/ IXbffdie REVELATIONS ON CHOLERA; y€ (^ OK, ITS CAUSES AND CURE. SAMUEL DICKSON, M. D., rOBMKRI.Y A MEDICAL OKFICKH ON THE STAFF IN INDIA. AUTHOR OF THE FALLACIES OF THE FACULTY THE UNITY OF DISEASE ; DISEASES OP INDIA ; AND FOUNDEK OF THE OHBONO-THERMAL SYSTEM OF MEDICINE. tp'i/ootr 'I^DON CHARLES GILPIN, 5, BISHOPSGATE STREET WITHOUT. 1848. we \S4fe LONDON: rjIINTED TOR CHABLES GILPIN, BISHOPSGATE STREET. F-l* NO- I«CS. K^i INTRODUCTION. CHRONO-THERMALISM. — ITS DOCTRINE OF HEALTH, DISEASE, RESTORATION, AND REMEDIES. Dr. Dickson's work called "The Fallacies op the Faculty, explaining the Chrono-thermal system of medicine, and proving the so called science of medicine, as taught in the schools, and practised on the public, to be little better than a random network of guesses, has passed through five editions in this country, as many in the United States of America, and has been translated into French, German and Swedish. The book and the author have been alternately abused, plagiarised and misrepresented,* and the system itself scouted as * The Report from the Select Committee on Medical Registration, ordered by the House of Commons' to be printed, 16th July, 1847, contains the following, among other " evidence :" — Veneris 180 die Junii, 1847. " The Right Honourable T. B. Macaulay in the Chair. "Edward James Seymour, M.D., called in and examined— t1359. Are you one of the Censors of the College ? — I 3 been Senior Censor and Junior Censor. " 1360. Are you not aware that many persons are calling themselves physicians, and are practising as physicians, ¦ V INTRODUCTION. quackery, and without acknowledgment adopted and practised. A wide amelioration of the practice of physic has resulted from such unacknowledged use of Dr. Dickson's discoveries, but still the probability is who have no other authority for so doing than the diploma of a foreign university ? — I know of no such persons but the homoeopathists ; and there is a Ghrono-thermal man, or something of the kind, but I am not personally acquainted with that case." Not personally acquainted with that case ! Why, then, Dr. Edward James Seymour, did you volunteer your " evidence" upon it ? You did it to sneer down a Medical Reformer. Yes, you deliberately went out of your way to slander a man whose torch of truth had set the old walls of your College in a blaze. You qualified your falsehood, to be sure, with the quibble that you were " not personally acquainted with that case." Turn to the London Medical Directory — Dr. Seymour, — that book is doubtless on the table of every College Censor — and blush, if blush you can, when you read there the true qualifications of the individual you have been pleased to call " a chrono-thermal man," with no other authority to practice than "the diploma of a foreign university." For the reader's benefit, and Dr. Dickson's justification, we may as well state them here :—: — Dickson, Samuel, 28, Bolton Street, Piccadilly, Physician. — Qualification, M.D., Glasgow, 1833 ; Member of the Royal College of Surgeons of Edinburgh, 1825; formerly a Medical Officer in the British Army ; author of— l. " A Treatise on the Diseases of India ;" 2. " Fallacy of the Art of Physic as taught in the Schools ;" 3. " Unity of Disease ;" 4. "Fallaoies of the Faculty, with the Principles of the E no-thermal System of Medicine ;" contributor to the icet" of a Paper on the Asiatic Cholera, and of various p Papers to,the "Lancet" and "Medical Times." INTRODUCTION. 5 that the great majority of people have never heard of Chrono-thermalism, or at best have only an indistinct notion, derived perhaps from their doctors; that it is some new and dangerous quackery, set up at random by some one who has never had a professional education, and who knows nothing of "the ills that flesh is heir to," and all the long list of specifics and remedies so abundantly set forth for them in the pharmacopoeias. It is necessary, therefore, to state, that Dr. Dickson was regularly educated in the schools of anatomy as a surgeon, and as regularly took his diploma as a physician, — that he practised both branches of the profession, as an army surgeon, serving on the medical staff in India, and administered for years the usual routine remedies for the usual diseases, with the usual success ; and it was precisely this success, with its long continuance of diseases, the fewness and slowness of its complete recoveries, and the number of its deaths, that continually forced upon him the question — Does medicine as taught in the schools deserve the name of a science ? And, after long and careful observation, he was led to the conclusion, that the teaching of the schools is not a science, that it too often takes/ the partial results of disease for the disease itself,! \ overlooks the most important phenomena of vi-j' tality and mortality, and takes some single resuHj of a drug as a proof of its sovereign efficacy. ( I n INTRODUCTION. There are four classes of books, in view of which any quite unmedical inquirer might find himself utterly puzzled. First, the nosologies, or lists of diseases; second, the pharmacopoeias, or lists of remedies ; third, the medical directories, or lists of men diplomaed as skilled practitioners of the mysteries of medicine ; and fourth, the registered returns of mortality. Let any one look over these returns from week to week, or year to year, either for particular districts, or the whole country, note how large the number of deaths is between the ages of 15 and 60, a period embracing the very flower of youth and vigour of the prime. Turn, then, to the causes of all these deaths, every one of the diseases set down has its description in the nosology, its remedy in the pharmacopoeia, and every case had its physician ; few of the deaths are set down as sudden, there was time enough for duly- administered remedies to be effectual, and force of life enough, with some little help to have shaken off the disease. With these facts before them, it is the duty of medical men to be somewhat cautious how they arrogate tQ themselves the true science of healing, and to investigate, immediately it is brought before them, any new theory of disease and remedies ; and it is no less the duty of the unprofessional public, to read and learn something for themselves, that in their own knowledge they may have some safeguard INTRODUCTION. against what often may fairly enough be called the routine quackery of medical attendants. Chrono-thennalism is here, but it is no quackery. Of all systems for the treatment of disease, the chrono-thermal requires the greatest skill and most observant attention on the part of the physician. The name chrono-thermal is made up of two Greek words, which literally mean, time and heat, and is sufficiently expressive of Dr. Dickson's discovery, that all the vital movements in health are periodic, have alternations of certain rates of motion, certain periods of action and rest, certain lives of temperature and nervous energy, — that every disease is a disturbance of the order or rate of the natural or healthful movements, and consequent temperature, and rate of wear and tear of the body, — that every such disturbance or disease is intermittent, having, like ague, its cold or lowest stage, its hot or highest stage, and its stage of rest, in which the vital movements and temperature are the same as in health, or make the nearest approach to it. Whatever amount of disturbance there may be, there is a continual effort amongst the vital forces, to get back to the. habitual or healthful alternations and rate of motion and temperature ; and when the vital organism is sufficiently strong to resist the disturbance, so that no vital organ is consumed or mortally wounded in the struggle, this Taismedicatrix naturse, or healing viii INTRODUCTION. Pture, will overcome the disease, and of *c the periodicity of health. In some measles, small-pox, scarlatina, typhus, idmitted fevers, the precise number of the fever will yield to the natural efforts to restore the state of health, is known and given in the medical books ; and it certainly says very little for the orthodox remedial