I ... JK \ A A* A i /A v I ' i HI .i- 4T— i — — — ¦ m 



lr"~ L ~ - ,™^^(B r^- — - I |>5 r^i-<Kk i I go — HJg 'ffiS 3ST*i mmr iff 





¦nature and treatment*! I C HOLER I I 11! , INCLUDING / ¦ Jy*| Wnft A HISTORICAL SKETCH OF TIJE D'SEASE, THE CAvh WHICH PRODUCE IT; (Jjjß f&M MODE OK I'BOPAGATION; PATHOLOGY; RULES /* ITS PREVENTION, fJ^M AND MEDICAL TREATMENT m[i L. M. LAWSOXj^I. D., JiF^f ;.', I fROKESSOR Of «ATEIUA MEDICjj^^^AND^NKRAL FATHOX-OOV IK | rtEPKINTKD PROM TIIJEfWESTEUN liANCKT. CINCINNATI: &W TV ROBINSON & JONES Western Lanoet. 



THt GREAT WEST, This Popula.ana elegant litjttnr newspaper will commence a NEW VOLUME with the first vv f k of November. Although this enterprise is comparatively of recent origin, its success has , e n unprecedented n the annuls of newspaper puplishing in tbe West, ana it vow dispenses .telligenc.e, Instruction and Amusement, to at least And is daily tokiithe place of the Eastern mammoth weeklies, to any of whi.;h it is equal iv stylo, merit, or i ult ,ty of matter. S.VERAL HUNDRED DOLLARS have already been cx l 1f j e{ j by the publishers, for Original Tales and Sketches by Western authors. giving an cii. st o f their deterniinatioii to place the GREAT WEST, in this particular, beyond all comp t j onj an j we 11O w announce, that with our new volume will be com mence.l, THE GRgAT PREMIUM .ROMANCE, written for the prize of yO HUNDRED DOLLARS offered in May last, which is from tbe pen of i be most p»piv o f Western writers, and the best living delineator of western scenery, character and nia». rs AIKRSON BENNETT, ESQ. Author of the "Bandits of O* Bi » "The Renegade," '-Mike Fink," &c. &c. all of which works were given to the publfay the publisher! of the GREAT WEST. We urther announce that Ml have lecently perfected arrangements with Mr. BENNETT by which liis LITERARY SERVICES Ar SECURED EXCLUSIVELY FOR THIS PAPER ! and our readers may therefore ex-ct a series of Tales and Sketches irom his pen during the succrfe img year, unrivalled in indent by those from any other source. Wo herewith subjoin a list of the regular CONTRIBUTOR TO THE GREAT WEST. Emeisov Bennett, of Cincinnati, aui^^f ihflfltaflHfcaof the Osage," "Mike Fiak," "The Jleneg nte," &.C. jfc. jJNS VBP"^P|B|m Joh i S. Robb, (••Solit -lir.i") of- Strouks Ot :- ; <|uatter Life," &.C. John Td.mmn, of Jackson 'I' (> n«HflH|^^^^^H&Bi olla," &c. Miss Ki.iz \ \. Doruv, of Fjv^H^^^^^^^^^L "Cunspinsiois." BO' 1 other tu\e*. Mits. Rkiiecc\ S. Nichols. "'^Hj^^^^flHVSr '"' <tber poe.ns, &c. Miss Puotjbk Carev. and MissA<J|^B^Tof Mt. Me illhy, Ohm. "Ellen Marshall," of Cinciiin ill, il *9^^H^W''~' <>f my Schoolmates," &.c. F. Li.M) •), Esa. author of "SJtetehns ni Lral America," -'Utfrenge," <fc.c. Prof. P. S. Kutcr, of Kentucky, author of-Renn i a.i Ol 1 Ftiyaieiaii," ttc. Capt. 'F\ WarkCtibso.x, of In.-1., author of "'i^ie Prie t <>i t\te Black Crafs, i tale of i ho Sea," &c. Mri. Cei.iv .VI Kellum, — "Celia" of Kentt ky, one of th#i^feles! western poetesses, and a brilliant proee writer. Mm Anna Cora Mowatt, author of "Fashing" a Play, "The Fortune Hunter," &c. Caft. C. Donnavan, author of '¦Advenhire;,,n Mexico'," &c. \V (; lm <ue Simms, E Cuimia llivi,, U S i, (Jl-illaWli-: Bito'iFT, Dr f.ouis A Baku, Dr A F Havnik, " Edwin, of Coahoanoc," Mm Anna P Dkmnies, Miss MARitrrA V Fullkr, M'na A.vva II Rickev, "I'ALcovoßnjoE," Felk Victor Dorm'eii, Dr T M Twikb, " Jkrry Nobi," John \I adows, Esijr., anii otliers Compriwag a greater amount of talent iv evtry branch of literature than hua ever been before enlisted in a similar enterprise in tllil com, try THE GREAT WEST, In addition to its Literary matter, condenses the spirit of the Eastern Press, pays due attention to General Intelligence, comprises the go.s-.ip of the Eustern an I Western Cities, and presents in every essential particular a i)l<jus; 4 nt and instructive companion for the FAMILY CIRCLE. TERMS. Two Dollars a year, (delivered by faithful carriers to any part of the city) payable invari<rt»ly in advance. £p:£opies may be obtained of the carriers or at the office for Five cents weekly. RnmiVSO'V & .IQiVKS. 



C HOL E R A: NATURE AND TEEATMi L M. LAWSON, M PRU^SiSIOR OiT MATEJIIA MED 7 REVRI.XTED FBUM Tin W^TKK.N LAP CINCINNATI: ROBINSON & JO N J > 1848. 







NATURE AND TREATMENT 

O F 

ASIATIC CHOLERA. 

At a period when cholera seems to be rapidly advancing following apparently its former well known course, it becomf important to recall the principal events of its past history and to designate as nearly a3 possible, its present more pn minent characteristics. To attain this desirable object, it he comes necessary to collate the various facts and opinions whic have been accumulating for! the last thirty years, and thu to establish, with as much completness as the intricacy o the subject will allow, the leading circumstances and phenc mena connected with its origin, mode of propagation, patho logy and treatment. The lflain object of the following pape is, to present a brief dig^^of those more irhportant facts, to gether with their appropriate inductions, which have bee steadily accumulating for several years, and which shed n inconsiderable light upon the dark pathway of cholera. I this attempt, we can offer only a mere sketch of the subject the field is to vast, indeed, to admit of more; and while w shall leave altogether untouqhed some of the more commo topics connected with the subject, we are precluded from offei ing more than a very brief exposition even of those whic especially claim our attention. 



2 

Nature and Treatment of Asiatic Cholera. 

HISTORICAL SKKTCII. 

Cholera is known by various names; thus the terms AsiaSc, Indian, Malignant, Spasmodic, Eastern or Oriental, Algide, and epidemic, cholera, and many others, have all been used to designate the same disease, it was called by the nalves of India Murdexym, a term which the learned Dr. Good egarda as a corruption of the Arabic word mordekie or vwrlecfiie, and which signifies the "death blow." In many parts >t* the East it has been denominated mort dv chien. 

No reasonable doubt can be entertained, that a disease r sembling cholera, has occasionally been witnessed in evei ge and country; but that particular form of the affecti( vhich is now known as Asiatic cholera, is of comparative! lodern origin, and is undoubtedly of Asiatic birth. As earl s 1702 it prevailed extensively in upper Hindustan, destro; )g in its ravages 30,000 negroes and 8,000 of the white po Illation. In 1783 it broke out among the pilgrims, who hac ssembled in vast multitudes, for the purpose of ablutioi t a sacret spot on the banks of the Ganges. It is said t lave destroyed not less than 8,000 of these wretched peop vithin the brief period of eight days. The disease, howeve vas limited to the pilgrims, who were much exposed to th ight air, and did not extend even to the adjacent towns. I ddition to these instances of the prevalence of cholera, ontiuued to appear occasionally in India, both sporadicall nd epidemically, from 1702 up to the beginning of the ep cmic of 1817. 

I No very definite history of cholera has been written, unti c reach the epidemic of 1817 ; since that period, it has beei mutely traced in its devious course over the principle por lions of the habitable globe. That no such epidemic occurrec ;h that above referred to, either in ancient or modern times we may fairly infer from the fac^aat none such has been re corded; for had a disease of so ilcicnt and fatal a charactt existed at any period since medical science, or even letters had an existence, it could not, by any possible contingency have escaped either medical writers, or the general historian 

The epidemic to which the name of "Asiatic Chokra^hns been given, is generally admitted to have made its appear ance in a distinct and unequivocal form on the 10th of An gust, 1817, at .Jessore, a small town situated in the delta o the Ganges near the tropic of cancer, and about one hundre( mile" northpflst of Pilrntt'i Thp district of Rnttiah Ind i i cill 



Nature and Treatment of Asiatic Cholera. 

a 

cd Jessore contains many marshes, which would seem we! calculated to originate disease. The soil of thai district is very fertile, and produces large quantities of rice. At the period when cholera originated, a rainy season had commence') and the rice becoming damaged ( the disease was erroneously ascribed to the inhabitants eating of that article; andihechoi eraic dishargea somewhat resembling rice water, served lo strengthen the conviction that it depended upon impure food. 

The epidemic spread from tin; town of Jessore, in a westward direction, and early in September following reached Calcutta, having severely scourged many towns in its march The ravages of the disease continued in Calcutta during the succeeding year; and it also extended over the entire province of Bengal. It spread in a northwest direction, following tin course of the Ganges, and finally reached the Himalayas |>untains, when its marcfe in that direction was, fora time rested. Apparently manifesting a preference for watei uneSj the epidemic passed from the Changes to the Ncrbudh river, and following that stream to the coast of the Aram sea, it reached Bombay in September 1818, where it de oyed 150,000 victims. The disease thus passed from the lV of Bengal to the Arabian sea, traversing the entire bread 1 1 Hindostan, a distance of about 22°, in a period of less thai c year from its commencement. 

I In the mean time the disease spread southward, extending or the entire Coromandel coast, and invading the island o ylon, and Malacca. From Ceylon it extended in 1819 to 3 20lh degree of south latitude and invaded the Mauritius id now again resuming its inarch from Malacca, it sprea< through the healthy climate ofSiam, invaded China, scourgec Canton, and other places, but did not reach Pekin until 1821 In 1820 it arrived on the eastern cost of Africa, at Zanguebar Thus it will be remarked that the disease spread to even point of the compass, and was not, as has been sometimes supposed, confined to a west or northwest course. In 181S it spread in three directions — northward to the Himalayas, south to Ceylon and Mauritius, and westward to the coast ol the Arabian sea. 

Continuing its northwestern march, the epidemic reached the shores of the Persian Gulf in the summer of 1S21; it thencv passed up the Tigris and Euphrates, and reached Bagdad itthe same year. It is worthy of remark, that the disease did not cross the deserts of Arabia, and that Mecca, on the we*- 



From Bagdad it crossed the desert to Aleppo: and in 1 8"J«i reached the shore of the Caspian, and also extended to the Mediterranean. At this period it seemed to cease lor a time, and did not extend heyond Astrakhan, a Russian town containing 40,000 inhabitants, situated on the Caspian sea, at the mouth of the Volga, in the 4b° of north latitude, and 48° • t east longitude. in looking back over the course of the disease for six year-, wo perceived that it passed over 90° ot longitude and 68° oi latitude, having extended from the Mauritius in the 20th degree of south latitude, to the 48th degree of north latitude, thus crossing the equator in one direction, and in the other extending northward to the temperate zone. 

The epidemic having ceased for a time its northwestern march, after reaching the western shore of the Caspian at Astrakhan, nevertheless continued it*> ravages in India, and ultimately passing the Himalayas, which seemed for a time to have arrested its progress, the disease invaded Chinese Tartar}' and devastated mnnv towns. 

After a delay in its westward march for a period of near six years, epidemic cholera resumed its progress in that direction and suddenly appeared, in the year 1829, in Orenboorg, a Russian town of 20,000 inhabitants, situated on the Ural river, in latitude 51° 46' north, long. 05° 5' east. Reappearing at the same time at Astrakhan, at the mouth of the Volga, it ascended that river, and invaded most of the towns and provinces in its line of march. It also spread through Ch cassia to the river Don, which it ascended, and thus Europe was fairly invaded in the year 1829. Ascending the Volga, the epidemic finally reached Moscow in September, 1830. Continuing its march, St. Petersburg was attacked in 1831 ; thence it passed along the coast of the Baltic, and invaded Berlin and many of the principal towns of Prussia. It next followed the course of the Elbe to Hamburg, which place it reached in October, 1831. 

We next witness the disease in England. It speedily pass- O'l from Hamburg to Sunderland, a seaport town situated at the mouth of the river Weare, at which place it appeared on the 4th of November, 1831. It reached Edinburgh on the 27th of January, 1832, and on the 10th of February following it invaded London; and in March of the same year it reached France and Ireland. Calais is said to have been the first place visited in France, which occurred on the 15th of March, 1832, but within the same month it appeared also in Paris. It spread 

4 





•/ 

5 

Prom Paris in every direction, but with different degrees of velocity. Tims its progress from north to south was about •>;.e league in twenty-iour hours, while from east to west it marched at more than double that speed. 

From England we find this frightful disease extending to the New World. Accordingly on the Bth day of June, 1^32, it wag manifested at Quebec, and on the 10th of the same month at .Montreal. On the 2ith of June, the disease unexpectedly 

appeared in the city of New York; and it is peculiarly worthy oi remark, that all the intermediate towns and provinces, on the seaboard, including those of New Brunswick, Nova Scotia, the stale-; of Maine, Massachusetts and Rhode Island, remained up to this period entirely free from the disease. It reached Philadelphia July the sth. 

Spreading westward, Asiatic cholera probably appeared in Cincinnati on the 30th of September, 1832. By reference to 

the Western Journal (f Medicine and Surgery, published at lit time in Cincinnati, it seems conclusively established, that c disease reached this city on the day above named. eh was the opinion of Dr. Drake, the editor of that Jour!; and although the board of health did not announce its exence until the 9th of October following, yet it appears conisive from the facts referred to, that the iirst case occurred the 30th of September, and that a number of others were witnessed between that time and the Oth of October. The 

intermediate country between Cincinnati and Lake Erie was unaffected at the time it tint appeared in the city. The disease appeared simultaneously at Cincinnati, Ohio; Madison, Indiana; Louisville, Kentucky; and St. Louis, Missouri. This tt in the history of the spread of cholera is highly impor', and throws much light on its mode of propagation. About the last of the same month (October) the epidemic reached Xew Orleans, but the towns between Louisville and that city generally remained free from the epidemic. The disease spread over the Ifniled States generally; and in the summer of 1832 invaded Mexico, and the following year appeared at Havana. 

It wiil now be seen by reference to the course pursued by cholera, that it has invaded a very large proportion of the id and New World. A^ia was overrun in every direction, A Europe was traversed from one extremity to the other. ius the disease in the old world extended o/er 128° of long., ving travelled from the Philippine Islands in east long. 125° Edinburgh, west long. 3 y ; and over 84° of latitude, reaching 



Nature and Treatment of Asiatic Cholera. 

6 

from the Mauritius in south latitude 20 c , to Archangel on the coast of the White sea in north latitude 64°. It will be remarked that Africa remained almost wholly exempt from the epidemic. The disease it is ttue appeared at Zanguebar on the eastern coast of Africa; but I lie western coast, a region peculiarly insalubrious on account of the intensity of heat and extent of marshes, entirely escaped ; and the regions watered by the Niger, Gambia, etc., never gave rise to a disease which often manifested such a peculiar fondness lor hot climates and water courses. The Cape of Good Hope also remained free from cholera. 

