i 

ON THE PATHOLOGY OF EPIDEMIC CHOLERA, 

WITH SOME 

PRELIMINARY OBSERVATIONS 

ON THE 

HISTORY OF THE DISEASE, 

AND 

THE GENERAL CAUSE AND NATURE OF EPIDEMICS: 

CONTAINING 

AN IMPROVED PLAN OF TREATMENT, 

THE MEANS OF PREVENTION, 

AND 

RULES FOR 

CORPORATIONS AND INDIVIDUALS TO PURSUE. 

HUNTING SHERRI^L, M. D. 

• t & Formerly resident Physician and Surseon to the New Yijrk Alms House Hospital; Late President of the Duichesi? Medical Society; Author of a Treatise on Epidemic Diseases, &c. &c. 

// Js>7 

NEW YORK: 

Published by Samuel Wood and Sons. Jackson & Schram, Printers, Poughkeepsie, 

1835. 







fil<m aIo- &, 71c 5 

Entered, according to Act of Congress, in the year 1835, by Hunting Sherrill, in the Clerk's office of the District Court of the Southern District of New York. 



PRELIMINARY OBSERVATIONS. 

It may be inquired by some " fastidious critic," why any one should undertake, at this period, to offer the public any thing on the subject which the following Treatise embraces, after so much has been said am written. An answer may be given, because after an epidemic disease has prevailed a length of time, or ha gone by, after there has been an opportunity to study it character, and to collect facts respecting it, and to have time for calm reflection, is the most suitable time to write its history. Another reason may be given, because something of the kind seems yet to be needed nearly a much as there was at the earlier periods of the preva lence of the disease ; and another reason may be given as far as the author knows, that others better qualifiec have omitted to take a similar view of the subject ; for after all that has been spread before the public on the nature and management of the late epidemic, it is doubt ful whether there are much more general fixed principles in regard to the intrinsic nature and treatment than there were in the early periods of its existence ; and whether it may be the lot of the writer to furnish such principles of Etiology and Pathology as will satisfy the reader, anc aid in fixing some general uniformity in the plan of treatment, will remain for time and the public to determine. 

The writer happened to be so situated, in a period of time, and circumstanced as to witness a large portion of an epidemic which spread over this country in an alarming 



4 

and fatal manner, in which much discordant opinion and practice was exhibited. He was impressed with a belief that some more general knowledge of the nature and character of epidemic diseases would be of much importance to the public. Whether any productions of his on this subject has contributed to advance this knowledge, or illustrate the nature of those diseases, or aid others in pursuing a fortunate mode of treatment, it is not for him io determine ; but he can say, with confidence, that the plans recommended have in two of the most severe epidemics that has prevailed in this country, proved very successful. 

He has long been of opinion that a concise treatise to explain the Pathological nature of Epidemic Cholera— to endeavour to harmonize the discordant and vague opinions, and sometimes heterogenous practices which have attended that disease — might be serviceable to the medical public, and of much value to the community But that an undertaking of this kind should be broachec by him was but recently concluded on, since the preva lence of the Cholera of 1834. In addition to the respon sibility and importance of the undertaking, and a wan of more extensive information, an almost constant inter ruption by numerous professional and domestic avoca tions, have contributed very much to retard and rende the work incomplete ; perhaps it may fall short of meet ing public approbation, but to that candid ordeal, he ventures with diffidence to submit. 

After the frequent prevalence of epidemic diseases which have afflicted man wherever he has fixed his habitation, and their scourges and their ravages , have clad society in the emblems of mourning, and numerous monlental 



5 

sepulchral inscriptions have marked the traces of ir existence ; — and after their characters have been so n described, and their manner of affecting the human tern pointed out, it might seem strange that there uld be so much discrepancy of opinion and discordeof practice in and about them. With great respect the opinions of others, the writer will not enter into an examination of those opinions, nor the diversity of practice ; but he will fairly and plainly state his own views, and endeavour to lay down such principles, and point out such practices, as from consulting such authors as he has been able to do, and among them the Book of Nature is included, and by close observation he has arrived at. Whether a perusal of authors of different views and opinions, or not examining any, but carelessly pursuing an empirical guessing way, has led to such a diversity of treatment of Epidemic Cholera, and such varied and unsuccessful results, he will not attempt to examine into ; it is sufficient to allude to the fact. Those differences of opinions and views sometimes held by physicians in regard to epidemic diseases, and particularly in that of Cholera, have shaken public confidence in the value, and usefulness, and dignity of the profession ; and have led some to the conclusion that the science of physic was an empirical or conjectural art, instead of what the ancients called it, of a divine nature. 

There are some general and uniform laws and principles which govern and regulate the universe, and th natural operations which take place on the surface of th earth, and similar general principles and laws appear to govern and regulate the functions and operations of th human system ; and epidemic diseases appear to produce very similar symptoms and effects on mankind now 



6 

that they did in days of antiquity, and they are in all probability produced by the same general causes ; and the human system is liable to be obstructed in its operations in a similar manner, and may be relieved from those morbid actions by similar means, as it has been at former periods. 

By reviewing the histories of those diseases, and gleaning from them what has been the general prominent characters of epidemic diseases, and what set of remedies have been, on the whole, the most useful in their treatment, will aid very much in fixing on some general plan of managing them. 

There appears to have been two general classes of practitioners in the manner and method of treating epidemic diseases, to one of which some have pertinaciously adhered. The one is what has been termed the alexiphaimic stimulating mercurialising method ; the other is the cooling, refrigerating, depleting plan. The former was founded on the opinion that in epidemic disease, there took place in the human system a state of direct deficiency in the action of the animal powers — that a gangrenous septic tendency and exhaustion of the vital functions were such as to require the system to be supported and kept up by a direct recourse to those articles of the Materia Medica, denominated cordial supporting stimulating remedies. On the latter side it has been the opinion that in those cases there took place an inflamma^ tory, or overloaded, or suppressed state of the system, which produced the violent and alarming symptoms in the first stage of the attack. This, of course, led to a method of treatment by which the ingesta, the calluvies and the fluids were to be abstracted and diminished in 



1 

quantity. In some instances, very probably, the advocates of each plan have proceeded to some extremes, arid not pursued the course they may have advocated, in the most judicious manner — for both set of remedies may be useful and proper in the same epidemic, and in different stages of the same case ; but the cases in which each would be most proper, and the period of using them, is an important point to arrive at, and one which requires much reflection and some experience to determine on with safety and accuracy. 

In the course of these observations, the writer will endeavour to point out, in a general way, the nature and state of some of those diseases in which the one or the other of those set of remedies will be proper. In relation to the Epidemic Cholera, considerable care has been taken to note many facts and circumstances connected with it, and to compare and collect such facts as might have a tendency to form some opinion of its characte and develope its nature. From this manner of proceec ing, and from the records of former epidemics, the write has derived much satisfaction and benefit in managin the Cholera, and in penning these remarks. The state ments made in this work are all founded upon facts care fully collected and scrupulously observed j and the au t.hors and opinions of others from whom he has derivec benefit are many of them referred to ; though some fact and histories of diseases, and the opinions of some may have been warped into the account, without particularly referring to the works from whence derived. 

It has been the aim of the writer to pursue an examination of general principles, and the general use of remedies, without going into particular detail ; therefore he 



8 

has generally omitted to notice the doses and quantities of remedies ; they can be ascertained by reference to works expressly on that subject ; but it may be remarked that the quantities proper to be used or taken to controul a case of Epidemic Cholera or violent disease, will depend entirely on the effects produced, the nature of the case and of the subject. 

This treatise will be rather of the nature of an enlarged view — a revised and new edition of a smaU essay be published on Cholera in 1832, included in his essay on the History and Nature of Epidemics, as they have prevailed under his observation. He has endeavoured to point out the manner in which the vital organs are affected in Cholera, and explain the nature and cause of collapse and asphyxia. If his views are correct on those subjects, it will lead to a general, uniform, and tolerably successful method by which it may be treated. 

It is with not a little diffidence that he offers opinions on a subject which has engaged the attention and talent of so many ; but it is every one's privilege to offer facts and opinions on those subjects, and if what may be considered errors have been committed, it in some measure becomes a duty to endeavour to correct them, and guard 



CHAPTER I. 

rxoίif of Epidemic Cholera, as it prevailed in POUGHKEEPSIE IN 1832 AND 1834. 

Before proceeding to give a history of the appearance and spread of the Epidemic Cholera of 1832, I shall give some account of the weather and the diseases which preceded it. The winter previous was more severe and cold than several of the preceding ones had been. The spring was very variable, attended with storms, and extremes of irregular heat and cold. The early part of the summer was unusually cool ; but in June and the first of July there were several very hot days, but very little rain fell, and the country experienced a severe drought. Intermittent fevers began to prevail early in the spring ; they were more prevalent and extended more generally over the country than they usually had done. Some cases of severe remittent fevers were interspersed with them in the month of June and early part of July. About the first of July many cases of disease were attended with more than ordinary severe symptoms ; many were attacked with severe colic, or other affections of the bowels, attended with diarrhoea, or painful irritations and tormina, and they began to be affected with diarrhoea. By the 12th of July there was a very general diarrhoea prevailing in those places about town. Where there was a large collection of filth and decomposing material, so as to render the atmosphere impure, there was a stronger crisposition to the disease. Near the eenfcre of the village, 

2 



10 

in Union street, there was a cellar with the lower floor timbers and floor only laying ; the house above had been burnt. This cellar was a common residence for a number of blacks, and indigent degraded whites, who promiscuously mingled there, indulging in vice and dissipation, and surrounded by filth. In this cellar there seemed to be concentrated a greater quantity of the infecting, material than there was in other parts of the village ; but it was not here alone that the generating cause of the disease was produced or existed ; for the material producing a predisposition to it, and which in many instances did produce similar disease, was spread over the whole village, and even in the surrounding country, as was proved by the general existence of the milder character of it — the cholerine, diarrhoea, or premonitory symptoms. 

On the 15th of July, one of the inmates of this place f a black man, was suddenly and singularly attacked with a sinking prostrated kind of disease, attended with diarrhoea, vomiting, &c. The Corporation took some alarm at this — they ordered the man to be carried to the county poor house — he was there placed in a retired part of the premises in a comfortable house, and means providec for his comfort, and there within 24 hours he died. A woman was sent from the place where this man sickenet to nurse him ; she sickened about the 17th, and died ii a very short time. Two more persons very soon afte were taken sick in a similar way at the same old cellar who also died. Although at this period there was a general prevalence of an irritable state of the habits of the body all over the village, and great numbers were affected with common diarrhoea, of common Cholera Morbus, (as it was called,) and the medical men, by the 



11 

21st, found themselves very much engaged in attending 1 the increased number of patients — they being so much engaged was a subject of common remark by the villagers. By this time there was a good deal of alarm among the inhabitants, for fear the place would be visited by the Epidemic Cholera. That disease had for some time been prevailing in Canada, and it was making progress along the northern part of the State. It was also prevailing in New York with much severity ; and the state of the weather and the prevalent diseases of the place, seemed strongly predisposed to the outbreaking of the aggravated form of the cholerine disease. The Corporation had created a Board of Health, and taken some measures to prepare for the Cholera, and endeavoured to guard against its injurious and fatal effects. The old cellar referred to seemed to be a focus for generating a increased and contaminated quantity of miasma or ma terial, which seemed to produce the disease from whic it was wafted in various directions, and was diffused i an atmosphere disposed to produce this disease, and wa well calculated to excite into action the cholerine malad} Several other cases had their origin from this place ; fo on the 21st a black woman sickened in Market street wit Cholera, who had frequented this cellar, and died in 14 hours ; and on the 22d, a white man by the name of Mackey, who had also frequented the cellar, and who had been labouring on the 20th and 21st at Mr. L. B. Van Kleeck's, about two miles east of the Court House on the turnpike, of intemperate habits, sickened about 6 o'clock in the morning — he went into Water street at the corner of Water and John streets — severe spasms, vomiting, and diarrhoea came on, attended with a cold purple shrivelled skin. He died in 5 hours ; he had little or no medical aid. 



12 

The Board of Health took early and prompt measures to clear out the above named cellar, and to tear up and demolish the place. It was now announced by the Board of Health that those cases were the Epidemic Cholera ; six deaths had already taken place, and a great number were affected with cholerine diarrhoea. From the places where those cases had originated, and where they had been, and where the patients had died, the disease spread in various directions. In Union street, from where the first case occurred, the disease spread both ways with a good deal of severity. This cellar referred to was situated at the junction of Perry and Jefferson streets. Cases of the disease took place in both of those streets, though in Jefferson, in one or two houses, it was very severe and fatal — 10 cases occurred there in one house- — they were mostly removed out of town. At Mr. Van Kleeck's where Mackey had been labouring the day before he died, three lads lived who had been at work with him — all sickened on the 25th, with disease in the same way in which the other cases were taken. Two sons of Mr. Patrick were sent to town, near the hay scales, at the corner of Main and Hamilton streets, when they had a most violent attack of the Epidemic. [See cases.] The father, mother, and another brother, also had severe at' tacks of the disease. All were attended with similar symptoms of vomiting, diarrhoea, spasms, and cold shrivelled purple skin. There were several families living in this block of buildings — among them I counted up twelve cases of similar diseases, and a number more took place in the adjoining houses. 

Several of my medical friends saw the first of those Patrick cases, who all pronounced it a severe and well formed rase of Cholera. 



13 

There were several cases of diarrhoea existing in Water street before Mackey died there on the 22d. After which the disease seemed to be excited to action, and spread to considerable extent, and with much severity. This part of the street was called the infected district. It was here where one of those peculiar violent cases occurred on the 29th of July, in which the principles of treatment were tested, which was attended with favorable and successful results. The manner of the attack as follows, is taken from a description of the case made by the parents, and presented to me : 

" Our daughter S. M. was attacked with diarrhoea and vomiting. The discharges were like rice water. At 9 o'clock, A. M. she became suddenly prostrated and nearly motionless, except the spasms. Her breathing was very difficult and almost stopped ; her skin turned purple, and was as cold as that of a corpse ; her pulse could not be felt ; her features and fingers were shrunk and withered ; her voice was fine, small and singular. She complained of great pain and weight at the stomach, attended with spasms of the different parts. 

J. R. FILKIN, L. FILKIN." 

She recovered. [See Case ll.] 

But it is a matter of some doubt whether Water street could be considered more infected than some other parts of the village, for there was a predisposition to this kind of disease all over the village ; and by the 27th of Jidy cases were occuring in other places with great severity, not only in Water street, but in Union street, Jefferson street, Pine street, in Main street on the corner of Ham ilton street, and the disease extended east on Main stree 



14 

beyond the limits of the village, near two miles from the Court House. The man who had died with the disease on the 22d July had supped at a public house kept by Mr. Near, with Mr. Near's son, about a mile and a half from the village, the evening before he was taken; and two black men who had buried him got something to drink of Near's said son directly after the interment — this lad was reduced with intermittent fever. On the 27th he was attacked with a rice-watery diarrhoea ; in two hours he sunk into a cold insensible state ; violent spasms and convulsions came on, attended with a cold blue skin. By great perseverance, after lying 48 hours in a state of insensibility, he convalesced and finally recovered. In this family ten cases of the same disease occurred, and most all of them were very severe. And in the house on the opposite side of the street, there were six severe similar cases, all fully formed. They all recovered. [See Case III.] 

Although the first well marked confirmed case of the Epidemic appeared at the old cellar, and from those again other cases seemed to originate — yet there were many cases of the Epidemic in which the patient had no communication with the cellar, or with any infected person or thing. The disease attacked the prisoners in the Jail, some of whom died ; with those there had been no intercourse with the sick or affected. To arrest the disease in the Jail, immediate measures were taken to clear the prison of its inmates, and as there were no one charged with crimes of much magnitude, they were all set at liberty by a general and summary jail delivery. 

The ground east of the village along Main street is 



15 

much of the time it is muddy. Along north of the road, the mill pond formed by the Fallkill extends a long distance. In this vicinity the intermittent fever had pre j vailed very much in the early part of the season ; over this ground the Epidemic Cholera spread very generally and with great severity. Of these there were 50 fully ibrmed cases which took place in 1832 in Main street east of the Court House, and within one and a half miles of it; besides these, the usual number of those affected with the premonitory symptoms took place. [See Cases 111. IV. V. VI. as examples of them.] 

The cases of premonitory symptoms only were always much more numerous than those of fully formed Cholera. 40 of those cases only were subjected to the plan of treatment, the principles of which are detailed in this treatise ; all of which recovered without a single failure. Out of the others there were seven or eight deaths. 

Although there was a good deal of severe disease o the bowels, of the nature of cholerine or diarrhoea, a over the village — the cases which were considered mor fully formed Cholera, were mostly confined to the sout of Mill street, and they principally took place in thos streets I have enumerated, though there were cases i several other streets, and beyond the limits of the corpo ration. In the country there were many cases of diarr hcea which inclined to a watery character, and those were sometimes attended with considerable pain and tormina of the bowels. This kind of bowel complaint was heard of more or less in different directions in the country. About the first of August the Epidemic made its appearance in the County Poor House situated about a mile from the village, near Main street. The disease 



16 

gfedtiied to make a general attack upon a great number 1 almost the same time. The bulletins of the Board of ialth of the 3d of August, states : 

tThe Board regret to state that the Cholera has made appearance in the County Poor House, about one 3 east of the village, and they have no doubt it origi-3d thefe. The first case appeared yesterday at six o'clock P. M. and the cases have increased to 18 up to 11 o'clock this day." And on the 4th, the bulletin states 26 new cases within the last 24 hours. 

In the features of those cases and symptoms compared to other cases which appeared out of the House, and in the vicinity of it, and in the village, there appeared to be but little difference, for precisely similar cases took place ; and the truth of the correctness of the opinions formed of the nature of the disease, was confirmed by a great portion of those cases proving fataL Although from the manner in which some of the cases of the Epidemic seemed to originate, from being some way connected with those who had it, I am assured by one of the Board of Health who took pains to examine, that after the most vigilant examination, no trace of communication or intercourse could be made out between any person, or thing infected with the disease, and this House of Charity, or the persons within it. The House is large and roomy ; at the time the Cholera commenced there, it contained about 190 paupers of all ages and sexes, collected from various parts of the county. Those that first sickened, who were removed there from Union street, were taken in at a back way, so as not to go within a long distance from the House. The Superintendent of the House states that nearly or all of those that remained 



17 

in the House had the premonitory symptoms; and the records of the House shew that during the prevalence of the Cholera in it, there were 106 cases of the disease, and that 96 proved fatal. 

On the appearance of the Cholera in this House, the sanatory authority, and those who had the charge of it, directed their unremitting attention to alleviating the sufferings of the afflicted, by endeavouring to stop the spread and progress of the disease; some were discharged and let go into the country ; temporary shanties were erected about the premises ; and the outbuildings were occupied, and the inmates of the building were as soon as possible removed and spread, and distributed in a more diluted and salubrious atmosphere, or had died, when after about six weeks the disease was put a stop to. 

By the spread and extending influence of the matter of production to disease, the Cholera made its appearance about the middle of August at Manchester, a small manufacturing village about three miles from the Court House. Here several fully formed cases of the Epidemic took place, and some of them terminated fatally. 

At another small village, six miles south, on the bank of the river, called Barnagat, about the first of September, the disease broke out and prevailed for about five weeks with great severity. The majority of the inhabitants, being about 300, were troubled with premonitory diarrhoea, and there were over 30 cases of what is termed fully formed Cholera, attended with vomiting, diarrhoea, and cramps, or a cold collapsed state of the skin. [For result of these cases see statement of results at the end of the work.] 

3 



18 

In just about six weeks from the commencement of 

Ie Epidemic in the village, it spent its force, and termiited its existence. The intermittent fever, which, a& is been stated, was very prevalent in June and the first July, entirely disappeared after the Cholera comenced; and during the Epidemic there was very little :ard of any other disease, except those of a cholerine iture. The whole number of cases of Epidemic Cholera which took place within the Corporation limits during the prevalence of the disease could not be very well ascertained ; and the manner of determining what constituted the disease and what not, would make a very material difference in the number of cases. If the most broad range was given to the term Cholera, as assumed by some of the European writers — that when an atmosphere exists producing that peculiar disease, all the cases of the character of it are more or less influenced by it, or are the disease — then a greater number of the inhabitants of the village might be said to have something of it ; but if the term Cholera is confined to those who are affected with watery diarrhoea or vomiting, or both, with spasms, and cold, purple or shrivelled skin, &c. then perhaps the number might have amounted to 400. Some of those who saw much of the disease, among them were two members of the Board of Health, have estimated those cases at much more than that number. Again — if the term Cholera is confined to the cases in which the state of collapse and asphyxia has taken place, then the number would be very considerably reduced, though of those there were many that recovered. In describing this disease, some authors have considered all the symptoms of bowel affections, from the moderate irregularity of diarrhoea, to the cases of more fully formed and aggravated symptoms, when there was a predispoftition 



19 

to the disease in the atmosphere, as grades and varieties of the Epidemic and the different symptoms exhibited in the progress of the disease, and the case may terminate without difficulty, or it may go on from bad to worse, and terminate fatally. Others have considered two grades or kinds of the disease — one is termed the stage of premonitory symptoms, or simple diarrhoea, attended with some uneasiness, pain, or soreness of the bowels, tormina, &c. and they have confined the term Cholera to those cases attended with vomiting, watery diarrhoea, and sinking faintness and spasms, cold or blue skin, or collapse. This mode of distinguishing the disease and the grades of the disease, has been the most common, and followed by the greatest number of writers. This latter is the distinction I have uniformly made in the disease, and judging from what has been the opinion expressed here, and the practice pursued, I should infer this mode of distinguishing the disease had been generally followed. If two persons seized alike with those symptoms constituting a disease, one by some means re- Irers, and the other by other means dies, it is not easy conceive that they are distinct and different diseases, surisy is pleurisy, whether the patient recovers or not ; and a set of symptoms constituting Cholera in the beginning, is the same disease throughout — let it terminate fatally or favourably. Again — some it appears have confined the term Cholera to those who have advanced to the stage of sinking coldness or collapse, and which have progressed to what is generally termed the fatal stage. Which of those methods are the most correct or most useful in a medical point of view, I shall not stop to inquire, and leave it for each to form his opinion. It seems to be a matter of some difficulty, however, and it has caused a diversity of opinion to fix a line where the set 



20 

of premonitory symptoms shall end, and the confirmed symptoms constituting Cholera ought to begin ; and in many instances the race from the one to the other is so rapid that it is difficult to keep pace with it. 

The distinction between Epidemic Cholera and common Cholera Morbus, has been used by many. It may do very well to give a pass-by name to the public, but it is very unmedical, and conveys an erroneous knowledge of the nature of epidemic diseases. It requires but very moderate information on the subject, to know that the two diseases are not likely to exist, and do not prevail together at the same time. 

Cholera Morbus, as described by writers, is a vomiting and purging of bilious matter. In this disease it is generally agreed that there is a deficiency or a suspension of the secretion of that fluid ; and it has been gravely declared, that, while a patient was labouring under violent symptoms of the Epidemic, that it was not a case of Cholera, because the matter discharged was dark or bilious. Diarrhoea, or cholerine diarrhoea, are mere appropriate terms, and those generally used. 