measures, that most of these diseases run their stated time in spite of the remedies. The chrono-thermal remedies are such as aid the restoring force of nature. It is perfectly well known, that quinine, hydrocyanic acid, iron, silver, copper, strychnia, musk, Kifetida,' lialerian, colchicum, suitz, bismuth, turtine, opium, and arsenic, to which should be ed the hydropathic treatment, which, after all, is but a portion of Dr. Dickson's doctrine, Edse a more or less rapid and powerful effect the rate of vital motion and temperature, tever the condition may be, the effect of : agents is to disturb it, and the more powerful of them do so almost instantaneously. They require, however, to be administered with the most watchful attention to the stage, or fit of fever, in which the patient may be, and in the X instance, the very smallest doses that can uce any effect, until their effect upon that parar patient is clearly seen ; for all these remedies have a duplex action, and we have yet to learn ix in every case with absolute certainty beforehand, what their action will be. The chrono-thermal remedy at the wrong period, exasperates that particular fit, but given at the right time, it assuages and shortens its duration. There is no such thing under chrono-thermal treatment as a fever running through its stated number of days. During every fit of excited action and increased temperature, the remedy is such as diminishes that action, lowers the temperature, and brings on, sooner than would occur in the fits of the disease itself, the period of rest ; so also the stage of diminished action is I »ken in upon, both extreme periods are shortid, the alternation of disturbance is itself disbed, and the natural force, by the lengthened iods of rest, aided in its struggle to restore the ilthful alternations and balance of vital motions L temperature. For more full explanation of Dickson's discoveries, theory, and practice, we st refer the reader to " The Fallacies of the P3ut it is essential even here to call attention the fact, first urged upon the public by Dr. Dickson, that in every form of disease, bleeding lessens the natural restorative force, diminishes the vital power, is, in fact, a wilful abstraction of its very essence from the system. It makes the action of remedies comparatively weak, recovery 10 INTRODUCTION. always more slow, less certain, and sometimes impossible. On this subject, Dr. Dickson says, "I " have not always had this horror of blood-letting. " In many instances, I have formerly used the " lancet, where a cure, in my present state of i( knowledge, would have been effected without : " but this was in my novitiate, — influenced by " others, and without sufficient or correct data to " think for myself. In the army hospitals, I had " an opportunity of studying disease, both at home '* and abroad. There I saw the tall fine soldier, on ok upon that operation as very simple and very mocent, because very commonly practised." — And again, Dr. Dickson says, "the long shiver " of the severest ague, the burning fever, the fatal " lock-jaw, the vomiting, cramps and suffocation of " Cholera, the spasm of asthma and epilepsy, " the pains of rheumatism, the palpitating and " tumultuous heart, the most settled melancholy " and madness, dysentery, consumption, and every " species of palsy have I traced to loss of blood." Fortunately for humanity, this denunciation of the system of letting out the life-blood, has not been in vain. Far fewer now are bled into weakness, disease or death. On the approach of such a disease as Cholera, it is not possible too strongly to impress upon the public, that any bleeding, no matter under what pretence, increases to an extreme degree the liability to Cholera, and may even suddenly bring on an attack in its severest form. It may also be as well to remind practitioners of medicine, that every immediate purpose which in any case can be answered by blood-letting, is attainable by the harmless method of tying a wet bandage tightly round the arms or legs. One further fact as to blood-letting, it may be worth while to mention, that in a given quantity of blood, the first, taken from a healthy subject, there are a certain number of red globules ; in the next bleeding, even long afterwards, there are found fewer of these globules, and even years after if the bleeding have been heavy or frequent, the original proportion of these red globules is not restored. It may be that we have not yet discovered the essential use of these deep dyed particles in the blood, whether they be a cause of motion and life in the blood itself, whether they are essentially connected with its electrical condition, or with the vital energy of the brain and nerves ; but we do know that they are slow and difficult, if not impossible, of restoration, and that just as difficult is it to restore energy, tone, and high vitality to a system from which they have been abstracted. We again, therefore, urge upon our readers, that whatever other absurdity they may submit to, they set themselves resolutely against losing by leech or lancet a single drop of xiii INTRODUCTION. blood, for the blood is the life, and on it depends the power to resist disease and to recover from its attacks. There seems little reason to doubt that before any very long period, the same conditions will be present here as have given rise to Cholera in India and on the Continent of Europe ; as however, the majority are not attacked even in those places where the epidemic is most prevalent, it follows that all might escape its influence, if they could be put in the same condition of resistance. It is perfectly notorious, that comparatively few of those who are in vigorous health, or who have opportunities of occasionally breathing fresh country air, or who live in good houses, and are not over worked, nor over nor under fed, nor crowded together in sleeping apartments, nor addicted to intemperance, are attacked by Cholera. If a deficiency of electricity in the earth or atmosphere, or any disturbance of the currents of that all-pervading influence, bring on Cholera, by depriving us of our vital electricity, and so paralyzing the nerves that give life to the lungs, stomach, and other vital viscera, it is still certain, that by far the greater number are enabled to withstand the deprivation or disturbance whatever it may be. Instead, therefore, of perpetual apprehension at the approach or near neighbourhood of Cholera, there should be the most active exertion made by every one to get into the best condition to resist it ; and they must be very few indeed who cannot succeed in ensuring their own safety, if they will take the trouble and practice sufficient self-denial. Of all protectives against Cholera, the most effectual is a clean skin, which fortunately the number of private baths, and the public baths and washhouses enable every one to have at no great cost and with very little trouble. To preserve the skin in such cleanness, assures its perfect tone and health ; it is not sufficient to bathe occasionally, or even once a week, the entire person should be completely washed every day, and that for the very reason that makes most persons think it unnecessary, because we are so closely covered by our clothes. On that very Imnt the pores of the skin which may be called vital safety valves are clogged by the deposits ;he insensible perspiration. Doubtless many ions will be utterly astonished at the idea of ing to wash all over every day. For them it uite trouble enough to wash face, hands and nuch else as is seen above their dress. It is er, however, to take this daily trouble than to rembling from day to day at the thoughts of lera And after all, this daily purification of skin is no such difficult matter. The best and jst way of accomplishing it is to have a coarse sheet partially wrung out of cold water, thrown INTRODUCTION. INTRODUCTION. 