On the American Continent, the disease extended from Canada to Yucatan, invading nearly every place of importance intermediate between these points. And here we have to record another remarkable exemption from cholera. South America was not invaded, notwithstanding many portions oi that country, especially along the coasts and in the vicinity ofitsgrent rivers, would seem, like the delta of the Ganges, peculiarly favorable to the production of violent forms of disease. 

Returning apparently from America, cholera resumed its ravages in Europe, and at this time visited Spain, France, Rome, Sicily, portions of Germany, and as some have asserted, destroyed the- last victim on the banks of the Thames. 

We are not authorized to say that, (he epidemic of 181? has ever subsided; it is true, its ravages have for a time abated, but it is equally certain that it never ceased to exist in some portion of, India. Within a few years, however, the disease lias acquired new activity, and now again appears as a wide-spread epidemic. 

The origin and progress of the present epidemic remains to be written, and we are therefore not acquainted with the exft time and place of its commencement. It is known, however, at during the winter of 1845-6 the disease remained comparatively inactive, but in the spring following this period of quiescence, it appeared with great violence at Kurrachee, a considerable town situated in the delta of tin; Indus. 'Since tisperiod, it has steadily advanced; and now, October, 1848, has spread westward over Russia generally, and at this time is prevailing in Berlin. The probability of its continued westward extension, must, of course, remain a matter of con- Kcture; but presuming" that the laws which have hitherto dieted its erratic course, may still continue to govern its march, ere is but too much reason to apprehend that the terrible scourge will again reach the American Continent. 



CAUSES 

In approaching the subject of the cause of cholera, every writer must feel overwhelmed with the magnitude and obscurity of the question to be solved; and being surrounded by litdeel.se than doubts and contradictory theories, we are tempted to abandon the investigation in dispair, and to occupy our time in the more agreeable task of describing those phenomena which are plain to the most casual observer, and which do not admit of misapprehension. • 

I But still in the midst oi this multiplicity of doubts and ao lowledged obscurity, there a re nevertheless some phenomena oil ascertained, and some facts duly authenticated, which rye to remove a part of the pre-existing perplexity, and to lieve the subject of at least a portion of its uncertainty. And though we may not even presume to lay bare the absolute cause of the disease, or to trace the epidemic to its primary source; yet we have a right to claim for the results of observation, and the powers of induction, something more than the barren account of events as seen by the populace, and conclusions more definite than those which spring from a mere historical record of the fatal results, as the pestilence sweeps on from country to country. Nor can we yield the position that, notwithstanding the primary question may still remain unsolved, we occupy a higher ground than the mere historian of rapidly passicfg events; and that our researches, although foiled in a material point, are entitled to be classed with the highest achievements of the human mind ; and we greatly ini>tfMte the tendency of human events, if the results which have thus far been obtained, and the facts which have been wrung from unwilling nature in the very teeth of death and destruct'on, are not at some furture day regarded by the world it'll'as the most brilliant achievements that our science has .¦cured to suffering humanity. 

The efforts made to discovery the intrinsic cause of cholehave very naturally been directed to two general sources, iiamely, a specific virus and certain atmospheric or meleorologictu changes. Those who have sought an explanation of the cause of cholera in certain conditions of the atmosphere, have not failed to notice, that the disease has very obviously manisfested a preference for water courses and wet localities; and moreover, its prevalence has been generally marked by an unusual 

7 





degree of moisture. Thus its very origin at the town of J sore, was accompanied hy an unsual amount of rain; and throughout India, generally, was either preceded or accompanied by a rainy season. The observation has repeatedly been made, that cholera was more common and malignant during damp weather than under reverse states of the atmosphere; thus it, was remarked that, the disease in Poland rapidly increased with the cool and damp weather of March and April, while it was speedily diminished by warmth and dry air. It is true also, that it prevailed most frequently in India with southerly or easterly winds, which favored moisture, and was as uniformly diminished during the existence of northerly winds. 

That the prevalence of cholera M in some manner associated with, or influenced by, low and damp localities, is conclusively established by the concurrent testimony of observers in every country and climate. Ju support of this opinion v. t may quote the statement of Dr. Park eg, who says in referen :i to the epidemic in Burma h, which occurred in IS 12: 

''Dining this progress from north to south, cholera, as already stated, attacked chiefly or exclusively, the towns and vilages stationed in low marshy places, on the banks of r«v-e.rs, or the shores of the sea. It, did not extend inland, find the Burmans were accustomed to escape it, by leaving their houses and travelling into the jungle.* * They universally slated, that, though they were left without food by this flight, and were exposed to the burning noonday rays, and to the heavy tropical dews at night, yet cholera invariably left them the second or third day's march inland." 

Alexander Thorn, Esq. surgeon to If. It. Mayesty's Sfith regiment, which was stationed at Kurrachee, when that, city was invaded by cholera in June, 1846, attaches great importance to the states of the atmosphere with reference to mois ture. The prevailing wind had been westerly lor two months, the temperature at the time the epidemic broke out, stood in the tents of the soldiers at 98" to 140° Fahrenheit; and tlu.- Cantity of nioisture, says this writer, "was greater than I r saw in any part of the world, at any season, the dew point being at o3°, and the ihermometi r in the shade, at 1)0' the lowest range: even this gives 12.19 grains of vapor in each cubic foot of air." And the writer adds, that, contrary to what usually occurs in that latitude, the weather was characterized by light, weak, and unsteady winds, or calms. instead uf strong, steady and cool winds, so common in the 

8 





month of June, at Kurrachee. It is also stated that, (he quantity of rain which till during the prevalence of cholera, was much greater than is usually witnessed at this season. These lacts which connect cholera in some rm iterious manner with a damp atmosphere, are very peculiar and striking! and deserve mature consideration; bill while we lire ready to admit the force and accuracy of the observations as stated, and that the cause of cholera manifests an obvious affinity for moisture, it is still sufficiently clear that we mv.-l look b« yond i his state of the atmosphere for the remote cause of the epidemic. And, however anxious we may be to sice v; > n such striking phenomena as being fully competent tosolve hitherto inexplicable mysteries, we are immediately n I that the fame disease has been again and again w»tnet ed when m.) such atmospheric conditions existed; and it is a not less obvious and conclusive fact, that an equal degr< c ol moisture, and that too combined with excessive heat, has repeatedly been manifested without the slightest symptom ol <•!;< lera being developed. It is well known that cholera prevailed almost or quite unchecked by H Russian winter: and that when the thermometer stood at 80° below zero, which could admit hut little water in the air, the disease still maintained its epidemic character. Indeed it has often been observed when no hygrometrieal change could he detected, and consequently when moisture could have had no agency either in originating or extending the disease. In addition to the hvgrometrical slate of the atmosphere, various other meteorological conditions have been msisted upon as the causes of cholera; among these may be mentioned the supposed influences of comets, earthquakes, tornadoes, unusual and terrific clouds, eletrical change , and many other phenomena which happened to coincide in point of time with the prevalence of the disease which they were supposed to have caused. In most of these alledged causes, howe\ er, we recognize merely a favorite hypothesis, which some zealous reasoner has brought forward, hoping to explain "t my 'cry which had so long puzzled the world; and instead of finding any relict by adopting such explanations, it only redoubles ihe difficulty by adding its own incomprehensible obscurity to the mystery which it seeks to explain. It is well known that Keeker, in his hisiory of the black death, deal largely in these mysterious causes. A reviewer makes the following observations: "Kvery body knows the lofty opening of Hecker in his history 

9 





of the black death; — there, as harbingers of great pestilences, the powers of creation are represented as coming into violent collision; the thunder mutters from beneath the earth; fiery meteors blast ihe fruits of the soil; the atmosphere burns with a sultry and unbearable dryness, or overflowing waters send up unwholesome mists; nature spurns the ordinary alternations of lite and death, and over the doomed people the destroying angel waves his flaming sword." But while we dismiss these unfounded theories as the offspring of too fervid imaginations, or at most admit the phenomena to which they refer as mere coincidences, we are at the same time constrained to confess, that the hypothesis oi electrical changes possesses some degree of plausibility. Without, however, attempting to defend, or even adopt this opinion as sufficient to account for the prevalence of cholera, we may nevertheless be justified in remarking, that such changes have unquestionably been observed. On several occasions during the prevalence of the former epidemic, it was remarked, that there existed an apparent deficiency in the electricity of the atmosphere; and inure recently, the same general observation has been made. At St. Petersburg it, was remarked that, during the prevalence of cholera, the magnetic instruments lost much of their power, SO that a magnet previously capable of raising say eighty pounds, was found to sustain no more than twenty. And we have the authority of the London Medical Times for the fact, that the magnetic instruments at Greenwich are, at this time, in a sluggish condition; by which we understand a want of their accustomed power of attraction, such as was witnessed at St. Petersburg. But while we admit the coincidence of this electrical phenomenon and the prevalence of cholera, it is not to be forgotten that the observations thus far are altogether too few and unimportant, to do more than simply call attention to the fact, and to invite further and more accurate investigation-. During the prevalence of cholera in England, or about its commencement, Dr. Front observed an increase in the weighi of the atmosphere; and he inferred from this phenomenon, that some malarious exhalation, more dense than air, had taken place, and that it might be regarded as the cause of cho!• ia. This impression was further strengthened by the disappearance of the phenomenon as cholera subsided. Hut unfortunately for this hypothesis, it has been found that, at other places during the prevalence of cholera, the atmosphen 

10 





was really lig/ite?' than natural; so that the observation of Dr. Front, however interesting in itself, can have no weight in explaining the cause of cholera. 

Finding insuperable objections to the various hypotheses based upon real or supposed meteorological phenomena, the attention of medical men was early directed to something more tangible, — a specific cause, — a wtateries morbi — which existed independently of the ordinary atmospheric changes. That the disease originated and subsequently spread independently of mere atmospheric changes, was conclusively proven by various facts too palpable to be overlooked or misinterpreted. Thus, common observation established the tad, that cholera has originated and spread in various latitudes from 90 degrees south of the equator to the 4Sth degree of north latitude; that it has resisted the intensity of a Russian winter, and has not seemed to be aggravated in severity, or lengthened in duration, by tropical heat ; it has prevailed in arid and sandy regions, low and humid localities, traversed valleys and ascended mountain heights; it has prevailed during storms and calms; traversed deserts and oce ans; bid defiance to quarantines and military cordons; at one time it follows the course of the wind, but at another marches in the very teeth of trade-winds and monsoons; and in short, it is a disease which appears under such varying and opposite circumstances, and spreads at times in such a peculiar manner — obeying no ordinary laws, nor acknowledging any natural or artificial restraints; — that it is altogether beyond t ho limits of probability to assign as a cause the common meteorological changes. Jt is indeed v disease sui generis, and cannot be otherwise produced than by a specific cause. 

1 Acknowledging, then, the impossibility of en atmospheric, origin, the curious and ingenious have persevcringly -ought to solve the problem of its source, and trace back to its beginning a disease so fearful in iis nature and s<» mysterious in its production. And in attempting to accomplish this Herculean task, almost every morbific agent known in science, together with many assumed pathogenetic canties, have been arrayed as sufficient to produce epidemic cholera. Thus the disease has been ascribed to malaria or that peculiar agent which causes the ordinary fevers; others have attributed it to animalcule/-, which were sui - posed to he floating though the atmosphere, and constituted the specific cause of cholera; and still more recently it has 

11 







been referred by Dr. Cowdell, to a vegetable origin. The malarial and animalcular theories have been so often discus- 

sed thai it. would be improper to tiilate on those .subjects Here; but the theory of Dr. Cowdell having been more recenily promulgated, and. withal enforced with so much ingenuity if not plausibilty, that we are induced to include its principal features in tin's sketch. 

Dr. Cowdell has assumed, as the result of certain (acts and analogical reasoning, that epidemic cholera owes its origin to the presence of certain macroscopic fungi, which arc in some mysterious manner generated and received into the animal system. As evidence of the capability of fungi to produce disease on a very large, scale, if' they he capable oi such an action at all, Dr. Cowdell refers to the observation <»{' Fiies. that, a siugle one of the reticularia maxima has produced 10,000,000 sporules; that they are exceedingly light, and consequently may be rapidly diffused over a huge extent of surface. It is also said that they multiply more rapidly alter storms, seeming to have a meteoric origin. Having thus shown the capability of fungi to rank high as a morbific agent, so far as rapidity of production and easy diffusion are concerned, it is next asserted that these fungoid productions manifest a very remarkable predilection for the hum-in body. It must not be forgotten that fungin, the b.isis of the fungi, is in truth a protein compound, and hence it is assumed in the theory before us that these bodies very readily assimilate nutritive elements of the blood, and thus perpetuate their own growth. But leaving this inferential mode of argument, more positive proof of the aptitude of fungi for the human body, is contained in the fact, they are really met with, not only in insects and animals, but likewise in tin; h imnn body. Thus, Dr. Cowdell observes that fungi have baen found in the fluid of pyrosis, in the exudations of puerperal f.jver and dysentery; and he refen to the fact that these vegetations exist in thrush, and that Berg has succeeded in inocculating that disease. Concluding that the occasional existence of fungi in the human body has been clearly enough established, Dr. Cowdell proceeds to point out their peculiar effects, and closes with an inquiry as to their capability of producing Asiatic cholera. Without further trespassing upon our limits to trace out the highly elaborated but very recondite theory advanced by Dr. Cowdell, we will quote a sentence from the July No. oi i'ne British and Foreign Medico-Cktmrgical Review, touching 



this subject, and refer the reader to that work for a more extended notice, "Still, with all the doubts which every one must feel in these difficult matters, we think the doctrine of the fungous origin of cholera more probable, based on stronger tirguments, and on more scientific foundations, than the animalar theory of cholera." 

Looking back over the various theories which have been propounded from time to time, we perceive that these investigations terminate precisely were all such necessarily niu-t end, and we are left no nearer a solution of 1 lie final cause than in the beginning. And what of this failure? Precisely the same obscurity hangs over the cause of fever, scarlatina, measles, small-pox, and all similar affections; and the fact thai we are unable to demonstrate the cause of epidemic cholera, no more proves our ignorance of the nature and treatment of that disease, than does our inability to detect the cause of fevers argue a want of practical skill in their treatment, or ;t competent acquaintance with their pathology. The truth is this anxiety to solve final causes, and to lay bare the ultimate operations of nature, will ever, as in this instance, lead the inquirer into inextricable labyrinths, am! at last terminate incomplete discomfiture. And although we would not if practicable restrain these investigations altogether, — for they often lead incidentally to important results — yet it should ever be borne in mind, that our legitimate province of inquiry has been limited by an All-wise ruler, to effects and results, rather than final or ultimate causes; and hence it is obvious, that the labors of the etiologist, the pathologist, and the therapeutist, lind a more appropriate and fruitful field of investigation in elucidating the absolute causes which are productive of disease, the physical and vital changes wrought by such agents, an.l the means pointed out by experience and principles for their cure, than in attempting to unfold those secret and intangible causes, which must ever elude the grasp of the most astute finite philosophy. 

Dismissing the subject of final or ultimate causation, we aproach another theme more practical in its character, and less obtruse in its nature. 

MODK OF PROPAGATION. 

Supposing the question to be definitely settled that cholera originates from a specific cause, or virus, it still remains to be determined, whether that cause is propagated through the 

13 





medium of the atmosphere, or whether it spreads from person to person as a contagion. 

The contagion or non-contagion of cholera still remains ;i vexed question. From the time of its first appearance in Europef and indeed anterior to that time, medical men have been divided in opinion upon this subject; some affirmed with great assurance that the disease was absolutely contagious, while others were equally positive that it manifested do such character. Several difficulties stand in the way of a fair and definite settlement of this questidn: in the 

first place, observers too often enter upon an investigation oi ihe subject with opinions already formed, and consequently the various facts collected are insensibly made to yield to such preconceived views; and in truth, so partial are most oi these attempts tosoivethe problem, that they amount to little more than an exparle array of the testimony which happens to fall in the way of the writer. 