It is a maxim which seems to be well agreed on by medical observers, that when a person is taken with diarrhoea and irritation of the alimentary canal, during the prevalence of the Epidemic — if it is left to itself the disease generally progresses through the different stages of the complaint — the severe and aggravated symptoms are produced one after another, until a coldness or collapse of the surface takes place, and death closes and ends the case. Again — cases may and do terminate fatally, without being attended with previous diarrhoea. 



21 

From the manner in which the Epidemic Cholera had made return visits a second and third time to many places where it had prevailed, there were strong expectations that it would again break out in this place in the next season of 1833. During this season there was considerable irregularity of the bowels, and there were some cases attended with severe symptoms of the most violent form of the Epidemic, but they were few in number, and the patients happened to recover, so that there was no public excitement, and the season passed off' without disturbing the public tranquility. 

The year 1834 commenced with an open winter ; the ground was scarcely covered with snow after the early part of January, yet there were some very cold days. The state of the weather and temperature is shown by the Meteorological Tables kept at the Observatory at the Academy in this village. On the 20th and 25th of January, the Thermometer fell to , 2 deg. above zero. The principal part of February was unusually warm, though the weather was very variable. On the 4th, the Thermometer stood at 49 deg. ; on the Bth it fell down to 3 deg. The two first spring months were mild and warm, but in May the weather was cold, and very variable. On the 15th May the Thermometer stood at 26 deg.— early vegetation was destroyed almost entirely, and what remained was very backward. A good deal of rain had fallen during the spring months. In June one of the longest droughts commenced that has been known in this part of the country in the memory of the present generations ; there were only five days of rain during this month. In July there was but. one day of rain noted, and in August there were five or six cloudy days noted, but not one of rain. In July there were several 



22 

days when the temperature was TOO cleg, or over, and during those months there was a good deal of murky weather. This season was accompanied by more unfavorable epidemic consequences, and it was the lot of the village to be again visited with the Epidemic Cholera. As early as the middle of July, symptoms of irregular and diseased state of the bowels began to show themselves. Occasionally a severe case of diarrhoea, and spasmodic affection in the form of colic, was met with. On the 26th of July I visited a man in Mill street, near the Woollen Factory, who was suddenly attacked with vomiting, diarrhoea, and spasms. On the 28th, a lady on board a boat at the Landing, was attacked with similar symptoms — she was faint and sinking. On the 30th, an old lady in Montgomery street, who had not been ou of the street, was suddenly seized with vomiting and di arrhoea, of a perfect rice-watery consistence ; she swoonec to insensibility — was cold, blue, and she had sever cramps. Another woman, in the same house, had milky diarrhoea of an excessive nature ; she declared sh had 40 dejections in 24 hours. On the 31st, a similar case occurred near the Red Mill ; and on the sth of August, a case of excessive watery diarrhoea took place at the upper end of Main street, and severe cases of diarrhoea w r ere heard of in different parts of the village. Some of the medical gentlemen of the village have assured me that they had met with similar cases of disease during this period. But there was no alarm existed till the 6tl of August, when several cases broke out, and some deaths ensued. In Union street, at the corner of Jefferson and Perry streets, where there was a good deal o material to collect foul and noxious effluvia, to generate miasmatic and foul air, it is moist springy ground. The houses are small, old, and they were filled with a great 



23 

number of poor families, crowded together. In a few houses in this immediate vicinity about 30 cases originated, and 25 or more of them proved fatal. Two only of these cases were subjected to the treatment in this account detailed. One recovered — the other, after being sunk into a state of deep collapse, by the use of remedies hereinafter mentioned, the warmth was returning to the skin, the pulse raising, and a sweating had commenced. It was thought necessary by the public authorities to remove him to the shanties, near a mile, during which a severe rain took place, which wet and chilled him, so that his pulse was suspended, and could not again be felt. He died in a few hours. This was an unfortunate error of moving while in the state of collapse. The most of the families, both sick and well, were removed from their abode ; some of them after the sickness broke out, and some of them were attacked with the disease after they left the place. Numerous cases of premonitory symptoms appeared all over the village, and in different parts of the place, severe and well formed cases of the Epidemic Cholera occurred in the village, and at the Shanties erected on the grounds attached to the County Poor House, and also at the Shanties got up by the Corporation, for the use of the indigent villagers. In Church street there was a severe case. [See Case VIII. J Another in Cannon street — another in Pine street — all of which sunk into the state of blue collapse of the skin, attended with severe spasms. In Cherry street, a half mile out of the village, an unusual severe case occurred, [See Case VII.] and two milder ones. In Mill street, near the junction of Clover street, there were two severe collapsed spasmodic cases ; these patients both sickened on the river, and were sent ashore. Those cases that proved fatal, were the most (though not all) of them made publi 



24 

— those which recovered there was little or no public notice taken of them. What the whole number may have been, it is very difficult to state ; but they were probably much more numerous than was generally expecte — at least 100 cases, besides the cases which were attended with the usual premonitory symptoms only. Of those I saw and attended, a number of them had asphyxia, and about half of them the usual symptoms of collapse, either commenced or had fully formed. 

The village of Barnagat, which had been afflicted very severely in 1832, was again doomed to an unusual severe visitation of the Epidemic in 1834. On the 4th of August a lady was suddenly and severely seized with spasms, cold purple skin, and moderate watery diarrhoea, from which she soon recovered. Several persons about the same time had diarrhoea — another female, on the same day, who had been labouring under intermittent fever, was attacked with very similar symptoms, attended with a faint sickening sensation. From this period, case after case of a similar and more violent nature took place, until there were not enough of the inhabitants free from the premonitory symptoms, or the severe attacks, in health to attend the sick ; and finally, about the Bth of September, all the inhabitants were advised to leave the place, and the village was entirely evacuated, which put a stop to the disease. During the prevalence of the Epidemic at this place, there were 40 cases of fully formed Epidemic. The trials and afflictions of this place during this Epidemic were very great, although the cases were soon arrested, when early seen to. Yet several of the cases put on a protracted form of fever, after these first violent symptoms were relieved ; others again sickened, so that about the last of August 



25 

and first of September, there were many of them sick at v time. Two females, in about the 7th month of pregnancy, were severely attacked with Cholera, which brought on abortions ; they both died, one after 6 days, the other, after being relieved, relapsed and continued 20 days. These were two out of the five deaths, treated by this plan* which took place. The number and severity of the cases some of the time, required almost constant medical attendance, and the distance being six miles, sometimes deprived them of the ready help required. [See Case X,] The frequent calls of the afflicted, and importunities of the friends of the sick, imposed a duty to devote attention to them not easily to be dispensed with. Several nights as well as days were spent with them, and the gloomy stillness of a midnight hour was only interrupted by the shrieks of the suffering, and the groans of the more prostrated and dying. In alleviating the distresses of these people, much is due to young Dr. Starr, my assistant in 1832, and Dr. Todd, my assistant in 1834 — who, with care and kindness, paid them very constant attention, and with fearless fortitude, attended to the prescriptions and the application of the remedies in the disease. Much was done to alleviate their suffering, and to aid in restoring them to health by the liberal and humane assistance afforded by the public authorities, the superintendents of the County Poor, and the Overseers of the Poor of the town. Situated as this place is, on a bed of lime rock, washed by the majestic Hudson on the one side, and surrounded and protected by extensive hills of carbonate of lime on the other — covered with evergreens of hemlock, cedar, and dwarf pine — it was supposed to be very favourably situated to escape those pestilential diseases ; but experience taught otherwise. The salubrity of the atmosphere was, how- 

4 



26 

ever, very much impaired by a large quantity of filth, mud, and decomposing and putrifying matter, collected in the defiles, and depressions among the rocks, and reservoirs of filth among the rubbish in and about the premises. 

By the extending influence of the contaminating atmosphere, while it affected different sections of the county either mildly or more severely, the small village of Hyde Park, on the bank of the river, six miles north of this place, had a moderate visitation of the Epidemic in 1832, and again in 1834. In the former year there were about six cases, and in the latter about the same number. With two or three exceptions, I am informed, they all proved fatal. 

It has been remarked that persons of intemperate habits were mostly subject to attacks of this disease, in proportion to the number in the community compared to those who are not addicted to a free or improper use of ardent spirits. With this, like other Epidemic diseases, they no doubt are most frequently attacked ; and when they are seized, the diseased and impaired state of their constitutions render them much more likely to fall victims to it ; for the vital principle with such subjects ie held to the corporeal matter with such feeble tenacity, that the first shock of violent disease of any kind is very apt to expel it from the system, and they sink beneath the transitory and feeble powers of reaction. But, as the Epidemic Cholera has prevailed in this place, it has not been materially confined to the class of intemperate persons, though many of those had it, and died with it, and some of them have braved out the dangers in nursing and attendance amid disease and death, with perfect fearlessness 



27 

and safety. As far as T have observed, the greatest number of those attacked have been females, and poorish women ; though many of the cases have been in families who were very temperate, and in those who had a comfortable situation of living in easy circumstances. Ido not design to enlist in favour of the contagious nature of this disease, or against it; but on this subject, as on all others, I shall state the facts as they come to my mind and my knowledge. In many instances there seemed to be an attack of the disease in persons who had been in company with others who had it, or where there had been communication with them ; but in numerous instances, cases of Cholera took place in those where there could be discovered no trace of intercourse with the diseased ; and medical attendants who were continually among the sick, under all circumstances, generally escaped an attack of the disease ; and nurses, and members of the same family where the disease prevailed, often escaped it. 1 have not been able to hear of a single case where the disease was taken by a person from the country, by coming to town to transact business merely, during the prevalence of the disease. This is a similar fact to what is said to take place in other miasmatic Epidemics. It is thought necessary for a person to remain in a vitiated atmosphere until the system is somewhat filled with the foul air, before he is susceptible of taking the disease. 

With those who saw much of the disease, and were a good deal among it, there was frequently exhibited a fearless indifference to their own danger, and to the results of those affected around them. They attended to their duties, and mingled with those affected with as much composure as they pursued any ordinary avoca- 



28 

lions, and this class of persons generally escaped the disease. 

A familiarity with scenes of danger, accustoms the mind to look upon them with composure and unconcern. But during tho prevalence of Epidemic disease, when suffering and death is presented Lo view in every directio — it is noticed on various occasions, that persons lose their sensibility and anxiety about their own welfare, and attend to their vocation, or look on the human suffering like viewing the scenes of a eharnel house, with entire composure or indifference. This state of the body and mind is no doubt in some measure produced by the sedative or exciting effects of the miasma operating on the system. Patients labouring under attacks of the Cholera, frequently, while the mind seems perfectly unimpaired, show entire indifference to their situation, and meet death with perfect composure 1 , and sometimes with heroic; fortitude. 

CONTAGION. 

The opinion whether the Epidemic Cholera or other Epidemic diseases are communicated and spread by means of contagion, or not, has furnished a subject for much investigation, and has been a fruitful source of altercation. But there seems to be more importance attached to this question, than on calm reflection it really merits. For whether the Cholera is communicated by contagion, or by atmospheric influence solely, it amounts to about the same thing ; for all agree that there must be some peculiar disposition to the disease before it does occur. And while contending about this question, attention may be diverted from one of more importance — that is, to the nature of the disease, and the best mode 



29 

of treatment ; lor whether ii is produced by contagion or atmospheric causes, the nature of the disease is the same when it is formed, and the same remedies are useful or injurious in managing it. So that it appears whether the Cholera is produced by contagion or by general causes, or whether it is brought on by one existing cause or another, if it is of the nature of the prevailing Epidemic, the manner in which it affects the system is about the same, and will have very little to do with the treatment. The patient recovers, or the case terminates fatally under similar circumstances. 

In general, the effect of this disease on the moral faculties of the inhabitants, and those whose duty or interest led them to mingle with those affected with it, was very visibly and sensibly perceived. In addition to the anx- X state of the public mind to alarm, and the state of sickness, and the progress of the disease, and an :avour to avoid it, or to aid their friends, in 1832 particularly, there was a solemn candour generally marked upon the countenance, and a direction of the E towards the all-wise Disposer of terrestial events, ently there was public assembling to offer up peand prayers in favour of the suffering and afflicted 



CHAPTER 11. 

DrSSERTATTON ON THR ATMOSPHERE. 

As this work may probably lull into the hands of some who are not particularly acquainted with the chemical nature of the atmosphere, and its effects on the human system, and as a frequent reference will be made to that in this treatise, I have concluded to give a short dissertation on the nature and properties of the atmosphere — shewing its use in supporting animal life. 

Probably from the earliest periods of the time that medicine was cultivated as an art, it was noticed that it was necessary for animals to breathe a pure air to support life. But why that was necessary, or what the property contained in the air was, which was so essential to life, they were unable to discover. In the progress of time it was ascertained that the air was composed of matters which were capable of being separated into distinct parts. The atmosphere, in its natural state, is called air ; the component parts of it, when separate, are termed gases. About the year 1774, Dr. Priestly, of Philadelphia, decomposed the air and obtained oxygen. Schele, of Germany, in 1775, also obtained it ; and about the same time, Lauvisier of France, arrived at similar results in experiments on the air. They used different terms to express the name of the elementary matters obtained. Lauvisier used those of oxygen, hydrogen, arote or nitrogen, which seems to be the most happy terms, and have been generally adopted. By those dis- 



31 

Iveries it was determined that the atmosphere, instead 1 being a simple elementary substance or matter, was a compound nature — that it was made up of different scs, which were capable of being decomposed and :mrated into distinct portions, possessing very different rperties. The chemists who made these discoveries, *ived at somewhat different conclusions, and gave difent names to the elementary portions of the air, but :ir discoveries came to about the same results. 

The constituent portions of the atmosphere are now considered to be composed of oxygen (or vital air) about twenty-five parts in a hundred, or one fourth part ; and azote or nitrogen, seventy-five parts, or three fourths. Those integral portions are united chemically in the atmosphere, but they are capable of being separated into distinct parts, and are continually changing and forming new combinations. Besides those constituent portions of the air, it contains a variety of other matter suspended in and mixed with it ; but the main elements of the atmosphere, it seems, remain in nearly the same relative proportions in all places ; if they did not, it would cause a destruction of animal life. This discovery has been of very important use in enabling us to understand many of the operations which take place in the human system in regard to health and disease, and in many operation and processes in the arts and sciences, and it has bee applied to many useful purposes. Since this discovery it has been ascertained that there was a strong attraction in the blood of animals for the oxygen or vital air, am that the use of respiration or breathing was to receive a portion of air into the lungs, where it meets with the blood while it is circulating through them. The membrane which divides the blood vessels in the lungs from 



32 

the air cells is very thin and delicate ; and while the blood and air is thus in near contact, the blood attracts the oxygen, and separates it from the other portions of the air ; it is incorporated with the blood, and conveyed away into the body with it. At the same time the blood gives off a quantity of carbonic gas, (or fixed air,) and some other impurities, which unite with the azote or remaining portion of the air, and together they are thrown off by expiration — this is the process which constitutes breathing. There are some different opinions held on the nature and use of oxygen on the blood — but this is the one more generally embraced, and one which appears to explain the effects of respiration in the plainest and most satisfactory manner. The nature of the blood, and the formation of animal matter is such that it is necessary to have a continual supply of oxygen conveyed into it, which being united with it, aids in the performance of many important operations in the animal economy, more no doubt, than can be discovered or explained, though many of them are very well understood. 

When the blood is returned from the veins by the round of circulation, and brought back to the lungs, it is dark and heavy. It has parted with a great portion of its oxygen heat. After it has again passed through the lungs, and received a fresh supply of oxygen, it is more florid, lighter, and warmer by two or three degrees. It is concluded by those who have examined the subject, that those changes which have taken place in the blood are owing to the effect of oxygen, by coming in contact with it in the lungs. It is an admitted principle that whatever interrupts the circulation of the blood through the lungs, or prevents a due and proper supply of oxygen to it, that it has a tendency in a less or greater degree to 



33 

produce ah injurious effect on the health, or vitality of the person, " The due oxydation of the blood, and its distribution into all the organs, is consequently the principal phenomenon on which the life of man depends." 

The effects of breathing, or adding oxygen to the blood, are very visible on the human system. It augments the heat — it keeps up or increases the action or vigor of the heart — it gives a more florid colour to the face — it fits and prepares the blood to convey the nutrition which it receives from the way of the stomach, and various materials, to every part of the system, to perform the various operations which take place in it. It is considered that the union of oxygen with the blood, and that again given off to unite with other substances in every other part of the body, is the source and cause of animal heat. It is calculated that by a diminution of oxygen in the atmosphere to 18 or 20 parts in a hundred, it becomes unfit to support animal life. Again, an increase of oxygen in about the same proportion, that is to about 35 parts in a hundred, it would hurry on the vital operations so as to cause death. When the lungs are deprived of a necessary supply of oxygen, the breathing is laborious and obstructed, attended with a sense of suffocation or sinking. Asphyxia sometimes ensues; the blood is dark and heavy ; the skin is cold ; the vigour diminishes, or a langour and indifference takes place. On the other side, when an air containing an increased quantity of oxygen is inhaled, it has a tendency to increase the vital energies and action of the system. Experiments of this kind are frequently made in chemical lecture rooms, where what is termed nitrous oxyde' gas is inhaled, composed t>f oxygen about 36 parts, and nitrogen 64 in a hundred, 

6 



for a short time. The effects of it are to increase the frequency and fulness of the pulse ; the eyes have a vivid sharp expression; it produces delightful pleasant sensations ; the muscular powers are increased in vigour, attended with frantic extacy. Sir Humphrey Davy says, " I breathed four quarts of nitrous oxyde from a silk bag — effects analagous to drinking fermented liquors ; in less than half a minute they diminished gradually, and were succeeded by a sensation analagous to gentle pressure on all the muscles, attended by a. highly pleasurable thrilling sensation, particularly in the chest and extremitie — the objects around me became dazzling, and my hearing more acute. Towards the last inspiration, the thrilling increased ; the sense of muscular power became greater, and at last an irresistable propensity to action was indulged in. I recollected but indistinctly what followed. I know that my motions were various and violent. These effects soon ceased after respiration. In ten minutes I recovered my natural state of mind." 

Mr. Robert Southey " could not distinguish between the first effects and an apprehension of which he was unable to divest himself. His first definite sensation were a fullness and dizziness in the head, such as indue a fear of falling. This was succeeded by a laugh whic was involuntary, but highly pleasurable, accompaniec With a peculiar thrilling in the extremities — a sensatio perfectly new and delightful. For many hours after thi experiment, he imagined his taste and smell were mor acute, and is certain that he felt unusually strong and cheerful. In a second experiment, he fell, pleasure still superior, and has actually remarked, that he supposes the atmosphere of the highest heavens to be composed of 

.'3l 



this gas." Such are the general effects of breathing this gas. 

How much the elementary properties of the atmosphere, or the properties contained in it, may have an influence in producing diseases, or aid in a curative process, it is difficult to determine, but it is more than probable they have a very considerable effect in both ways. The nitrogen gas does not destroy life by being inhaled, only by the absence of the oxygen it does not support it. Carbonic gas (or fixed air) is another elastic fluid, which is more or less blended with the atmosphere, but does not form an elementary part of it. It is produced in a variety of ways, and passes into the air. But the property of it is supposed to be very soon changed by a strong affinity it has for oxygen and other materials with which it unites. This is the heaviest of all the gases ; therefore, it generally settles in low places, such as deep wells and grottos. This gas does not support animal life nor combustion ; on the contrary, it puts out fire, and is directly deleterious and poisonous if received into the lungs in any considerable quantity. It is this gas which destroys life so suddenly, when persons are confined in close rooms where charcoal or carbon is in a state of ignition. It also has a similar effect on going into it in deep caverns. This gas enters into a great variety of combinations with other materials, and is of very great use in natural productions as well as in the arts. As injurious as it may be to animal life by being taken into the lungs, it is a very useful article of food and medicine by being exhibited by the stomach. While it ma}' be an important article in those noxious gases which produce disease by being inhaled, it is a valuable correcter of them, and an antiseptic, by being passed into the stomach. 

35 



36 

Such is the wise and peculiar structure of the human frame, that the lungs are fitted for oxygen, and oxygen is adapted to the lungs, while to this organ carbon is poisonous. But to the stomach carbon is congenial, to aid in supporting health. These facts borne in mind, may be of much service in managing disease. 



CHAPTER 111. 

I Discourse on the general causes, nature and prevalence of epidemics — delivered to the Corporation and the Citizens, by request — with a view to extend the knowledge, and correct many erroneous opinions on those sub- JECTS. 

Respected Auditors* 

Of all the subjects which occupy the human mind, and arrest the attention of mankind, that of preserving health < — the means of removing those diseased actions and derangements to which the human system is liable, and endeavouring to perpetuate the existence of life, is the most prominent, and most keenly arrests the attention. It is decreed in the divine oracles, " Thou shalt not kill,"— 'but the law of nature, and the instinctive principle incorporated with human animal matter, goes further, and continually admonishes man to avoid injuries and pains that may be inflicted on him, and to use all means in his power to guard against disease, and to preserve life. Hence, at all times, the minds of mankind have been actively directed to the examination of the nature of diseases, the means of preventing them, and the method by which cures have been most readily effected. 

In periods of ordinary disease, whea no peculiar malady exists, and only ordinary cases of sickness and fatality occur, the anxieties, and excitements, and the attentions 



38 

are mostly confined to the relatives and friends of those who are afflicted with sickness. Others of a community hear of those cases with sympathetic feelings ; it is passed over, and soon forgotten ; the ordinary avocations are pursued, and the attention directed to other objects. But when those peculiar changes take place in the atmosphere, or on the surface of the earth, in a district of country, a village, or a city, which produces a great amount of disease, assuming an Epidemic character, which spreads with violence and terrific aspect, then a general and fearful anxiety pervades the human mind, an universal excitement runs through the community, and all are simultaneously engaged in the inquiry — What is the nature of the malady ? What is the best means of guarding against it? What are the best methods of conducting a cure, and arresting from the grasp of death those who are seized ? To answer those inquiries, in some measure, will be the object of the following observations. 