15 sheet briskly for five or six minutes, and then to rub dry with as coarse a sheet or towel as the skin can comfortably bear. Those who adopt this practice, or who even rub all over every morning or Iht with a well wet towel, will soon learn from ir sensations of increased vigour, spirits and Leral comfort, that even so simple a process y be a powerful resistant to disease. Those who fancy that it would be impossible for them to bear the touch of cold water, can dip the sheet or towel in warm water, but if they use a warm sheet they should have a dry one thrown over them along with the wet one, and be rubbed Kr both, that they may not feel chilled by the id evaporation of the warm water. Next in importance to keeping the skin clean, is occasional change of air, which the railways make sufficiently easy to the great majority. So long as it pleases the authorities to make what the Times most justly calls a churned stagnant pool of the Thames, and to poison what should be a source of health, by pouring the whole drainage of the million population of London into the river, we cannot recommend the metropolitan population to seek the invigoration of pure air upon the Thames. If the working classes object, that either of these measures of protection are too expensive for them, we have but to reply, that for the most part the sums spent in gin-palaces and public-houses in increasing the tendency to Cholera would be more than sufficient to accomplish both the above powerful means of prevention. It is also important to avoid crowded ill-ventilated sleeping apartments, and it should be borne in mind that night is the period of greatest liability to attacks of Cholera. There can be no doubt that, were the system of model lodging-houses so extended as its complete success so far proves it might be, the victims of Cholera would be greatly diminished, merely by the increased comfort, healthfullness, and cheerfulness of a residence in such apartments. It may be taken as a proved fact, that Cholera is not caused by any pestilent exhalation ; it does not rise from choked-up sewers or cesspools, or open stagnant drains, or the churning of a city's filth up and down its rivers ; but each and all of these debilitate, and dispirit, and weaken the power of resistance to disease. Under such circumstances, the healthful alternations of motion and temperature are in the condition most easy of disturbance, and most liable to be upset by the conditions, whatever they may be, that give rise to the epidemic of the day. It becomes, therefore, the public duty of every individual, to see that Government and the various local authorities do not sleep over sanitary measures, and that no pretence of vested rights be allowed to stand in the way of the prompt removal INTRODUCTION. of every cause of predisposition to disease. The City authorities are no more entitled to continue any festering cause of pestilence, than men have a right to lurk behind a hedge with some deadly weapon to be discharged on passers by, or to poison the daily drink of a whole people. In conclusion, it may be well to remind our readers, that although in some instances attacks of Cholera seem to come on with the utmost severity, almost instantaneously, and without any premonitory symptoms ; yet, in by far the majority of cases, t patients are disordered in the stomach and els, and are out of spirits and oppressed with a feeling of lassitude and uneasiness for some days. In every such case, the best advice is, to avoid quack medicines and self-doctoring ; send for a medical man at once, and trust yourself entirely to his care. In cases, however, where premonitory symptoms have either not been present, or have been overlooked, and the attack of Cholera is sudden and severe, where there is no difficulty of breathing, it can do no harm, and may very probably afford considerable relief to foment the stomach, with flannels wrung as dry as possible out of hot water ."* * The best mode of administering these fomentations is to lay a folded blanket across the bed, under the patient's back, to pour water nearly boiling on the flannels, and wring them in a towel, and having laid them over the INTRODUCTION. In this milder form of Cholera, the cramps, however severe, are the reverse of dangerous. They are, in fact, the struggle of nature to furnish the Brain with an increase of vitality for the restoration of the paralyzed nerves. Dr. Wardross points out that, in his ingenious work on Diseases of the Heart, spasms have a purely mechanical action. By constricting the great muscles of the limbs, they constrict also their veins and arteries, stop the supply of blood to and from them, diminish the quantity of venous, and increase that of arterial blood in the heart, and excite it to greater activity. Thus a larger supply of arterial or vitalized blood, and the power of generating more nervous energy, are furnished to the brain. The cramp, therefore, is an eifort of the healing power of nature. We do not yet know how the paralysis of any important nerve produces spasms, but we do know that the tendency of these spasms is to enable the Brain to revitalize the nerve. In Suffocative Cholera, unless air be artificially furnished to the lungs, the cramps increase the danger. As no air can be inhaled, there is no vitalised blood in either the heart or arteries, the increased quantity sent to the brain is but an increase of pressure, that brings rapidly on the stomach, to lap the blanket tightly over, and pull up the bed-clothes. The flannels should be changed about every six or eight minutes. 19 INTRODUCTION. heavy stupor of approaching death. In Suffocative Cholera, therefore, it is important to stop the spasms, and the external application of chloroform for the purpose deserves a trial.* The great point however, the real resource for the preservation of life, is to get, as Dr. Dickson has most forcibly urged, air into the lungs. Do that and the mortalism of Suffocative Cholera is overcome, you gain time for the action of remedies, you may try the effect of a galvanic current along the course of the gastric branch of the paralyzed nerve, and there will, at all events, be intervals of vitality for the administration of the more active chrono-thermal remedies. It is right to state that Dr. Dickson is in no way accountable for this introduction. — Ed. * The hot fomentation mentioned above should also be used in Suffocative Cholera, but not for any long time, and in every case it would be well to place a folded handkerchief or linen bandage wrung out of cold water round the throat, covering the wet bandage with one of flannel, sufficiently tight to exclude the air, and changing it every ten or fifteen minutes, and a similar bandage should be tightly folded round the stomach. REVELATIONS ON CHOLERA. The Cholera is coming to England !— What is the meaning of this cry ? — What is this Cholera — this word which carries such fearful import to the ears of the world at large ? The term Cholera is a derivative from the Greek words x o^ bile, and pew, I flow. It conveys, then, not the least information as to the nature of a disease, where neither the abundance nor paucity of that secretion — its vitiation or variation — is an element entering into the danger to life which the phenomena called Cholera involve. To know Cholera, you must know every wrong movement of the body. To describe Cholera, you must describe every purely functional disease to which humanity is liable ; for, with the single exception of structural change, for the development of which the complaint is too brief in its duration, there is not a possible morbid movement which may not occur in its course ! Its study is consequently pregnant with instruction, equally to the inquiring physiologist, and to the lover of pathological research. Hitherto the morbid anatomists have been almost the sole authorities on Cholera. Confining their B 2 observations to the post mortem changes which the Brain exhibits on dissection, certain of them suppose the disorder to consist in a peculiar inflammation of that organ ; others, looking to the dark and vascular state of the stomach and bowels, believe inflammation of those parts to be the origin of every symptom and change : not a few imagine the liver to be the chief seat of mischief, from the congestion which it in general betrays ; while the state of the bile, its presence or absence in the alimentary canal, has each in its turn been stigmatised as the immediate cause of the disease. There are not wanting some, however, who believe that the post mortem appearances, which their brethren look upon as causes, are in reality the mere effects or results of nervous derangement; forming their opinion on the rapid succession of the symptoms in life, however difficult they may find it to connect them with the discoveries made after death by the scalpel. From this discrepancy of opinion on the very nature of the disorder, is it wonderful that the practice should be equally unsettled? Bleeding, blistering, and leeching, in rapid succession, if not simultaneously, have been had recourse to by those who ascribe to the disease an inflammatory origin. Emetics and purgatives, with calomel usque ad nauseum, form the sheet-anchor of all who look upon the state of the liver or the bile as its proximate cause ; Avhile the absence of this secretion in CHOLERA. 