In the second place, another obstacle to a fair and conclusive settlement of the question, consists in the difficulty of distinguishing between an epidemic and a contagious disease: indeed, epidemics so frequently furnish cases of apparent contagion when none in reality existed, — and on the other hand contagious diseases so often assume an epidemic character, that it requires the greatest precaution to avoid the mosi serious errors; and finally, if we add to the preceding conditions another fact, namely, that diseases originating, nay even spreading as epidemics, sometimes manifest unequivocal contagion. we have assuredly an array of difficulties demanding the most patient investigation, and the most impartial deductions. 

In attempting to settle the question of contagion or non-contagion of cholera, conclusions have too often been drawn from a lew facts, limited in their application and relations, and derived from the disease as it appeared perhaps in a single locality. Such opinions and conclusions are comparatively worthless: for facts thus arranged and classified, will often be contradicted by those drawn from the same affection as manifested in the next district of country, or as it appears the succeeding year; it is, therefore, self evident, that conclusisons on this subject to be entitled to full confidence, must be drawn from a world-wide observation, and that no single authority should be permitted todecide the question, but thai the testimony of all accurate observers must be taken into the account. 

Non-contagious propagation of C holer a. — Perhaps one of 

14 





the most authorative papers which has been publish on this subject eininated from the Metropolitan Sanatory Commission, London, which numbered among its members Dr. South wood Smith and Professor Owen. The report of this Commission assumes that cholera is emphatically Qon-contajious, and the numerous facts appealed to in support of thi> -•pinion are peculiarly apposite and forcible. We draw the following statements from the report : The invasion of cholera in the different European cities was remarkably uniform, presenting generally the same characteristics; it usually attacks first the lowest and damp-1 it part of a city, as was observed at St. Petersburg, Moscow, Breslau, Warsaw, Berlin, Paris, Sunderland, London, etc.; facts clearly indicating its connection, in some waj with the conditions of the atmosphere. Crowded and destitute populations, damp and filthy localities seem to be its special hot-beds. The Commission adverts to another important consideration, which is, that quarantines and military cordons have often signally failed in their attempts to arrest the spread of cholera; and this result has been equally apparent both in Europe and Asia. Numerous individual instances might be adduced to sustain the opinions here put forth; but only a few will be introduced, taking care to select such as may serve as a fair type of those relied upon to establish this view of the subject. The following instance is peculiarly forcible : IT. M. 9th Lancers in passing up the Ganges came into a region where cholera prevailed, and many of them, although previously healthy, were immediately attacked with the disease ; but as they passed onward, and emerged from the infected district, no more new cases occured, and all signs of the epidemic speedily vanished. Immediately succeeding this remarkable instance, another detachment of troops passed through the same district, and were similarly affected. A very remarkable example of what is regarded as noncontagious evidence occurred in France. During the prevalence of the epidemic at Marseilles, not less than 1O,(HH) inhabitants fled to Lyons, and notwithstanding constant intercourse was kept up between the two cities, the latter remained free from the disease. It is also mentioned that Birmingham remained exempt from cholera, although the disease prevailed at Bilston, but eight miles distant, and constant intercourse was kept up. As an evidence of the non-contagious spread of choltra, 

15 





it has been stated that the Mahomedan Harems although strictly secluded, were nevertheless invaded by the disease. It is stated by Clot Bey, that a company of 500 Arabs, incamped in a desert, and strictly isolated from all persons rind places, were, notwithstanding their complete seclusion, attacked by cholera in a very violent manner. The surgeons in the British army in India, furnish many examples in which one regiment would he attacked, while thai 

adjacent u;n passed by and the next invaded, and so on. In one instance, a Sepoy regiment which suffered the least, was stationed immediately adjoining the 31st, which Suffered the most of any regiment in the army. . In the epidemic of 1831, cholera advanced from Astrakhan to Saratov, and the colony of Serepta, which lay in the route, entieriy escaped; and it is very remarkable that the same event occurred at the same place in LSI 7; although free intercourse was continued with the affected place. 

Bui to close this part of the subject, and to settle the question of its non-contagious propagation definitely and conclusively, we must advert to another class of evidence which will admit of no doubt or misconstruction. It has been observed 

in very many instances, that cholera suddenly invaded cities and countries winch had previously maintained no intercourse with any Infected population; and although souk; have affected to question this statement, yet the facts have mlutiplied to such an extent, as to admit no longer of doubt. 

The invasion of Cincinnati, in 1532, furnishes some important facts on this subject. By reference to the Western Journal of Medicine and Snrgenj, then published in the city, we learn from an article written by the editor, Dr. Drake, that the (ir>t unequivocal case of chotera occurred on the 30th of September; and it was not until the 9th of the succeeding month that any importation of the disease was known, and then a single case arrived on a steamboat. Between these two period-, namely the 30th of September and the 9th of October, there was no communincation known between Cincinnati and any infected town or country, and yet twentyone fatal cases of cholera occurred anterior to that which was imported. It is important, also, to observe, that the disease appeared simultaneously at Cincinnati, Louisville, and St. Louis, an occurrence which could hardly be attributed to contagion. 

Now what shall we add, in conclusion, as to the non-coniagious 

16 





spread of cholera? Let us sum up: the disease makes its appearance at various points simultaneously; attacks cities which have held no intercourse with cholera subjects; hundreds sicken at the same moment; isolated Arabs and guarded Harems, are equally the subjects of the disease: quarantines and military cordons have utterly failed to arrest its course. Is the case made out? Most assuredly it is. The evidence is too conclusive to admit of a moment's doubt, that cholera originates and spreads, in many instances, wholly independent of contagion. 

CorUagioui Propagation of Cholera. — Let us now examine the opposing evidence on the subject, and endeavor to make out what foundation there is for the opinion that cholera is contagious. The admission already mnde, that cholera is propagated, in some instances, independent of human intercourse, does not of itself imply a disbelief in the opposite opinion: let us then look to the facts. 

Many eminent members of the profession have contended that cholera is positively contagious; among these we may name Graves, Copland, WWatson,W r atson, <fee. ; and some of the evidence upon which they rely, we shall shortly proceed to detail. 

Probably the first circumstance which attracted attention to the contagious propagation of cholera, was the indubitable fact that it manifested a preference for the great thoroughfares of human intercourse, both by land and sea; and it. lias been asserted apparently with truth, that it does not advance more rapidly than the ordinary rates of human intercourse. And pursuing this idea a little further, it was perceived, that the disease made more rapid progress through maratime countries, and where the most extensive and rapid intercourse took place. Thus the disease evidently advanced very slowly through India and Persia, more rapidly in Russia, Great Britain and the United State-- — the rapidity increasing in the order above mentioned. Observing also that the disease did not seem to be limited by any ordinary barriers; that it crossed seas and deserts; icy mountains and burning plains: prevailed in a tropical summer, and was not arrested by a Russian winter; bid defiance to the monsoons and trade winds — the belief was easy of admission, nay irresistible, that cholera was not propagated solely by epidemic causes, but that its Hpead vva<, at least in some measure, dependent upon human intercourse. The difficulty, however, with the arguments which have been put forth on this subject is, that they assume 

• > 

17 





Nature and Treatment of Asiatic Cholera, 

18 

too much; they attempt to prove that the epidemic ispropn[rated entirety by contagion, and this involved many contradictory positions: whereas human intercourse was but one, of its modes of spread. 

The propagation of disease independent of human intercourse, should, as a general, perhaps universal, rule, be guided by the course of the wind, and this is, indeed, in strict accordance with universal observation; but such is not Hie case with cholera. It. is stated upon good authority, that during the passage of the disease from the government of Astrakhan to Saratov, in IS 17, it constantly advanced against the wind; and it has often been a mailer of careful observation, that it travelled against the currents of an Indian: monsoon. We have likewise the authority of Dr. J'errine for the statement, that during the prevalence of cholera in Yucatan, it was observed to progress in direct opposition to the trade wind-. 

The preceding testimony touching the propagation of cholera, certainly does not conclusively establish its contagion, nor are the facts adduced that kind of evidence which can positively prove the position; but then they are highly instructive so Car as they <zo, /md constitute an important part of a series of corroborative facts, bearing on the same point. 

Another class of testimony which has been brought forward to establish the contagious character of cholera, is based upon the direct results of personal intercourse. And here is the great field of controversy; assertions and denial*; a blind admission of the most improbable events, and an equally absurd rejection of the most palpable facts, constitute much of the material met with in this connection; but, discarding ail theories and preconceived opinions, and groundless prejudices, let us attempt to analyze the facts which exist, and classify them according to their true import and character. 

Many observers in India and Russia, readily admit the spread of cholera by contagion. Drs. Rutftel and Barry, who were, sent out by the British goverment, in 1831, to investigate the subject, say that in Russia the disease was generaliv preceded by persons or vessels from infected districts; that no other mode than importation from the Volga could account for its arrival at St. Petersburg. This conclusion of Drs. Itusscl and Barry, although merely conjectural, show*, nevertheless, that some evidence exi-ted for attributing the disease to direct importation. 



I'm in.* trie p'iss'lgfj 01 cnoier;i lrom lYamuclun to oiiratov, in Russia, some foreign colonies in the direct line of march were spared, and they remained free until travellers arrived lrom Saratov, where the disease prevailed, and then cholera made its appearance. 

The St. Petersburg Gazette expresses the following opinion: The disease was brought by the pilgrims of Trebizonde from Herat to Hamarcand, in September, 1845, and in Bulgaria in November following; and after reaching Bagdad, it was conveyed to Mecca, in December, by the pilgrims. 

A Russian correspondent of the London Medical Gazette, April 28th, 1848, holds the following language: 

"There is scarcely any room to doubt its infectious nature, or to hs being propagated from individual to individual. The steady progress of the disease from place to place, along the threat thoroughfares of human intercourse, is of itself a Itroog evidence in favor of this opinion, independent of other cumulative proofs; at the same time there appears to exist a peculiar state of atmosphere favorable to the propagation of the disease (which, under certain circumstances, may give rise to it by spontaneous evolution), or the poison acquires' increased virulence by passing through the human constimioij, and the progress of the disease from individual to individual is thereby made more palpable* * *The vehicles of infection appear to me to be people's wearing apparel; and J would strongly recommend travellers from infected places* and their clothes, dec. to bj subjected to a process of purification." 

A writer in the July No. of the British and Foreign Mfdiro-Chimrgical Review, although a non^contagionist, makes the following candid admission : "lint, in some cases, the poison has certainly appeared to be transported by a body of men — it has become 'portable,' to adopi a term which has been used, we observe, by Dr. Watson. As a good example we would quote the fact of regiments in India, which have been attacked at a certain place, continuing to be attacked during their inarch through an unaffected district, and at a period of time too remote to allow us to attribute it merely to an incubative period, unusually prolonged." 

The preceding testimony, although very striking in its character, will hardly be regarded as conclusive in establishing the contagion of cholera, and it therefore becomes necessary for the oontafrionists to produce more specific tacts, and to rely upon leas ambigous reasoning. We proceed, 

19 





then, to introduce a class of testimony of a very pointed character.* 

The following remarkable instance is related by Professor Simpson, of Edinburgh : — An inhabitant of Pensa, a village in Russia, had a sou who died of cholera, fifty versts (about 34 miles) distant from home. The father repaired to the spot, and brought home with him the son's clothes, which he wore. In a few days he was seized with cholera, and died. Three women who nursed him, and aftei death washed the body, were soon attacked and died. Immediately upon the occurrence of these cases, the street on the opposite side was barricaded, and all intercourse with the affected side prevented On that side of the street where the disease first appeared, more than one hundred cases occurred, of which forty-five died; on the barricaded side not a single case vas known. 

A soldier and a woman had been exposed to cholera at Orenburg, Russia; they left, and went to the fortress of Iletsk, where they immediately sickened and died. At that time, the country over which they passed between Orenburg and Iletsk, was free from cholera. The disease goon spread to other persons in the fortress; two gills who visited the man, were attacked; the aunt of these girls, who nursed them, was also seized; and the aunt's two sons W( re the next to sutler. Thus the disease spread rapidly, and within twenty days 113 persons* were attacked. 

The city prison in St. Petersburg contained about UK) inmates, in 1831, when cholera prevailed in that city. The prisoners were not attacked until the 23d of June, when one of the number, who had been sent to a public hospital, returned with diarrhoea. This prisoner, who was a female, mv and embraced her husband as she passed. In a few hours sh<: was seized with cholera, and died that night. This was the tirst case in the prison. The next cases were three women who were in the room with the first case; these all died within three days of the first. Next the husband of the first case took the disease, and others in the same room with him were likewise affected. From these it extended to 27 cases, 15 of whom died. It is also added, that none of the noble class, occupying a separate part of the prison, were attacked. 

The introduction of cholera into Edinburgh was under the following circumstance*, as related by Dr. Simpson: — The dis- 

? For most of the following f;« H, we in indebted to Dr. (irave's v<-ry excellent article on the Origin mid I'rogrt.ss of Asiatic Cholera. 

20 





ease prevailed to the east of Edinburgh before reaching that city. The first which were witnessed in the city, occurred in January, 1532; and they were all person* who had visited the infected district. The second case was an Irish woman, which was presumed to furnish no evidence of contagion; but it was finally ascertained that she had slept in the bed of a cholefi patient at Prestonpans. Thus far the disease did not spread in Edinburgh. On the 28th of January, another female died, after nursing her son, who had been exposed to the contagion at Mtimelburgh. This woman, says Professor Alison, was the first case in Edinburgh who had not visited one of ihe infected towns; but her son had slept in a house, at Musselburgh) on Monday, in which a woman was dying of cholera; and returning to Edinburgh, he was attacked on Wednesday. On the following Saturday, the mother was attacked and died. Dr. Alison adds : "When 1 was satisfied as to these facts, I have never doubted of the disease having a contagious property, although I have never thought it proved that its extension is to be ascribed to that property alone." 

Dr. Simpson next refers to the introduction of the disease into Campbelton, a town containing 9 or 10,000 inhabitants: — A man named Withers slept in Glasgow, in a house where cholera existed. Shortly after arriving at Campbelton he was attacked. A female who had visited this patient, was the next case, which proved fatal. The mother of the last patient was soon attacked with the disease, and died. The mother of the first case, who had nursed her son, was the next victim. A man, 600 yards distant from the seat of cholera, who had been working with Withers, while the latter labored under the premonitory symptoms of the disease, was attacked and died; and his wife soon after had also a fatal attack. The next case was a girl, a sister-in-law to one ot the hospital porters. Three other cases followed, but it is not stated what connection they had with the first. As evidence that the disease was thus communicated by contagion, and not merely the beginning of an epidemic, it is distinctly mentioned, that the la<t case was on the 3d of May, and no others occurred until the 28th of July following. 

The invasion of Greenock was equally remarkable. Dow, n fishmonger, went from Greenock to Glasgow, the last ot February, and slept in a house where cholera was raging, lie returned to Greenock, took the disease within a few days and died. Mrs. Black, who was his nurse, had a seizure next day, and died. On the following day Dow's wife was attack- 

21 





cd. The next was a fisher boy, who had been with !><•-.. while the latter labored under the premonitory symptoms <>t cholera; ho was attacked and died. The hoy'a mother was seized next day, and died; and on the following day tiie b<>v\. father and brother were also attacked. From these cases Undisease rapidly spread. 