It will be proper here to define what constitutes an Epidemic disease. There is perhaps at this period no diseases taking place materially different from those which at sometime or other have before prevailed ; or at least, are attended with many prominent features common to some others. When diseases prevail in an ordinary manner, here and there a case, they are termed ordinary diseases. When they partake of the character of some known Epidemic, whose existence is near by or has just passed, they are called sporadic, or scattering cases of that disease, and are not fully of an Epidemic nature. But when great numbers of cases occur, attended with severe and violent symptoms, and spread over a district of country, a village, or a city, they 



39 

are called Epidemic, as taking place in great numbers, and attended with sudden effects. Thus the Plague has prevailed as a sporadic disease, and at other times the cases have been greatly multiplied, and it has assumed the nature and character of an Epidemic. Mr. Volney, in his travels in Egypt and Syria, and other writers, state that the Plague is an annual disease in those countries — where it excites no material alarms, and is not very fatal; and it sometimes prevails as an Epidemic. An aggravated form of bilious remittent fever has several times prevailed in this country in an Epidemic character. It has also frequently occured as a sporadic disease, here and there a case only appearing. Yet we have every year, in many places, a bilious remittent fever, as an epidemic of the season. There also has prevailed in this country an Epidemic spotted fever, or winter disease, and the same disease has often occurred in a scattering or sporadic manner ; and for centuries, that character of disease denominated Cholera, or Cholera Morbus, has been known, and described sometimes as sporadic cases, at others as an Epidemic. It was described as long ago as when the Coan articles were promulgated by Hippocrates, before the advent of our Saviour. It prevailed more or less sporadically, and as an Epidemic, in the 16th century, and is described by Sydenham, and other cotemporary writers. And here we take occasion to make some remarks on the name applied to this affection, as names may sometimes do good, or they may produce evil. I perceive an opinion is prevalent that Cholera and Cholera Morbus mean different diseases, or states of the system. Now, morbus simply signifies disease ; and why that term should ever have been added to the term Cholera, more than any other disease, I have not been able to discover. As well might we say pleurisy morbus, 



40 

or pleurisy disease, or yellow fever morbus, or yellow lever disease. But names in themselves are merely significant, and often are governed by custom, and they are not very material, if correct ideas are attached to them. If the term Cholera is proper, a better use of it would be common Cholera, or sporadic Cholera, or Epidemic Cholera. But the name has been objected to as not conveying an idea at all of the nature of the disease. But in some other Epidemics, as well as in Epidemic Cholera, there is no doubt names have wrought much injury. In France nearly all the writers on Epidemic Cholera have retained the morbus, and described the disease as Cholera Morbus. The influence of names will be further noticed hereafter. 

Some objections may be raised to the attempt of offering the public and lay hearers general observations on subjects relating to disease, as there may be some things necessarily said which cannot be very well comprehended ; and some may think the public ought not to be instructed in the mysteries of the medical art. There are, to be sure, some views to be taken of the nature and peculiarities of the human frame, and the effect of disease upon it, which may not be perfectly intelligible to all ; but by using as delicate and familiar language as the case will admit, the subject will be rendered very comprehensive to ordinary capacities. 

It has been the opinion expressed by some wise heads, that it would be well for the community, and particularly for the police bodies, to make themselves acquainted with the general nature and management of Epidemic disease. The public have manifested much anxiety on this subject, and all classes o{ readers have more or Jess 



41 

directed their attention to obtain information on the history, nature, prevention, and cure of Cholera. There are many unprofessional persons who take an active part in the management of Epidemic disease, and frequently exercise i i good deal of influence in conducting and directing, not only in the police regulations, but in the actual administration of remedies. (This was very much the case here in 1832.) They may do much good, and they may produce much injury. But the common drift of these prescribers, unless correctly directed by some general views, in such severe cases of disease, is to adopt the use of remedies very illy calculated to afford relief in the case, and they may do much injury. Twice have we seen public opinion, and popular practice combined, in an unfortunate management of Epidemic disease. (In the Epidemic of 1812-13, and again in the Epidemic of 1832.) Although, under some circumstances, public opinion has been so directed by judicious instructions, that many nurses and lay prescribers have been very useful in aiding and treating those cases. Dr. Rush has expressed an opinion that there was no danger in informing, and trusting individuals in the management of Epidemic diseases, after having some general principles correctly fixed. If the public are informed that a disease is incurable, they may think they will not fare much worse by taking the management into their own hands. When the Epidemic appeared in the south part of this town in 1832, and six cases in succession were fatal, the people were thrown into consternation, and almost despair, by being told, on medical authority, that the disease was incurable ! ! Twice have I known lay practitioners treat cases of Epidemic diseases tolerably successful, by having some general rules laid down. In the Epidemic Cholera of 1832, two women, who with great fortitude 

6 



42 

and care, attended as nurses in many violent cases. After they were instructed in the mode of management on the first attack, and had left with them some medicine, tev attended several cases so as to arrest the disease in J c early stage, even from an incipient state of collapse. And hundreds of cases of yellow fever, we are told, were cured by lay practitioners in 1793, from general instructions given them by means of public gazettes, during the prevalence of the Epidemic. This class of practitioners have no theories to bind them, nor professional jealousies to govern and dictate them. 

The severe and alarming manner in which this place has been twice visited with the pestilential Epidemic Cholera, and, for aught we know, may again be afflicted with the wafting influence of this contaminating miasmatic disease — that here, as in other places, whatever may lead to an investigation of the nature of the Epidemic Cholera, and aid in disarming it of its malignancy, it is presumed may be well received, and contribute to the general welfare and safety of the community. In examining this subject, we can offer no promise of entertainment by figurative and fanciful description — by drawing imaginary figures, or by flowery oratory. But our subject will be a plain investigation of health and disease ; the theme will embrace principles connected with life and death. 

In our remarks, in speaking of the Epidemic which has recently visited us, we shall use the term Epidemic Cholera — not because the term Cholera, as some have observed, is the most appropriate name to convey an idea of the nature of the disease, as will be shown hereafter, but because it seems most in conformity with public 



43 

opinion and custom, and is preferable to the term India Cholera, Cholera Asphyxia, Spasmodic Cholera, Collapse Cholera, common Cholera Morbus, &c. There is no good reason, and it seems to be far-fetched to travel 10,000 miles to import a name India for a disease, which may be mi generis among us, because a similar complaint has prevailed in that remote region, as well as in others ; and the terms asphyxia, spasmodic and collapse, are only symptoms exhibited in, and are united with the nature and progress of the disease. They may lake place, and may not. 

To name a disease from a locality of origin, or a symptom sometimes attending a case, and sometimes not, does not convey an idea of the nature of the disease ; and by association of ideas with names and remedies, often leads to erroneous practices, as will be further illustrated. Therefore, we infer when this character of disease prevails, it would be better to simply call it Epidemic Cholera ; and whatever place it prevails in, it either prevails sporadically, or as an Epidemic of the place and season. But when this, like other Epidemics, does prevail in an Epidemic form, all the cases embracing the general symptoms peculiar to the disease are of the Epidemic nature ; and it may be attended with mild or aggravated symptoms, and these again may be very much influenced by the mode of management. 

In tracing the histories of Epidemic diseases, as they have appeared at different periods, and examining into the result of the modes of treatment which have been pursued in them, two important subjects of consideration are forced upon the mind : the first is — That there appears to be some similar general symptoms presented fn 



44 

many of them ; and the fatal effects on the vital organs of the human subject, are produced by similar causes. Second — The same philosophical principles have governed the most advisable and successful mode of treatment in many of them, and the same general remedies have been successfully used. This view of the subject we shall endeavour to show in the progress of our observations. If some general principles can be fixed on, in regard to the nature and treatment of Epidemic diseases, without regard to name, it may have an influence to unite the minds in medical management, and lead to useful results. It may a/void as great a confusion in the medical republic, as has on some occasions taken place, as there was of languages at Babel's Tower. Then, on the out-breaking of a complaint, attended with unusual or violent symptoms, we may avoid the necessity of studying the whole character of the disease anew, and pursuing an experimental course of management, the general principles will be fixed, and the application and the detail will only require to be filled up. 

It is probably from a want of some fixed general doctrines on the nature, and mode of operating on the human system in Epidemic diseases, that they have been viewed as of separate and distinct natures, which has led medical men to pursue very different plans in managing them ; and it would not require a very deep or learned argument to show, that courses of treatment directly opposite in their principles and effects, would not both be the best. Good old women have a notion that one doctor is much better than another ; and there may be much truth in it. But medical history teaches that some modes of treating violent Epidemic diseases, are much more successful than some others ; and the aim of our discourses 



45 

will be, to endeavour to point out those general means, which in a variety of instances, have turned out to be the most successful. Like other facts, and principles connected with medical questions, it will require an extensive view of the ground ; for, as has been well observed by my friend, the late Dr. S. Bard — " Medicine is a comprehensive and an intricate science, founded on numberless facts which have been discovered through the successive periods of ages, and have been collected and preserved in the writings of almost innumerable authors. By the discovery of the circulation of the blood by Harvey, and the introduction of sound philosophy by Bacon, in which opinion was made to give place to observations, and experience, and facts, by which the science of medicine was placed upon its proper foundation of nature, observation, experience, and sound reasoning." — Address as President, to the Graduates of the College of Physicians and Surgeons, in New York. By tracing those histories, and comparing those facts and deductions, has, on several occasions, led to very useful results, and it is believed, it may do the same again. 

It has been the opinion of some, and it may probably be a very prevalent one, that the character exhibited by Epidemic Cholera is something new, and entirely unlik any thing that has gone before it. In my remarks I sha show that similar symptoms have been attendant on othe diseases, and that they have been produced by the sam diseased cause ; or, rather, by the same changes takin place in the human system; and that those symptom have been relieved, and cured, by the same general remedies. 

The question is often asked by the public, particularly 



46 

during the prevalence of Epidemic disease — Whm produces them f <>i, what is the cause of them t Ifthisques* lion refers to ilh % general remote cause, wo shall be some" wliai ai ;i loss to give n, very satisfactory answer. II it is confined i<> inquiring the cause «>l ihe symptoms connected wiili ilx 1 disease, then ii might In* more fully answered) Souk 1 general explanations on this subject I shall endeavour to make* On the first, I shall offer all that seems to be known ; on the second inquiry) the cause and nature of the symptoms as connected with the disease, will be reserved for a future time. [See Pathological explanation of Cholera.] 

There is no subject of medical investigation, perhapsi which has arrested the attention of medical philosophers more than that of examining into the cause and prevalence of Epidemic diseases. It has also attracted the attention of governments and police bodies. We find at oeriain periods a disease of a particular character has broke out, and spread more or less extensively in a village, or city, or over a country ; during its prevalence, all diseases of a febrile, or general nature, are mostly of the peculiar character of the reigning Epidemic, either mildly affecting the patient, or violently seizing him in a fearful and aggravated form. This peculiar kind of disease exists for a series of years, and either continually prevails, or returns annually, at a certain time of the year ; though generally those diseases have an annual return at a certain period. They continue to prevail for a series of years — gradually diminish in their violence, and finally entirely disappear, and cease to exist. After a series of years, a new train of disease breaks out, attended with some general and some peculiar symptoms, and spreads in an epidemic manner, sweeping before it 



47 

tlUttUMftUfl victims of the human nice. AltlKWgli MMireifl no account of an Epidemic which hat disregarded season and climate) and set at defiance the efforts and regulations ofsanatory bodies, and (Ik- quarantine regulations of governments} more than the modem Epidemic visitor — yet there have been Epidemics which have spread much more extensively over a country, which have lasted a longer period, and which have been attended with much greater fatality* The Plague spread over Europe fourteen times in the 14th century; and again, it visited London nearly every year from 1593 to 1613 — and again, from 1636 to L 649« But the most severe one is described by Drs. Hodges and Sydenham, of 1665, which destroyed a multitude of inhabitants* Whether these diseases were more fatal than the Cholera, in proportion to the nurnbfrr taken with them, cannot be determined ; but, in the aggregate, they carried off a great many more people. 

In the same manner, at different periods, Epidemics have prevailed in our own country. Some of the instances are — the yellow fever which has visited different parts of the Union ; in 1732, 1739, 1745, 1748, it was in .South Carolina; in 1741, in Virginia; in 170], 1804, 1822, in New York ; in 1756, 1793-4, in Philadelphia. But the most extensive, the most difficult, and the mos fatal Epidemic that has visited this country, was thf Epidemic which spread in the early part of the presen century — the spotted fever. Just 20 years from the appearance of that disease in this county, we were visitet with the Epidemic Cholera. 

It is to be borne in mind that many of those diseases, although they appear in an Epidemic manner, are contined to a small district of country or city, which goes to 



48 

brbVe that whatever the generating cause is, or by whatever means it is communicated, its extending influence is not very great. This is a forcible argument used in favour of local origin, and sui generis production, as opposed to their contagious nature. 

Again — some Epidemics extend their influence am effects far over the country — visiting place after place — desolating the inhabitants like a pestilence ; not exact! travelling in darkness, but boldly marching in dayligh to seize its victims. Of the latter description seems t be the Epidemic; Cholera. These are produced by th atmosphere being impregnated with a material strong] disposed to produce diseased action in the human body and to terminate life. And whatever the remote caus may be, or the properties of the peculiar matter whic produces those diseases, the atmosphere is the medium through which it is conveyed from place to place, am from person to person ; and whether this communicatio is termed atmospheric or contagious, it amounts to aboi the same thing. When an atmospheric predispositio exists to produce a peculiar kind of Epidemic disease, may be communicated by something like contagion, o direct communication from one to another — or it may b spread entirely by the influence of the atmosphere. Bu this is to be borne in mind, those diseases are not com municable as an Epidemic, unless there is previousl an atmospheric predisposition to produce them. 

This generating material, or matter of a poisonous nature, which affects human health and life, has been called miasma, malaria, septon, matter of contagion, animalcula, &c. which are very synonymous terms. Those who have endeavoured to furnish a cause for the origin and 





49 

prevalence of tlio.se diseases, have traced out a variety oflocal sources, and generating means. Those diseases have been charged upon stale and putresent provisions, imperfect crops, poisoned waters, to the filth and crimes of a particular class of countrymen residing as aliens in another nation. Thus lie Israelites were charged by the Egyptians with being the means of the prevalence of the Plagues of" their day ; and recently the Jews were charged with poisoning the writers of Paris, which there produced Cholera. Recourse has also been had to the introduction of impure ships and cargoes into a place, producing pestilential disease — to contagion- — to the occurrence of earthquakes, and to internal terrestial ignition and volcanic eruptions, and to what may bo considered the easiest and shortest mode of accounting for natural causes — to special Divine interposition. 

Ever willing are we to bow with reverence to Divine dispensat ions, and the general overruling influences of an Omnipotent Power. But we are inclined to the opinio that it is not infringing on supreme authority or govern ment, and it is better for the community to endeavour to account for natural phenomena on philosophic principles and from natural causes. In Turkish climes, and ir some other countries, where exists a bigoted and igno norant population, Epidemic diseases have been ren dered very fatal by a belief of their being the conse quence of fate. The inhabitants have quietly and slug gishly shut themselves in their houses or strong holds and avoided those means which are found to be mos useful in arresting the progress of the disease, and waiting the pleasure of Dame Fate, to stay the pestilence. 

An unfortunate instance of a belief in a supernatural 

7 



50 

cause of Cholera is related by a traveller, which took place in Scotland in 1832, and which we here subjoin : 

"On the very day that I took up my quarters in the Caledonian Hotel, another, and I have the vanity to think, a much less welcome visitor, arrived in the town — the Indian Cholera. I attended at three churches during that day, but shall only notice the doctrines propounded in one of them, where, by all accounts, the most learned, pious, and popular pastor of Inverness presided. The text (if I recollect right) was from Amos ; 1 Seek ye the true God, and ye shall not die.' A more appropriate and exhilerating portion of Scripture could hardly have been selected, because it pointed out to the sinner the means of escaping the cholera, and confirmed the righteous in his security against the evil. 

" According to the preacher, the Indian Cholera was wholly a dispensation from the Almighty, on a sinful people. He maintained this proposition by an appeal to facts. It had been ten times more destructive in other countries than in Great Britain — because the people of those countries were a wicked and ungodly people ! Unhappily for his arguments, it had been much more fatal in Scotland than in England ; though the Scotch are universally allowed to know the 'true God' better than their neighbours. Not the slightest allusion was made to the possibility of the Epidemic arising from natural causes. No. It was a direct visitation of God, on nations and on individuals, for their sins ! This is a serious doctrine ! Let us examine it a little more closely. Did the pestilence fall exclusively on the wicked? It fell chiefly on the wicked — provided always that they were very poor. The rich man might murder, rob, and ruin 



51 

I around him — he was perfectly safe from Cholera. 3 poor man might be the most virtuous, religious, intrious of his race — but poverty was the sin that ren* ed him the sure victim of the Epidemic ! Such is the cies of justice with which Man has dared to invest Creator! If Cholera was sent by a supernatural ser on earth, as a scourge, and independent of natucause — that power would seem to have been evil, ler than good ; for imagination can hardly conceive a tation more partial and unjust, than the pestilence in 

" In the very first year of the pestilence (1832) consumption carried to the grave double the number of those who fell victims to the Epidemic, in this country. But Cholera came from God, while consumption comes from climate ! This doctrine is scarcely less impious than preposterous. More than one half of the towns, villages, and hamlets of England, entirely or almost entirely escaped the divine visitation — ergo, there were no sins to be punished in these favoured spots. Of the two universities, Oxford [the poor of] was scourged, while Cam bridge remained free — ergo, the poor inhabitants of Ox ford were wicked, while the fat professors and the vir tuous youths of both seminaries were the chosen people Glasgow, where stands the colossal statue of JohnKnox was desolated by Cholera ; but Rome, where the lady in scarlet is considered to hold her court, has hitherto re mained free from the pestilence ! 

"To return to Inverness. The eloquence, the fervor, and, I have no doubt, the conscientious zeal of the preacher, had all the effects which he could desire, on the general mass of the audience. That sermon, Ido 



52 

think, sent sonic to their graves by cholera, who would otherwise have escaped ! The ghastly features, the quivering lip, the up-turned eye, the heaving bosom — aIJ showed how effectually the denunciations from the pulpit were disposing to, and aiding the epidemic influence, which was spreading over the land. Inverness suffered severely — and so did Scotland generally. No wonder. Terror was the prime auxiliary of the natural causes which occasioned Cholera; and the injudicious orations from some of the pulpits gave an additional power of destructiveness to the Epidemic." — Johnson's Jour. 

The foul exhalation from moist and unclean situations has been considered one of the most fruitful sources of disease. In this list of causes may be enumerated mashes, stagnant pools, the collections of putrifying materials accumulated in sewers, gutters, and the receptacles of offal in and about villages and cities, acted upon by extremes of heat. No doubt, from the most of these causes, noxious materials are generated, which vitiate the atmosphere, and generate disease. The most reasonable, and the most generally established opinion is, that they originate from some great general cause, operating on the atmosphere, and vitiating it, and contaminating it as it spreads — generated primarily by some peculiar changes which are produced on the surface of the earth by natural causes — either by exhalations from the internal parts of the earth, or by chemical combinations, decompositions, and operations, which are continually taking place on its surface, and in the atmosphere which surrounds it. Some of those effects may be produced by a change of the equalized portions of the elementary pro- Grties of the atmosphere. These observations apply >re particularly to the general causes of those wide 



53 

(eading Epidemics, vvhicli spread extensively over » ad expanse of country, and become the prevailing disc of a season, or period. Those local causes, being 3d upon by the atmosphere, and by heat and cold, ungo a chemical change by fermentation and decomposition, by which new compounds and combinations of matter and gases arc formed ; those gases or effluvia exhale from their origin into the atmosphere, and fill and impregnate it with this peculiar matter. By the act of breathing, with the air, it is taken into the lungs, and mixes directly with the blood ; it also may be absorbed by the skin, and taken into the stomach with the food and drink, which produces disease — operating somewhat different at different times ; and they are more or less violent in proportion to the quantity or poisonous quality of the matter received into the system. At this period it seems to produce that kind of affection termed Cholera ; at another period it may produce a complaint somewhat different. What the peculiar qualities or chemical properties of this matter or gas is, it is very difficult to determine. It has generally been considered to be of an acid or septic nature, which has led to the use of alkaline remedies — calculated chemically to neutralize and destroy it. 

Medical investigators have thought they have satisfied themselves with explaining the origin of it, and ascertained the means of its production. Some have thought this a peculiar kind of poisonous air or gas ; others are of opinion that it was produced by innumerable small, indivisible, undescribable gnats, or animals, termed animalcula, which were produced in those seats of putrifaction and fermentation, and floated about in the air, which were swallowed and inhaled by voracious men, 



54 

which clogged up, deranged, or poisoned the system. Others have thought the matter producing those diseases was a matter of contagion — but what that consists in essentially, or chemically, they are again at a loss to determine. In those receptacles and collections of decomposing matter, to which all writers refer for the source and origin of those foul gases, there is continually going on a formation of new chemical compounds and gases — and vapours are thrown off. Those gases are considered unfit for respiration, and injurious to health. Now, the formation of such gases is much more easily produced, than the formation and production of animalcula, and, indeed, they are a necessary consequence of those process ses — unless chemical process could be brought to a degree of perfection which Dr. Caustic, in his Terrible Tractoration, sarcastically said they had arrived at in France, where 

" By a process in chemical contrivance, They made little Homo (men) all alive once." 

We shall now trace some of the general laws, which in all ages, have in some measure been observed as connected by natural causes in producing Epidemic disease, and notice some of the general features of those diseases. 

It is doubtful whether medical investigators have not more or less departed from the cvi dence of truths suggested by causes and effects. Many errors may have been committed in the investigations of the origin, nature, and cases of pestilential diseases ; the mind has often been extended beyond the operations of nature, within the immediate observation, and directed to the influence of some other unknown and undefinable causes ; and it is frequently directed to sole contagion — to fate — to the aid of celestial or infernal beings, as producing 



55 

morbid operations on the vital functions of man. Each Epidemic has been rather considered as having peculiar characters of its own, and requiring a specific mode of treatment. But it is an important consideration, that most Epidemics at different periods of time have been connected with some peculiar vicissitudes of season, inclemencies of the weather, peculiar localities, or state of the atmosphere — extremes of heat or cold — of moisture or humidity — or habits, or excesses, or indulgencies of men. As the great and general powers operating in the production of Epidemic diseases, this shews that nature never changes her course, nor Providence her laws; that Heaven never changes her immutable decree, nor deviates from the fixed course of procedure. And it seems that from those natural causes operating in the production of diseases, the effects produced on the human system in all ages have been very similar, and they have uniformly exhibited some general similarity of symptoms. This is in some measure shewn by observing that an application of remedies on similar general principles, which were most useful in the Epidemic of London of 1665- — of the winter Epidemic spotted fever of England of 1685— 0f the Epidemic of Philadelphia of 1793— of the Epidemic spotted fever of this State of 1812, proved tolerably successful in the Epidemic Cholera of 1832. 

Why those diseases do occur at one period and not at others, when some of the local causes of them exist every year — and why they prevail in cold as well as in warm seasons, it is impossible to explain. But whenever they do take place, they are produced by some of those general causes which create extremes of excitement, and irregular action in the human system — prone to produce 



56 

inflammatory action. lam aware this state will be catled typhoid debility — so it will be, if not restrained ; and the more violent the inflammatory attack, the sooner it assumes the typhoid or gangrenous state. 