3 others to prescribe the bile of the ox, and having prescribed it, they have not failed to vaunt its virtues in the disorder ! — Those who see in Cholera a rapid exhaustion of the powers of life, naturally turn with contempt from such modes of treatment, and fly, too exclusively perhaps, to stimulants and cordials. What a picture of the medical science of the nineteenth century ! The correctness of the present designation of the disease, we do not mean further to discuss ; it is more desirable to ascertain the extreme symptoms which all unite in calling " Cholera/ and to be aware how far these differ in their essentials, from another form of disease which may have received the same denomination. An individual with flushed face, full bounding pulse, and hot skin, is in a totally different state from one labouring under difficult breathing and oppression at the chest, pallid withal, and pulseless, though there should be present in both a multitude of other symptoms perfectly identical. Both of these states having been produced by the same epidemic influence, receive the same name ; but they have this difference, that the difficult breathing of the one makes the very danger from which the other, enjoying an immunity from this symptom, is free. The first is Cholera mitior, analogous to English Cholera ; the second is Cholera asphyxia, or Suffocative Cholera. We shall first consider that form of the disease which, from the early difficulty of breathing, has been denominated Cholera Asphyxia. 4 Cholera Asphyxia. Mr. Orton has well described the symptoms :—: — "An extraordinary depression of spirits, and " general uneasiness, come on, attended by tremor " and sense of debility, giddiness and headach ; " and occasionally ringing in the ears is also felt, " particularly on rising from the recumbent posi" tion, or making any sudden movement : pains " resembling those which attend the accession of " fever, are frequently felt in the limbs. The bowels " are griped occasionally, and natural loose stools Biccur. Nausea comes on. The circulation and emperature of the body are variously disturbed ; "but most commonly the pulse is accelerated and " weakened. The skin is moist, and colder than " usual to the hand of another. In general, how" ever, the severer affections quickly set in. Acute " griping is felt in the bowels, the stools become " extremely frequent and watery, and change to a " grayish-white colour, so as exactly to resemble " the congee or barley-water. Vomiting comes " on ; and, after the common contents of the " stomach, a clear watery fluid, interspersed with " flakes of mucus, is discharged. Copious sweat " breaks out, and the anxiety and debility rapidly " increase. The countenance assumes a very pecu" liar appearance, by which alone the disease may " generally be distinguished. This is so remark" able, as occasionally to render servants recogc a useless repetition of the events related in he preceding history to which the reader is re"ferred. — History of Epidemic Diseases, vol. ii. Mr. Orton's researches prove, that earthquakes 40 appearance of the Cholera as an epidemic. My own observations will not allow me to believe, that these were mere coincidences. On two occasions, an earthquake happened at Bangalore, while I was stationed there, and. among other intractable cases of disease, some of the various forms which the I.emic has been known to assume, were shortly rwards admitted into the European and. native >itals of the place. On the whole, from all I have seen and read of this Cholera, I incline le belief, that telluric rather than atmospheric icy is the chief element in its production. But k, I do not exclude atmospheric influence — on contrary, that influence has appeared to me, in lerous cases, to have contributed both to the ad and to the disappearance of the disease, — particularly thunder-storms, east winds, rain, and so forth. Still, even these, in a great degree, depend on the electrical and magnetic conditions of the earth. The great majority of Cholera cases in the East have happened between sunset and sunrise. Its attacks have very generally commenced either during sleep, or soon after getting out of bed in the Srning, and not unfrequently on a march, which India is always begun long before the sun kes its appearance above the horizon. I have )wn the epidemic confine itself to those who slept on one side of a river — nay, I have seen it exclusively attacking those only who slept on one side /¦»+¦ q r\Q WO /"* IT" "t* rWVII r**rl oil "i~ rl £1 4"! TYI O 4* ri O YV4/"\C''4* T\£ST» \j\. it ' /til X ctl/lv —— Lli'Wlli^H till 1 1 11. LI XXX t? LIIU XXXvJo v 1 JL.I ™ CHOLERA. 41 feet daily intercourse was kept up with the people on the other side of the barrack or river. How can you account for the escape of those last, but for the fact that they did not pass the night on the side where the epidemic prevailed. During the day, there was every kind of intercourse between the affected and the unaffected sides ; but as the people of this last did not remain the night on the affected side, the fatality must undoubtedly have reference to the place of sleep, and this, I think, is evidence of a telluric, rather than an atmospheric origin of the epidemic. The first appearance of Cholera, as a great epidemic disease, in India, took place when the Marquis of Hastings lay with his army before the fort of Gwallior.* In three days and a-half, of his native and European troops and their numerous camp followers, ten thousand were swept off At the very same moment Sir Rufane Donkin, with a force of 7000 men, lay on the other side of Gwallior, without an instance of even one man being attacked by Cholera ; and when the Marquis of Hastings moved his camp twelve miles, the disease at once ceased ! Some years after, while the forces were in cantonments at Meerut, the Horse Artillery being placed on the right, the 14th Regiment of Foot in the centre, and the Bth Light Dragoons on the left, the Centre was fiercely * A- violent shock of an earthquake was felt in his camp at the moment he was mounting his elephant to begin his march against this fort. 42 attacked by this malady, and the Artillery and Bth Dragoons did not lose a single man ! Such facts are utterly incompatible with the idea that the disease is caused by any malaria or effluvium in the air. Electrical or magnetic perturbations of the earth are, to my mind, the really predisposing cause of the epidemic; — and curious enough, perturbations of the magnetic needle have by some been observed during its continuance. It has been asserted, even, that electrical instruments and magnets have in som instances been rendered almost useless, in place where the epidemic prevailed. Whether this te luric influence is, of itself, sufficient to produce a attack of the disease, or be predisposing only, have my doubts. This much I am satisfied o that while it prevails, any other cause of diseas may at once set it up. A slight debauch, exces of heat or cold, an emetic, or a purge given for some other complaint, have appeared to me to be the immediately exciting causes ; and in one case, the