At Doura the following facts were noted: — A young woman left Sprinebank, near Glasgow, where the, disease was prevaUtag, on the 20th ofFebruory, 1539» She was attacked on the road, and stopped at Doura, a village containing 17( ? inhabitants, where she died. Two fenfmles, who were sisters but not related to the patient, it tended her; on the 24th, one sf the sisters was attacked, and the other on the 25th; they both died. Doura was healthy previous to this first case: but the diseaso spread, and. twenty -one cases occurred, bein^ one to every five inhabitants, then in the village. 

The following is what occurred at Braebead : — A strange i coming from an infected district, stopped in a house at Braehead; he was attacked with cholera, and after being removed, died. Two females, who cleansed the clothes of the house were speedily seized with cholera; one died, the other recovered. Two hawkers at this time came to the same housi they both took cholera, and one died. Ko cases previously or subsequently occurred at Braehead. 

A man and his wife visited an infected district, and slept in a cholera house. They returned and both had cholera. In a short time their two children were likewise attacked with the same disease. 

Some very remarkable (acts were noticed at Terryden These facts were related by Dr. Brevvstcr, brother of Sir David Brewster, to Professor Alison. While cholera was prevailing in different parts of the country, Terryden, with a population of 700, remained exempt from the disease. In June, 1833, the smack Eagle, from London, arrived at Monrosc, on the banks of south F,sk, and opposite Terryden. Two cases occurred on the smack during it^ passage. Upon reaching Montrose, the crew dispersed to their homes. Robert Finley carried his clothes and bedding to his house in Terryden. Two days afterwards, two children who had been seen tumbling on Finley 's matrasses, as they were laid out to air, were attacked with cholera and died; and this occurred, seas Dr. Brewster, when cholera had nearly or entirely disappeared from Scotland. On visiting Terryden, Dr. Brewster found the mother of the children laboring under cholera of, 

22 





v ' 

23 

which she died. From these rases the disease spread through he village. It generally appeared, adds Dr. Urewsier, among the relatives, visiters and neighbors of those previously affected; thus seeming to he conveyed from one to another, according to his observation. 

Veipean,who was anun-contagiouist when the disease first appeared in Paris, bears the following testimony : — "Out of 

eighty odd cases in this city, the history of which 1 have noted, there is none, the subject <>i which had not some previous communication, direct or indirect with oth< r cholera patients." In confirmation of this opinion, he adduces the following renaikable instances : — A man had remained with two ofhtl friends who were affected with cholera: three days afterwards he was attacked and died at his own house. Soon after this event, the following cases occurred in the order named: his eldest son, wife, daughter, another son, all were seized niter visiting the lather; and a child often years, who visited them, was attacked, as was also an artist and his wife. These people, it was stated, were temperate, in comfortable circumstances, and the house was not more insalubrious than the neighboring habitations. M. Velpeau also states, that choiera did not appear in the surgical ward of St. Jean, at the Hopitai la Pitin, until one of the nurses attached to it, had ;n; n in attendance upon cholera patients in the medical 

wards; and the disease success it'/// attacked those nearest the first case. A pupil who had avoided cholera cases, came to tiie surgical ward on the morning of its appearance, and that night he had cholera at disown bouse; and his brother who i'.xlged ill the same room, had a fatal attack next day. 

The following very remarkable occurrence, is also related by Professor Simpson. The brig Amelia left Xew York on the 19th of October, 1832, bound for New Orleans. Oa the sixth day of her passage, cholera made its appearance. Some of the passengers were attested even before leaving New York: and in the course of eight days, '21 of the number died. At the and of this period, the brig was stranded on Folly Island* a low sandy place, occupied at the time by four negroes, the property of Air. Milne. The captain, passengers and the crew of the vessel, were allowed to take refuge in the buildings on the island; these, together with a detachment of 18 members of the Charleston guards, and a boat's crew of wreckers, who came to their assistance, numbered about 150 persons who were then collected <>v the Island. Of the persons thus suddenly thrown together, all of whom were previously 



healthy, except those affected with cholera, twenty-three fata! cases of the disease occurred; and of these there were twite of the passengers, six of the wi-eckers from Charleston, three of Mr. Milne's negroes, the nurse and one of the city guards from Charleston. Of the remaining 1? city guards, every one was affected with symptoms of cholera, except the lieutenant, and nine were severly attacked. Dr. Hunt, one of the attending physicians, was also attacked. 

Is the preceding testimony sufficient to prove the contagious propagation of cholera? We think so. Jt is assuredly beyond the bounds of all human probability, that so many instances of cholera spreading by personal intercourse, can be ascribed to the events of chance; there are, indeed, so many cases of successive attacks, and so many instances where the disease lias been introduced into a healthy locality, that it were worse than madness to deny their truth and condusiveness. Take for example the instance of Folly Island. This island is an isolated spot, about 20 miles from Charleston, situated far out to seaward. At the time of the arrival of the Amelia, its only inhabitants were four negroes; but immediately alter the passengers and others were congregated upon the island, and cholera was introduced by those laboring under that affection, the disease speedily attacked many of those who came from Char lea too. It will be remarked in connection with this history, that not only did new cases occur among the passengers, but the city tfiumls, the wreckers and negroes, where likewise attacked, a large proportion of whom died. Now discarding all prejudice and speculation, and submitting the case to a naked array of facts, we are compelled to say, that this single instance of the introduction of cholera on Folly Island, is perfectly conclusive, and leaves do room for a reasonable doubt. If, indeed, such testimony be not received as final and conclusive, then have facts lost their meaning, and human reason its power of discrimination. 

It is obvious, however, that cholera, as a general remark, i> not so actively contagious as some other diseases; and as we witness a remarkable difference in the facility with which several contagious affections are propagated, it is by no means unphilosophical to aknowledge a comparative feebleness in the transmission of the cholera virus. While we readily concede, then, the contagious character of cholera, we presume, at the same time, that it is much less so than smallpox, and some other diseases. This comparative feebleness of the cholera virus, is one prominent reason why so many 

24 





escape who are exposed to its influence; or, it may be, that the contagious agent usually becomes so largely diluted with air, that its power is greately diminished; and further, when the atmosphere becomes confined, and the poison concentrated, as occasionally happens, then the disease is readily propagated. 

o 

Basing our conclusions upon the preceding facts, we think it abundantly proven that cholera is propagated both by its general epidemic cause, and by a specific virus; the testimony derived from so many sources is entitled to the fullest credence, and it is too copious and pointed to admit of a serious doubt. We can now readily understand why a contagious and a non-contagious party exists; each have proved their positions; both are right, but neither exclusively 80. 

An attempt has been made to draw a distinction between the portable and contagious mode of transmitting cholera virus: thus some suppose that poison may be conveyed by adhering to personal apparel, although that same poison, while passing through the human system, is incapable of self multiplication; in other words, it does not reproduce a similar principle, and therefore is not strictly contagious. We confess that this is a very subtle discrimination, so much so, that its proof or disproof would be an impossibility; and moreover, the practical difference would be so slight, that it is hardly worth the labor of an investigation. 

P A T II O I. O G Y. 

Tn considering the pathology of cholera, our attention will be first directed to its morbid anatomy — the tangible changes which take place — as the salient point in the investigation. 

The most accurate information which we have on this subject, as derived from numerous and careful post-mortem examinations, is contained in J)r. Parlies' work, recently published in London. The author has carefully recorded the dissections of 46 cases of cholera, which occurred in she British Army in India : of these cases, 30 were in a state of collapse, and 7 died during the stage of febrile reaction, 'live conditions of the several organs are thus described : 

Head. — Of 34 cases, the sinuses and veins of the dura mater were considerably congested in 16; moderately »o m 5; the remaining 13 natural in this particular. Pia mater much congested in 9; moderately so in 7: natural In 18; effusion in arachnoid in 8; effusion in the spinal canal in I few enses; substance of the brain softened in 12; harder than natural, ~; 

25 





uulematous, (with softening) 5; red points exagerated in (I; • Hid natural in 23; v utricles contained one drachm of fluid in 3. Cerebellum slightly vascular and softened in a few cases. From these cases we learn that the only common or characteristic rhnnge occurrfng in the brain was that of congestion, or accumulation oi blood in the membranes of that organ. Lungs. — The most frequent changes met with in the lungs woe ihese: accumulation of blood in the large vessels; collapsed and deficient crepitation, arising from reduced quantities of blood and air; — collapsed in 14 case's; did not crepitate in 1;) out of 3D, but floated in water. It thus appears that the lungs were not congested; the principal changes seemed to be deficient capillary circulation and collapse. Heart. — Coronary veins congested. In 2(> of 30 cases, the right auricles and ventricle were flaccid, distended with tibrinous clot-, or dark semi-coagulated blood; left ventricle firmly contracted and the auricle partially so; little or no blood in the left side. In 4 cases opened fifteen minutes after death, the heart was found flaccid; but within a half or threefourths of an* hour, the left contracted, but the right remained relaxed; in another case, examined fifteen minutes after death, the laft side was even then contracted. The>e cases show the right eide of the heart and pulmonary artery to have been congested, while the left side and tin BX>rta were empty. Liver. — Of 3 ' case;, no change in 10; colo 11 : pale, 21; duncolor, 2; light red, '2; pale-slate, 3; dark-slate, f>. Consilience natural. Here we perceive but little change; it is said there was -"in" accumulation of blood in the larger branches of the vena portae and hepatic veins; gall-bladder moderately full. Spleen. — This organ was generally contracted. Kidneys. — In some instances congestion of the cortical structure existed. Stomach, Mucous membrane congested in several cases; in 3, red stria.*; in one softening; consistence natural in the remainder; veins oi the omentUAi and mesocolon turgid with blo< (I. Sffutll intestines. — Thirty-nine cases examined. Vermillion of the peritoneal coat, 8; fainter color, 2; not changed, o ( .) : generally dilated. Mucous membrane. — various shades 

26 





of redness, ia patches, dilTu.se, or punctiform, varying from |>ini< to brown, in '2(5; consistence unaltered i glands, both agminated and solitary, generally enlarged — in a few cases unaltered; Brunner's glands in duodenum often enlarged* 

Large intestines. — Colon contracted in one bull ol the cases; peritoneal surface pale; mucous membrane consistent, and vascular in some cases; glands visible and often ealnrj 

The most remarkable change exhibited in ihe intestinal Canal, is the enlargement of the glands; the mucous coat was generally somewhat congested, but not softened. 

Contents of the alimentary canal. — The liquid contents of the alimentary canal were of a whitish, or light-gray color. and consisted of two portions — a clotted substance, which adhered closely to the mucous membrane, and a thin or serous part, which was purged off. The ilocculi found in choleraic discharges are probably fragments of this clotted material. • 

li nits somewhat different, in some respects, have been rded by other observers. Thus the lungs have frequently been observed to be engorged, instead ot the deficiency ot blood noticed by Dr. Parkes. But the most important differrelates to the condition of the mucous membrane oi the 

intestines, which, according to many observers, is paler than natural ;md softened, in many cases, and in others — and these 

are said to be rather frequent— positive evidences ot inllam ination can be detected. 

Dr. Masse}', surgeon toll. M. 31st in India, examini nutely Jifty cases, and the following are the general results-. Congestion of nearly every organ — brain more so than any other; left heart empty; right filled with blood; luDgs con- 

gested; entire nervous system greatly congested; glands of reyer and Brunner sometimes enlarged; mucous membrane of intestine occasionally of a higher color than natural; live t frequently engorged, but in some of the worst cases it was healthy. 

These results certainly vary in some important particulars; for example, Dr. Parkes found the mucous membrane of the intestine maintaining its natural consistence, while others report it as constantly softened. Again, Dr. Pa/kes found the lungs containing less blood than natural in the capillary Piystem, while others have generally found this structure engorged. 

Hut after all, is there any thing characteristic — any structural change constant and invariable — any organic lesion which can be regarded as the pathological anatomy oi Asiatic 

27 





cholera? Certainly none; for admitting the accuracy of the observation, that the intestines are frequently inflamed, or that the mucous membrane is often softened, still these changes are not always — nor perhaps commonly — present as is clearly shown by the reports of Dr. Parkes; and if There are many cases which present all of the symptoms of cholera, and even progress to a fatal termination, without the lesions in question, then most assuredly they are not one of the essential elements of the disease, because it can exist without them. Nor can we regard the glandular enlargements, so forcibly dwelt on by Dr. Parkes, as constantly and invariably present; for many observers have not detected that lesion; but admitting that it was often overlooked, still it cannot be regarded as a uniform change, for it is distinctly stated by Dr. Parkes himself, that in a lew cases these bodies remained unaltered. Now if they can remain healthy even in a few cases, they must be regarded as tecondavy instead of primary, and by no means essential to the disease. 

The alledged inflammation and softening of the intestinal mucous membrane, we regard as extremely problematical: it is scarcely possible, indeed, (hat a disease passing through Its stages within a few hours, could take an inflammatory action, and terminate in softening. The thing itself is extreml-V improbable, and, it seems to us, is not sustained by a sufficient concurrence of testimony, to warrant its adoption. The article Cholera in the Cyclopaedia of Practical Medicine^ adopts the opinion that inflammation is a common change in the intestinal mucous membrane of cholera subjects; but it is evident from the phraseology employed by the writer, that he is in reality describing mere congestion, a condition undoubtedly met with; and we strongly suspect that this is the lesion which has often been mistaken for inflammation. 

What then shall we say of the morbid anatomy of cholera? Shall we admit our inability to point out. any common and invariable lesion, or •¦an we with gravity and dignity adopt the conclusion of I>r. Fraser, — "if there is any one post-obit appearance almost always present, it is the rigidly contracted bladder" Fortunately we are not forced into either of these meager alternatives; but looking at the facts as they are reported by all of the writers, we are forcibly impressed with the singular uniformity with which one morbid condition is recognized, which is congestion. All concur in the statement that congestion, to a greater or lesser extent, is met with in fatal cases of cholera; true, they vary in degree, and in the 

28 





¦f 

29 

organs most largely and uniformly implicated; but nevertheless, they agree with singular unanimity* that congestion in .some organ did exist, and was manifested by unequivocal signs. And in those cases where no very obvious degree of engorgement was present, or even where an organ — as the lungs or liver — was preternally pale, it cannot be considered as conclusive evidence that congestion had not previously existed, for the excessive discharges from ihe system may have abated the vascular fullness, and possibly left the part in an anffimic condition. The evidence is certainly clear and irresistable, that the great element in the pat koiogical anatomy ot cholera, so tar as it is cognizable to the senses, is congestion: and it is immaterial whether we regard this lesion as primary or secondary in its relations to the general pathology of the disease, it still remains as our only tangible basis, and the out upon which all our opinions must rest. 

Leaving now the morbid anatomy of cholera, we come next to inquire into its general pathology, or those primary but intangible changes, which result in the more obvious phenomi - na, and the fatal symptoms. And iirst, in this investigation, we fee] authorized to take the position, that the disease is nol properly "cholera;" this we shall proceed to prove. 

An opinion has been maintained by several pathologist.*, that cholera is intimately connected, if not dependent upon, an undue acciimmulatiou, or rather retention of carbon in the 

system. 