Dissections of the bodies of those who have died of these diseases, at various times, have exhibited internal marks of disease very similar in all cases-^-shewing a state of compound inflammation and congestions of blood in some of the internal and vital organs. To sustain this statement, the reader may refer to the accounts of dissections which have been made in the yellow fever, bilious remittent fever, typhus fever, jail fever, spotted fever, dysentery, cholera, &c. It is true that the same organs are not affected alike in all these cases, neither ate the external symptoms alike in them all. But there are some general symptoms which are very similar, and some of the internal organs are very similarly affected. In those cases the location of the diseased action is sometimes on one part and sometimes on another. If we inspect the histories of medicine from the earliest periods of time down to this day, we find that Epidemic diseases have prevailed at different times and seasons, and that they have always been described as connected with some irregularities, and extremes of temperature of the seasons ; or they have prevailed, in some place which from its local situation, the air or water has been im» pregnated with a material of a poisonous and deleteriousnature. The symptoms which have attended those diseases in the early stage have been described as very similar in most all cases ; they usually begin with chills, and rigours ; these sometimes are so severe that the pa- B falls down senseless and helpless, and dies without er warning — -or they are followed by burning heat, 



57 

Violent pains in the head and other parts, distressing inclinations to vomit, or vomiting, severe diarrhoea, burn* ing biles or carbuncles, delirium, spots on the body, spasmodic convulsions, &c. They all seem to be the peculiar effect of a material of a nature to produce an unhealthy state of the blood and fluids, being conveyed into the body through the medium of the atmosphere. 

In an account of the sweating sickness which prevailed in Europe about 1520, and which has been compared to the Epidemic Cholera in its effects on the system, it is stated that "it was preceded by stormy, tempestuous weather, and extremes of heat and cold." Its malignancy was never equalled. The symptoms correspond extremely well with those of Epidemic Cholera, except the excretions from the blood were to the surface of the body, instead of the alimentary canal. The symptoms were sudden coldness, sensations of heat running through the part affected, internal heat, unquenchable thirst, profuse sweating, anxiety, restlessness, violent pains, stupor, drowsiness, &c. It sometimes terminated fatally in six hours — and at others, in 24 hours the patient was out of danger. Its terminations in sudden deaths or recovery, is similar to what many observers have noticed as taking place in Epidemic Cholera ; it was said to have yielded to about the same general remedies. During the prevalence of the Epidemic Cholera, cases frequently occurred of the most violent kind, which terminated in health in a very short period. A feeble description of the powers of the human system, in such cases, to endure the sinking state of the vital powers, and a return again to health, we introduce here : 



8 



58 

state of low depression, as in the collapse state of Cholera—the heart and vital organs just on a doubtful poise between suspended motion and reaction — the respiration interrupted, or almost suspended — the vital principle doubting whether to remain with the morbidly deranged matter, or make its cxit — by a prompt use of means to abstract the miasma from the system, and remove the diseased state of the blood vessels, the excretions of the fluids into the stomach and alimentary canal are restrained or checked ; the heart released from its superincumbent load, regains its powers of action, and propels the sanguineous fluids along the course of the blood vessels to the surface of the body, and a balance of the circulation is restored ; the lungs, by little and little, more freely expand to receive an increased volume of vital air, to improve the qualities of the blood, and stimulate to more vigorous action the heart and arteries; a genial warmth is diffused over the whole system ; the fluids return to the surface of the body, and a rapid approximation to health is established ; the spasms are shaken off, and in 24 of 48 hours the patient may be up and walking his room. Many who have written on this disease have noticed the rapid recoveries which sometimes took place. 

The pestilence described in the earliest records of antiquity, do not appear to differ materially from those of more modern times ; and with all the histories of them, in addition to the influence of Divine indignation, winch has frequently been supposed to be the cause of their existence, they are always described as being preceded by a concurrence of those atmospheric causes which we have enumerated as producing those diseases. The Plagues of Egypt, as sacredly described by Moses, were attended with a troubled atmosphere, extremes of tern* 



59 

perature, convulsions of nature, overflowing of the Nile, so that all classes were affected, from the Prince on the throne to the beggar at the gate. And the Psalmist, in contemplating the divine greatness of Jehovah, displayed by the awful grandeur of natural causes, declares — "The Lord causes the vapours to ascend from the earth; He maketh the lightning for rain ; he bringeth the wind out of his treasure ; He causeth the fire, and hail, snow and vapours, storms and tempests, to fulfil his will." The allusions to these convulsions of nature took place during a pestilential period, and great sickness prevailed. 

Ovid, in poetic strains, in his Metamorphosis, describes an Epidemic which occurred in Egina, about the time of the Trojan war, which nearly depopulated the country. He connects with its prevalence, remarkable cloudy weather and extremes of temperature ; and the earth was strewed with putrifying materials. The features of the disease is described as almost exactly similar to those just referred to, which afflicted the Jewish nation, and to the modern Plagues of Europe, the yellow fever of America, and other Epidemics of modern times — such as extreme chills, great heat, pain, difficulty of breathing, vomitings, spasms, prostrations of strength, delirium, coma, &c. 

'• A common faintness now invades them all, In wqods and fields promiscuously they fall ; The air exhales the stench, and strange to say, The rav'nous birds and beasts avoid the prey ; The putrid bodies rot upon the ground, And spread the dire contagion all around. Meanwhile, the Plague acquires a larger size, It feasts on men, and scorns a meaner prize ; Intestine heats begin the civil war, 

And flushings first the latent flame declare ; And fiery breath, which seem'd like burning air. 



60 

Their black dried tongues are swell'd, and scarcely move, And short thick sighs from panting lungs evolve : 

They gasp for air, with vainest hopes to sate Their raging flames, but that augments their heat. No bed, no covering, can the sicken'd bear, 

All on the ground, expos'd to open air, 

They lie, and hope to find a pleasing coolness there.' 

In ancient Rome, the great seat of military and political power, and equally famous for her Pontine marshes, and decomposing materials on the surface of the earth, was also famous for her Epidemic diseases — all of which are attributed to being produced by, or connected with a peculiar unfavourable state of the atmosphere. Her historians declare that " Rome has no truce ; the intervals of warfare are wasted by disease ; when wars cease abroad, the wrath of heaven is agitated at home." The fabulous story of Hercules fighting with the many headed monster Hydra, is said to have had its origin from the scenes connected with those Pontine marshes — by the efforts of the government and the people to subdue and divert the poisonous effects of the thousands of streams of miasma, emanating from them. 

The histories of the pestilential diseases of our country, relate also the occurrence of peculiar states of the atmosphere and seasons, or locality, as connected with them. 

I have stated that some prominent symptom frequently governed the treatment in those diseases. In the spottec fever, which has been alluded to, the attention was directed to curing and preventing the spots and typhoic disposition. In high grades of bilious fever, the supposec derangement of the liver, and the yellowness of the skin has arrested great attention, and occupied the attention 



61 

of men to obviate or correct them. In Epidemic Cholera, the evacuations from the 'alimentary canal has very much arrested attention, and the ingenuity of many prescribers have directed their attention almost exclusively to checking this excessive evacuation ; and by the time that this was checked, frequently the increased morbid derangements, and pressure of the fluids upon the vital organs overpowered them — depression or collapse ensued, and the case was all finished together by the expulsion of vitality. Now, all these symptoms, I infer, are the consequences of general diseased action of the whole system, acted upon in every part by the miasma absorbed into it ; and those peculiar symptoms are produced by a diseased action of the blood vessels, and when the general state of the disease is relieved, the local ones disappear. 

From the hasty manner in which I have taken a review of this subject, it will be perceived that all those pestilential diseases are, in some measure, produced by the action of the atmosphere on the human system — that it receives the general contaminating agent, and it is conveyed into the blood — there it insiduously contaminates the whole mass ; and that, under all circumstances, and at all periods, the general causes are about the same, which produce those deranging effects on the human system. Yet each particular Epidemic is attended with some peculiar symptoms of its own nature, and those local features of the disease generally have arrested public attention, and frequently have furnished a name by which it is christened ; and sometimes this name has had great control over the mode of treatment. 

As there is one uniform general cause of those diseases, they are mild and controllable, or more aggravated in 



62 

number and multiplicity of those attacked with them, in proportion to the greater or less quantity of miasma being generated and floating in the atmosphere, and concentrated in a particular place — and that again is excited into action by the peculiarities attending a subject, and the nature and magnitude of exciting causes. In the milder attacks, the system is excited to increased action ; in the violent ones, the excitement is so great that it produces depression, and destruction of the vital organs. This principle is in some measure illustrated by Milton's remark, that — "Excess of light produces darkness." 

This comparative view of the subject might be continued to a much greater length — but this must suffice. I shall endeavor now to compare the symptoms and character of Cholera with those of other Epidemics which have preceded it, and point out the manner in which they affect the organs of the human system, the cause of the prominent and fatal symptoms, and the manner in which asphyxia and collapse are produced. If I succeed in this undertaking, a broad foundation will be laid upon which to conduct a most advisable mode of treatment. There is one pleasing reflection to buoy up the spirits in the investigation of this important subject — that notwithstanding the severe visitations of some of the modern Epidemics, they are not as frequent in their return as they were in earlier periods of the world, and the extent of their fatality has not been as great. By some of the best writers on these subjects, this cause has been very justly attributed to the improved state of society ; to the cleaning and draining of lands ; to the more airy, and well ventilated houses ; to greater attention to wise sanatory regulations of cities and villages ; to the influence of 



63 

the principles of civil and religious liberty, extending far and wide ; to the wise administration of laws. And our tble profession may come in for a share of agency in general cause — by a more extended knowledge of animal economy — a more accurate acquaintance with histories and nature of diseases — and by a more exive and well cultivated state of medical science. 



CHAPTER IV. 

On the Pathology of Epidemic Cholera* 

Notwithstanding the many and talented writers who have directed their attention to the examination of the subject of the Epidemic Cholera, among them there appears to be such a diversity of opinion held in regard to the nature of the disease, and modes of treatment — 'it appears that an examination into its essential character as it produces its effects on the human system, to arrive at a method of fixing on its pathological character, will have a tendency to form and establish some general principles, on which to found a mode of treatment, and unite the opinions of medical men in the leading outline of the remedies by which to conduct the suffering patients. Although in the great variety of essays published on this subject, containing minute, accufate, and interesting descriptions of the manner in which the Epidemic affects the subject, and produces its ravaging effects, together with a detail of the remedies which have been used in the treatment, we do not recollect any one who has attempted to point out its true pathological character, and draw the line, to show whether the disease ought to be placed in a nosological arrangement in the class of phlegmasial inflammatory action, or congestive depression, or whether it belongs to the group of diseases of direct typhoid debility or diminished excitement, attended with debility from abstraction. For whether the disease ought to be arranged under the one or the other 



65 

of those classes, is of the utmost importance ; for Under the one it would require a mode of treatment of a very opposite tendency from the other ; and a set of remedies to be used, whose effect on the human system, as allowed by writers on the Matcria Medica, in arresting the progress of violent disease, would be as wide asunder, as Dr; Townsend expresses it, "as the antipodes." [See. Townsend's Guide to Health. 

Wherever Epidemic diseases have appeared, and spread their desolating influence over the earth, they have passed by some general name, or by various names applied in different districts, or sections of country. Those names have generally been adopted from some prominent symptoms exhibited in the progress of the disease, and have obtained a popular assent, and perhaps an influence, to designate that disease by, when the name has frequently not been of that nature to convey to the medical mind a pathological character of the disease, so as to form an index to the treatment ; but from the ideas associated with the popular name, a set of remedies have on some occasions been united, which has led to injurious and pernicious consequences, as may hereafter appear. 

Thus, at different periods, there has appeared in Asia, Europe, and other parts of the globe, Epidemics equally violent and malignant with the Epidemic Cholera, which have passed b) r various names ; and that set of symptoms from which the term Cholera is adopted, has several times attended diseases which have prevailed. It has been stated already, that this disease was noticed and described by Hippocrates. Among the many accounts of Epidemic diseases described in sacred history, 

9 



66 

many of them are noticed as being attended with burn- 1 ing heat and pain — inflamed state of the body — a violent fermentation of the blood — excessive fluxes — sinking — falling down insensible — " they were all as dead men ;" the most vigorous, the young, robust — the rich rolling in luxury, became a prey to the Epidemic ; while those who lived on milk, vegetables, fruit, &c. were scantily supplied, and enjoyed free country aairr r escaped the disease. 

In about the year 565, during the reign of Justinia the first, Procopius relates an account of an Epidemic which ravaged the world. It was not confined to one country, nor season of the year. This disease was a compound of several others ; numerous patients were seized with [Cholera or] looseness of the bowels, and died the first, second, or third day, with the body and mind apparently sound. 

A peculiar feature in Epidemic Cholera has been notice — that the mind remains sane and unimpaired amid the ravages of disease, and until a fatal termination of the case. 

In the year 1000 till 1002, an Epidemic flux prevailed in England, and other parts of Europe, producing dreadful mortality. It was attended with burning heat, agues, violent fever, &c. &c. In 1110-11, after great extremes of temperature, a great pestilential disease broke out and spread in England, Jerusalem, India, &c. It was attended with excessive fluxes, fevers, pains, &c. 

InlV/'S, an unusually severe dysenteric Epidemic prevail in Europe, which is said to have thinned the inhalj^i&nta in a remarkable degree. Again— after tbe 



67 

sweating sickness had subsided, about the year 1670. the Cholera, or a disease attended with excessive evacuations from the bowels, and spasmodic affections, prevailed in England, and in other parts of Europe. Those diseases are described as having, in common, some general similarity of symptoms ; and the recovery from them, or their fatal terminations, seem to have been influenced by, and attended with, very similar circumstances to each other, and to those which influenced and attended Epidemic Cholera. 

By passing over a number of Epidemic periods which are mentioned in history, I proceed to notice that of the 14th century, which is stated to have been attended with the most fatal and extensive Epidemic diseases that has ever visited the world. It wa3 called the Black Death of that period ; it was also called the cold Plague—the great Pestilence, &c. It was preceded by, and attended with, famines, storms, extremes of heat and cold, overflowings of rivers and streams, large quantities of animal and vegetable matter spread upon the surface of the earth, going into a state of decomposition and decay. It commenced in China, and spread entirely over Asia, invaded Europe and Africa, and visited place after place, and in some instances almost depopulated villages and cities. The symptoms attendant on this disease were, imposthumations of the legs and arms ; of those who were taken with it, some had diseased affections of the brain, many were stupified, and fell into a deep stupor, losing the power of speech ; others were sleepless, arid continually wakeful ; the mouth was covered with black scurf; their burning thirst could not be allayed ; the organs of respiration were seized with a violent inflammation ; a violent pain in the chest attacked the patient ; 



68 

blood was expectorated ; the breath effused a hot, pestiirous odour ; the disease was attended with violent af» stions of the head, stomach, glandular swellings, and ually a great fever took place, (after reaction came out,) miting, spitting of blood, discharges of blood from the se, ears, eyes, and bowels, indicating an unusual de» rangement of the system ; raging delirium, furious mad" ness ; turbid and black urine was discharged ; the blood Es black and thick, greenish or watery. The patients n died in two days ; in many other cases they died in 1 or five days. 

In the introductory discourse I have stated that the Epidemic Cholera, on the whole, had been much less fallal than many of the former Epidemics. To give an idea of the fatal effects of this Plague, the following statement will show : — Cairo lost daily, when the Plague was at its height, from 10 to 1500. In China, it is said, more than 13,000,000 perished. 22,000 people, and most of the animals were carried off in Gaza ; and it is stated that through the east, except China, 23,840,000 persons fell victims to it. In 20 of the principal cities of Europe, it is estimated that 678,000 human beings were removed by it. 

This disease was called Black Death, from the circumstance of the patient's turning dark or black in the progress of the case, or immediately after death. It was also called cold Plague, from another circumstance — 'that the patient was suddenly seized with an excessive severe ague, and sometimes fell down dead in it. This, however, gives us an idea of the symptoms only, and not of the pathological nature of the disease. By recurring to the symptoms of this Black Death Epidemic, and those 



69 

which attended the Epidemic spotted fever, or bilious puemonia which prevailed in America from 1810 to 1816, it will be perceived that there is a great similarity in them. Immediately succeeding this period in the next Epidemic season, in about the year 1550, a disease appeared in England, and in other places, the prominent symptoms of which were an excessive discharge of the fluids of the body, by the pores of the skin. This has been called the sweating sickness, or the English sweat, (Sudor Angelicus.) From this probably arose the old adage, applied to those who sweat copiously — " He sweats like an Englishman." From the manner in which this disease produced its effects on the human system, and the circumstance of the fluid excreted from the blood to the surface of the body being very similar in its nature to the serous fluid secreted into the alimentary canal in many cases of Epidemic Cholera, — the Cholera has been compared to this Epidemic sweating sickness more than to any other Epidemic, except those which are clearly attended with serous alvine evacuations. In this disease, as in Epidemic Cholera, the name only informs us that the patients sweat profusely and copiously — but that conveys no indication of the pathological nature of the disease. "It was attended with most symptoms of the Plague— as anxiety, restlessness, violent pains in the head, delirium, stupor, excessive drowsiness." The period of this character of Epidemic disease, continued alternating with the Plague, and some other diseases, to about the year 1600. 

During the 17th century, that character of disease called the Plague, which is very common to the Levantine countries, several times became Epidemic, and spread with great fatality over Europe ; affecting, at different 



70 

periods, almost all the cities of Europe, and destroying a great portion of the inhabitants of the places devoted to its malignant influence. It was one of those visitations of the Plague which in 1665 prevailed in the city of London, and left such melancholy traces of its existence. 68,000 human victims were deprived of vitality by it, and their sepulchres formed a memorial of its deadly grasp. It was during this period, also, that Sydenham describes several other Epidemic diseases, and lays down the doctrine of the pathological nature of some of them, and recommends a mode of treatment founded on those doctrines. " O terrible times ! dismal calamities! horrid destruction of creation!" While we explore the annals of medicine, and behold such an annihilation of human beings, our hearts are led to deplore the lot of man, and say with Homer of old — " Go, consult the prophets, the priests, or the interpreters of dreams, who can tell why the anger of Heaven so intensely burns against humanity !" But the business of the medical investigator is, to examine into the natural and visible causes of those calamities, and endeavour to divine the means of averting their fatal influence, and of controlling them. 

Many other diseases, of an Epidemic character, that have prevailed in eastern countries, might be noticed— but leaving them, I now direct the attention to those of our own country ; and first, the disease termed yellow fever, which has several times made its appearance, and which has been attended with many similar symptoms to those accompanying other general Epidemics. Yet, there may be something peculiar to the yellow fever in the diseased situation of the vital organs! in this disease, however, there is found to be many symptoms similar to 



71 

those of other Epidemics. It seems that nations, and inhabitants of a country, have frequently adopted names for popular or Epidemic diseases, suitable to their language, and corresponding with their prejudices, and diseases have received epithets from their different degrees, and from their violence or mortality. They were called Epidemic, because they spread extensively ; pestilential from a supposition that they were directly contagious or infectious — so the yellow fever has received various names in different places $ malignant, on account of its destructive tendency ; yellow, from the mere symptom of a jaundicen yellowness of the skin, appearing in the progress of the case, or after death ; bilious, from the secretion of the liver being so changed, in many cases, as to throw off an increased quantity of bile ; remittent, because remissions of the symptoms frequently took place, alternating with those of a more violent, and aggravated nature — all shewing the influence of an altered inflammatory state of the blood and system. 

From referring to the symptoms attending the great Plague or Epidemic, which prevailed in ancient Athens about the year 3570 of the World, as described by Theucydides and Lucretius, it may be inferred that it was very similar, in its nature and effects, to the yellow fever of the United States. By recording some of them, the reader may compare them with those enumerated in the histories of yellow fever : 

" The invasion was sudden and unexpected, attended with constant headache, fiery redness of the eyes, inflammation of the throat, difficulty of breathing, sneezing, hoarseness, cough, pains in the chest, violent fever, ¦vrakefulness, delirium, stupor, prostration of strength, 



72 

vomiting of bilious matter, urgent fiux from the bowels,' stools bilious, black, fetid, &c. skin covered with pustular blotches, reddish lived, and spotted." It invaded young and old, all ages and sexes. 

The causes of this calamity are attributed to large armies being collected, and those as well as the inhabitants had no houses, but dwelt in booths and tents, where there was scarce room to breathe, during a hot summer. 

This character of disease Sauvages called jaundiced typhus. Cullen denominates it fever, attended with yellowness. Vogel terms it golden fever. The English call it bilious remittent. The French term it Maladie de Siam. The Spaniards, Vomito Prieto, or black vomit. The Americans term it yellow malignant fever, which shows a want of uniform knowledge of the pathological nature of the disease ; and has probably led to the diversity of the mode by which it has been managed. Some prominent and visible symptom has arrested attention, and formed an index for a name, and those symptoms frequently do not occur in the case. Those names again are sometimes treated by the medicalprescriber, instead of the pathological disease. It demonstrates that an appropriate name has not been given to this disease, to designate its real character, and some have imagined that this, like Epidemic Cholera, was a new disease, lately introduced among mankind. But these ideas will be found erroneous, by examining the histories of Epidemics, and comparing the symptoms which have attended them from time immemorial. 

One of the most extensive and most fatal Epidemics 



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ihat has prevailed in this country, was that which appeared in the north eastern states in 1810, extended over this county in 1812-13, and marched to the southwest, taking leave of the United States about ]816. This Epidemic obtained a great variety of popular and provincial names — some forming an index to a correct mode of treatment, and some the very reverse. It is now a question worthy of serious consideration, and one to which many are inclined to the belief, that notwithstanding the great variety of names by which this Epidemic was called, and the modes of treatment to which it was subjected, it was not a disease generally of a phlegmasial or Eestive character. The nature of congestive disease, manner of affecting the human system, was not at period as well understood as it is at the presen time ; for since that, by the writings of Armstrong am others, who built up a valuable system, founded some what upon the principles and maxims laid down by Dr Rush, the nature and character of congestive disease, ha been well illustrated. 

If that Epidemic was essentially, in the first stage of the case, of an inflammatory or congestive nature, then the terms spotted fever, typhus fever, typhoid pneumonia, putrefaction in the fluids before death, &c. as associated with direct debility— and with those ideas, cordial and stimulant remedies were associated, and used in the early stage of the treatment, must have been erroneous ; and the result of the treatment founded on those ideas, proved to be extremely unfavorable. 