prostration which followed a broken leg actually became Cholera Asphyxia! How much the passion of terror disposes to the disease, I have had many opportunities of observing. I have already shown the effect of this passion upon the dog, and certain I am, I have seen persons with every symptom of Cholera from a similar cause ; females more particularly, among whom authors have remarked, that certain disorders, such as we denominate (absurdly enough) hysteria, epilepsy, 43 CHOLERA. chorea, &c, become absolutely epidemic from sympathy or horror. I have known the disease in the female commence with hysteria, take on the form of Cholera, slide into lock-jaw, and finally end in The knowledge of the first link in the chain of causation, can make little difference in the mode of Treatment. Let us not imagine that a specialty of cause will throw a mystery over effects; that Cholera from terror differs' in essence from Cholera produced by a poison or a mechanical injury ; or that Fever from a blow is less a disease of the nervous system than the same disease occurring from loss of blood. "The Fevers," says Mr. Abernethy, " produced by local disease, (injury ?) are the very " identical Fevers which physicians meet with " when there is no external injury." Are not both equally subject to remissions or alternations ? — and do we not successfully combat them by the same remedial means ? What is the proper treatment of Cholera Asphyxia ? — Reader ! what can be the proper treatment of a disease in which the door to medication, is, in most instances, all but closed by the early paralysis of the gastric nerves ? When the pneumogastric nerves are artificially paralyzed in the dog, not only does digestion immediately cease, but arsenic and some other poisons have not their usual 44 iii xjic w I i « 1 1> niciionxy 01 Octocs ox v>iioj.cxner prescribes solely for a name. We have ady pointed out the difference betwixt Cholera hyxia and Cholera Mitior — Suffocative Cholera Cholera with Fever. Having their origin ;he same epidemic influence, they receive the c denomination. The results of medication d 2 52 oi every k.ih& 3xe wicieiy cLiricreiiL m tiiese dis** When I first read in Mason Good, that Dr. Burrell saved 88 out of 90 of his later cases, I could with difficulty credit the assertion. But when, upon turning to the pages of Mr. Orton, I found these were all cases of Cholera Mitior, — Cholera where the face was flushed and the pulse was full and bounding, my astonishment at once ceased ; for this form of the disease, though produced by the same epidemic influence as Cholera Asphyxia, generally terminates well under any mode of treatment. It was in such cases Mr. Whitelaw Ainslie worked miracles with a few grains of magnesia. When he proposed the same remedy for Suffbcative Cholera, he showed he had at least some faith in simples ! IDhe warm bath may be used with impunity in olera Mitior : not so in Cholera Asphyxia, ere, in my experience, it was found to be the most deadly measure, next to blood-letting, that could possibly be pursued in the disease. The shock of the cold bath at the very commence[lt might prove useful in Cholera Asphyxia. Persia, however, when the disease raged there, indiscriminate use would appear to have inised the mortality from the disorder. Ej form of disease, by whatever produced, tendency to disappear" after a particular The ancients had some knowledge of this bey ascribed critical days to fevers. Sir B. 53 death from poisons which caused a disease similar to Cholera, he has by artificial respiration kept up life till the Brain had become accustomed to the shock, and the animal was thus restored to life under circumstances where it must indubitably have died without such a process. Artificial respiration most assuredly might be teficially resorted to in Cholera. By thus inuring the state of the blood, life might be kept till the Brain recovered its powers over the ilyzed respiratory nerves. Contagion. The proofs of a disease being non-contagious, must be either analogical or negative. As an example of the negative, I cannot do better than refer the reader to what took place in the respective camps of the Marquis of Hastings and Sir Rufane Donkin, before Gwallior. In the Marquis of Hastings' camp, where ten thousand died of the disease in three days and a half, neither among the bearers of the sick, nor the immense number of hospital attendants, nor the soldiers or sepoys visiting their dying comrades, nor among the sick in hospital (with the exception of the convalescents) were there more attacked, proportionally, than among other persons not thus exposed. That the identical disease called Cholera can be produced by loss of blood, poisons, passions, and local injury, may be looked upon as analogical pox, measles, plague, — each of these has some iture of its own which distinguishes it from all Ler maladies. It has something which cannot produced by art. Every and all of the forms Cholera may be brought on by artificial means ! rr. Orton has indeed attempted to show, that disease, after having made its first fearful ravage in the Marquis of Hastings' camp, spread in successive time to various other parts of India, as from the centre of a circle to the circumference. But this, be it remembered, is the law of storms. It is the law of many other telluric and atmospheric phenomena. Besides, as I have already said, all diseases have a tendency to propagate themselves by sympathy or terror ; and where the telluric or other influence predisposes to Cholera, any depressing passion will frequently produce every symptom of this disorder. Cholera, however, is not a new disease; nor would any one who thoroughly understands its nature, imagine that it is so. In India, it can be traced as far as medical records extend. In some places of the Peninsula, it has been endemic time immemorial. The natives, it is true, are fearful of taking up their abode in such situations when it is prevalent ; but this is not from fear of contagion, but because they know that they subject themselves to some hidden local influence by remaining there. The disease prevailed in England in the time of Sydenham, who 54 55 CHOLERA. Dr. Perston, of the 4th Light Dragoons, showed me some manuscript cases which occurred in Ireland among the 26th Foot, of which Regiment he was formerly surgeon. I recognized at once the Asiatic scourge in all its features. These cases took place long before the Cholera made its epidemic visitation in Europe in 1831 and 1832. tt has often been said, that one positive fact is th a hundred negatives. This is not quite true ; a positive fact may be a fact wrongly interpreted, but, at all events, the positive fact should be a very stubborn one indeed, to convince us of the necessity of closing our ports, stopping our commerce, and interdicting intercourse betwixt man and man. A gloom is in this manner thrown over the minds of the mass of the people ; and nothing, I am certain, conduces so much as panic to favour the ravages of any epidemic. The natural effect of such measures is to add to the poverty of the indigent classes : their food becoming consequently more scanty and depraved, contributes with the gloom of mental depression to extend the disease in all its horrors. In all times experience proves that men speculate upon the misery of their fellow-creatures. If the merchant, anticipating a period of scarcity, hoards ithe necessaries of life in his granaries, there are wanting members of the medical profession 3, eager to profit by the chances of an epidemic, tribute to spread alarms, most suitable to their ividual purposes. The public as usual panders 56 CHOLERA. i"1 • i i t* j 1 I_C 1 * ___ * Tf\ tno i MtOVOCtC {~\ T T l"l fr CO ITIC tl €I TI fl fi £*Q1 (TTl m Cf ITI €\ L w lIIV ¦ IIIH ICo LA vyl Lilt ol^Xxloll OiUll UAyolciHillli • tlllA* Quackery and Folly go hand in hand to increase the misery they pretend they would alleviate. Phe question of Cholera being a contagious dis\, has not been altogether free from this base ciple. Long and expensive quarantines can r be kept up with a certain medical staff — and interests of these