The physical appearances of the blood, its dark and gnnnous aspect, very naturally led to the supposition, that, as in asphyxia, the carbonaceous element was not properly eliminated; and the experiments of Dr. Davy established as a fact what was thus merely conjectural, that the air expired b) cholera patients was not only below the natural temperature, but that it contained a diminished amount of carbon. ]\lr. Thorn hns sought to explain the principal phenomena of cholera by reference to this retention of carbon; his facts and reasoning are plausible and ingenious, and deserve more than a passing notice. The observations of Mr. Thorn were made at Kurrachee, in June, 1845, when the disease prevailed in 11. M. B(ith Regiment. He argues that an increase of tempera tur< and moisture, necessarily augmented the bulk of the almo* phere, and at the same time diminish its specific gravity; and it is obvious that these conditions reduce the quantity oi oxygen in a given amount of air. And it is estimated, that with the thermometer at 1R) W and the dew point at 83°, the atmosphere 



would yield about one-eighth less of oxygen in June than it did in February. The oxygen being thus diminished, an undue proportion of carbon wonrd necessarily be retained, and a morbid condition would be ,the result. This slate Oi the atmosphere existed at Kurraehee, in June, when cholera made its appearance ; and to this condition Mr. Thorn adds that afmoiiturCi which was present in a remarkable degree, and was supposed to contribute to the development ot the epidemic. Moisture preventing the ordinary evaporation from the surface, was presumed to favor congestion, in a very obvious degree. Thus a retention of carbon in the blood, a high temperature and moist Atmosphere, constitute, according to the views of Mr. Thorn, the "general cause" of cholera. It is not averred, however, that the remote cause of cholera is exactly these conditions of heat and moisture; but Mr. T. insists that there is some sort of connection between them. Had he ranked these iitmospheric changes as exciting causes. and not sought to connect them with the absolute origin ot ihc disease, he would not only have been better understood, but, we are of the opinion, much nearer the truth. 

Dr. Parkes, in his excellent treatise on cholera, has sought 1o connect still more closely, the phenomena of cholera with derangements of the respiratory function, but differing from ihc views of Mr. Thorn. It will be remembered that Dr. I*. Innd the lungs comparatively free from air and blood, and nsequently collapsed; and drawing an inference from thai thologicai condition, the conclusion was reached that the .«.,!, from some causes, failed to circulate freely through c pulmonic capillaries. This condition, Dr. P. regards as state of asphyxia; and the sympioms which follow, point to eh a lesion, namely, loss of heat; lost of voice, from diminum of air; peculiar color of the surface; arrest of circulation; 

Kllapse of lungs; contraction of the left and dilatation ot the rht heart; are several conditions, which prove the failure of the blood to pass through the lungs. 

Dr. Parkes proceeds to inquire for the causes of ibis failure of circulation in the lungs: does it depend on a failure of the powers of the heart? do the lungs refuse to admit air, or is ihe failure on the part of the respiratory muscles? All ot these interrogations are answered in the negative; and, as a last resort, the author declares his conviction, that the failure of the circulation in the pulmonic capillaries depends on the peculiar condition of the blood, which is a change in its fibrin. 

30 





The theories advocated by Dr. Park eg and Mr. Thorn, although leading 10 conclusions certainly unwarranted by the data upon which they are founded, may serve, nevertheless, to point out in a very lucid manner, the chief morbid change existing in so-called cholera. 

Mr. Thorn has clearly shown that a remarkable state of congestion exists, which he attributes mainly to the combined influence! of external heat and moisture and retained carbon. But in contradiction of this hypothesis, we have only to mention, thai exactly similar changes of heat and moisture occur again and again, without developing cholera, or any symptom of it. This fact is of itself conclusive against the hypothesis; and Mr. Thorn himself virtually abandons the position, when he admits that the remote cause is probably different. 

Of the explanation offered by \)\. Parkes, we have but litlle to say: it may or may not be true; but there is one fact which strongly militates against it, which is, that the lungs have not always been found in the bloodless condition noticed by this writer. Now the fact is, the lungs have generally been set down as positively engorged, and we are not permitted to doubt that such is really the condition in many instance-; and if this admission be correct, it completely destroys the theory of J)r. P., for his opinion is based no less upon the appearance of the lungs, than on the consecutive symptoms. 

I)i agreeing with both of the writers referred to, as regards their inductions, we nevertheless freely admit the main position so clearly elucidated by both, namely» the state of congestion invariably present. This state of congestion is, according to universal observation, the only tangible and Uniform morbid change ( which is left after death; and as a mailer of necessity we are restricted to that condition, as far as morbid anatomy is concerned; and looking back from this point, we are induced to connect with it certain antecedent 

cau-es, supposed to be competent to produce the condition named. 

The remote cause of cholera, be what it may, is evidently a poison which operates generally on the system: but whether its primary action is directed to the nervous or vascular system, is difficult if not impossible to determine. Avoiding all hypothesis, however, we can turn to certain indubitable facts, showing beyond the possibility of doubt, that the choleraic poison impresses the entire organism, and impairs the vital functions generally. In confirmation of this statement, we 

31 





would ' one-eighth text of ox; it did in February. The oxygen be-in** thus diminisi: idue proportion of carbon v trily be r ilion won!! be ( the result. This visted at Kurracht '•¦ ¦ ¦¦.¦ hen cho}< and to this en Hit ton Mr. Thorn adds . which wa« present in a remari tribute to the development ol the :\i . jture ¦ venl •rdhmry evaporati ; •¦ n.inav of carbon in tlio bloo ¦ cholera!. It cholera 1 Mr. T. •A T een tlv I iliem with the ab i ."¦ mid not only have been better understood. but, rarer the truth. Nt treatise on cholera, has sor • enmfiena of <-hol( »n, but difTeii Jt will 1 that 1 >r. }'. lound ttit- »m air and blood, and ? ¦ reached that I ihn • 

0 







• of it. T - ¦ when 1)4 Of the expianuli tie to say; it may or which strongly militates have not always been fou by this writi v - v been set down as positively ¦ t » 1 "' mitted to doubt that such is i "¦ tftom stniice-:; and if this admission be cor mplet stroys the theory ot" Dr. P., for his opinM^^H -d >m« fc< upon the appearance of the lungs, than • - i • v - ¦ .iptorns. 1 >i agreeing with both of the writers referred tOv^H their inductions, we nevertheless freely admit the HWJB lion so clearly elucidated by bctth, namely, th * invarinl nt. This eiAic of congestion 





may refer to the condition of a community where cholera prevails{ a large number labor under certain symptoms, — among which are lassitude, impaired functions of the stomach and bowels, impeded respiration, etc.; — a class of symptoms dearly indicating that the poison has gained access to the system, and is operating generally upon its vitality. 

Observation has abundantly testified, that the first impression is not on the gastro-enteric mucous surface; indeed the functions of that membrane often become deranged lo ng after other and obvious symptoms have occurred; and there seems every reason, both positive and analogical, to class the derangements of the alimentary canal as altogether secondary. In support of this opinion, we may instance the important facts, that the disease is sometimes developed in its must malignant and fatal forms without purging; and in many Kore instances has it been observed, that there was no close lationship between the algide symptoms and the vomiting and purging. Thus there appears at times to be a complete arrest of the circulation, a "mortal coldness" conies on, evidenily not produced by purging, and the patient dies within a few hours. Dr. Parkes, speaking of the connection between purging and vomiting, and the algide symptoms, makes tht following observations : 

•'My cases bear out the observation of Scot, Jameson, ( )i - t<»n, Kennedy, Copeland, and in fact, almost all the English writers of reputation, that there is absolutely no ratio between these two classes of symptoms; or that they appear even to observe an inverse ratio to each other. Thus at the period of the case when algide symptoms were most fully developed, viz: in the last live hours, the purging ceased; in the cases where algide symptoms were prominent throughout, and which cases were consequently the most malignant and the most rapidly fatal, the passage of the fluid from ilie intestines was oftentimes trivial in (U'tjixic, and shortened m the period of its occurrence. Jn cases in which the vomiting and purging were excessive, the algide symptoms came on sloWrVi and were less marked and deadly." 

In confirmation of these declarations, Dr. Parkes instances the case of a soldier who had but two stoo/saud yet died in eight hours alter the attack; and many fatal cases were attended by only three or four evacuations. Two to four stools were often attended with more rapid and fatal results, than cases .n which lu:puh/-Jire discharges took place. The contrast is forcibly exhibited by two soldiers; one had two stool> and 

32 





«iied in tight hours;' another had twenty-fix stools, and lived seventy hours. 

It is impossible not to recognize in these facts the opinion already expressed, lhat the disease is not located primarily in the alimentary canal, but the symptoms connected with these organs are to be regarded rather as tecon* dary than primary. 

it is certainly an irresistible inference, if not a demonstrated fact, that cholera impresses the whole organism, and that the development of abdominal symptoms is altogether a secondary matter — a mere symptom — and cannot by any means be regarded the disease itself. But while we make this admission, it still remains a question, what portion of the body is first impressed by the morbid agent: is it the nervous or the vascular system? Very different opinions have been promulgated on this subject: thus Mr. Annesly and Dr. Parkei refer it to the blood: Dr. Kennedy and Mr. Orton to the nervous system generally: Mr. Bell to the ganglionic system; while the French pathoiogistfl in general attribute it to the disease of the gaitro* enteric mucous membrane. 

We do not feel called upon to enter minutely into a consideration of Ihe primary location of the choleraic poison, but the subject is too important to be entirely overlooked. It appears from the various phenomena developed by so-called cholera, that the nervous system is primarily impressed: thus the lassitude, failure of the circulation, accumulation of blood in the central organs, all point significantly to this portion of the animal system. We have not space to enter into the subject of congestion, otherwise it might not be difficult to show the intimate connection which subsists between capillary circulation and innervatiou; but this much we may say, that a poison acting on the nervous function and depressing its action, such as the malarial poison causing fever — causes, in the exact ratio of its action, a tendency to congestion. Weakened capillary circulation; oppressed and depressed action of the heart, and impaired respiratory function, all tend directly to produce the condition called congestion. 

We suppose about the following events occur in a case of cholera : The nervous system in general, is impressed by the poison, and its action becomes impaired; next, and as a direct consequence of the first, the circulation of the capillary system becomes impeded, and this occurs especi- 

: ( > 

33 





ally in the lungs. As a consequence of the obstruction in the general capillary system, an undue quantity of blood is thrown upon the central organs; the heart labors, and the viscera generally become more or less impressed; but especially is the capillary system of ihe lungs impaired, which tends to diminish the animal heat, 1o retail carbon, and particularly to engorge the right side of the heart. As these several morbid changes progress, the right side of 1 c heart becomes more and more distented with blood, while the left is rendered proportionally empty; and thus a double cause ii operating to impede and exhaust the action of the heart. in the meantime the engorgement of the right heart reacts upon the venous system, and the ascending cava becomes engorged, and through it the vessels of the liver equally suffer; the vena ports become.-: distended, and all the intestinal canal from which this sys\..i conveys blood, becomes engorged. Here we perceive an extensive and profound stale of congestion exists; commencing in the right cavity oi the heart, the chain continues t trough the cava, vena porte, and capillaries, terminating on 

the intestinal surface; and with the minute vessels thus engorged, it ceases to be a matter of surprise that serous discharges occur. Indeed so completely are the intestinal capillaries distended* that in all probability, mere mechanical pressure is sufficient to cause very active exudation. 

The condition of the blood, and its relation to the serous discharges from the bowels, deserves a moment's eonsiderat on. The most reliable observations on ihe condition of the blood, show just what might be anticipated, namely, a diminution of serum, and a relative increase of fibrin and solid constituents. This diminution of serum results, beyond all i! i'.bt, from that constituent of the blood being exhaled Irom ihe intestinal -capillaries and ultimately discharged by purgation. The serous discharges met with in cholera, consist of water, albumen, and salts; indeed, its composition is exactly 

¦ aino of blood serum. The occasional arid reaction tnet \,ith in these discharges, should be regarded as entirely accidental, for they are almost invariably decidedly alkaline; and 

te presence of urea is equally fortuitous. 

Tlie opinion has recently been attributed to Andral, that the serous discharge occuring in cholera does notarise from the blood, and i< nothing more than a mucous secretion. Such an opinion could hardly t>e entertained by one , c o accurate as Andral; but even if lie did express thai belief, we couH not 

34 





yield to a suggestion so manifestly erroneous, and that too. when directly opposed to the observations and experiments ot many of the most distinguished pathologist*. 

The most important consideration connected with this dis-. • 'harge ot serum, is, the physical changes which take place in the blood. Ih consequence ot the removal of so large a quantity of serum, the crassameiitum greatly predominates; and hence the blood is more thick than natural, and consequently circulates with great difficulty. Indeed, where the quantity exhaled is \o-y large, the circulation become* suspended aftu direct consequence of the predominance of the clot over the serum, This fa an important pathological condition, and one which merits the mature consideration of the practitioner: for while this physical impediment t<> the circulation of the blood remains, no external applications, nor internal remedies can arrest the failing action of the heart and arteries. Al the same time the hlood assumes a dark aspect, and coagulates either not at all or very imperfectly. The spasmodic action which occurs in cholera is important as a symptom, and can he introduced here as appropriately as at any other point. The iirst question whi'-h presents itseii in this connection, ]-, what causes tiie muscular contractions »o generally arising during cholera? This question is by no insane easy of solution. Widely different opinions have heen expressed on this subject; some attribute the spasms to one cause and some to another; hut when we remember that various nfiorbid states may produce spasmodic action; and, moreover, when we perceive; that several states exist in cholera cither one of which is competent t<> induce such a condition, we cannot hesitate in expressing the opinion, that the spasms attendant upon the disease result from more than one variety of lesion. Three several conditions exist in cholera, cither of which may cause spasmodic action. 1. Intestinal excitement. — Although the intestinal excitemen — erptliism, perhaps — is really si'<ondan/ in its relations, yet the effects upon the nervous system will be precisely the sM'ne as though it was idiopathic. This excitement depends I ion the distended state of the capillaries, caused by intense Wgestton. And it is easy of comprehension, thnt. capillaries • distended, will readily cause nervous excitement, co-extenve with the vascular turgescence; and the irritation, or er- Uism when produced, is, by a Wen" k knOWllftWjTea\di4y p J»l lopai>1 opai> ated to the spinal cord, and through the excito-motory I'unc -. 

35 





tion produces spasms — such as Marshall Hall would call vccettfric spasms. And we may state further, that the mere distension of the intestines with serous exhalation, may Incompetent to cause this reflected action. Dr. Parkes, indeed, has observed that, in some cases, the spasms and purging alternated ; so that the muscular contractions recurred when* ever the intestines filled with serum, and were as invariably relieved when the contents were discharged. tl. The altered condition of the blood. — We are not permitted to doubt th.it the physical and vital changes in the b100d,. -ac sufficient, in many cases, to induce spasmodic action. It is a law generally admitted by physiologists, that during any material diminution of blood, whereby its ordinary degree of pressure is vuried, spasmodic action may arise, and especially if the change is brought about in a very speedy manner. Now in cholera the rapid loss of serum very quickly reduces the amount of circulating fluid to a very great extent, and therelore greatly diminishes the pressure; so that the condition required to produce spasms is very fully developed, and we cannot reasonably doubt its agency in producing the condition under consideration. To this cause we may add another connected with the blood, which is, the change in its vital properties. It is by no means improbable, that the great change in the relative proportion of fibrin and serum, the altered condition ot" the blood-corpusc!es, and other derangements, may be productive of spasmodic act ; on. 3. The impression of the primary cause. — Jt is by no means impossible that the remote cause of cholera may so forcibly impress the nervous system, as to produce spasmodic action, independent of purging, changes in the constituents of the blood, or intestinal irritation. There seems to be evidence to prove that some agents, such as miasmatic influence, will sometimes, by an immediate action on the nervous system. produce spasms; but aside from analogical argument, we have the more direct testimony of observers to prove, that spasms do occur in cholera without much purging. On this subject we may quote the declaration of Dr. Parkes, in which he says, "it was also certain that they (spasms) were very severe in some cases with little purging." In such instances, there seems no means of explaining the phenomena, but by refer* ence to the impression of the choleraic poison, made direct! v on the nervous system. 

