M.D. f
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-
nal.
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