Byrhany writers the name Chdktdj as applied to the pfcejent Epidemic, is considered an inappropriate term* and calculated rather to mislead the practitioner, than to 

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Irect to a correct pathological mode of treatment ; fforr r is said by some, that the disease frequently does not hibit a single symptom which that name implies. I w, in .1832, a rugged man seized in the County Poor Duse, with hippocratic countenance, shrivelling ol 3 skin, gastric distress, and receding of the pulse, suceded b} r excessive coldness and collapse. He soon came helpless, and spasms supervened. This case was observed by several by-standers r one of whom was a member of the Board of Health, (my friend, Mr. Coffin.) We were informed by the attendants that he died in six hours, and was not affected with vomiting or diarrhoea. I observed some others nearly of that nature. Similar circumstances are noticed by writers on the Cholera. My friend, Dr. Francis, states — "that in some instances collapse takes place before there are any discharges from the stomach or bowels." Drs. Bell and Done say, "the case sometimes runs through the stages, collapse ensues, and death takes place, without the patient's having vomiting or diarrhoea." And we have many accounts of persons being seized, and dying almost immediately with Cholera, sooner than any material effect could be produced on the system by a gastric or alvine discharge and even without their having had those evacuations. These are important facts connected with the pathological character of the disease. It seems to go to prove, what other circumstances show, that the noxious material producing Epidemic Cholera, enters into the system, so as to impregnate the blood with its deleterious influence, and produces injurious effects on the nerves and other parts of the body. It may be said of the general operation of the miasma producing this disease; what the eminent Dr. Hosack has said constituted. fe ver — "A disease of the whole system. It appears no 



75 

less in all the faculties of the mind, than in all the functions of the body." So that a state of increased excitement, or altered, or morbid action of some, or various functions of the body take place, frequently while the person is walking about, and is unconscious of his body being indisposed, before the local irritation or morbid action on the villous coat of the stomach and intestines take place, and before the vomiting and diarrhoea supervene. This circumstance shews that the Epidemic Cholera affects the whole system, and produces a morbid and deranged state of the blood vessels, and other functions, either connected with alvine evacuations, or without them. Though it is readily admitted that a prominent, and very uniform feature of the disease, is a morbid, irritable, and inflammatory state of the villous coat of the stomach. The peculiar morbid action which takes place in the blood vessels, and on the internal surface of the stomach and intestines, produces a secretion, and throwing off, of a peculiar thin, watery matter from those organ — connected, in the first instance, with marks of increased or inflammatory action of the whole system — frequently changing those symptoms suddenly to low depression, diminished circulation of the fluids, and torpid or convulsive irritability of the muscular fibre. 

Khe term Cholera, according to literal construction, is xcessive evacuation of bile. Now, in this disease, there is a total suppression of the secretion of that fluid, Ban absence of it ; and one of the prominent objects in treatment has been to produce a reproduction of that 1. Hence, if with the idea of Cholera, agreeable to the nosological use of the term, remedies were to be used to suppress and restrain the secretion elimination of bile, it would undoubtedly lead to more unfavourable consequences 



76 

than many other remedies that have been used. From these, and many other circumstances, the importance may be perceived of arriving at correct views of disease ; and, if names are to govern at all, to obtain such as shall not lead to error, 

One of the most prominent instances of this kind, was the name " spotted fever," which the Epidemic of 1810 to 1813 passed by. With this name was generally connected the idea of debility, typhus and putrefaction, which led to the use of cordial stimulating remedies — under the use of which the disease proved so extremely mortal. Subsequent investigations have shown that disease to have generally been of a transcendant inflammatory and nervous nature. 

Id ancient periods, while there was a limited knowledge of the human system, and medical science was at a low state of improvement, opinions were held by the mass of medical philosophers, that in violent Epidemic disease, there took place a direct debilitating effect — that a gangrenous tendency and putrefaction of the system took place ; and the idea of malignancy and mortification were asaociated together. By the influence of more modern and enlightened observation, this ancient doctrine has been in general exploded, and pathological inquiries have been directed to another and more rational cause, to account for the symptoms presented in Epidemic and violent diseases, It is that state of the system which Sydenham alluded to when he said, " All Epidemics seem to be of a spirituous inflammatory nature in the beginning/ 

The state of the blood vessels, and other organic affections 



77 

which generally take place in them, are such, as is described by Dr. Rush, as produced by over action, or debility from increased action, or depression of the system. It is described by Armstrong, and other writers, as a state of congestion. If this state of the blood vessels and other parts of the system takes place in the onset of violent attacks of disease, as noticed by many writers, there is not a very material pathological difference in the modus operandi on the blood vessels of several Epidemics, or of most diseases of that kind, which have appeared at different periods, although their popular names have varied, and there has been considerable difference in some of their visible, prominent symptoms. There are many facts to show a great similarity in the nature of Epidemics — for there appears to be a particular set of symptoms attending all of them ; and at the same time, symptoms peculiar to each of them. These facts borne in mind, would lead to the conclusion, that all epidemics belonged to one family, or were nearly allied to each other. On this general knowledge, and the principles on which those diseases had been most successfully treated, would prepare the mind to encounter a new set of symptoms in the shape of an Epidemic ; and we would not, as has been often remarked, have to learn the treatment by new, and perhaps by experimental experience. It was this view of the subject which led to the adoption of a successful method of treating the Cholera in 1832. 

The interesting work of Professor Smith on the etiology and classification of Epidemics, seems to be well received, and is found useful in investigating and explaining the nature of Epidemics. But the Professor has overlooked, or neglected to point out their modus operandi on the blood vessels, or to explain and fix their 



78 

relative pathological character. If we can arrive at some general principle which seems to be a leading tract in the character of Epidemic disease, on which the minds of medical men may be in some measure concentrated, a general index may be formed to point the way in managing the treatment. From many facts to be gathered from the history of Epidemic disease, and the results of the various modes in which they have been treated, there are proofs furnished to show that there is a similar phlegmasial state of the tissue of some of the organs which take place, or a congestive situation is formed, and exists in the blood vessels. I think lam not incorrect in stating, agreeably to the present received doctrines, that sudden and immediate death at the first attack, which often takes place in Epidemic disease, is not the effect of a typhoid state, nor of debility from abstraction — or, in other words, not from direct debility. And the circumstances under which these severe attacks of disease take place, are not such as are attendant on a state of direct debility or exhaustion ; nor are they the effect of a putrefactive process having taken place in the fluids ; although it may be true that a high state of phlegmasial excitement, with or without nervous irritability, may run its race so very rapidly that, if unrestrained, some of the vital organs or other functions may suffer such injury, or the blood may be so altered as to become unfit to furnish the system with its ordinary nutrition and secretions — so that dissolution early takes place, and in such instances, gangrene after death rapidly ensues. 

Then, to arrive at a mode of explaining the phenomena connected with Epidemic disease, we cannot discover principles warranted by facts or circumstances, to enable us to find a solution of the difficulty by resorting to a 



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lite of' the system, and set of symptoms of disease, proced by typhoid or direct debility. We then are led the conclusion, that the essential pathological charac¦ of Epidemic Cholera, as well as of some other Epimics, is of an inflammatory congestive nature ; and it is a fair inference to arrive at, that when an Epidemic disease prevails, all the cases having the majority of the symptoms of that complaint, are of one general character—some more, and some less violent ; and may sometimes be rendered milder, or disarmed of their violence, or aggravated, and made to progress to fatality, by different modes of treatment. This has been the case in all Epidemics that I have had an opportunity of observing. Dr. Rush mentions that the milder attacks of yellow fever exhibited symptoms of ordinary increased action of phlegmasial fever ; and when the case was more violent, there was less arterial action or reaction, &c. 

In the Epidemic of 1812-13, many of the cases which were not very violent in the attack, did not differ from an ordinary attack of inflammatory or pneumonic case of fever. [See my history of this disease. Mann's Sketches. Gallup on Epidemics.] But when the attack was violent, the patient strongly predisposed to disease, a sinking depression took place — there was a diminished action of the pulse, or that suspended, and death, on many occasions, almost immediately closed the scene. And when the system was relieved from that sinking prostrated state, by unloading the vessels, and exciting warmth and action on the skin, the case showed generally more active disease than those less sinking. Similar facts are stated by Sydenham, in his accounts of Epidemics in several instances ; and they are repeatedly noticed by Dr. Rush as taking place in yellow fever, and in other 



80 

tices of violent attacks of disease of the same na- 

In the Epidemic of 1810 to 1816, as it prevailed in this county, the most violent cases sunk down, prostrated the most, and in some of these, if reaction took place, it was of the most active kind. In my account of that disease, p. 22, I say — «" Sometimes there was sudden prostration of strength, and great want of action on the skin ; there was a disposition in the disease to assume a malignant typhoid type, where evacuations were not early used. This, I am informed, was also the case in several instances in other places." p. 24. In Mann and Gallup' s works similar statements are made. This phenomenon was often presented in Epidemic Cholera. In the milder cases, before severe spasms came on, while the premonitory symptoms were present, the patient had many of the ordinary symptoms of disease, attended with moderately increased inflammatory action. But when the attack was violent, or had assumed a violent form, or was rendered so by injudicious remedies, the symptoms of ordinary increased excitement were riot present ; those of a transcendant degree of action were exhibited, and the system sunk under it to near a suspension of the vital functions, and the state of collapse supervened. When this depressed state of the blood vessels and other functions of the system was early, and judiciously relieved by abstracting from the blood vessels, and removing the deleterious depressing material from the stomach by emetics or cathartics, a reaction uniformly took place, and even from a state of collapse the patient rose up ; and when reaction was once established, in many instances, a very active run of inflammatory disease ensufed, which required the loss of nearly or quite 100 oUfrcfeS 6f 



81 

blood, at five or six times using the lancet, to effect a cure. Of those cases under my direction, not one proved fatal. Cases of collapse frequently recovered. I seldom failed to restore a patient if I could get the blood to run ; but from the stagnation which takes place, and suspended action of the heart and arteries, the blood sometimes ceased to flow. 

In the Epidemic Cholera, as far as I have been able to collect information on the different modes that have been pursued in the treatment, the methods that have been attended with tolerable degrees of success, in fully formed cases, have included some active evacuations from the blood vessels, stomach, bowels or skin, produced by medical means — combined with antispasmodics, and external means to produce excitement and warmth of the skin. 

From these facts, showing in some measure the pathological character of several Epidemics which have prevailed at different periods, and the effect of remedies upon them, it appears that, as we have remarked in the outset, there is a good deal of similarity in the pathological character of many of them, although some of the visible and prominent symptoms may be very different. 

It is very generally agreed that the matter producing the predisposition to those diseases, and particularly to Epidemic Cholera, exists in, and is conveyed in the at" mosphere ; and it appears to be a material capable of being generated and formed by local causes in various places. As to the Plague, all authors agree in attributing to it similar origin ; and its unequivocably comnjunicable character confirms this etiology. And with respect 

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to the Cholera, we may safely and fairly affirm, that it is the result or effect of some unknown principles devel- Ked in, and diffused through the atmosphere ; and there but one way of introducing these morbific agents into j body, and that is by absorption. They become blended in truth with the blood, and their first effect is to induce some change or other in its properties, either by simple admixture with its contents, or by a direct action upon its composition. But the manner in which this affects the subject, and produces derangement in the functions, may be in some manner explained. 

It has been the opinion of some writers, that the brain and nervous system were primarily affected by the miasma producing Epidemic disease. Others are of opinionthat the blood and fluids are primarily impregnated with the material. The more probable conclusion is, that the blood and the nervous system are simultaneously affected ; for in Cholera there are symptoms exhibited of morbid affection of both, and all parts of the system. Although Epidemic Cholera generally produces an irritation upon the villous coat of the stomach and alimentary canal, inducing a change of the secretions of its surface, and increased ejections or dejections, previously however to that taking place, in a great number of instances, symptoms of action and inflammatory affection exist in the subject. " The blood exhibits a decided change in appearance — dark, uncoagulable, pitchy — and the nervous system is affected by vertigo, tremors, spasmodic irritations, syncope," &c. Those cases referred to where the state of collapse came on, and death took place without any visible derangement of the alimentary canal, show that the sinking state and fatal effects are produced by some other cause independent of the mere evacuation 



83 

from the stomach and bowels. [See a case in Shith, on Cholera.] 

In those cases where there was a severe attack of the Cholera, attended with great distress and pressure at the preecordia (stomach) without violent evacuations, the patient generally sunk down sooner, and passed into the state of collapse, than in those which were attended with previous diarrhoea. Again, in many cases where there is a presence of vomiting or diarrhoea, the quantity evacuated before the fatal symptoms supervene, is much less than often takes place in ordinary diarrhoea or dysentery, without any very serious or exhausting effects. From all these considerations, it would seem that during the (redisposition to an attack of Cholera, there is existing in ie system a morbid action, insidiously operating — and rhen the latent miasma is excited to more determined action, a diseased deranged state of the blood vessels takes place. The secretions and excretions that occur, seem to be more symptomatic of this morbid state of the blood and of the blood vessels, than a primary disease. The secretion of the bile and urine is suspended or diminished. The system, struggling to sustain and protect itself against the deranging effects of the miasma working in the fluids, and operating on the nerves, makes an effort to relieve herself, and throws off a quantity of .fluid material, as an excretion into the alimentary canal. 

" The result of experience," says Mr. Roche, " adds strength to this supposition. It teaches us from analogy facts and reasoning that typhus, yellow fever, Plague, and the Cholera, are produced by the absorption of some principal or morbid agent, differing somewhat in each of those maladies, diffused through the atmosphere." Now 



84 

this contaminating agent, like other deleterious matter, will pass into the blood, and if the efforts of the constitution be sufficient for, the purpose, may again be expelled ; and some of the phenomena of Cholera render this very probable. All the excretions of a patient labouring under this, the matters excreted and rejected have a similar and peculiar odour ; and those by vomiting and stool have exactly the same appearance. A similar remark is made as applicable to some of the other miasmatic diseases. Says M. Cruvilhier, "If the system fails, it sinks down under the superincumbent load, is unable to bring about reaction, and the vital functions are interrupted or suspended by a congestive stagnating effect of the fluids." 

By referring to histories of Epidemics, we learn, that in many of them, sudden deaths have taken place by the violent onset of the attack. In about the same way, in that of 1812-13, in several instances, we observed sudden fatal terminations under circumstances that could not have been produced by the exhausting effects of disease, nor from typhoid derangement — ergo — it must have been the result of suppressed inflammatory action or congestion. [See Gallup, and North, on this disease.] 

Under the same circumstances, and from the same pathological causes, from the facts that have come to our knowledge, we infer that sudden deaths, and deaths by a state of collapse in the early stage, takes place in Epidemic Cholera. When the disease does not produce its sudden fatal effects, and runs on a length of time, then its fatal termination may be owing to other causes. It then generally terminates, if it terminates fatally, by a location of the morbid action or congestion on the brain. 



85 

This is the termination of Cholera which was popularly called dying with brain affection. It is apt to take place subsequent to a free and exclusive use of small doses of calomel, opium, and stimulants. With painful sensations, I have seen patients struggling under this state of disease, whose lives were terminated by it. 

It may as well be remarked here, that there is this marked difference in the progressive character of the Epidemic of 1812 to 1816, or what has been called winter Epidemic, and the Epidemic Cholera — that in that, if the congestive or inflammatory symptoms were not relieved, or cut short early, a state of typhoid disease almost uniformly ensued. [See authors as above.] " The disease frequently had a disposition to assume a suffocated or typhoid character, particularly when early evacuations had not been made." [Account of it in Dutchess, p. 43.] This circumstance made it necessary to use much caution in the time and manner of using blood-letting in that Epidemic. Not so with Epidemic Cholera : for in this Epidemic there appears to be no disposition to a typhoid state taking place. Symptoms of typhus are not present in either stage. Therefore this circumstance furnishes a warranty for the use and safety of using sanguinous evacuations in Epidemic Cholera, that would be unadvisable in some other Epidemics. 

Sydenham states, that " all Epidemics at their first appearance, seem to be of a spiritous and subtile nature. Thus, in the Plague, some of those seized with it died suddenly, without having had any previous sickness, (p. 51.) For as those fevers, principally, entitled malignant, are found most inflammatory, (429,) if it be inferred that there is some malignity in the case, I, answer that all the 



86 

symptoms only proceed fiom nature being in a manner oppressed and overcome, so as not to be able to raise regular symptoms." 

Dr. Rush states, that " sudden death from the yellow fever of 1793, took place without previous symptoms of disease." Debility is induced from depression. In those states of the system, " the pulse lessened in its fulness, and became weak, frequent, and imperceptible." 

in the Epidemic of 1812 — 13, in the early part of its valence, the pulse became soft, slow, and intermitt; and death frequently took place suddenly, before lptoms of febrile action, or apparent disease ensued. s fact is mentioned by Drs. Mann, and Gallup, and th, in their works on that disease ; and in some intces it occurred in this county. 

In the Epidemic Cholera, in violent attacks, a great se of fullness at the gastric region, chest, brain, and king, occur — the skin becomes cold — the pulse is trelous, receding, small and imperceptible — and death ues, either with or without alvine evacuations — though some instances attended by a mighty effort of the sysi to relieve itself, and expel the irritating, noxious maal lurking in it, by copious evacuations. Death taking place under these circumstances, in different Epidemics, appears to be produced by one general cause — which is, an excess of stimulus acting on the brain, nerves and blood vessels, producing a depressing and inflammatory effect, by a slow or rapid accumulation of blood in the large blood vessels and heart. They are overloaded and unable to keep up a regular circulation, by which the blood is deprived of vital air, and asphyxia ensues. They 



87 

sink under its weight, and cease to perform their action* • Death seldom or never takes place in this manner from exhausting disease, when the blood vessels have a diminished quantity of fluid in them. 

Says M. Cruvilhier — "At the period of asphyxia, Cholera resembles those rapid malignant fevers, the cause of which may exist in the fluids or nervous system. But if medicine, or the powers of the patient's constitution, have enabled him to rally, another train of symptoms is established, more consistent in their characters with those of common occurrence, attended with marks of inflammatory action." 

In the preceding remarks it is shown that the pathological or essential nature of Epidemic Cholera is of a phlegmasial inflammatory nature, attended with irregular transmission of the nervous material, and irritable spasmodic action of the muscular fibres, and a train of other symptoms such as are always attendant on similar states of disease. 



CHAPTER V. 

An Explanation op the Nature and Cause of Collapse. 

I shall now endeavour to trace out the manner in Which collapse is produced, and explain the immediate cause of it. The miasma, or the generating cause of the disease, operating on the nerves and blood vessels, first produces an exciting state of the system — which is shown by most of the persons who take the disease having been in a contaminated atmosphere, have some symptoms of indisposition, approaching to the prevailing Epidemic. This has been observed by many of the writers on Epidemics. When the Cholera prevailed in this village in 1832, every person who I examined had some of the primary symptoms — a reddened tongue, gastric uneasiness or pain, a tremulous or altered state of the pulse, with or without some of those mentioned — a diarrhoea, or what is generally termed the premonitory symptoms. When the attack is violent and sudden, from whatever may be the immediate or exciting cause, the excess of stimulus acts with such force, that an indirect debility of the heart and arteries takes place ; the nerves lose much of their nervous energy ; the muscles of the heart and the arteries, in an equal degree, are deprived of the aid of the nervous power to enable them to continue their usual healthy action. The heart propels the blood from its ventricles with a diminished force. The arteries, having been deprived of part of the aid of the nerves, lose much 



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of their elasticity and propelling power. Those varied and diminished states of the pulse, which have been noticed and so often referred to, necessarily ensue. From the tailing of the heart and arteries to transmit the usual quantity of blood to the capillary and superficial small vessels, the quantity contained in them is of course diminished. The veins continue gradually to return the blood to the heart and large internal vessels, increases the quantity of accumulation upon the heart, and adds to the amount of labour for it to perform. 

In the same way, and from the same general cause, the arteries passing through the lungs are deprived of a part of their propelling energy. From the sluggish circulation in the pulmonary veins, an accumulation of blood takes place in the pulmonary vessels, which deprives it of the chance of receiving oxygen from the atmosphere by the act of respiration, necessary to furnish the mass of blood with that material ; or, according to some modern chemical opinions, to furnish oxygen to enter into combination with the carbonic gas which is evolved from the blood, and to unite with it in the cells of the lungs. On either theory, the effects of oxygen on the blood are such, that its admission into the lungs in a free unobstructed manner is necessary to convey the vital air of the atmosphere to the blood. Hence it loses more and more of its florid color ; the blood becomes dark, grumous, heavy, and unfit for the purposes of supplying and sustaining the system. This produces the state of the lungs described by John Bell. In noticing this state of disease, he says — " The lungs are entirely c ammed with blood ; the heart can no longer move." With this state, determinations to, and congestions of the brain take place. In this situation, the efforts of the 

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heart are lessened and diminished until, in some cases, it is fairly overloaded, and ceases to act, and of course sudden death ensues. 

If what has been advanced is a correct view of the subject, then, as has been already stated, sudden deaths take place in Cholera and in other violent diseases, from the same general cause. This accounts for several phenomena which are exhibited in Cholera, that can in no other way be very well explained. The sense of fullness at the stomach and about the heart, and sinking faintness, is owing to the over-fullness of the blood vessels in this part, and accumulation of blood upon the heart, which it is unable to propel along the arterial canal with sufficient celerity. The diminished and slow circulation in ths cutaneous vessels, producing the state of collapse in the early stage of the case, is owing to the same cause. The lurid and blue appearance of the skin would necessarily take place from the blood being deprived of oxygen, and sent to the capillary vessels at the skin in diminished quantities, and remaining there stagnant in that state. The sinking of the features, and withered ringers, would naturally follow a diminution of the usual quantity of fluids to fill and distend the vessels of the skin. The blood having lost or been deprived of a great portion of its usual supply of oxygen, or vitai air, which is allowed to be intimately connected with the production of animal heat, and transmitted to the surface in that state ; the usual extrication of heat from the blood, and its combination with the solid substances at the surface of the body, ceases to be performed — and a great diminution of heat occurs there, or excessive coldness 



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The cause of collapse has been attributed to the dis^- 

charge of the serous portion of the blood, by the diarrhoea, 

which empties the vessels and suffers them to collapse or close up ; and many prescribers have attempted to close up the mouth of the lacteals of the intestines by remedies to prevent the serum from draining off! If the sinking and collapse was altogether owing to this cause in some instances, what can produce it in those cases, some of which I have referred to, where there is little or no evacuation from the stomach or bowels ? Yet, in those oases, if the attack is severe, the patient sinks sooner than where there is a considerable diarrhoea, and collapse of the skin more rapidly takes place. Indeed, after full collapse has formed, I have seldom noticed much vomiting or diarrhoea — [See Chapter on Pathology.] It will be borne in mind, also, that when a person in the enjoyment of good and vigorous health, if he is suddenly seized with disease, sinks under it, and violent symptoms ensue, and this state termed collapse takes place — he generally retains all or nearly all the blood and fluids in the system which he had immediately before the attack. Then if the vessels near the skin have a diminished puantity of blood and fluids in them, the skin is shrivelled, the extremities withered, the vessels collapsed — it must be inferred that the blood has receded to the internal or larger vessels, and on dissection here it is found. "In the brain the membranes are thickened, and the vessels injected" — " the inflammatory state does not differ from inflammations of mucous membranes generally" — " Venous congestions (collections) are shown by thick black blood in the vessels, and traces of injections in the mem- Kes," In the cranium, in Russia, there was found ctions of thick black blood — the lungs and heart i filled with the same substance" — " inflammation of 



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the villous coat of the stomach and bowels, &c. — a fullness and distension of the abdomen, the stomach and bowels, or some part of them injected and reddened." 11 In France, the brain has exhibited a fine injected blood shot appearance — the teeth were tinged with a red color, appearing to be injected with blood," similar to what sometimes takes place in persons who fire hanged. [See Sterling's Collections — Dr. Francis's Letter — Brussais — Spooner, &c. 