require contagion. To meet the fact, that few medical men have fallen victims to the disease, even when constantly employed in attending on the sick, it has been pretended they have an immunity from that very circumstance. But of the many young medical officers who arrive at the different presidencies of India fresh from England, and who are at once, and without any preparation, introduced to the hospitals where the disease is prevalent, has there been observed any mortality from this disease ? I never heard of a single case. Can a similar fact be cited in the case of small-pox or the plague? The truth is, there are few diseases which have not some time or other been thought to be contagious. Ophthalmia, fever, dysentery, ague — each in its turn has had this opprobrium fastened upon it. I shall not be astonished if broken bones be added to the list ; for in medicine, as in religion, there is nothing so absurd but will be brought forward as true or miraculous ; and, having been so, will find everywhere, and among all classes, its dupes and disciples. Useful innovation alone meets with 57 If facts favouring the notion of contagion do come before us, let us view them dispassionately, and without timidity. Let us examine them in all their bearings, but be cautious how we construe them either one way or other. An embargo upon trade betwixt town and town — the shutting up the gates of cities and of garrisons — are measures that cannot long be enforced without giving rise to many miseries, and these too of a nature much more painful than what in fancy we flee from ; — gloom, discontent, and penury, can cause diseases of a more disgusting kind than Cholera. Those who are most disposed to view the disease as contagious, are yet fain to seek other causes to account for its spreading. Contagion then does not explain it. The best preventives of epidemic disease are serenity of mind, cleanliness, comfort in clothing, a happy moderation in the pleasure of the table, — in a word, a generous temperance, — avoidance of indigestible substances, heavy suppers, and generally, everything tending to irritate or debilitate the system — shut your ears also to rumours of the prevalence of the disorder. Daily bulletins and reports on the subject of the disease only keep up public alarm, and tend to make men selfishly alive to what God will take from them at his own due time — the existence which He gave. POSTSCRIPT. It is now something like twenty years since the greater part of the matter of the above Essay first appeared in print; — yet nothing I have seen or read during that long period, has in the very least tended to make me alter or modify the opinions of my early experience. The physiology of the suffocative form of Cholera, I hold to be therein completely elucidated. As the reader has seen, it has primary reference to the Brain and Nervous System. Last in the number of fatal phenomena, is that immediate precursor of dissolution — the death of the blood, — though a recent writer of ability, Dr. Starr of Leamington, looks upon this as the first link in the chain of causation. Were such the fact, there could be no recovery. The disease in that case would be invariably fatal. Reason and analogy, then, are with me. To poisons, passions, and mechanical injury, which we know act primarily on the Brain, I have traced one and all of its signs and symptoms; while, by the artificial paralysis of the pneumo-gastric nerves of the dog, b reader may produce at will, first, the whole p of the dangerous or essential symptoms of 59 CHOLERA. V/ HUlvl 9 x 111 • 1 1 1 1 II • nl I.V f I ill ty ¦ I 1 II identical state of blood on which Dr. Starr rests his case ! The deterioration of the blood proceeds pari passu, with the wrong primarily done to the Brain and Nerves. Moreover, it does not take place at all in cases of Cholera mitior, — those cases -where the pneumonic portion of the pneumo-gastric Nerves escapes the paralyzing influence of the original cause of attack. With regard to the Treatment of Cholera :—: — In addition to the remedies previously recommended, I would here suggest a trial of chloroform as an anaesthetic agent in the earjiei* stages, par-, ticularly when the cramps are painful and severe, — ' that agent having in my own hands given speedy relief to patients suffering from other spasmodic Inplaints, depending on a similar loss of nervous :rgy. Taken in the dose of a few drops by stomach, chloroform would, in some few cases, Sporadic Cholera, appear to have been successful when prescribed by others : but as this preparation, after all, is only one of many (ethereal substances, I do not apprehend that its exhibition, i in the latter form, will be found more extensively j effective, than were the nitrous and sulphuric aethers < when similarly employed during the epidemic at- \ tacks. In the outset of the disease they occasionally appeared to do good, but when given in the later stages like opium and alcohol they seemed 60 tAJ ilLy - tU I lct>>Lv II tlltv oLUJJUI LllclL UICCCU.C& UCcLLll* Hydrocyanic acid I have already mentioned with favour; — and here I would again beg to impress on the mind of my reader my very high opinion of its value, attention being at the same time paid to time and temperature. Let me also in this place suggest the cautious employment of creosote, phosphorus and strychnia, — those preparations, particularly the two last, having, in common with hydrocyanic acid, proved of essential service to me in various nervous affections, such as vomiting, difficult breathing, spasm, palsy, &c, affections which we find so often existing separately in the subjects of ordinary disease, but which in Cholera Asphyxia all enter into the aggregate of the symptoms that constitute that complaint. In this disease your patient must, if possible, be favourably influenced at once. Try to do so, while yet the gastric nerves retain their influence, however weak or partial, over the stomach; and do not quite despair of your case, even where the stomach is completely paralyzed, for in numerous patients there would appear to be a natural tendency in the Brain to recover its lost influence over every nerve of the body, as is evident from the partial improvement which from time to time takes place in most cases, and the occasional perfect cure in some few where hope had been all but exhausted. Kemember, that the danger of the disease depends on the state of the Breathing. Let your prinstages, 61 CHOLERA. the paralysis which takes place in these nerves is intermittent, — partially intermittent in some, in others, the intermission is complete. Now a knowledge of this fact is of great importance. Keeping it in mind you may, during the continuance of the paralysis, relieve the suffocation consequent on it, by inflating the lungs with atmospheric air, and thereby also give the Brain a better chance of regaining its lost energy over the whole nervous system. Spare your opium after the first stage. If a good result do not immediately follow its first employment, do not repeat the dose. In my experience its repetition then only hastens the state of stupor which precedes dissolution; Con no account practise blood-letting here in mode or manner. For myself, it is now more than seventeen years since I have resorted to this gbarous practice in any disease whatever. As calomel, cayenne pepper, assafoetida, &c, of eh you constantly hear so much, waste not r time — in this disease so precious — with such puerile and inert medication. You have powerful Eurces in hydrocyanic acid, phosphorus, and clmia ; of all the remedial means in your posion, none can so rapidly influence the whole human frame as these particular agents — agents which all, luckily for us, enter into the pharmacopoeia of every civilized country. Still, such is the energy of their action, such the rapidity with which they can influence the Brain aud nervous system, 62 I jiouocxv uui d |)ij>si(']itii pcrjt/L'Liv ooii* c. j ?