There is every probability that the existence of either one of these causes may produce spasms; and as they all do OC- 

36 





Mr, singly or combined, we arc forbid by the most obvious reasons, to rely exclusively upon cither one alone. Spasmodic action may, therefore, depend on the concentrated form <>f the poison causing the disease; it may arise from intestinal excitement reflected upon the exeito-motory system; it may be the result of changes in the blood; or, finally, these several causes may all exist at once, and their combined action be directed to the same result. What now shall we say of cholera? Assuredly this — that the disease is not located in the gastro-enteric mucous membrane; that it probably commences in the nervous system, cerialnhi that function is early involved: that congestion is the profound lesion produced, and this is the precursor, and immediate cause, of the rice-water discharges. If the disease was essentially located in the alimentary canal, the earliest symptoms would not only be located in those organs, but the intensity of the abdominal symptoms would be an exact measure of the violence and danger of the disease; but we possess the direct testimony of Dr. Parkes, and others, that death frequently occurs with but little intestinal disturbance, while the most violent vomiting and purging are often not followed by such rapidly fatal results. The conclusion to which we ate led is, that so called cholera first dynamically impresses the nervous system, and consecutively various organs, lerminating\n a peculiar form of disease in the gastro-enteric surfaces, from which arises the most obvious and alarming symptoms. Now is this disease Cholera? We think not. Without delaying to state the principal phenomena of "common cholra," we may merely say, that the disease is one which is essentially located in the stomach and bowels; and whether this be the result of heat, irritating ingesta, increased biliary secretion, or other causes, the result is the same — gastro-ente- K irritation constitutes the essence of the disease. Here We ceive a radical difference between sporadic, and Asiatic lera; the former is essentially located in the alimentary canal; the latter is a disease operating primarily on the system at large, producing profound congestion, and secondarily implicating the intestinal canal. If this be true, — and it scarcely admits of a rational doubt, — then the disease termed Asiatic cholera should be removed to another class; for both the etymological and accredited import of the term "cholera,' forbid such an application. Without attempting to be very precise on this branch of 

37 





the subject, we feel strongly inclined to believe that the disease under consideration is more nearly allied in pathology to certain terms of fever, than to the class of cholera. This opinion is by no means new; it has been advocated by several medical writers; and indeed it was one of the earliest opinions expressed by those who carefully investigated the subject. The able report on cholera, as it appeared at Bombay, in 181,9, directed attention to the symptoms of congestive typhus as described by Dr. Armstrong, and adds, that there is not only a striking analogy between the first symptoms of that torm oi fever and those of cholera, but that the same remedies are applicable to both. Some have compared so-called cholera to malignant hit :rmitent lever; and there seems, indeed, some ground for such a comparison, at least so far athe congestion is concerned. There is probably no positive evidence, however, to prove that the disease takes on distinctly either the remittent or intermittent types of fever; all that we now contend for is, the relationship between a congestive form of fever, and cholera: and whether that congestive form ot fever does or does not manifest periodicity, is quite immaterial in the discussj mof the question before us. A close examination will reveal a very striking analogy between the more prominent symptoms of cholera, and those which characterize some forms of congestive fever; and this analogy holds good not only in relation to the primary congest iv< stage, but it is equally manifest in the phenomena of reaction, when that condition is established. Iv confirmation of this opinion, we need <>nly refer to the symptoms characterizing severe forms of congestive fever; such as coldness of the extremities and surface; failure of the circulation and animal heat; vomiting and purgiug; and sometimes spasms. Indeed, so nearly do the ;e symptoms correspond in their outline* that a description of the one might, in many instances, be applied to the other. But what we especially desire to enforce iv this connection is, that the general symptoms of the two forms ol disease bear such a remarkable resemblance, that, we are justified in regarding them as partaking more or lessoi the same natures; and consequently, that, the disease called cholera doei not. really belong to that class, but is in truth more nearly allied to the class of levers than to cholera. 

This view of the nature! of cholera is important, not only in a pathological sense, but also in its relation to treatment : for so lon<r as the attention is directed exelu- 



sively to the alimentary canal as the absolute seat of the 







disease i so long will our remedial agents be addressed to the same organs; and thus, by a partial and incorrect consideration 01 the seat of the morbid action, the state of the general system is entirely overlooked, and the true nature of the disease mistaken, and remedial agents improperly employed* In support of the opinion that cholera bears some relation to certain forms of lever, we may quote the following extract from the Cyclopedia of Practical Medicine, article Cholera. 

"Were we to endeavor to illustrate in a few words the nature of cholera, by examples drawn from anaiogus diseases, we should say that its choleric stage presented in a more intense degree the initiatory coUapsed symptoms of certain bad levers before reaction had taken place, combined with excessive gastro-iutestinal irritation; while the febrile stage bore :i very close resemblance to such level's after the establishment of reaction, or in many cases was, at least in external character, perfectly identical with them." 

The above extract conveys very forcibly what we conci \\ to be not only an analogical illustration of cholera, in its external features, but as representing with equal accuracy its .•actual nature; but at the same time we feel equally well convinced, that the expression "intense gastro-intestinal irritation" is not so applicable to cholera as is generally supposed. I'athologists and practitioneis seemed to be constantly impressed with the idea of gastrointestinal irritation as the very essence of cholera, and consequently all their attention is absorbed by that single consideration* But as already stated, we can but regard such an opinion as extremely limi; ¦dand erroneous? and that the seeming intestinal excitement depends upon an anterior condition. Now this condition which is primary and principal, is clearly a state of congestion; and this congestion, reacting on the intestinal surface, produces the symptoms of vomiting and purging, which are prsumed to depend on absolute local irritation. If, indeed, such irritation existed as a primary condition, some traces of it would assuredly remain after death ; but as many I' the most rapidly fatal cases exhibit no signs of an intense id all powerful mucous irritation, we are forced to reject at opinion altogether. Hence, there is an evident improiety in saying that cholera is analogous to congestive fever, ith intense gaslro-inlestinal irritation; for the symptoms of eh excitement result from the congestion itself, and therere do not deserve to he considered as one of the primary ements of the disease. 

39 





pneven t i o w. 

The prevention of cholera, so far as it can be accomplish ed, is resolved into a few plain and simple rules, if the views which we entertain upon this subject be at all correct, cholera depends upon a specific virus, and this virus we believe is capable of self multiplication in its passage through the human system, or, to say the very least, it is susceptible of transportation by personal apparel, so that the disease become* virtually contagious. But it is equally evident that the cholera poison can be rendered more active and destructive by the intervention of certain auxiliary causes; indeed, some of these predisposing and exciting causes are so potent, that. ihey constitute the most material danger. Now in directing our attention to the subject of prevention, two consideration are naturally presented : 1. To neutralize the choleraic poison; 2. To remove or modify the predisposing and exciting causes. 1. To neutralize the choleraic poison. — It appears from the best testimony which can be produced upon this subject, thar no chemical agent thus far has been found competent to destroy the cholera virus; and it seems fully established that all the disinfecting agents, which have been employed for tho purpose, do nothing more than remove the unpleasant odors arising from animal and vegetable decompositions.* These agents, however, accomplish some good by the removal of those offensive gases, and thereby purifying, to some extent, the atmosphere; but at the same time there is a wide diflerence between removing unpleasant odors, and destroying a virus causing a specific form of disease. The value ol tjiseniecting agents, then, consists in their ability to remove sulphuetted hydrogen, or similar gases, thereby puriiving the atmosphere, and consequently removing what might prove an exciting cause of the disease. 

In the selection of so-called disinfecting agents, it is important to employ those which will yield to the atmosphere aslittle as possible that is injurious or offensive. Thus in employing chlorine we secure the action of a powerful agent in 

• It has often been iMOltod that clilorino <jas afforded a complete immunity I'rom cholera; and instances liavo been referred to in Scotland, in which tho diffusion of this gas seemed to arrest the progress of the disease; but tho evidenm adduced is by no means conclusive. 

40 





destroying offensive odors; but while it removes one, it adds nnother, ¦which to some is almost as objectionable as tint: which it was designed to destroy; and it is by no means impossible that an atmosphere loaded with so active an agent a* chlorine, may of itself become an exciting cause. Tims we perceive that by employing chlorine, we really poison the air, and may indeed cause instead of preventing the development of disease. 

Without extending our inquiry to all the various agents which have been mentioned in this connection, we will restrict our remarks to two — the nitrate of lead, and common cotfec. The nitrate of lead is unquestionably one of the most valuable agents which has been employed with the view <>i purifying contaminated atmospheres, its especial superiority consists in its power of absorbing sulphurated hydrogen, and thereby at once removing all unpleasant odor from that cause: and while it thus completely neutralizes offensive odors, it yields none of its own to the air. It may, therefore, be employed with the greatest freedom, and always with the most marked advantage. One drachm of the nitrate to one ounce of water, makes a solution of the proper strength ior ordinary purposes. This solution may be placed in the night vessel. applied to the persons, sprinkled upon the floor, or in any other way found necessary to destroy unpleasant odor from offensive animal or vegetable substance*. There is no probability, however, that it will destroy cholera virus; its only use, therefore, is to purify the, atmosphere, — a very importan measure for the purpose of preserving health. 

Common coffee has been alledged to purify the atmosphere by removing offensive odors. It is stated in the London Medwitl Gazette, on the authority of Dr. Webber, that fresh washed coffee immediately destroys the odor of decomposing animaJ substances. The mode of employing it is to pulverise dried coffee in a mortar, and then strew r it over a moderately heated iron plate, allowing it to become brown in that situation. The vapor arising from the coffee, it is alledged, neutralises the offensive odors of an apartment in a very effectual and speedy manner. It is worthy of trial, although we have seen nothing to confirm the opinion above expressed. 

"2. To remove or modify predisposing and exciting causes. — During the prevalence of epidemics, the great object should be to preserve the general health in as vigorous a state as possible, for all agents which depress or derange the vital actions, necessarily reduce the power of resistance, and in a 

41 





proportional degree invite an attack of the prevailing form ot (Incase. Our attention is directed in this connection to two classes of agents : 

11. Those whioh relate to the slate of the atmosphere, in- Lidiilg heat, moisture, ventilation and general impurities. 

•2. The influence of ingesta. 

I The agency of particular states of the atmosphere in aiding c development of cholera is now well known. It i;s a fact tested by universal observation, that low and damp locali:.s manliest a remarkable tendency to develop the disease; (I when an epidemic invades a oily, those portions which are >st remarkable for dampness, sutler the most, extensively d severiy. There seems, indeed, to be some mysterious nnection between the poison of cholera and moisture. In »W of this important (net, it is evident that persons should oid, as far as practicable, damp apartments during the prcvmce ot cholera. The best means of obviating the effects of inpness will be tooecup)' the highest apartments especialibr sleeping; and at the same time securing the advantage of l's to dissipate any undue accumulations of moisture, especially in basements. There is in all probability, an advantage in occupying elevated sleeping apartments independent <>t" loiding dampness, 'for it has been observed that persona .¦re less frequently attacked while in the upper stories. Dr. arle mentions on instance in India, in which cholera attackthe men on the lower floor of a barrack, while those above tirely escaped. Analogous facts in relation to fever, would Zgest, that the cholera virus, owing to its specific gravity, 1 not so readily rise to the more elevated apartments. Be tt as it may, the fact is important, and should be acted up* whenever practicable. We would strongly advise persons, during the prevalence of cholera, to sleep in the highest apartments, and to resort to the use of fires, even in warm weather, it' any considerable degree of dampness was present. 

The next consideration connected with the atmosphere, relates to its purity. The atmosphere should be preserved as nearly pure as possible; because all noxious states of the air we breath tend more or less to impair the vital energies, and thereby to invite an attack of the prevailing disease. Hence all local causes of impurity should be carefully removed before the disease, approaches. For the purpose, also, of preserving the atmosphere in a state of purity, free ventilation is of the highest importance, and as few persons as practicable should occupy the same apartment. The London Central Board of 

42 





Health, in an address directed to the people, remarks that cholera is rarely if ever contagious, and consequently there is m> necessity for separating the healthy from the rick. This advice however, is certainly not well founded, and it' acted upon would probably be attended by mischievous eoaseqaences. \n addition to pure air and the avoidance of moisture, suitable clothing, including flannel next the skin, is highly important, tor a derangement of the cutaneous iuria.ee would very powerfully predispose to the disease. 

The rules which should regulate the diet are few and simple; indeed the exercise of a little common sense on this subject, will he sufficient for the guidance of every observing person. In the first place, we should not attempt too much; the mode of living should not he made to vary materially from the ordinary habits and regulations; and the only precaution required is to avoid excesses of tvtry kind, and to relinquish the more indigestible vegetables. Animal food, being more? digestible and nourishing, is better adapted to the circumstances, than vegetables. An experiment was made in the Russian Imperial nrmy on this subject, by placing two companies of soldiers, of equal numbers, under exactly similar circumstances; to one animal fond was given, and they entirely escaped cholera; but vegetable b were allowed to the others, and of Ujeir number thivty-Jivc were attacked with the disease. Still it would hardly be propei to interdict the use of vegetables entirely; but suck facts as the above, conjoined to the well-known law that animal ford i more easy of digest ion than vegetable, show the importance of great prudence in the use of this class of food. 

it is important to remark in this connection, that durin* the prevalence of cholera, almosi all persons tire more or lesa affected; the)' complain of some degree of debility, loss of apetite, etc. Now in view of this impaired state of the digestive function, it would be manifestly improper to ikse the ordinary quantity of food, even of a suitable kind; and although wu would by no means advise starvation, yet sor>;e degree ot restriction becomes at times important, especially when evidences ol impaired digestion exist. 

¦The drinks should be of the simplest character. Urn it >uld not be advisable to make any great changes in this 

particular. If persons have been accustomed to stimulants, it would be imprudent to abandon their use at the time when cholera appears; and it would be still more hazardous t<> those who had not previously taken wine or spirits, to resort to them as a preventive. Previous habits should be very 

43 





largely consulted, and as few changes made as possible. Fermented liquors should be especially avoided. Simple water, in a majority of cases, will be found preferable to all other drinks; nevertheless, where evidences of impaired digestion be* come manifest, the addition of a little brandy or whisky to the water, especially during meals, may be productive of some good by aiding the functions of assimilation. We need scarcely refer to the influence of the passions in exciting disease. There can be no doubt that thousands have fallen victims to fear during the prevailence of cholera. Pear i-: ;i depressing passion; and when long continued, it so greatly subdues the vital energy, that the weakened system becomes an easy prey to the prevailing disease. Every one should cast oil' this unmanly timidity, and meet the emergencies oi the ease with energy and fortitude, thereby performing the duties incumbent upon every citizen, and at ihe same time more certainly securing his own personal safety. T R ¦ A T M i: If T. The treatment of cholera has been very largely empirical. In our own country, no settled opinions seem to exist, but almost every physician lias his own peculiar method. We shall not attempt to review and criticise the various modes which have been proposed; but our remarks will be restricted to some of the more prominent empirical remedies, and to an elucidation of what we conceive to be the rational treatment. us based upon actual pathological conditions It is peculiarly unfortunate both for the profession and the public, that specifics have been so ardently sought after and blindly relied upon, in the treatment of cholera; it seems, indeed, that the profession, to a very large extent, have been constantly anticipating the advent of some individual remedy, or combination of remedies, which would be applicable to all •"(taues of the disease and conditions of patients; and hence with this ill-founded hope, practitioners have been misled, and patients lost, by a reliance upon pretended specific remedies. Some of these empirical prescriptions and supposed specifics we will proceed to enumerate. The Chinese rely upon a decoction of pepper, quince and Unt ; which they declare will cure cholera. They also give a decoction of orange peel and mint leaves; also half a drachm of soot from the bottom of a cooking pan, and one drachm and a half of soot from the top of a chimney, to be given at 

44 





*>ne dose. During cramps, they direct hot salt, one ounce: ivory black, one drachm; to be made into a decoction, and given for the purpose of vomiting, which is to restore the energy of the stomach and relieve the spasms. 

A physician of Marseilles, noticing that charcoal-men were exempt from cholera, acted upon the hint, and it is alledged r.li.-it he used charcoal internally with great success. 