Now let us turn our attention to the internal organs, and endeavour to arrive at some solution of the difficulties there. In Epidemic Cholera there is a sense of uneasiaess, fulness, or pain, at the stomach ;; — not always really pain, but a sense of fulness and weight at the lungs and region of the heart. The same symptoms occurred in the Epidemic of 1812-13. If we can place reliance upon accounts of dissections, they show that in both instances those symptoms were produced by the same causes, viz. — an accumulation of blood in the vessels of those parts, of a dark, black, or stagnant quality, and an inflammatory or congestive state ensues. And those collections of fluids discovered in the internal organs, explain what has become of the blood that ought to fill and distend the vessels near the surface. It shows also that this state, termed collapse, is partly collapse, and partly fullness. But the fullness and distention is the situation which is productive of danger. It has already been stated that the term Cholera, as a nosological generic term, was an inappropriate name, as not conveying an idea of the nature of the disease. It will also appear that the term collapse, pathologically, is not collapse — but over distention of many of the parts essential to life. 

From taking a whole view of the subject, as well as it 



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can be arrived at from the previous facts and principles advanced, it is inferred that the true pathological character of Epidemic Cholera is of a phlegmasial or inflammatory congestive nature; and that a name for the disease, with which an indication of treatment would be associated, and prove an index to guide the prescriber, would be — Epidemic inflammation of the villous coat (inner surface) of the stomach and bowels, of a general congestive nature, with or without alvine evacuations ; or, to simplify the term, we may adopt the method used by Dr. Cullen, Dr. Darwin, &c. of making the termination of the word indicate the nature of the disease — such as Gastritis, for inflammation of the stomach — Enteritis, for inflammation of the bowels — Trachites, for inflammation of the lining membrane of the wind pipe, or common croup, &c. If we take the term villous, the name used for the inner surface of the stomach and bowels — that of alimentary — the term by which the whole track of the tube is called, and the Latin term for inflammation, Itis — by joining those together we have Villous Alimentaritis, or inflammation of the villous coat of the alimentary canal. This seems to be the most appropriate name that can be given to this Epidemic disease. Although many cases probably will not come strictly within the range of the term, for it is impossible to " compel diseases to march in regular lines." This conveys a general idea of the pathological nature of what the disease seems to be, and forms a general index for a mode of treatment. When we divest ourselves of the alarming name of Cholera, which really does not seem to be warranted by the nature of the symptoms, much of the terror connected with the term may be dispensed with, and prescribers will be apt to use remedies suitable to the name and nature of the. disease. Tt has been observed that the name spotted 



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typhus, as the terms were commonly used, had an unfavourable influence in the Epidemic of 1810 to 1816, and in the recent Epidemic, the term Cholera has been marshalled into service ; without a definite or apprapriate meaning, it operates as a bug-bear to frighten and decoy. 

It is infered, on fair grounds, that the foregoing view of the subject, furnishes an explanation of the true pathological nature of the disease, and of collapse. This state, collapse, is the situation which has generally been considered incurable. Although it is a very alarming and unpropitious state, and one which may frequently prove fatal, it is now well settled that this is not necessarily a fatal state of the disease. And it is trusted, that a mode of treatment will be pointed out in this treatise, which will furnish a means of restoring a great many of them. A great majority of those who have been treated by it have recovered. 



CHAPTER VI. 

Asphyxia — Explanation of the Cause and 

Nature of it. 

Having given my views of the nature and cause o: collapse, I now proceed to attempt an explanation of the nature and cause of asphyxia. As this is a symptom and state of disease exhibited in Epidemic Cholera which has occupied much attention, and exercised the minds and investigations of many a medical philosopher it has terrified nurses ; impressed with fearful anxieties friends and attendants ; it has baffled and frustrated the means and ingenuity of medical prescribers. 

Many of the fatal symptoms of violent disease, anc remarkable and terrifying phenomena in the materia world are rendered somewhat familiar to our comprehension, and capable of being averted or controlled by investigating their nature and cause, so as to understant them ; by which, a means or remedy may be adopted to counteract their injurious and fatal effects. Let us examine into the cause and nature of this symptom. — ¦ Asphyxia, or a state of the human system somewhat analagous to fainting or swooning takes place in a grea variety of instances ; besides in Epidemic Cholera, i may be described a sudden diminished, or suspended action of the heart and arteries ; a diminished, interrupted or suspended respiration. The pulse is lessened, or imperceptible — the skin is cold and shrivelled — the mus* 



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lar powers arc feeble or interrupted, or attended witfi ?gular spasmodic irritations. Tlie sudden deaths ich are noticed as taking place in Plague, where the ient is suddenly siezed, drops down, and in a few irs dies, are affected in this way. Those who are zed violently with yellow lever, sometimes sink down Idenly into a state of asphyxia, and if not promptly eyed they speedily die. Jn the Epidemic spotted er, many were suddenly taken, dropped down, or ik into a state of asphyxia, and life in many instances s very soon extinct, very similar to the asphyxia atdant on Epidemic Cholera. 

I have already shown that an obstruction of the free :ulation of the blood through the lungs, prevented its ng impregnated with a due and necessary quantity of r genous air, and any cause which produces that effect, i a tendency to produce asphyxia. 

Immerse a man in an atmosphere which is deprived l due proportion of oxygen, or vital air ; difficulty of atbing ensues, the action of the vital organs are dimiled or suspended, the pulse ceases its regular beat, if he continue in the same atmosphere a length of c, life soon becomes extinct. If a man or other ani[ is not only deprived of an atmosphere containing a al quantity of oxygenous gas, but is surrounded by air largely impregnated with carbonic or fixed air, i asphyxia more suddenly takes place, the functions of life are soon suspended, and the life of the subject may very shortly be terminated. 

A severe spasmodic stricture across the chest produces very similar effects, to those which sometimes take 



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fee in Epidemic Cholera. In the most of those install* of asphyxia, the surface of the body is cold, and the » and skin before death, assumes a purple or dingy :, whereas in a simple fainting from loss of blood, or den nervous emotion, a paleness ensues, and the skin erally retains its warmth. It is a convulsion which ms to be deducible from the analagous instances in which asphyxia takes place that this symptom which occurs sometimes in Epidemic Cholera is produced by similar effects on the lungs, heart and blood, in this disease, to that which produces this state of the system in other instances, although, a remote cause may be very different. It is by the blood being suddenly deprived of a necessary and usual supply of oxygen, or vital air, that the brain, nerves and heart consequently are deprived of the exciting properties of oxygen, which acts upon them through the medium of the blood. Hence the vital functions are suspended, and asphyxia, and with it collapse takes place. 

By this method of investigating and explaining the subject, several phenomena which take place in Epidemic Chelera may be explained. Instances of this kind are often noticed, by persons being found suffocated, or asphyxiated, by being confined in close rooms where charcoal and other substances are igniting; in such cases the combustion consumes the oxygen, and carbonic gas is extricated, so that the sleeping subject is compel led to breathe an atmosphere deprived of vital air, am often before the unconscious sleeper awakens, respira tion ceases. Again, when persons about a brewery ate confined in the carbonic gas which is extricated from fermenting ale, or happening to go into a butt which i just emptied, and which contains a large quantity of 

1-3 



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fixed air, sometimes asphyxia suddenly takes place. A noted instance of this kind took place in this village many years ago, at the conflagration of the first brewery that was erected here [by Mr. Vassar.] Several workmen were rendered insensible, and seme of them died, by descending into a vat containing a small portion of fermenting lees, and a large volume of fixed air. Persons descending into deep and unfrequented wells are often asphyxiated from the same cause ; similar instances take place by going into the Grotto del Canini of Italy. 

Under similar circumstances, and from the same pathological cause, several hundred persons, prisoners, parished in 24 hours, by being thrust into the black-hole at Calcutta, where there was no admission of fresh air, except through a very small aperture. When the blood is deprived of its usual quantity of vital air, and its circulation through the lungs obstructed so as to produce those, effects on the vital organs, by suddenly being deprived of oxygen through the act of respiration, or by the introduction of carbonic gas into the lungs, or by miasmatic poison of an Epidemic nature being introduced into the system, and paralyzing the action of the heart and lungs, or by a sudden distension of the lungs from inflammation, or a congestive deposition of blood in them, so as to produce an interruption of the action of the heart, the immediate effect seems to be about the same ; asphyxia takes place, and death ensues. The difficulty in all these instances seems to be produced by one general cause, viz : a morbid change of the proper. ties of the blood, and a deranged or interrupted action of the vital organs. 

Since writing thus far, and laying away the manuscript, 



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I accidentally came across the following remarks, which fortify the statements made. Among other dilases, Dr. Hope, in his Pathological Anatomy, enumer-3S asphyxia as attendant on imperfect oxygenation of 3 blood, and congestion of the brain. Mr. Carson ys — " The cause of coldness which takes place in lolera, is owing to the distended state of the blood vessels of the brain, by the stagnation of the blood in them, which impedes its return to the heart ; the usual quantity of oxygen was not absorbed into the blood ; the nonabsorption of oxygen prevents the evolution of caloric" (heat.) 

M. Bichat, a French physiologist, and Mr. Brodie, an English surgeon, have shown by their experiments, that when blood, not arterialized or oxy dated, passes from the heart and reaches the brain, the animal becomes insensible, and generally convulsed. It appears from these facts, that in death from asphyxia, the deleterious influences of venous blood is exerted first on the nervous system, next and most fatally on the circulation of the lungs. 

Dr. Kay remarks — "In asphyxia, the imperfectly arterialized blood which circulates through the brain is less conducive to the maintenance of its functions than arterial blood ; but those functions and life are abolished because the circulation is arrested in the lungs when the respiration ceases." Again — " In asphyxia, the blood from a want o ' a regular supply of air to the lungs, rapidly loses its arterial (florid) character, until at length it becomes so much deteriorated, that it is incapable of exciting the organic sensibilities of the lungs, which therefpre refuse to transmit it through the vessels." When 



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this situation takes place in this disease, we remark from Dr. Kay — " The general conclusions concerning asphyxia are, first, that the circulation is arrested after respiration ceases, because from the exclusion of oxygen and consequent non-arterialization of the blood, the minute vessels of the lungs are incapable of conveying the dark venous blood, which therefore stagnates in the lungs. The functions of the muscles cease in asphyxia, because the circulation of the vital fluids which is necessary to life, is arrested in the lungs," Says Johnson — (Medical Journal) — " We shall briefly allude to a topic of much interest ; one, the consideration of which is very intimately blended with that of asphyxia. We allude to the phenomena of syncope (or fainting.) It is no very easy task to point out accurately all the differences between these two states of suspended animation—this fact we know : that the one is much more speedily fatal than the other, and hence we have a priori, strong reason to infer that their pathological conditions are different; the obstruction of the blood in the lungs, or suspension of respiration, arises from a deprivation of pure atmospheric air." 

By taking this view of the state of the system in asphyxia, its pathological cause will in some measure be explained, and an indication furnished for the use of remedies in it. The first general indication would be to remove or avoid the cause as far as that could be done ; the second to use remedies adapted to the nature of the cause. 

The remedy required for relief in these cases, will in a great measure depend upon the cause which produced it. But in all those cases, the most appropriate means 



101 

(affording relief are such as increase the quantity o ygenous air to the blood, or facilitates the circulation the blood through the lungs. Those remedies calcued to relieve asphyxia which takes place in Epidemic olera, will be enumerated when I come to detail the .n of treatment in that disease. 



CHAPTER VII. 

Symptoms of Epidemic Cholera, examined and explained. 

I And now I proceed to enumerate the symptoms which, addition to what has been stated, warrant the concluns I have arrived at. 

|[n a place where the Cholera is about to prevail, or 3S actually exist, there is a sensitiveness, and marks an increased action in many persons, or a great pro•tion of those residing in the place. Diseases exhibit re severe and obstinate symptoms. Among the many o are affected with diarrhoea and other premonitory nptoms of the Cholera, there is a reddened inflamed gue — a tremulous pulsation, or an altered diseased Le of the pulse, indicating morbid arterial action ; a ighty sensation or pain of the stomach ; dizziness or n in the head — and the eyes are often red and blood shot. 

From the symptoms exhibited in diseases, and the state of the weather in the latter part of July, 1834, there seemed to be a pretty strong predisposition to the Cholera, and the attention of some of the members of the Corporation was called to the subject about the first of August ; and on the Bth, its existence in the village was proved, by some cases being fatal. 



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When the case is such that the active disease comes on with vomiting, diarrhoea, &c. the tongue is red in its substance, with a lively red edge. If there is fur on it, it is of a fine, erect, white appearance. Generally these symptoms have been a test of a phlegmasial state in other diseases. When the case is violent, so as to transcend the usual grade of inflammatory or phlegmasial action, 'tis true the tongue is flattened, pale, coldish, and covered with a whitish, slimy substance, which seems to be a mark of great congestion occurring in the early stage of acute disease. In Cholera, if reaction comes on, and the patient convalesces, the tongue again assumes more or less the appearance and marks of inflammatory action. As far as I have observed, those symptoms have uniformly occurred. The pulse is sometimes full and firm, indicating full inflammatory action in the forming stage ; but generally, it is tremulous and soft. When the disease is formed, and as it progresses, when evacuations are not made, the pulse becomes lessened, softer, receding — and, as the state of collapse forms, nearly or quite imperceptible. These are marks more or less noticed by Drs. Rush, Hosack, Mann, Gallup, Armstrong, &c. as symptoms of an inflammatory or congestive state of the system, in the early stage of disease. 

It has been remarked, and facts will show, that during the premonitory or forming state of a case of Epidemic Cholera, an altered or diseased state of the blood vessels takes place ; and not only this, for there seems to be a morbid state of the blood itself. The blood loses its florid color, and assumes a dark, dull hue. This takes place in all persons, in whom I have had an opportunity to examine their blood. In a village or place, during the prevalence of the Epidemic, and as the disease forms and 



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progresses to collapse, the blood grows more and more dark — go that in the state of collapse it is so dark and thick that it runs from the arm only by drops, or as from the arm of a drowned man, or not at all. It is almost or entirely deprived of oxygen ; and in some instances it is so devoid of a vital property as to be incapable of attracting oxygen from the atmosphere, after it is drawn in a cup : when this has occurred, in several instances, by continuing slowly to abstract this dark blood, the patient has recovered. 

Whether a diminution of the usual quantity of oxygen in the atmosphere can take place locally, so as to predispose to Epidemic Cholera, is more a matter of conjecture than susceptible of proof. Or whether a morbid change takes place in the lungs at the approach of the disease, it may not be easily determined. But we do observe, when the Epidemic Cholera prevails, there is a sense of a deficiency of oxygen in the surrounding atmosphere* The air seems to be dry and inelastic — and we often see attendants about the sick, and even those in the street, give a long inspiration, to enlarge the chest, and increase the quantity of air in the cells of the lungs, so as to obtain more oxygen. This I have often experienced in myself, and had frequently to turn away from a patient, or go out of the room to a purer air, to respire or distend the chest, so as to obtain more oxygen. 

There also is a luridness upon the countenance of many persons, particularly on the countenances of those who are labouring under the premonitory symptoms of the disease. Which facts all show that there is a diminished quantity of vital air in the blood, and somewhat of a difficulty of obtaining it ; and all who have seen confirmed 



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cases of collapsed Cholera, must have noticed the difficulty the patient has to draw his breath, or to respire ; and how eagerly they gasp for fresh air (as they term it.) This explains why the patients in the collapse state of Cholera, if left to themselves, turn upon the side, draw up the legs, and bring the head forward. It is to enlarge the capacity of the chest, so as to breathe with more ease, or to obtain the greatest quantity of oxygen ; for in that position the chest dilates the most and easiest of any. 

On this chemical physiological principle, attendants ought to be cautioned against burning substances in the rooms of the sick to consume the oxygen, which deprives the patient of it, or to have more persons collected around the patient than is necessary. I have been struck with the force and injury of this practice of igniting substances in the rooms of the sick. By order of the Board of Health, and for the best of purposes, substances were ignited in the wards of the Poor House when the Epidemic prevailed there, which emitted an unpleasant effluvia — more so than the noxious exhalations from the collapsed patients. It consumed the small portion of oxygen that was there, which seemed to be much needed by the sick. It was founded on erroneous principles. 

The heart and arteries are stimulated to action by a due proportion of oxygen received into the lungs and united with the blood. And when the blood is deprived of the usual quantity of oxygen, and assumes a dark hue, the action of the heart loses much of its muscular propelling powers — not from a diminished quantity of blood in the vessels, nor from v thinness or paucity x>f that suH— for that state does not generally take place hi the 

14 



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first stage of acute disease — but from the quantity of blood which is thrown upon the heart being greater than that organ, in its state of diminished nervous power and muscular action, is able to propel from its ventricles to fill and distend the capillary vessels at the surface of the body ; — hence an increased quantity of fluids accumulate in the large vessels in and about the heart, and a diminution of them takes place in the superficial vessels. From this taking place the regular balance of the circulation is interrupted, and in some instances destroyed. 

A similar diminished action, in a lesser degree, of the heart and large blood vessels, and congestive state, I am induced from many facts to believe, takes place from those states of fever generally called typhus of the country. In those cases the blood is dark and heavy — the pulse is small and soft in the beginning — the skin is lurid, with symptoms of fullness internally, and suppressed action. These typhus symptoms, as they are termed, may generally all be obviated by unloading the vessels early after the attack. 

ITor many years I have scarcely had occasion to attend irotracted case of typhus fever. Where I have had care of the case from the beginning, they have most formly been cut short in a few days by active evacuations in the early period; however, the temporizing Homcepathic-alterative-opiate course, which is more generally pursued, and which generally takes four, six, or eight weeks to carry a patient through, is generally more popular. 

In Dr. Maygel's Essay on Typhus, which obtained the prize medal before the New York State Medical Society 



107 

in 1828, it is remarked— " Typhus is by many associated with the ideas of debility and putrescency, as its standing and prominent symptoms. The prejudices on this head are beginning to give way ; blood letting and cathartics are among the most useful remedies for it." In this Essay, Dr. Maygell has taken the same view of this disease, and adopted about the same remedies, that was several years before detailed in some observations I had made on that state of disease, which it would seem he might have seen. This subject is enlarged on from page 67 to 75 — Essay on Epidemic. 

The following remark from Gallup on Epidemics, sustains the position of the previous observations : — " One of the most alarming phenomena of fever is a state of depression or oppression, or suffocated excitement. The system partakes of the same torpor that is manifested on the surface. The heart is unable to respond to the pressure of the column of blood, sufficient to restore the customary circulation; and yet the pressure is not so great as to destroy life suddenly. Congestions form in the numerous capillaries, and the blood is deficient of oxygen. It is in this state of the disease that the pulsations at the wrist are often wanting." [p. 170.] 

Again—" Let us suppose torpor increases, which is sometimes the fact in those diseases called malignant, which terminates in a few hours in death — there will be a paleness of countenance, a coldness of the surface of the body, a shrivelling in of the veins under the skin. The blood suffers a change of colour from the want of a due oxygenation. Blood is drawn with difficulty, and can seldom be made to run a stream." All this took place in the Epidemic of 1812-13, and of 1832-34. 



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|[n Cholera, the manner in which the aqueous matter furnished and thrown into the intestines, has been a jject of much speculation and inquiry. Although it is >art of the disease, and forms a prominent feature of yet I have already shown that the aqueous discharge, I the exhausting effects of it, are not necessarily a consent part of the disease — for patients are seized with olera, collapse, and die without having much, or none the alvine evacuations. If I were to attempt to exin the proximate cause of this excretion of alvine mak, connected with the pathology of the disease, I have empted to establish — if it should not prove correct, it might only have the fate of others which has gone down before. 

It is a principle very well settled, that morbid action of a part locally situated, and of the internal coat of the stomach particularly, does not take place unless the whole system is, to a greater or less extent, brought into the morbid action. And no part of the system is so immediately affected, or has so much influence in the animal economy, as the blood vessels. It is from the blood, conveyed by the arteries to every part of the system, that the secretions are all formed. It is from the blood that the nutritious matter is deposited to supply the waste and wear of the machine ; to produce its growth and repletion. It is from the blood that the excretions are formed ; and it is from the blood that the morbid depositions of matter, and formations of extraneous substances are produced. It is from the blood, by a morbid 1 actn of the blood vessels, that dropsies ara produced ; d from the same source and cause, diabetes takes place. It. is from a disordered state of the blood, or morbid action of the blood vessels, and a diseased situar 



109 

tion of a part, that gangrene and mortification is produced. And the manner in which Dr. Darwin accounts for the production of the water in diabetes, is from a reverse action, of the capillary blood vessels ; and De Witt accounts for fever from a reverse action of the capillary and cutaneous blood vessels. 

I shall infer, then, that by keeping in view the genprinciples of the animal economy, and the analof other morbid actions, that in violent Epidemic lera the blood undergoes a change; a morbid dejed action takes place in the blood vessels — and in state, from the irritation produced on the villous coat le stomach by the miasma and noxious matter accuated in that organ, a diseased state of the blood vesof the abdomen, and more particularly of the stomach, or an inflammation of the villous surface, takes place;, and from those vessels, probably by a reverse action,, they excrete and throw off the serous matter, which is poured into the alimentary canal. On the principles of ordinary secretion, it would seem not to be possible for the quantity of matter which is sometimes evacuated from the alimentary canal, to be excreted in so short a time, except it is produced by a reverse action of the small arteries and the lacteals of those parts. 

It is shown by Dr. Rush, vol. iii. pp. 229 and 263, and by Armstrong, p, 147, that in many cases, and particularly when there is a depressed state of the system, or suffocated inflammation, and a morbid action of the blood vessels in the early stage of the disease, by abstracting a portion of blood from them, often restores them to a regular or healthy grade of action, when an active state of inflammatory action did not indicate it. 



110 

In that state of disease termed congestive, or where there is a partial stagnation of the blood in the vessels, a " depressed " state of the system — a cold, torpid situation of the skin, which often takes place in the first stage of disease, and particularly in Epidemic disease, marks of ordinary inflammation do not exist. As Sydenham observes — "Nature is overloaded and oppressed, and borne down so as to be unable to bring about regular symptoms." Under such circumstances, give nature a chance to react, and symptoms of inflammatory affection will be pretty sure to show themselves. 

From what I have stated in the progress of these remarks, and what is noticed and admitted by all the writers on this Epidemic, in addition to the altered state of the blood, the principal seat of local irritation or diseased action is in the liver, and in the internal surface of the stomach and bowels. Here the miasma producing the disease seems to concentrate its accumulation and force. Irritation, tenderness, soreness, and inflammation is the consequence; and a morbid deranged secretion of fluids in those parts is the result. 

I shall now take a comparative view of the symptoms attendant on this state of disease, and other diseases that affect those organs, and trace their similarity. It is well known to medical men that diseases of the bowels are generally attended with severe and violent symptoms, more so than most other morbid affections, and particularly when diseases affecting those organs become Epidemi — and it will readily be perceived, that like other Epidemics when this occurs, the severity of those affect jtions will be very much increased. 