*uij 1 l tVjX.ii i their doses and possible effects, whether salutary or morbid, ought to be entrusted with their exhibition. No one who is ignorant of the duplex action of all medicinal substances, can possibly, but by hap-hazard, turn them to a good account in this or any other disease whatever ; for in this very disease of Cholera, as in every disease to which our frail humanity is liable, the medicine that will produce a salutary influence in one individual will do precisely the reverse in another. In certain cases, this depends on the constitution of the individual, in certain others on time and temperature. Without a perfect acquaintance with these facts, how could you know when to continue and when to change any given medicinal force ? There is no " red-tape-ism " in true medicine, — no specific that will always do the same thing in all persons and at all periods ! Before I quit this part of the subject, I would again earnestly impress upon you, the necessity for inflating the lungs during the state of Asphyxia, with their proper pabulum — atmospheric air. Eschew oxygen here; the lungs were never made to inspire it undiluted. With regard to the supposed exciting cause or causes of the Epidemic Cholera, I question if the bulk of the profession is one iota nearer the truth than it was when the pestilence first broke out; unless it be that in this country there are now fewer terrorists, fewer advocates of the doctrine of conta°ion than there were some sixteen or seven- 63 COHLERA IS NOT CONTAGIOUS. When the disease first appeared epidemically in the 30th Foot in 1831, I was serving with that Regiment at Wallahjabad, in the East Indies. Nothing could equal the fatality — fourteen and fifin deaths frequently in one night; yet for whole hts together did I, being then the medical officer 3harge, feel it to be my duty to sleep, — if broken mber could be called sleep, — within the hospital Is. Could place, time, or contiguity, be more ourable to test the doctrine of contagion ? On every affected man, woman, or child, that lived or died, I gave my own personal attendance, — taking the deepest interest in the success or failure of my remedies, making also numerous post mortem examinations with my own hands, — yet neither myself nor any one of my numerous assistants in the hospital, ever suffered from a single symptom of the Ksase. This one fact, I give as a sample of the eral experience I had of this epidemic while ing in India. The experience of the best observers in other quarters of the globe, has been fcisely to the same effect. I extract the foliowfrom a letter I have just received from Captain itt, commanding Her Majesty's ship President, when the Cholera appeared off Halifax, in North America :—": — " Upon the arrival of the President at 64 " plague — the Asiatic Cholera — was about to visit " us. Nor were we kept long in suspense. The " troops in the barracks were the first attacked, " and a great many men died. On their retiring, " however, from the town, to encamp some fifteen " miles off, the disease ceased among them : no " fresh case, so far as I remember, occurred. My " ship lying close to the shore, I gave orders " that in case the disease should show itself on " board, the men seized should be at once sent " to a temporary hospital, which I had in anticipa" tion, provided in the victualling yard. The first " seaman assailed, was a main-top man, while doing " his duty aloft in the top ; and so sudden and " severe was the seizure, he was obliged to be in" stantly lowered down. He was then put into the " boat and taken with all expedition on shore to v the hospital, where he died in less than five hours " from the time he was attacked. The disease " from that day became prevalent in the ship — " the number of seizures increasing gradually to " eighteen and twelve men daily. I then, at the " suggestion of my Admiral, Sir George Cockburn, " ordered the moorings to be slipped, and the ship "to be run up into Bedford Basin, where we " anchored off Navy Island, a distance of three " miles from the former anchorage. Just as we " had made sail, a man was attacked on the " quarter-deck, and sent on shore. This was the " last case that occurred on board. From the time 65 «of our moving, not another case took place. It " appeared as if the cause of the disease occupied " the very spot we had quitted, and a very con" traded one it would appear to have been, for of v three other ships of war anchored around and " close to us, not one solitary case occurred among " their crews." Were the disease contagious, do you think that after having been in such close contact with those affected, you could possibly escape it by the mere removal of a few miles from the place of the first attacks — the same thing taking place both on shore and at sea ! A word or two as to what I myself saw of Cholera in this country, to which by the way, I returned only a few months before it broke out in 1832. I was at that epoch, quartered with my Kegiment, the Royals, in Edinburgh Castle, and there, notwithstanding the cordon sanitaire that was strictly established by the military authorities of the place, a few cases of the disease — the identical disease, Ino mistake, — occurred. The patients were all ,ted professionally by myself and assistants with feet impunity to all of us. In the Cholera ipital, established in Drummond Street, Edin;h, I had also many opportunities of seeing the ase as it appeared there — some hundreds of ents having been treated for the complaint in establishment. And what was the opinion ;hose connected with this civil hospital ? Dr. jkintosh, the presiding physician, scouted the idea of contagion. In a book which he afterwards 66 out my own experience would be conclusive :—"ln: — "In " the Drummond Street Cholera Hospital, there " were two hundred and eighty bodies examined. " Two and sometimes three hours were spent in " examining each body. The room where these " examinations were conducted, was a miserable " place, eight feet square ; generally six or eight " persons were present — sometimes more ; and in " an inner apartment, about ten feet square, there " were generally six dead bodies. Not one of those " who frequented this den of death, and who had (t their hands imbrued in the secretions of the dead " for six hours out of the twenty-four, was affected " with Cholera, although their hands were irritated " and punctured daily. " — Mackintosh's Practice of Physic, p. 345. Yet in the teeth of these, and thousands of similar facts, did the College of Phylans of London, in 1832, terrify the people of gland out of their senses, by officially declaring disease to be contagious ! A better apprecia-1 of medical evidence, has since led the " Health f Towns' Commission" officially also to declare reverse. The reader can choose between two h eminent authorities. One thing is certain, octors differ !" Among the various hypothetic causes of this terrible disease, an opinion has been expressed that Cholera Asphyxia is animalcular in its origin, though Dr. Cowdell, who has more recently 67 I have just detailed, are a complete answer to the maintainers of either hypothesis. Where have you such escapes as those in any recognized organic contagion — in itch, or ringworm for example — diseases which we know, have, in one case an animalcular, and in the other a vegetable origin ? No, reader ! Cholera is neither propagated by flies nor fungi ! The naturally rapid extension of a living generating principle, whether animal or vegetable, which could set up in man the series of phenomena you see in Cholera, would produce such a constant and uniform succession of results, no opposer of contagion could possibly shut his eyes to the connexion. Before the microscope discovered the insect of itch, and the fungus of ringworm, few or none doubted the coinmunicability of these diseases by touch or contagion. Vain will be the effort by similar means to detect any thing analogous as the originating cause of a disease which can be produced, as I have already shown, like any other constitutional complaint, by poisons, passions, and mechanical injury even, which in fact, — during the prevailing epidemic influence, can be set up by any other cause of disease whatever. Look at the history of other epidemics — erysipelas or yellow fever, for