M. Bruno Taron, surgeon-major of the Ottoman army, was cured of cholera by the use of ether, in the city of Marseilles, in 1837. M. Taron was attacked at midnight with the usual symptoms of cholera, including vomiting and spasms. Being alone and having no medicine at hand except a bottle of 'ether, that remedy was employed. M. Taron says: "Having no other resource, I seized this large bottle, and I inhaled it freely. Immediately my respiration, which had been oppressed) became more free, and I felt a sensation of relief and general comfort. Afterwards the perspiration, which had been cold and wearisome, became warm and gentle. The functions of my senses were soon suspended, and I slept profoundly. 111 these happy ameliorations took place promptly under the lluence of the inhalation of sulphuric ether. I slept withit pain or disturbance for six hours, niter which I awoke. cling all over me great weakness. I had unconsciously been a perspiration through the night. This day and the folwing I had some blackish alvine evacuations. My strength turned by degrees. I was completely cured." Other cases ive been reported in which the inhalation of ether has proved beneficial] but it remains to be determined by future observations, how far anaesthetic agents may be successfully inhaled in cholera. 

Petroleum has recently been introduced as a specific in the treatment of cholera. Dr. Andreyeoski, surgeon in the Russian army in Circassia, is said to have employed it with great success. Dr. James Tunstall, of Bath, England, claims fhave been the first to call attention to this remedy, hich he did in 1846, in a letter to Sir Charles Napier, Go;rnor of Scinde. Dr. Tunstall says petroleum is found in any parts of the East Indies, Persia, and the Island ofßaridoes; a drachm contains fifty-two grain of pure carbon, ith eight of hydrogen; and he adds that it is the only known ibstance which contains these elements alone. He regards it as a mild but effective stimulant, antispasmodic and antiseptic. The following is his mode of exiiibiting it: — "Take the yolk of one egg, and amalgamate with it a tablespoonful <-t 

45 





petroleum, and tc it acid forty drops of aromatic spirit* of ammonia, filling O wine-glass will) equal quantities of brandy and water: and this dose may he repeated according to the emergency of the rase." Of course this is not a specific; but it is doubtless a valuable stimulant. 

Electro-magnetic insulation has been proposed by M. Fourcalti in the treatment of cholera. Supposing that the disease \a caused by non-equilibrium of atmospheric electricity with terrestrial magnetic fluid, he proposes to remedy the difficulty by using non-conducting materials for bedsteads. A bed supported on glass legs has been used ia the treatment of epilepsy, and other nervous affections, and would fill the indications proposed by Fotircalt. It is apparent, however, that even ndmiting the truth of the theory, insulation could not In: accomplished so as to remedy the supposed QOn -equilibrium. 

Some one has recently revived in his memory an old Arabian prescription, which was found many years ago in an ancient medical work. This pretended remedy consists ofassafoßtida, opium, black pepper, of each two groins, made into pills; when used, they are to be chewed, or broken down in brandy and given every half hour. It is evident thai U\ > grains of opium repeated every half hour would be dangerous practice. 

The muriated tincture of iron has been highly extolled f<'. v its curative powers in cholera. Mr. Hancorn states ihnt he gave it in doses as concentrated as the patient, would bear, with the effect of speedily arresting the vomiting and purging. 

Dr. Stevens proposed to supply the loss of salines by administering them copiously by the mouth. For tiiis purpose he gave 

Carl), soda, 3m. Mur. soda, gj. Oxym. |)ot., gr. ij . 

dissolved in a glass of toast water, and repented every hour, until reaction commenced, and then given less frequently. He also gave injections containing common salt. His practice did show great, success: probably because the action ol the absorbents was measurably suspended. 

Those who have regarded cholera as an n^ue have resorted to quinine* We are not sure, however, that it has been i'aiily and thoroughly tested. Dr. Bell (physician to the Manchester 

46 





# Quin. di-sulph. ST. xij to x\, Ferri sulph. gr. ix. Acid, sulph. all. M. xl Aqua, 0 jss. 

To be given according to circumstances. American practitioners would doubtless regard the quantity of quinine as too small to be of material service. The remedy deserves a more extensive trial. 

Dr. Jephson, regarding cholera as an ague, gives epsom salts, one ounce;: turtar emetic, two gr».; witter, eight ounces; dose, one ounce every hour. He aflirms, that alter the third or fourth dose the vomiting and purging often cease. It will be remembered that Dr. Billing advocates the same ¦ :";ictice. lie explains its curative powers by mpposing thai :\'.e medicine is taken into the circulation, and by "repressing" ' ie expenditure of nervous influence, by virtue pi its sedative powerii, causes the heart to struggle less and to take repose; •',nd upon reaching the capillaries co%sUHnge» them, whereby their action is increased. Tartar emetic without the salts has also been administered. Dr. Hall, in an article published in the London Lancet, gives the result of eight cases treated with this remedy, all of which recovered, with the exception of one. The remedy was dissolved in camphor water, five grains to the halt pint, of which an ounce was given every two hours. Toast water was also given freely. Finally iolei-ancc was established, and the disease rapidly abated. 

Dr. McGregor relied on croton oil and opium. "If no blood c,\n be obtained," he remarks, ' I give the following draught immediately : 

# 01. crotonis, gtts. \ 

Tinct. hyotoynmi, 3i. O|)ii, gr. v. — M. ft. haust. or the following : IV 6;) ii gr. iij. 01. crotcxiis gtU. v. — M. ft. pil." 

tree doses generally succeeded; in one case six doses were en. Our philosophy fails to explain the modus operand i this prescription. 

We might greatly extend this li?t of specific*, and empirical prescriptions; but neither our limits nor the interests of the reader admit of more on this lopic. We have only to add m regard to these remedies, that each one has dbubtle:'s been successful under particular circumstances, but 

47 





that they cannot be regarded as doing more than accomplishing 'an occasional cure; and that the employment oi any one of them, indiscriminately, would be not only empirical, but fata) to many more patients than it would cure. There is but one rational mode of proceeding in these caiee; and that is, to keep the attention constantly fixed upon the pathology of the disease, and the rational experience of those who have observed its phenomena. For practical purposes, we may divide cholera into four stages : 1. The premonitory or stage of incubation. •2. Stage of congestion, usually announced by vomiting, purging, and spasms. 3. Stage of collapse. I. Stage of febrile or inflammatory reaction. 1. The premonitory stage. — The history of cholera in every country, shows that' it is almost invariably preceded by certain premonitory symptoms, among which are lassitude, impeded respiration, gastric derangement, but more especially, a mild iiarrhau. the latter symptom is that which is most frequently witnessed, and is, withal, the most reliable. Pew •uses of cholera occur without this premonitory diarrhoea; and it should be carefully impressed upon the public, that Mich a symptom is always of the most grave character, ami should never for a moment be neglected. It is a very curious and important fact, that the diarrhoea preceding cholera is generally very mild in its character; indeed, it usually amounts lo no more than a very slight looseness, without pain or uneasiness, but gradually augmenting until it terminates ni fully developed cholera. It is often difficult to impress upon the' public mind, that a slight diarrhu-a, wholly free from pain or even the slightest uneasiness, is the forming stage of a disease which may destroy life within a few hours. But such is indeed the truth; and the public should be constantly advised to guard against the insidious approach of so deadly a malady. The diairhcßtJ stage of cholera is the period when the controlling influence of remedies is most remarkably exhibited; and the physician should ever be on the alert, and embrace the very earliest moment to arrest these precursory symptoms. The experience of all medical men fully attests (he fact, that the premonitory stage of cholera is, in a vast proportion of cases, very readily relieved; indeed so easily it 

48 





the disease controlled at this period, that almost any treatment at all adapted to the case will prove successful. I The first precautionary measure to be adopted with those boring under this form of diarrhea — or cholerine, as it lum ?en termed — is, to prohibit exercise and exposure to the opi air, especially if it be cool or damp; and it will also generly conduce to a more speedy cure by confining the patient There is every probability that even in this stage there is n ss of balance in the circulation, and that, the diarrhoea spends on a tendency of the fluids toward the abdominal gans; hence the primary indication is to give a centrifugal rection to the circulation. The function of the skin is genally, perhaps always impaired, and hence the class of diaphoretics becomes necessary. In a majority of cases, the use of gentle diaphoretics and astringents, will restore the action of the skin, and arrest the alvine evacuations, and thus relieve all tendency to internal congestions. In all these cases, the activity of remedies must be proportioned to the violence of the disease. Let us assume that ther are three grades of violence, and then adapt remedies to each; The mildest form may generally be relieved by simple means. and we would prefer the following as a general prescription: I-fc Calomel, gr. x. Camphor, gr. v. Mur. morph., gr. j. Comp. powder of chalk, 9'ij. Mix, and divide in five parts; one to be given every two or three hours, according to circumstances. The relative proportion of these remedies may be varied to suit individual cases. In some very mild cases, a dose of laudanum and tincture of kino will arrest the disease. Sugar of lead has also been extensively used as an astringent; there are fobably few superior to it. Opium is generally combined. ith the lead. Tannin is also a valuable astringent, which the practitioner will not forget. Indeed, the choice of astrinlents should be guided by the conditions, habits, and peculiaries of the patient. But should the symptoms become more violent, then in adition to the above means, it will be proper to employ diahoretics, such as the warm bath, hot bricks or bottles of hot rater about the body, diluent drink?, or any of the ordinary iaphoretic ptisans. Should the disease be still more violent, " not arrested by the above means, we would strongly urgt 

I 

49 





l!ie propriety of general blood-letting, or at least, cupping or ching over the abdominal region; sinapisms will also prove hly beneficial. The chief remedies upon which we place; greatest reliance during the premonitory stage, are, the tringent and alterative powder above named, diaphoretics, counter-irritation and blood-letting, varied and combined according to the peculiarities and emergency of the case. The propriety of purgatives following the use of opiates and asnU is more than doubtful. It is recommended in the ilopEßdia of Practical Medicine, that the administration of >mcl, opium and capsicum in the diarrhceal stage, should be followed in ten or twelve hours, by castor oil. This we con- C sive to be extremely reprehensible practice. The action of tor oil may reproduce the diarrhoea whiph had been previ[y arrested; and, indeed, there is no indication for the use urgatives, lor the alvine evacuation will return suiliciently early without any medicinal aid. It is, therefore, far better to upon the natural return of the peristaltic action, at least i general rule, than to risk the operation of purgatives. would also strongly condemn active stimulants in such cases. The reprehensible practice of resorting to brandy, an ! similar agents, has doubtless often precipitated an attack. I) randy which has been burned so long as it will blaze, and i mixe I with prepared chalk, may however be used in some cases with great benefit. "2. The stage of congestion, usually announced by vomiting, purging and spasms* — The development of true cholera, or that stage in which vomiting, purging and spasms, constitute prevailing symptoms, is accompanied by profound internal ;est ions; and the main point in the treatment is to overcome condition of the circulation. There are three principal classes of remedies to which the attention of the profession has been directed for the cure of this stage of cholera : J. Calomel, with the view of restoring the secretions; % Stimulants to sustain the sinking powers of nature: '.). Blood-letting to relieve congestion. The employment of calomel in the treatment of cholera, has met with the very general approbation of the profession; but it has been given with very different objects: someadrninter very large doses, as the chief remedial agent; others rely upon small quantities, thereby assigning to it a secondary position, We cannot believe that calomel is an agent which, m itself, can he relied on in the treatment of cholera. If, in-1, the disease id principally a state of congestion, (which 







U assuredly beyond doubt,) we are unable to perceive the utility of calomel, as an agent to remedy that condition, its local action on the intestinal mucous surface could hardly accomplish such a result; and before its general action could be secured the patient would undoubtedly sink. There h m very decided testimony, it is true, in favor of the mercurial treatment of cholera; but the facts are not sufficiently numerousand definite to be conclusive in behalf of such treatment, or at least to prove that it is superior or even equal to other and more rational modes. But while we thus condemn the mploytneot of mercury as the principal remedy, we an- firmly convinced that it may be advantageously given in moderate doses, and as a secondary agent; about as recommended for the diarrhoea! stage. 

The next feature of the treatment is the administration of stimulants. And here we conceive has been committed greater errors than in the employment of any other class of remedies. Practitioners seem to he overwhelmed with the idea of debility and prostration, and the remedy 100 commonly suggested is some form of stimulant. Now what are we desiring to remedy? Is it debility? certainly not; it is congestion. In this condition of the system, the right side oi heart and the venous system generally are engorged; the heart is laboring and already acting violently; and daring such a state of oppressed and excited action, stimulants would necessarily augment the difficulties. Oi' course reference is now made to what are known as cardiac or arterial stimulantagents which directly increase the action of the heart; nervous stimulants, on the other hand, would not be productive of the same evil consequences. We hold, then, that the employment of stimulants in cholera, when the heart is laboring and oppressed, is the most irrational and destructive treatment, which could possibly be devised; for this class of remedies not only fail to relieve the congestion, but they directly increase the difficulty which is designed to be remedied. Practitioners should reflect upon these important facts, before they employ stimulating remedies so indiscriminately. The third great mode of medication resorted to in the second stage of cholera is blood-letting. There seems to be an almost instinctive dread of blood-letting in cholera: and this unfounded apprehension arises from a supposition that cholera is essentially a disease of debility. Blood-letting is by no rins a new remedy; it was one of the first rational methods cure adopted ; and it was employed with the view oi 

51 





removing congestion. We can advantageously consult on this subject the able reports made by the Bombay and Bengal Medical Boards, as early as 1819. The Bombay report deftomkiatva blood-letting the sheet anchor, in Europeans; the natives were probably to much debilitated to be relieved by such a process. The Bengal report holds the following language: "In Europeans generally, and in robust natives, bieeding could commonly be practised where the patient was seen in one, two, or perhaps three hours, from the beginning of the attack; and in all cases in which it was resorted to, under such favorable circumstances, it was more successful than any other remedy, in cutting short the disease: usually resolving .spasm; allaying the irritability of the stomach and bowels; and remoping the universal depression under which the patient lalK>rcd.'' 

Some practitioner! have, it is true, condemned bleeding, but then many more have advocated it; and it seems probable tit a little more careful thought and observation would rdly leave it an opponent. 

lint it must not be inferred that we would recommend bleeding alone, or thatwe would entirely prohibit stimulants; <>n the contrary, it is to a combination of these great remedies, that we are to look for the most favorable results. The first object should be to bleed; thus we remove the tension of the right side of the heart, and relieve very greatly the venous engorgement; and then, immediately following this partial relief, the employment of stimulants, combined with other appropriate remedies for equalizing the circulation, will produce the most favorable results. Bleeding alone would produce, in many instances, too much debility; — stimulants alone aggravate the very condition which we seek to relieve; but by lirst depleting to an extent proportioned to the conditions of the patient, and then using diffusible stimulants, immediately afterward, we secure the beneficial influence of both great agents, without producing the injurious effects of either. 

We conceive this to be the great feature in the treatment of cholera; and it is the point which requires the greatest scrutiny on the part of the practitioner; for, if bleeding be delayed too long, or the patient is passing rapidly into collapse, it may but hasten the fatal issue. It must not be forgotten, however, that even in many cases of great debility, bleeding or cupping may be resorted to, especially when followed by the judicious employment of stimulants. 

We have the testimony of many careful practitioners to 

52 





prove that ieeches applied to the abdomen often mitigate tbe symptoms more speedily than any other class of remedies. — The employment of bleeding in cases of cholera should be regulated by the same general rules which guide us in its application to any other form of disease; some cases requre it freely, others sparingly, and a third class not at all; some will l>e more benefitted by venesection, others by cupping or leeching; — all of which must be submitted to the good judgment of the practitioner. 