111 

A small, obscure, and imperceptible pulse is rather peculiar to irritations and inflammations of the stomach and bowels. In the description of inflammation of the stomach, Dr. Cullen enumerates — "acute pain in the region of the stomach, vomiting, hiccup. The pulse is small, and there is a great loss of strength in all the functions of the body. Inflammation of this organ may be attended with fatal consequences, by the great debility which it suddenly produces. In this disease we can advise the cure to be attempted by large and repeated bleedings — and we are not to be deterred from this by the smallness of the pulse." Other writers notice very similar symptoms attendant on this affection of the stomach, and recommend the cure by the same general remedy. 

In enterities, or inflammation of the bowels, the pulse is small, obscure, and in severe cases sometimes it is scarcely perceptible. An inflammatory affection of the mucous membrane of the stomach is frequently met with. " In some cases, rapid diarrhoea and vomiting ensue." — ¦ Abercrombie, p. 73. Again, says Abercrombie — " Inflammations of the mucous membrane of the stomach vary considerable. There is pain in the abdomen, tormina, tenderness, irritability of the bowels, diarrhoea, sometimes copious ; there is frequently vomiting, sometimes hiccup, and a peculiar irritability of the stomach and bowels. The evacuations vary very much in color and consistence ; sometimes they are like coagulable lymph — at others, of a watery matter." pp. 241, 242* 

Dysentery, which affects locally and principally the internal surface of the stomach and intestines, is attended with pain and distress in the gastric region. The pulse 



112 

is small and soft, or tense and obscure. In the Boyleston Prize Essay on this disease, by Dr. Mann, it is observed, " It is usually accompanied with small action of the arteries, or rather contracted pulse, with no remarkable increased heat of skin." In the treatment, he remarks — "from much experience, bleeding is a remedy of too much importance to be omitted." When the dysentery is Epidemic, in many of the severe cases, the pulse is small, soft, compressible, and sometimes very obscure. This kind of pulse probably attends congestive disease of the abdomen. [Essay on Epidemics, p. 182.] And in cases of dysentery, I have, on several occasions, seen the eyes sunken in, and exhibit much the appearance they do in the milder cases of collapse in Cholera ; and the fingers show a contracted withered appearance ; a short, labored respiration attends the severe cases, similar to that in Cholera. "In this dysentery, blood letting was attended with the most happy effects." [Ib. 183.] 

In dysentery, Armstrong observes, " wherever there is much irritability of the stomach, it is a certain sign that some of the abdominal organs are overloaded with blood ; and bleeding is then particularly indicated." [p. 189.] Again — " in all abdominal inflammations, the breathing is much disturbed ; and this is a circumstance which ought never to be forgotten." [Ib. 59.] A disturbed laboured breathing attends in the collapse stage of Cholera. 

Abercrombie observes — " In dysentery if we apply the term inflammation of the mucous membrane, we can be at little loss to fix upon the first great principle to be followed in the treatment, which is precisely the same as that which applys to other inflammations." pp. 277,278. 



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I Cholera there is an inflammation ol" the mucous mem,ne of the intestines. 

Illeus, or ordinary colics, we find, are attended with irritability of the inner surface of the stomach and intestine — severe pain, sometimes with vomiting ; and those cases are frequently attended with severe spasms. Cases of the Epidemic Cholera, while this Epidemic is prevailing, often are ushered in with symptoms very similar to those of ordinary colic. A number of cases occurred, during the prevalence of the Epidemic, of severe gastric or abdominal pain, and spasms of the abdominal muscles, without alvine discharges, which passed off by the aid of some of the ordinary remedies for those affections. Others, again, had distress of the stomach, pain, weight, and difficulty of respiration, without spasms or alvine discharges, which were relieved by an emetic or cathartic, or by blood letting, without other difficulty. These were not considered formed cases. 

|3y examining the effects of the various kinds of moraction on the stomach and bowels, it is discovered t in all of them there is connected a peculiar small and cure state of the pulse ; and when the stomach is the t of the disorder, the pulse is the smallest and most cure. Inflammatory affections and morbid irritations he stomach seem to have a peculiar influence to lessen action of the heart, and diminish or contract the aral pulsation. 

From all these considerations, and from this analogical view of the subject, it appears that the symptoms of diseased states of the internal surface of the stomach and bowels, of various grades and character, are very similar to each other ; and those, in many respects have a 

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Iy great similarity to those produced by Epidemic olera. 

i[ have taken occasion in the progress of these rerks, to point out the unity and similarity of various idemic diseases, showing their nature and mode of ;cting the human system. By this analogical com¦ison of the morbid affections of the alimentary canal, we are led to the conclusion that the effect of the morbid matter causing Cholera, where it locates on the stomach or bowels, produces a similar irritable or inflammatory state of the villous or mucous coat of those organs, to that which takes place in other morbid affections of those parts ; and from this circumstance, I should be led to use remedies which from experience have been found most useful in the management of those diseases. 



CHAPTER VIII. 

General Plan of Treatment. 

If I have succeeded in arriving at a correct view of this subject, and furnished a satisfactory pathological character for the disease, then the general plan of treatment adapted to it will, without much difficulty, be adopted. For it is of much importance in the management of a disease, whether the prescriber falls upon a plan which is accommodated to the general nature of the Epidemic, which is calculated in all cases the best adapted to it ; or whether a course is pursued under which only now and then a case happens to recover. " Diseases may be arrested by different measures, but the grand question is, what measures are most efficacious in the general run of practice." — Armstrong, 289. 

" Important therapeutic results may be derived, we think, from our manner of contemplating the alterations of the blood, and the change which takes place in the blood vessels. The first remedy in the treatment, then, ought to be to relieve, as far as possible, the system from the pressure of morbid or poisonous matter, by abstracting a portion of the fluids in which it seems mainly to exist. This is to be done by medical evacuations ;by these means we shall sometimes succeed in evacuating a great portion of the noxious matter, and the diminished portion that remains in the system is enfeebled and modified. The second indication is to obviate and neutralize 



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the effects of the specific operation of the poison. IWe should never confine our treatment merely to the filment of one or the other indication to the exclusion all others, and the circumstance of the same treatment : being applicable to all the stages of the case, may be reason why very different modes of treatment have been pursued by equally respectable authorities." By lessening the quantity of blood in the vessels by blood letting, the volume is diminished which presses upon the vital organs ; the heart is relieved from its burthen and t^r; it is able with more freedom to force the lesed quantity of blood from its ventricles, and as the remaining portion of blood is circulated more freely through the system, and passes with more celerity through the lungs, it has an opportunity to receive more oxygen from the atmosphere by the process of respiration. This has a tendency to give the blood a more florid color, and furnishes the best stimulant that can be had, viz. oxygen, to the heart and arteries. 

JBy the miasmatic or noxious material, or the influence cold and heat, a disposition to diseased action in the system is formed, in a slow or rapid manner the miasma passes into the blood by the means of respiration by direct absorption through the skin, and by passing into the stomach with the food and ingesta, the whole mass of blood and fluids are more and more mixed with, and saturated by it, and through this medium and agent, the brain, nerves, muscular-fibres, glands, &c. are aU affected by its influence, so as to produce a local, deranged, diseased effect on some one or more of the organs of the body. This effect on the internal organs seems to be very different in a variety of Epidemics, showing that a compound inflammation takes place, sometimes 



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locating on one part, at other times on another — at other times several of the internal parts show traces of disease. By referring to the brief notices of some of the symptoms of the Epidemics which are drawn, it will appear that many of them are very similar, and it will be shown that the plan of treatment which has been pursued in many of them, and which has proved to be the most successful, are those which eliminates the poisonous miasma from the system, and subdues or relieves compound inflammation. The general and prominent indications of cure in all those cases ol acute diseases, then, is to arrest the progress of the violence of the symptoms in the early stage of the disease, and whether the local affection is on the brain, lungs, heart, diaphragm, stomach, intestines, or their villous coat, or the liver, mesentary, &c. the general remedies are about the same. 

E'he indication of the treatment then, is first to evacuor abstract from the system as large a portion of the sma prevading it, as can be safely and judiciously done, and secondly, to dilute and neutralize the remaining portion, and thereby to aid and encourage the reaction of the arterial system, and regular circulation of the blood, and thirdly, to sustain and support the powers of the system. 

Previous to the particular details of the remedies calculated to effect those objects, established on the basis of the foregoing pathological principles and maxims in the principles of practice in Epidemic Cholera, it appears proper to premise that the method of treatment presupposes a belief that all those acute fevers in the first stage, is an inflammatory or congestive state of some of the internal vital organs or parts of the body, and 



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these again are modified in their symptoms and features by the part of the body or viscera on which the local action happens to fall. Thus in the Black Death, in the Athenian Epidemic, in the yellow fever in many cases, and in the spotted fever, the brain was a prominent seat of inflammation and congestion ; but other parts were also affected. In the yellow fever, and that character of Epidemic, wherever it has prevailed, the liver has generally been a prominent seat of inflammation, producing deranged and increased secretions of bile, the brain and other viscera also, in this disease, suffered from morbid, inflammatory lesion. In the Black Death of the 14th century, in many cases ; the pneumonic Epidemic of the 17th century ; the spotted fever and pneumonic Epidemics of the United States of 1810 to 1816, &c, the lungs were the most general seat of inflammation and congestion ; besides those organs, however, the brain, the liver and other parts were more or less affected. 

In the great sweating sickness of the 15th century, the prominent feature was a copious discharge of fluids by the skin ; but the internal organs were affected by traces of compound inflammation, as violent pains of the head, brain, affection, delirium, anxiety, inflammation about the stomach, evidenced by excessive thirst, and those most prone to inflammatory disease were first siezed, — the young, robust and vigorous, with these it was the most fatal. 

In the Epidemic denominated Cholera, when the internal coat of the stomach and bowels are the principal seat of the local affection, traces of inflammation or congestion in other parts are almost uniformly discovered, showing a compound state of inflammation. Congeslis 



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and inflammations arc also discovered in other sera, such as the heart, the lungs, the brain, &c. Ye have noted that inflammation of the covering of the 3stines produces no disturbance of the alimentary ca; but inflammation of the villous coat creates violent seness, vomiting and dysentery — that inflammation of villous coat of the small intestines produces diarrhoea excessive fluids of a watery kind." — [Abercrombie.] is is the seat of the diseased action, and those are the tery discharges which take place in Cholera. 

Another important indication not to be lost sight of, is to relieve the lungs from the obstruction, and congestive or inflamed state, and to use means to introduce an increased quantity of vital air into the blood. This indication, although connected with others, may be answered by lessening the quantity of blood in the vessels — which enables it to pass with more facility through the lungs, and respiration is then more full and easy, by which the oxygen from the atmosphere is more copiously blended with the blood by its passage through the lungs. Those indications are best answered by blood letting. This remedy ought to be confined generally to the first 24 or 48 hours— when if the arterial action comes out tolerably fair, it may be used with great freedom. But it is not confined to those periods; for when the symptoms of pain, spasms, difficulty of breathing, &c. do not yield, or are considerably protracted, it may be used with very great benefit in more advanced states of the case. Some medical gentlemen have recommended the mission of 2, 3, 4, to 6 lbs. of blood in this first stage of disease, and I have frequently abstracted that quantity with perfect success. There is, however, an important rule respecting blood letting, which it is of the utmost importance to 



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observe. It is in those cases of disease of an Epidemic nature, where there is a great degree of morbid action, where the pulse is small, obscure, or imperceptible, which so often takes place in Epidemic Alimentaritis — then the quantity of blood drawn at a time ought to be small, and the operation often repeated until a more fullness, and fairness of the pulse of the artery comes out ; after that the abstraction of blood may be large. [See some of the cases.] A large quantity of blood drawn in this state of Cholera, if it could be obtained, would be attended with unfavourable effects ; for a sudden diminution of blood before the arterial system acts upon that fluid, a real collapse might ensue. Professor Brussais of Paris, and Professor Chapman of Philadelphia, and many others, have recommended blood letting after reaction has taken place. With deference I notice those elevated opinions, when I remark that if the prescriber waits for fair reaction in the sudden, prostrated collapsed state of Cholera to take place before the system is relieved from the pressure and paralyzed state of the blood vessels and other parts of the system, there will be danger of waiting until the reacting powers are so impaired as to lose their vitality, death may close the scene. It is this small and repeated evacuation which seem to enable reaction to take place. 

It is presumed that a want of knowledge of this fact, and from not observing it, blood letting has been injudiciously used, and by that means it has been brought into disrepute. This was an important point of practice in the treatment of the Epidemic of 1793, as noticed by Dr. Rush, and of the Epidemic of 1812-13 — and is particularly noticed by Mann, Gallup, &c. and I paid much attention to it in that disease, (see pp. 33, 42 and 46, 



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I say on Epidemic,) and it was the means, I have no όbt, of restoring many from the sinking prostrate col>se state of Cholera ; and for the want of using this nedy altogether, or by using it injudiciously, it is more m probable that many, very many, have lost their lives Epidemic Cholera. 

I have stated on a former occasion, and I repeat it again, that in this state of small, soft, imperceptible pulse taking place in the first stage of disease, by small and repeated abstractions of blood, and the application of warmth and stimulants to the skin — the pulse uniformly raises, and grows more firm and full. 

Alvine evacuations, procured by means of medicine, in those acute malignant diseases, are of the utmost importance, so as to evacuate the miasma and colluvies from the alimentary canal. Another reason why blood letting has failed in being a means of restoring the patient, I am of opinion, has been owing to its not being connected with or succeeded by this evacuation. While the blood vessels have been in part unloaded, and the morbid miasma contained in the blood partially abstracted, the poison and the irritating matter has been left remaining in the alimentary canal, which continued to depress and derange the functions of the system. This it is thought, has been the case in the Epidemic yellow fever, and it was in that of 1812 and '13, and is particularly referred to by writers. It was also probably the case in Epidemic Cholera. 

I^n these states of violent disease, by allowing the whole the fluids, the miasma and the colluvies to remain in •¦ system, depression, a gangrenous disposition and in*- 

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terruption of the circulation of the blood more readily ensue ; and this fatal state again is hastened by a continued and sole use of cordial stimulant remedies. 

Without special regard to the lew accounts which then had appeared here on the Cholera, which seemed to be very unsettled in the mode of treatment, when the Epidemic appeared in 1832 — the first case I had an opportunity of treating, (see case I,) I applied those general principles of treating Epidemic diseases which I had adopted in 1812, and had detailed in a summary manner in my account of that disease. My anticipations were more than realized in the happy recovery of the first, second, third and fourth cases, &c. and by continued success in it. My feelings on these favourable results may be more easily imagined than described. An extract from some remarks, penned at the time, in a letter to a friend, may be here indulged in : 

"The result of those cases involuntarily produced a pleasing train of reflections — and a hope, that for this Epidemic, which had traversed a great portion of the world, and spread desolation and dismay in its progress, by its pestilential influence, there might be adopted a successful method of treatment." 

Tt was a decision of an important principle in medical science, and one that was directly to affect the lives of numerous members of the human family. 

In the severe attacks which often takes place in Epidemic Cholera, attended with violent pain, vomiting, spasms, &c. there is no doubt that antispasmodics, opiates, alkalies, cordials, &c. may be useful and necessary, 



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I id opiates should be given large enough to quiet the lin and gain a truce ; but they ought not to be conmed to the exclusion of evacuations — it is better genally to omit them in a short period, and use blood letting, emetics, or cathartics, or both. 

I Many, perhaps I might say the majority at the present riod, have recommended or used blood letting. The :ommendation is only to bleed, without pointing out 3 manner of using it — this is of much importance to be served. 

I It is a circumstance which has not been particularly ticed, that there is an important difference in the indition for blood letting in the state of deep congestion, or a depressed state of the system, and the state of sims inflammatory action. In the former case, the abaction of blood relieves the depressed action of the irt and arteries, and facilitates the circulation of the iod and aids reaction, and thereby prevents difficult fatal obstructions and stagnations in vital organs ; — lereas blood letting in simple inflammatory affection trains the phlegmasial tendency, and lessens the aci of the heart and arteries. 

In cases of a depressed or congestive state of the sysl, if reaction can be restored so as to produce a state dmple inflammatory fever, as frequently takes place Cholera, and other violent Epidemic diseases — then case may be managed as an ordinary case of fever — i has occurred in many cases of Cholera. Among a nber, a remarkable case of this kind occurred in a y, Mrs. B , who had the Cholera in 1832. The tck was violent, attended with spasms ; she was very 



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depressed, cold, blue, almost pulseless ; by three bleedings and other means, reaction came out — when it was so active and violent, that it required three more full bleedings to subdue the inflammatory action. In all, she lost 100 oz. of blood — when she soon recovered. Facts sustaining this practice may be found in the works of Rush, Gallup, Mann, &c. and by adopting this, several cases recovered of the Epidemic of 1812-13. 

Bottallus, a. celebrated physician of the 15th century, relied more upon bleeding in the Epidemics of his time, than upon all other remedies. The noted story told by Sydenham in 1665, fortifies the position we advance, " Among other calamities," says he, " the Plague raged at several places; and at Dunstan Castle, in Somersetshire, where some soldiers dying suddenly, it happened that a surgeon, who had travelled much in foreign parts, was in the service, and applied to the Governor for leave to assist his fellow soldiers who were afflicted — which being granted, he took away so large a quantity of blood at the beginning of the disease, that they were ready to faint and drop down — for he bled them all standing and in the open air, and had no vessekto measure the blood, which falling on the ground, the quantity each person lost could not be known. He gave no remedy after bleeding; yet, of the numbers thus treated, not a single person died." 

In the Epidemic of 1793^ in Philadelphia, Drs. Rush, Physic, and Griffith, used blood letting with great success. In this disease, it is stated, the pulse in violent cases was small, depressed, intermittent, or nearly imperceptible. It rose to more fullness and fairness after blood letting. 



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In the Epidemic of 1812-13, which in some cases exhibited as great a degree of torpor, cold skin, small sunken pulse, &c. as any Epidemic we have an account of, Cholera not excepted, was treated with success by a judicious use of blood letting. 

Kn those physiological principles and pathological re which in the preceding pages are advanced, a se of treatment has been pursued in the management of Epidemic Cholera, which has answered so well, that it is with considerable confidence that an outline of the plan is laid down. 

The leading remedies proposed will now be stated 

BLOOD LETTING is the most important and useful remedy in all simple and compound inflammation, during the acute period of the disease. 

It ought to be used early after the attack, before the blood assumes an acrid, hot, gangrenous tendency, and before congestions and permanent obstructions take place. 

It tends to lessen and regulate vehement excitement of of the system, and prevents the vital organs being affected with fatal obstructions ; 

It removes a disposition to faint and sink ; 

It removes pain and spasms ; 

It reduces the frequency of the pulse in active inflammation ; 

It increases the fullness and firmness of the pulse in depressed congestive states of the system ; 

It checks sickness of the stomach and vomiting, and is the most efficient remedy for that symptom in Cholera. 

It restrains and stops diarrhoea, and quiets uneasiness of the bowels ; 



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It overcomes obstinate costiveness ; 

It disposes the patient to sweat more than any other remedy ; 

It removes stupor and delirium in the first stage of the disease ; 

It induces natural sleep ; 

It increases the strength and powers of the system, by removing the pressure and prostrating influence of disease. 

Small bleedings, in low states of excitement, are in imitation of spontaneous hemorrhagies, when they take place in the first stage of fever, are generally followed by recovery. It was a spontaneous hemorrhage, followed by recovery, of one of the first cases, in a young lady, in the family of the late Dr. Bard, which was one circumstance that led to the use of blood letting in the Epidemic of 1812. But in Epidemic Cholera, in many cases of severe attacks, one free bleeding will answer the purpose, with other remedies; — in others, and particularly in the state of full collapse, repeated blood letting may be necessary. In many cases, by moderate evacuations and remedies to quiet the irritability and spasms, the disease may be checked — and then it may be carried off by cathartics, or by means to check the diarrhoea. But these are not the violent sinking cases. 

EMETICS — Many have placed great reliance on emetics, both in Europe and in this country — and have reported that great numbers have recovered under their use — a fact that cannot be doubted. But when the state of collapse has formed, the emetic plan alone has often failed. In this state of disease, the combination of emetics with small bleedings, I do not know as has been re- 



127 

Kmmended ; and this is a combination of remedies which 3m to be particularly useful, and by which many have been raised from a prostrated sinking state of collapse — therefore, in this state of disease, after the violent irritation of the stomach, if that is present, is in a measure quieted by opiates and soda, or alkalies, combined with fn aromatic, or spirits of camphor, or ether — then remeies ought to be used to abstract from the blood vessels, and to evacuate the stomach either by vomiting or purging. 

Emetics have an important effect, independent of the mere evacuation of the contents of the stomach, by a mechanical operation exerted on the muscles, which are brought into action by the effort of vomiting ; they aid the action of the heart and arteries to force the blood from the centre internal organs towards the surface of the body, by which means they are powerful aids to produce sweating. 

For the purpose of vomiting, a variety of articles have been recommended in Europe and in this country ; some have been partial to mustard seed in powder, (sinapis niger,) to salt and water — some to tartarized antimony, sulphate of zinc, (white vitrol,) ipecacuanha, lobelia, blood root, &c. The state of the stomach ought in some measure to direct what the article should be. If it is quite torpid and inactive, as it often is, a remedy should be selected which would produce a stimulating sickening effect, for wnich reason those of that class have been more generally recommended and used. Ipecac, blood root, and mustard equally combined, given in infusion, answers this purpose very well. After the vomiting is over, if it is exhibited in small quantities as a drink, it 



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very much aids sweating. The mustard seed with ipecac, makes a very good combination, to be given in the Kie way ; or some of the other articles named may be d to advantage. 

CATHARTICS — Startle not at the mention of this remedy in the disease of diarrhoea. These remedies have also been recommended by many. They remove the miasma and crudities from the alimentary canal, and promote a secretion and discharge of bile, they change the diseased action of the villous coat of the bowels, and remove the inflammatory state. A great variety of articles have also been recommended for this purpose — some have been partial to calomel in large doses, rhubarb, magnesia, sulphate of magnesia, (Epsom salts ;) others have used jalap, cathartic pills, cream of tartar, charcoal, soda, senna, Croton oil, &c. Those are best which are calculated to neutralize the acrid matter in the bowels, and restrain their irritable state. For this purpose, magnesia, rhubarb, Epsom salts, soda or charcoal, seem the best adapted. Equal parts of magnesia, Epsom salts and rhubarb, makes an excellent preparation. 

In an Essay published by Dr. Stevens, formerly of the West Indies, it is stated that neutral salts and substances containing alkalies, were found to be most useful in treating malignant Epidemic diseases* Those remedies have been in some instances used in Europe in Cholera, with very favourable success. Their virtues seem to depend on their alkaline, neutralizing, refrigerating property. He states that while using them the blood grows more florid — and that while giving acid and oxydes the blood becomes dark — if so, it would be an important fact in the treatment of those diseases : it would militate 



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Kust the advocates of a free use of the oxydes of mer, and other substances containing oxygen. 

I attended some experiments made by Dr. Stevens, on blood drawn from the arm of Dr. Hosack, at Hyde Park, which was standing in cups ; the result showed that when alkaline and neutral salts were added to it, the blood grew more florid — and when acids and oxydes were added, the blood changed to a dark hue, and seemed to be deprived of oxygen. 