example. When either of these forms of disease predominates in a given locality, exposure to wet, cold, or heat, a transient passion, or a mechanical injury, which, under other circumstances, WOlll fl TIP of TIO ITTinOVi" RTi OP 7TI IV fit" (\X\ PP P*l V P I*l 68 POSTSCRIPT. to the predominally form of disorder. Dysentery and diarrhoea manifest similar phenomena, being set up epidemically at a given place or period, by whatever would set up any other disease whatever in any other place. I have a strong impression that the atmospheric or telluric influence, in any epidemic, whether erysipelas, dysentery, yellow fever, or Cholera, is predisposing only, — that that influence merely determines the form, the more immediately exciting cause being one thing with one person, another thing with another. Take the case of erysipelas for example. When I served with the Royals in Scotland, erysipelas predominated for a time in that Regiment. If a man was flogged, he was sure to get erysipelas. A blister almost always set it up : and I have known a mere scratch bring it on, — particularly the application of a lancet to the arm. The late King of Denmark died from the erysiploid inflammation of a vein ; he died from the blood-letting practised on him when affected with the disease ; and no medical act can be so fool-hardy as bloodletting in that form of fever, termed erysipelas or rose. I hold fever to be the type of all diseases. Most assuredly it is the -type of all epidemic disorders. The epidemic influence, whether telluric or atmospheric, whether local or general, would appear to determine the form simply. While in India, I had many opportunities of witnessing epidemic diseases, particularly cholera, dysentery, bilious remittent fever, and ophthalmia. When any 69 CHOLERA. one of those disorders predominated in a place, you scarcely ever had an instance of any other acute complaint among the regiments stationed in that particular place at the same period. The form was almost invariably determined by the atmospheric or telluric influence at work. The immediate causes were infinite. Drunkenness bringing on the given form in one, exposure to the sun in a second, being out during the night air in a third; while an extra drill in heavy marching order, would produce numerous cases where this was ordered. When an epidemic prevailed, whatever the immediately exciting cause, the form of the disease of the place and period was uniform. Where Cholera prevailed, there was little or no dysentery ; where dysentery, little or no Cholera ; where bilious remitting fever was the predominant form, you had neither dysentery nor Cholera, or at most, an occasional case. Look nearer home at the influenza, you will find where it prevails the influenza absorbs all other complaints. When predominant, you will find a perfect paucity of all other acute disorders. " The clearest and most striking general obser" vation which occurs regarding the prevalence of " the disease, (Cholera,) in different classes of " people is, that the higher ranks of society have " been found in India to suffer less than the lower ; " and this seems to hold good in all its branches, " military as well as civil, native and European." — " Thus we constantly find that the officer suffers " less than the soldier or the sepoy * that the 70 a (who form the elite of the army,) suffer less than Rhe infantry, and they again, greatly less than he hard-labouring and ill-fed camp-follower. So also is it as constantly found that the " Bramin, the supreme or priest-caste, and the ff sleek Banian, (merchant,) suffer less than the " ryot, who pays often as much as half the produce " of his rice-fields for rent, and extorts from them " a scanty subsistence, under a burning sun, and " still more remarkably less than the poor out" cast pariah, who carries a burden ten miles, and K:turns the next day empty handed for fivepence erling." — Orton on the Indian Cholera. — This entirely accords with my own experience. The proportional difference in the amount of attacks among the various classes, depends in the difference of their social opportunities of obtaining comfort, regularity, cleanliness, good food, and rest ; and the consequence of all these united, — a healthful energy of Brain and body sufficient to enable their possessor to stand firm under the insalubrious circumstances that determine the epidemic in question. Now, a knowledge of these facts is of the greatest importance to us. From the vital nature of the nerves, principally implicated in the Cholera form of disease, that epidemic is necessarily a most fatal one, as indeed is any disorder where the breathing is seriously involved. The true method to prevent attacks of Cholera then is, to avoid all the immediately exciting 71 causes of all acute complaints whatever. Mental depression, dirt, drunkenness, defective nutrition and ventilation, imperfection of draining and light, (the window tax !) are assuredly exciting causes of general disease. When the Cholera first prevailed epidemically in England, who were its principal victims? Precisely those exposed to any of the above causes. The friends of the few who suffered among the higher ranks may, for the most par thank the College of Physicians for the attacks tha carried off their relatives; for to the terror in spired by the official declaration of those worthie that the disease is contagious, I have no hesitatio in ascribing the loss of many a valuable lif There is no cause of disease, as I have elsewher Kwn,* so certain and powerful as this depressin sion. One word, in conclusion, to the venerable College. Somewhere, about twenty years ago, I read the history of "The Gold Headed Cane." There I learnt how that cane had been B-adcliffe's, and how it had passed from one great doctor to another, till it came at last into the hands of Dr. Baillie, who made a gift of it to the College of Physicians. Relic of departed greatness, there it has remained ever since. Like the busts of Linacre and Harvey, it is preserved in Pall Mall East with a holy reverence, showing to all who enter the • See Fallacies of the Faculty, with the Chrono-thermal System of Medicine. Simpkin and Marshall, Stationers 72 v^oiicffc jporcii iiOt* xiigiiiVj cLLLriiig xncir nvcs^ xricsc great men must have been esteemed by their fellows. Linacre, Harvey, Radcliffe, Jenner — these are the names that can never die within its walls. You see how the College worships science — how it honours scientific men. Such were the reflections of my earlier years ; I had rather an exalted opinion of the College then! Without its fostering care what, I asked, would become of science and scientific men ? Not one word had I then heard of the College being a mere doctor's shop — a club — a coterie — a clique of small creatures who had always, where they could, obstructed science. I knew nothing of the College persecutions, — how in his lifetime Harvey was treated by it as a quack, and how Radcliffe was called a quack too, and how it had refused Jenner its license to practice physic in London. Not one word had I then heard of all that. Out it came at last, however, that no man had ever made a great scientific discovery who had not lived to repent it. Eternally prating of the advancement of science, the only thought of the people of the College of Physicians was how to advance themselves. Science ! — What cared they for science ? As a cry, science answered their purpose ; but as for Harvey, Hunter, Jenner, &c, science, according to their own confessions, had nearly been the ruin of one and all of them. And who were the opponents of those truly great men ? Not the magnates of the College of Physicians at least — not the censors or great officials, who stand 73 CHOLERA. out so prominently from this body of imbeciles. No ! Such persons would be ashamed to attack »true promoters of science — to call them quacks > whisper away their lives in private and before imittees of the House of Commons — slander mem, and say they had no diplomas. College of Physicians ! put your house in order ! London : Printed for Charles Gilpin, 5, Bishopsgate Street Without