No reference has been made to the particular article among the stimulants, which should be preferred; and, indeed, there is probably no single one which deserves an unqualified preference. Probably the petroleum mixture already adverted to may be found among the best; then the spirituous articles, pepper, camphor, turpentine, and similar agents, all deserve attention. But we would particularly suggest that what is termed nervous stimulants may lie found useful; such as assaf'jetida, musk, valerian, but especially ether and Hoffman's anodyne. But more especially would we commend the employment of chloroform as a stimulant. This agent we conceive to be a diffusible stimulant and antispasmodic; and judging from its acknowledged properties, there is every reason to suppose that it may prove more appropriate than either, Hoffman's anodyne, or any agent of this class. We have also the direct testimony of P. Brady, Esq. of Harron, (England) in favor of the effects of chloroform in cholera. — lie gave the remedy in doses of ten drops, mixed with brandy and water, and with the effect of immediately arresting the vomiting. It appears to be more efficacious in arresting vomiting than the purging; but its influence was altogether highly beneficial. The following is his usual formula: 

XI Mucilage, 3ij; 

Chloroform, Mxx. 

Tinct. cardamon comp. 3iv. 

Distilled water, 3vj. 

Dose, one-fourth part every hour. Much largsr quantities (say drachm doses) might be given; but large doses may become sedative. We believe, also, that strychnine, employed after depletion, may become a valuable remedy; this agent we class with the cerebro-spinal excitants. 

In addition to these remedies, of course every practitioner would resort to external heat, and counter-irritation. Dry heat seems preferable to moist; and dry friction is altogether more efficacious than the employment of stimulating lotions; 

53 





in both Instances the external moisture is injurious, for it is impossible to prevent the evaporation from carrying off more or less animal heat. 

3. The Stage of Co/lapse. — For this stage we believe there is but one remedy, and that is, venous injection. Of course a large proportion of cases will prove fatal under any mode of treatment; but it is worse than folly to rely upon ordinary medication. In the first place, the serum of the blood has *en largely lost by exhalation, and the physical condition ot at fluid absolutely prevents it from circulating with any degree of freedom; and in the second place, absorption is so completely arrested that remedies remain in the alimentary canal without producing any medicinal influence; and adrnitr ting that some classes of remedies might operate by si/mpathy, it is still but too apparent, that the circulation is so completely depressed, and with it innervation and the vital actions generally, that the effects of medicines are measurably lost. In this condition of the circulation, the primary object should be to impart to the blood an adequate amount of serosity to render it sufficiently fluid to flow through the vessels; and this can be accomplished in no other manner than by injecting suitable liquids into the venous system. It must be remembered, however, that collapse comes on in some cases in which the serous discharges are too inconsiderable to have cruised the the succeeding depression; in such cases, venous injections would be wholly inappropriate. The suggestion of venous injections was originally made by M. Hermann, of Moscow, and first carried into effect by AI. Delpech, of Paris; but we are indebted to Dr. Latta, of Leith, England, for the first successful experiments of this nature. And the most successful experiments were those first performed by Dr. Latta; thus, of two series of cases in the stage of collapse, he cured three out of nine; and of the second series, five out of seven. Others, however, have not been so successful; indeed, the ordinary success with this mode of treatment has proved about one in five. But we should remember that the experiments were often performed under the most disadvantageous circumstances, frequently at too late a period, and doubtless in many cases without observing the necessary precautions. Hence we conceive, that under all the' circumstances, the results thus far fully warrant a continuance of the practice. Our own experience in this treatment is limited to a single case, and that of the most unfavorable character. Completey 

54 





collapsed, the patient, an aged lady, had been pulseless for lours; she was also speechless. Venous injections, however, estored the circulation, voice, and some degree of strength; )ut in three or lour hours she again collapsed, and finally ied. Yet the effects were most remarkable and salutary, >v a time, and such as no other agent could have produced. uch manifestations of the effects of remedial agents are not o be hastily rejected, even if nothing more favorable could be adduced. 

Dr. Latta, and after him Dr. Macintosh, of Edinburgh, employed the following combination: 

Chloride of sodium, 3*s; sesqui-carbonate of soda, giv; dissolved in ten pints of water, varying in temperature from 106 L 1 to 190° Fahrenheit. This mixture was injected within about half an hour. Dr. Parkes used the following preparation: sesqui-carbonate of soda, 3iv; chloride of sodium, 3ij; albumen of one egg; and four pints of water at a temperature of 98° Dr. Fra/er used the following proportion of salts: chloride of sodium oiij; sesqui-carbonate of soda, 3ij water, lbvj. 

It will be remarked that the solution used by Dr. Latta contains a considerably less proportion of salts than either < the others, and on that account it is probably preferable* — Dr. Parkes used a much more concentrated mixture, and at lower temperature; and while the former succeeded in a m< jority of cases, the latter cured none! This disparity may c may not have depended on the different quantity of salts an the degree of temperature; but it is reasonable to infer tha these conditions influenced the results. The albumen, how «« r er, is a desirable addition; and this substance combine* itli Dr. Latta'a mixture, at a temperature of about 105*' would probably be the best combination that could be em ployed. 

The temperature of the fluid injected has varied from 08° to l' 20 Q Fahrenheit It should evidently be proportioned to the degree of collapse, and the development of algide symptoms; but the propriety of greatly exceeding the physiologic cal degree of temperature, in ordinary cases, is very doubtful; and on the whole, 105 v Fahrenheit might probably be regarded as a safe medium. 

The fluid should be injected very slowly; this precaution is indispensable. If thrown in rapidly, death may almost instantly follow. We cannot believe that, in any instance, more than a pint should be injected within an hour; and durlg 

55 





the operation, it should frequently cease for a time, with neview of allowing the system to accommodate itself to the apid increase of fluids. The probability is that the fluid has renerally been injected too rapidly; and if more time could >c allowed, less danger would result. Nor should the injecon be too long continued; for repletion would prove as detructive as collapse. Immediately upon the reappearance f the pulse, we would advise that the process be suspended, t least lor a time, and again resumed if circumstances required it. Immediately following this mode of treatment, we should resort to the ordinary medicinal agents, always iemembering the venous injection is designed rather to rejove a physical impediment, than to effect a cure of itself; 1 though it may prove successful alone. 

Transfusion of blood if properly conducted would probably prove more salutary than saline mixtures. For this pur>ose, we would give the preference to arterial blood, espeally if it be passed at once into the circulation; and under ny circumstances, great advantage would be derived from sing defibrinatcd blood. Physiological experiment! prove lat the fibrin is not required where we desire merely the imulus of blood; and then, in cases of cholera, there is aleady too much crassamentum in the system, and hence tho ore fluid the injected material, the more readily will it reore the circulation. 

We have thus far said nothing of emetics. Ordinarily this class of medicinal agents should be avoided — we mean tho common nauseating emetics; their depressing influence will certainly produce injurious effects in many cases. But those agents which cause emesis solely by their stimulating propertie — such as mustard, salt, etc. — may be advantageously employed either in the stage of collapse, or when the patient is rapidly passing into that state. With the same view zinc and copper emetics may be employed; but their use will require some care and discrimination. Stimulating enema have been employed with the view of bringing on reaction; among these we would prefer Sir John Fyfe's, which is made thus: Two pints of warm water; four to eight ounces of brandy; one to two drachms 6f laudanum. Powdered mustard has also been given in enema, and is supposed to aid in restoring the urinary secretion. 

Drinks are probably less important than some imagine; they should be warm or cold according to the preferences of the. 

56 





ttient. Generally there is a raging thirst, and we would by means prohibit cold water. 

4. The stage of febrile reaction. — This is either a stage o raple febrile reaction, or, what is more common, reaction omplicated with visceral inflammation — most frequently o le brain. There can be no doubt that the indiscriminate ud excessive use of stimulants has contributed in many if no nost cases to this secondary form of disease. Of its treat ment we have no space to say any thing; it will be regulatet pon general principles. 

Let us pause a moment before we dismiss the subject, t lswer the question, is cholera curable? The answer to th terrogative shall be the report of George Oglivy, Esq., Sec etary of the Medical Board of Bombay. The number of ascertained cases in the district of Bombay at the period o le report, amounted to 15,945; of these 1294 were withou edical aidj and Mr. Oglivy states that they all perished; an< »c is also of opinion that no cases recovered without medic d. At the same time, proper medical treatment reduced tl ortality to 6 - 6 per cent! We are prepnred to admit, how f er, that some cases may recover without treatment ; b ertainly many more with it. Indeed, if appropriate trea ent be applied in an early stage, cholera is just as cur able, i lions fever. If cholera can be treated in its earliest stag may generally be cured; — so of ordinary fever : if the trea ent of cholera be delayed to the second stage, many caa will prove fatal; and so of ordinary fever: if cholera be no eated until its third stage supervenes, then it will general >rove fatal ; and so of ordinary fever. We feel justified, the n expressing the opinion, that cholera is quite as curable a ever; and the difference in the results relates rather to the apidity of invasion and progress, than to any necessary mo ality belonging to cholera. 

Is it advisable to allow cholera patients to be crowded toether? Not as a general rule. We have already introducd many facts to prove that it may be communicated by perons contact: we now add one or two additional facts. It was mentioned in the "Historical Sketch," that cholera xtended from the island of Ceylon to th© Mauritius, a distance of two thousand miles; but we neglected to call particlar attention to the fact that the disease was originally mported to that island. The late Dr. Good remarks in his Study of Medicine" that he was informed by Sir James Mcregor, that cholera did not appear at the Mauritius until 

5 

57 





fter the arrival of a ship from the coast of Ceylon, where the isease was raging, some of the crew having been seized durno; the passage. To the preceding we may add another fact'holera has recently appeared at Trieste, situated at a re. lote point on the northern coast of the Adriatic. This place emained free from cholera until the arrival of a ship from Constantinople, where cholera was prevailing; the captain as seized with the disease on his arrival at Trieste, and it oon spread through the town. At that period, neither last of the Adriatic; had suffered, and most of the points beveen Constantinople and Trieste were also free from cholei. This bears strong marks of direct importation. 

JJut notwithstanding these facts, the interests of the more estitute classes will demand the establishment of temporary lospitals; for it is impossible that physicians can attend each \»e separately, when an extensive epidemic is prevailing. t is well known that the more destitute and exposed are lose most largely attacked; and as remuneration is not expected in such cases, but more especially as it is impossible o attend to each case separately, it becomes the duty of unicipal authorities to establish places of reception for them uler such emergencies. 

IWe must here close this article, which has already reachbeyond the limits originally prescribed. Many points of ep interest have necessarily been omitted; others discussed ) briefly; but we have accomplished what was intended — ondensed view of the nature and treatment of cholera. And w near have we arrived at the truth? VVe feel morally rtaiti that the views of the pathology of cholera which are vocated in this paper, are true; and if so, it will hardbe doubted that the treatment, is equally correct. The md objects are to equalize the circulation and to arouse rvous action. What more appropriate remedies to accomsh these indications, than those proposed.' Let the facts d inductions which we have presented, answer this ques- 

TIIE END. 

V 

58 





WEiF" hsBfgeeived since its first issue, we subjoin the following, at the san time, returni sincere thanks, for the very cordial greeting the press g Frvm the philadHjihia U. S. Gazette. well supplied sheet. devoted to the interests, ij " Till. C ilu.l i U T as*l in the )proj)riiiie title of I stroctiou, mid amusement of the peop.e oft a larga anJ spleiith'd (ftokijig sheet hailing, from w «*taud south west. Those who have, aspei Cinciuiu it fejj^etyls uuii abaritcter. not tt ' i.oterwt in western events aud liu-ratu ta ill ike our in mySpHi Phiiad#i§j»ia weeklies, cou 'd not fTfatilj- tliemnelven more thau by i but bits •oinenov&r^md ttf^ujfiHnttir»i which ! S? $2 0 J ti>e an u uul su bscrip lion tnouj freeh aud vigorous latejlocls of the expensive From theClarkttdlU, Term. Je^fersonianl . 'o*a«lii ilftu Our eastern he-bdoim " n " °^ our fa'orita exchanges and one ' will find ih «tv dv rival *. ooint)etitor of no* I T o1 *^ nM>B ' dwerfuMy recocmnwud to those d'hiv uower' !¦« aiieWtbev baVbUiur b«!J"al- OUr reat^ pr * ]n waut °»* • family paper is t laust undisputed oossession ef " etc. r'Gremt Went. 1 ' It in v«ry mach upon the pi " ' of the Philadelphia Suturdity papers but from the Philadelphia City Item. loa ">' respects is superior to them. The fet «• T Civ W^» *h dao mammoth ! uro fchimtfa'pit fttoa arly recommends it . J H 7 " RE * T **Ye- a ¦. r j^ s and lit«r*^i'^**"^ > '^ °^ we9t IS *** devolion to th< «©c , evo c .K. t'/ it nence in its (l( l " tereet ' al '^ tho evnleirt design of its editu U(6| P'*" 11 ' 1 ' c a _ V iun , Ito save l'rom oblivion everything ofimpof > i Dumw. le j>u \ii>\ ii o^ a « elo sub- I inCe Gonne^ lo< ' with tbe settlame'it of tl V V t T Fr ° m tfie Pranklln Dmmwat, Brookville, I ' j "It is well filleti with light reading superi " Tlrt wM*f,' Wwtt is the- title of a '$*&* j to that usually found in such journals. Tho and el. guilt wuekly ftepor just comruauc#a in I wbaprefer such matter need no longer sei try.'* From the NathmlU, Tenn.Orlhopo titan. m the Cincinnati Rnqurer. "It is a large" sheet, devoted to literatui '< Tt ' tl I- £r t • idmoirt interest- i ' ence ' *^ c art*, agriculture, news, etc., ai a \ bi am °"f. ft^ country and is entirely l 9 u WfßH,«»t«rtainiog aud good. The liter inw )eb omai.a s o cc . ; ' -y\{ 0 ' r >' d*p»rta»ent is graced by several of the be (leyo.ecl to i era ure, lei ,j wort | 1V men ' wr ' tt3rs ' ia M** 'W«tt. Each numher ;h au ia ¦ Li r uvakitjir a DftDBF suited to thft I ¦ rß ''oOicina upuu iia preufccHsor wants of the western reader. We commend the From the Vineenrm, la. Gazette. urbai 51 ¦ * ««|t ig full of new features, all bespeaking a o. tio pu k . I interest which cannot fail to make it popul; Fromthe Cincinnati Gazette. with the reading public." "As its name would scein to indicite "Ihe j From the Sat. Visitor. Bardstown, Ky, <*re<it eara r * l*i I'l "^' if.fiUarge and beautiful sheet, after oi courigemen owe . (. t l ei)t i jw;i miud.throaghout, aad i.i full of iuteres I U mUS *TW*bvw Q Wj 10 " "¦ ***v '¦¦¦ i»r j ™ I ji-j— |)»( I ter " £rS!^« b^wir^ "Th^listri^i^t^re Jk ticalar inferior to the best eastern publications. SO mo of the best written tales from ink W o notic© in Its columns nid coninuuiioua oi I gjggj.^ a |Q{jted rs in th 6 wwt, at much en som»ofo»r most brilliaut western writers. J^,^, We hope th» poofle of the wes;e« win tJ^S!S^^m^%^oZ £¦££ a w jj %\^?ZFw"*^«i "It is a lai^, bcauUful shostconwlßinfl^^jJ^ ir«>aotry thlu'thvGrZm m»ra matter ih'tiitnw rniiad. !»f v/ooner,anfl|j^^ It J» a iarg* and handsomely printfl Frtm the Conoordia, L*., IntdHgtnter. Jo-asJeßt tea* of this journal, and cordialfl • --*¦ I "sL_j^afc to'^a^» ssrtßSMat'asaastraWllil " I