Patients in the collapse state of this disease, require to be seen often by the medical attendant, so as to apply the remedies with decision and vigour — to watch the pulse and other symptoms — to repeat the bleedings often as they may be indicated. Where there are a good many cases to attend, this is very difficult to do. Students in medicine and assistants may be very useful, but for the want of those in such urgent cases, intelligent nurses may be selected, who may soon be instructed how to give remedies, if they are supplied with them, and how and when to bleed. I have seen much benefit derived from this kind of assistants. 

In addition to these remedies, others which seem to be most advisable, will be named in the next chapter. 

17 



CHAPTER IX. 

Plan of Treatment. 

This will be divided into four stages, though they cannot always be followed. 

li'irst — During the premonitory stage of diarrhoea, or en there is uneasiness of the bowels, give a few drops laudanum and essence of peppermint, or annis, to ich a little soda had better be added, or take occalally a dose of the common chalk mixture. The swing formula, which is one that was a standard in New York Hospital, a little improved, is one to which reference may be given. 

Take Gum kino ; prepared chalk ; each a half an ounce. Laudanum ; ess. peppermint ; each 1 ounce. Ipecac powder, 1 dram. Hot water, 2 lb. 

Rub the gum and chalk finely together, then add the water and other articles — mix. The dose is a teaspoon full, three or four times a day, or as often as may be required. Or, 

Take Ipecac ; opium ; each 6gr Super carbonate of soda ; Gum kino ; each 12 gr. 

Form them into 12 pills. One of these may be taken three or four times a day, or as occasion may require. 



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If the diarrhoea continues, take a cathartic ; after that, some of the above remedies are to be repeated. Let the diet be light and easy of digestion, and less in quantity than common. 

Second — If the symptoms are more severe, the diarrhoea urgent, with soreness or pain in the abdomen, a tremulous pulse, reddened tongue, &c. take an active cathartic, or an emetic. If there is considerable distress at the stomach, let blood be drawn; after which the anodyne astringent remedies, above mentioned, will be proper. To quiet the pain, nausea, &c. the following formula makes one of the best of preparations : 

Take Super carbonate of soda ; {Laudanum ; each 2 drams. Water 4 ounces. Ess. annis, 1 dram— mix- 

Dose — a teaspoon full, to be repeated every hour, in urgent cases, till the stomach is quieted ; at other times, as occasion may require; small doses of camphor has been found very useful; charcoal is also a very good remedy ; the quantity of diet ought to be lessened, and stimulating articles avoided. Let all things be taken in moderation ; a light vegetable diet is best. What could ever have led to the practice of using and recommending meat, heavy stimulating diet, to the exclusion of vegetables and fruits, it is difficult to conceive. Which renders the blood the mildest ? Which is most likely to create inflammation ? This seems like prohibiting the use of cold water and other errors, that floats along the current of opinion, without discernment or courage to resist them. If the subject should be examined, I believe it would be 



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found that those who have confined themselves the most to moderate use of good vegetables and fruits, have more generally escaped the disease and vice versa. If those are taken in bad order, or in enormous quantity, like alcoholic preparations, they may prove injurious. Equal parts of milk and water, simmered together, to which a little wheat flour may be added, is an excellent diluting nutriment, or arrowroot prepared, or barley water, is very proper ; use cold diluting drinks, such as soda water, lemonade, milk and water or cold water ; use good succulent ripe fruit in moderate quantities. Bear in mind that the inner surface of the bowels are in an inflamed state, and whatever is taken into the stomach, passes directly to the seat of the disease ; and therefore it ought to be mild, diluting, and cooling, and such as not to increase the feverish state of the system. It is not the liquid matter taken into the stomach which produces the diarrhoea, for that is mostly taken into the circulation, and rather produces a milder state of the blood. But it has been shown in this work, that the matter of the diarrhoea is thrown off from the vessels by their diseased state, and the intention of the remedies are to correct and remove the irritable inflamed state of the inner coat of the stomach and bowels. There is generally a feverish state of the system during this period, therefore remedies' to promote sweating combined with those mentioned, will be very beneficial ; and for this reason also, the articles taken into the stomach ought to be easy of digestion, diluting, and such as are calculated to lessen a febrile state, or not to increase it. With the use of these remedies and regimen, the diarrhoea will generally in a short time be subdued. 

Third — We now come to what is termed the formed 



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Cholera, or a more aggravated stage of Villous ntaritis, and this is frequently the commencing stale of the disease passing by the two former stages. 

When vomiting, diarrhoea, spasms, cold surface, &c. have taken place, with a commencement of a shrivelled skin and collapse, give a teaspoon full of the laudanum and soda, mixture, every hour, or at longer intervals, till the pain and vomiting is quieted ; tie up the arm immediately, and draw blood, less or more, according to circumstances. If the symptoms of depression continues, bleed again. If the retching continues, give an emetic ; after that, again quiet the stomach by the anodyne, soda, mixture. Now give effervescing draughts of soda or seidlitz powders ; follow these by cathartic medicines — equal parts of rheubarb, magnesia, and epsom salts, is an excellent preparation — seidlitz powders, in full doses, or a large dose of calomel, followed by some of the above articles. Soon as the stomach is quieted again, give very small doses of ipecac, James's powder, antimonial powder ; give cooling refrigerating drinks, as above mentioned — a little pure cold water is among the best articles of this kind — warm and stimulating applications to the skin will be advisable. If the cramps continue, use moderate friction ; apply a mustard sinapism (poultice) over the stomach and to other parts of the body. 

A great number of articles have been recommended and used as external applications — some with a great deal of parade and ceremony — but those which may very soon be procured in the family, are about as good as any: which are hot water, hot flannel applied, mustard seed and vinegar, horse radish, or the leaves wilted in vinegar, and gentle rubbing, if there are cramps. In 



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tort, all articles which warm and irritate the skin, are eful, when that is cold. 

I After the severe symptoms have abated, if fever conmes, antimonial preparations, in small doses ; or ipecac, thartics and diluting liquids will generally, in a short ne, remove the fever. If the diarrhoea continues, use c of the astringent preparations before mentioned, any other articles have been recommended and used * the same purpose, but those seem to be among the st and most advisable, and if judiciously and promptly 3d, will answer all the purposes. The case is generally rested in its progress by them in a very short time. 

I Fourth — When full and deep collapse has taken place, th sunken depressed state of the system, cold blue ;n, pulse nearly or quite suspended, with spasms, miting, diarrhoea, &c. — and this state sometimes is the ry commencement of the disease — immerse the arm o very hot water : draw blood as soon as possible ; it U run very slow, perhaps only drop at first — do not c vp — perseverance will obtain 4or 5 ounces. Give iof the stimulating emetics ; apply heat and moisture ;ernally, with active irritating substances to the skin ; ; steady moderate rubbing ; furnish the patient with jrgenous air to breathe, if possible. The vapour of vinegar, which contains much oxygen, formed by pouring it on a hot iron, for temporary use, is probably the best that can be obtained ; which, in cases of deep collapse, is very grateful to the patient. 

Oxygen gas may readily be obtained by filling a gun barrel one fourth full of nitrate of potash (salt petre,) put the lower end into the fire or furnace, heat it very hot : 



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oxygen gas will then be discharged irom the open end and diffused in the room ; or it may be obtained from black oxyde of manganese, used in the same way, or if a small portion, say about one half the weight, of sulphuric acid, be added to the manganese, by a moderate heat, oxygen gas will be thrown off; or if two parts of manganese and one of sulphuric acid be put into a glass bottle (a Florence flask will do) and a lamp set under it, a considerable quantity of oxygen gas will be evolved. These preparations might be very useful in public Cholera hospital wards, or in shanties. Keep unnecessary attendants away — allow free air in the room. 

If there is a good deal of vomiting and distress, first give the anodyne soda mixture in repeated doses, say one every half hour, until that is quieted and a temporary truce is gained ; then give the emetic infusion, or some other article to produce vomiting, after which, the stomach may again be quieted by the anodyne mixture and effervescing draughts of soda powders or seidlitz powders, they should be given in very small doses, or a few drops of spirits of camphor, often repeated, is very serviceable. 

The patient should be covered up warm in bed, so as to keep the warmth and vapor of the external applications about him. Let him be quiet as possible ; he ought by no means to be taken out in the cold air if it could be avoided. 

It is frequently difficult to obtain nurses and attendants enough in such cases ; but sometimes a number of persons crowd together in a small room, where the air is confined, and by a constant breathing of the air tlie oxygen 



L 36 

is consumed and the patient is deprived of it. The doors or windows ought to be opened tor a while, so as to admit fresh air to the face. Apply a cloth wet with hot vinegar to the nose, but the face ought not to be wet ; rub that with a warm dry flannel. The practice of rubbing the face and temples with wet substances in such cases, or almost any other, is an unadvisable one. All the use the vinegar, sp. camphor, sp. ammonia, or any of those articles are, is the vapor or fumes that is taken in by breathing ; the application of those liquid articles to the skin of the face evaporates immediately, carries off the heat and increases the coldness, which ought to be avoided. 

In the collapse and vomiting stage, there is generally an excessive irritability and burning heat of the stomach, from the inflamed or congestive state of its internal surface, and this is the stage in which ice is found useful and has been given to great advantage. Ice, from its solid form, is retained on the stomach when other articles would not be ; it requires a large quantity of caloric to dissolve it, which it absorbs directly from the inflamed surface of the stomach, by which the heat and inflammation of the part is diminished, and as the ice is converted into water it allays thirst, which is excessive in such cases — it dilutes the poisonous matter collected in the stomach. When ice cannot be had, cold water may be used as a substitute, with great benefit. This is more apt to be vomited up than ice, but that ought not to discourage the prescriber, nor deter from using it, for it cools the burning pain of the stomach, dilutes and washes out the miasma, and by its coldness allays heat, and checks the inflammation of that organ. By the effect of misguided opinions, many a poor patient has been compelled to 



137 

beg for a little cold water. To deprive patients of cold drink in this stage of the disease, is an injudicious cruel practice. Says Professor Brussais— " We have a remarkable instance of this folly in the late treatment of Cholera, but now, thank God, the poor sufferers are permitted to have as much water and ice as they desire. 

After the patient has vomited sufficient, and it is desirable to check that and allay the irritability of the stomach, ice or cold water may be repeated, combined with morphine or laudanum ; this will generally answer the purpose and quiet the vomiting. In a short time, with those remedies, use externally, cloths wrung out of very hot water, or apply vapor of hot water, hot bricks, jugs of hot water, or blocks of wood boiled and laid f)ut the patient. Active stimulating articles should be )lied to the skin and particularly over the stomach; 'oultice of mustard seed, powdered, and mixed with egar, or the India pepper, are probably the best articles this purpose ; those peppers infused in vinegar should used to rub the skin with. Use moderate friction, particularly if the legs and arms are cramped, but the Ktion and rubbing should be moderate and gentle ; sh, rough rubing, expels the vital principle from the and may do much injury. 

While there is a paralyzed state of the heart and arteries, and a stagnation of the blood in them, it will be difficult to make the blood circulate by goading up the vessels at the surface of the body by rubbing. After 2or 3 hours repeat the bleeding ; take 5 or 6 oz. only, if the pulse is still imperceptible or very obscure ; if the pulse is raising considerably, a larger quantity may be taken. The emetic infusion in small draughts may now be given 

.18 



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as a sudorific with great advantage, or cathartic medicines may be used. After the skin has got warm and moist, the hot wet applications had better be omitted, and warm dry ones used in their stead, with a continuation of sinaprisms. The following preparation for external use has been highly recommended : 

Take A pint of spirits of wine. Half a pint of best vinegar. 1 oz. of gum camphor. 1 oz. mustard flour. 1-4 oz. pepper. A tea spoon full of garlic. A half oz. of powdered cantharides 

Mix them, put the whole in a bottle, keep it warm 12 hours and shake it often. The method of using it, is to cover the patient up in bed and rub him with it continually, until he gets warm or sweats ; this, with the aid of blood letting, would be a very good preparation, or it might succeed in some cases without bleeding. Some have relied on a similar remedy with bleeding. Various other articles have been recommended for outward E, but those enumerated are all sufficient for this pur:e. The room should be well sprinkled with vinegar, some cases, it will be necessary to repeat the blood ing several times in the small way, when the reaction is slow ; but when the action comes out more free, a full, copious bleeding may be used at once. Notwithstanding, it may be necessary to allay the irritability of the stomach at first, by some of those articles mentioned, yet it is advisable in some cases, when the torpor continues and the reaction is slow, to occasionally and moderately produce vomiting ; it aids reaction and promotes sweattand 



139 

opening the pores, more than any other remedy ept bleeding. 

Iw is the period for using cathartic remedies, if the se is not subdued, which is somtimes the case. I of the purgative articles heretofore named will be )le for the occasion; the prescriber will suit his and convenience ; the magnesia mixture given in repeated quantities, with an occasional draught of or seidlitz water, is rather to be preferred ; or calexhibited in large doses, aided in its operation by of the other articles, will answer well. Frequently, the diarrhoea ceases, it will take a very large quanf purgative articles to produce the effect. If the lcea continues, which is very seldom the case, some ! astringent remedies will be necessary. 

E. though it is advisable at first to give opiates to allay , they ought not to be continued during the stage of pse, for they rather retard the reacting powers of the system and increase the stupor. If blood can be drawn freely, then opiates may be more liberally used. Good authorities might be referred to in this subject. I have noticed cases in which it appeared very clearly that i'um by being continued done much injury. By the i of those remedies opium becomes unnecessary, for pain and spasms have generally very soon subsided, the pulse rises, as by those means early and promptly used, it almost uniformly does, the blood letting should be continued until the blue and purple appearance leaves tjie face ;¦< — if the face becomes clear and pale, the patient may be considered safe. Such has been the result of my observations. 

If a feverish state of disease continues after the violent 



140 

symptoms of collapse, &c. are over, the fever is generally of a congestive nature ; then, the ordinary remedies for that state of disease will be required. Now is the period when if calomel is useful at all, it is proper for it to be given ; before this period, during the sinking stage, it cannot be of much, if of any use, except in large purgative doses. It is too slow in its operation to enter the system, in the torpid congestive stage, soon enough to meet the emergency of the case, even if it was an advisable remedy if it did. Dr. Sterling, of England, says, " Calomel has been used in all places, yet the patients have died." 

Dr. Leo, of Russia, states — "Calomel irritates the alimentary canal and aggravates the disease." 

Dr. Wilson, of Belfast, says — " I cannot see on what principle calomel is used — for if the patient recovers, their constitution is ruined." 

In some cases, when the prostration is very great, blood cannot be obtained at first — then it will be necessary to use the other remedies enumerated, by which success may sometimes be obtained, or blood may be drawn after a short time has elapsed. 

After the first onset of the disease is relieved, if the sinking state continues, it will be advisable to give some warm diluting drink, and cordial supporting nourishment. After evacuations, those remedies may be used to a very good advantage. 

In some cases, after the reaction comes out, it requires restraining to prevent too much action taking place. In 



141 

the progress of the case, seidlitz and soda powders exhibited in an effervescing state, are very grateful. Those remedies when used in the early stage of collapse, when the patient had a good constitution and proper nursing, have almost unformly succeeded. If they remain in the collapse state a length of time, the blood is so stagnated and deprived of oxygen, and the heart and arteries become so much paralyzed, that all remedies are likely to be fruitless, and stimulants, to be relied on, I believe uniformly proved injurious or fatal. 

In many of the cases which have occurred here, if the patient was of a good constitution and blood had been obtained freely, the vomiting, diarrhoea, and spasms have very soon ceased, The patient has often got up in 24 or 48 hours, or required only treatment as for ordinary fever. In some instances, after the sinking is removed, and the active state of disease is in some measure over, the strength will require supporting by nourishing cordial stimulating remedies; those are so well known and understood, that it will be unnecessary to enumerate them. 

Some, perhaps many, may be partial to a course of stimulant remedies for the diarrhoea, as well as for the state of collapse. In this, like all other diseases, they will sometimes chance to succeed, but frequently fail. "Stimulants," says Dr. Rush, "maybe given to surmount the stimulus of the disease, and force the action over it." This is somewhat like an invading army, forcing their way over an embankment of a fortified place, and scaling the walls to obtain their object — many will fall into the fosse ; — instead of causing the gates to be thrown open, so as to march quietly in. 



142 

Of all the instances of diseased action, producing depression of the human system, and diminished motion of the blood, connected with torpor and sluggish circulation, which I have known or noticed an account of, a case of regular Epidemic Cholera proceeding to a state of collapse, and a reaction to the raising of the drooping powers of the system, and a restoration to health, furnishes the most complete instance of the reacting powers of the human system, and exhibits the most beautiful principle of those powers to be met with in medical philosophy. When a case of Cholera progresses moderately, the patient sinks regularly down into a state of low depression and collapse ; when by moderate or active use of the means recommended here, the superabundant load is removed from the brain, nervous system and vital organs, the blood receives an increased quantity of oxygen, the heart and arteries regularly reacts — the pulse grows firmer and a little fuller — marks of increased action are exhibited — a diffusive warmth pervades the skin, until finally full reaction is restored, and a plain case of fever, or restoration to health takes place. 

When the attack is sudden and violent, and asphyxia takes place, the remedies enumerated in the preceding remarks are those best calculated to relieve this symptom. 



CHAPTER X. 

Sketches of Medical History, and Results. 

ti the progress of the preceding observations, a course been taken to show that there was a great similarity ie nature of Epidemic disease, in their general causes effects on the nerves and vital organs of the human system, in the early stage of the case ; — that they were commonly attended with those symptoms which were connected with an obstructed or inflammatory state o the system ; and that a course of treatment which has been attended with the most favourable results, was one the effects of which were to abstract a portion of th generating matter of disease and fluids from the system and restrain a tendency to obstruction and depression, o an increased movement of the vital actions. 

To show in some measure how this doctrine may be sustained by practice, it will be necessary now to fur nish some of the instances of the results of treatment The review might be extended a long way back, as far as history informs vs — but it will be confined mostly to a modern period. 

There seems to be no better method of testing and proving the correctness of a plan of treating a disease than by comparing the results with that of other modes of management. This is the only safe way for medical 



144 

men to pursue, and one which is resorted to on most occasions, to arrive at the most advisable and safe way of using medical means, by drawing such a comparison as will shew whether there is truth and propriety in the principles endeavoured to be established in this treatise. The pursuit of different modes of treating Epidemic diseas — the one proving very unsuccessful, and the other very successful, has on several occasions led some to insist that the disease was incurable, and that the patients who recovered even under other modes of treatment, could not have had the disease. This circumstance is mentioned in the history of the yellow fever. It is noticed also by the historians of the winter Epidemic. The same practice has been brought into use again during the prevalence of the Epidemic Cholara. By means of this and other causes, many are induced to believe that the disease is incurable — which probably has added very much to the panic connected with it, and no doubt has augmented its fatality. It furnishes a good excuse to the public for a failure of treating a disease, by creating an impression that others are equally unsuccessful, and that all modes of treatment were equally good and advisable, or equally bad. 

I shall now trace some sketches of medical history, showing the result of two general plans of treatment of Epidemic disease — the one principally by the use of cordials, sudorifics, calomel, opium, and other stimulating materials — and the other by that of blood letting, and other evacuating remedies in the early stage of the 

The stimulating, or what was formerly called thfe alexipharmic mode of treatment consists in making very 



145 

little or no evacuations from the body, and to add remedies to it, such as would be likely, if there was no obstruction, to increase the vigour and heat of the system, and to promote sweating by an increased action and determination of the fluids to the skin. The class of remedies for this purpose are stimulating articles to produce sweating, combined with opium and calomel in small doses — spices, bitters, spiritous alcoholic articles, &c. variously used and united. 

Evacuating refrigerating remedies are blood letting, emetics, cathartics — those articles which restrain action, heat and inflammation — cools the system, and removes obstructions of congestion,' such as sweating remedies, that lessen action and open the pores of the skin, &c. 

It will be observed that the early period of the case is referred to as fixing on the plan of treatment. 

In making these comparative remarks, no invidious comparisons are intended. To arrive at the most correct and advisable principles in medical practice — to guard and protect human life from the emergencies and dangers of such violent diseases are the main objects ; and (by an enlightened liberal reader they will be so considered. Similar results of plans of treating a disease, has frequently been drawn by writers on those subjects. 

It has been a subject of laboured investigation, attended with a diversity of opinion, whether Epidemic diseases generally were most advisably treated as an inflammatory or depressed state of the system, or as one of direct debility, a gangrenous tendency, and a typhu&na- 

19 



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ture. During the dark ages of the early periods of medical history, the dogmas which influenced the medical world were mostly in favour of a cordial, stimulating, alexipharmic mode of treatment of such diseases, until about the year 1665, when a distinguished physician arose, who opposed and objected to the old doctrine of the common stimulant practice, and advocated a depleting plan of treatment in those complaints. The historian of the 18th century, Rev. Dr. Miller, of New York, in alluding to this man and the effect of his doctrine, says — " To oppose the alexipharmic heating practices of the old school, the illustrious Sydenham was eminently suited ; the sagacity of this physician led him by almost seeming intuition, to discover and obey the vdictates of nature, and relieve her from oppression. The effects of this revolution were immediately seen in the improved treatment of acute diseases of every description. A safer antiphlogistic or cooling plan was adopted, with a view to unload the oppressed habit." 

This question was warmly discussed during the prevalence of the Epidemic yellow fever in Philadelphia in 1793 — Whether a mode of treatment by stimulants, or one by evacuations was the most advisable. On this occasion, as on some others, the popular feeling at first, and the majority of the faculty enlisted in favour of the alexipharmic practice. The result showed, by the elegant historian of that Epidemic, (Dr. Rush,) was immensely in favour of the depleting plan. In some instances, equal to 2 cases out of 4 were fatal under the stimulant plan, and not over one in thirty under the other. When the yellow fever occurred in New York in 1822, very similar results of the two modes of treatment are described as having taken place. 



147 

When the Epidemic which prevailed in this country from 1810 to 1816 made its appearance, the question came up, whether a course of treatment without evacuation, and one of a stimulating nature, to close up the outlets of the body and keep all in except to produce sweatin — or one by which evacuations more or less in the first stage of the case were likely to be the most successful. From a variety of causes, great numbers adopted the opinion that it was a disease in which evacuations ought not to be used, and that it ought to be treated only by cordial, sudorific and stimulant remedies of which calomel frequently formed a prominent part of the plan. 

On no occasion, perhaps, did the public take a more lively interest in, and form an opinion about the treatment of a disease, than they did in this. Their prejudi ces were strong, and frequently obstinate, and they were inclined the way that it is most generally observed the opinion of lay practitioners are directed — that is, in fa your of the class of stimulant remedies. From ha.ving this influence to resist, by those who were disposed to pursue a different plan, there was frequently a very great risk of reputation incurred, and powerful opposition to overcome. This influence will be perceived more fully by an abridged extract from an intelligent writer on it, of Vermont : "On inquiry what was to be done, the reply was, give opium, brandy, ardent spirits, wine, sweating, and go the whole round of the alexipharmk: treatment. These opinions generally prevailed among the people and the physicians. It was considered malpractice to neglect these remedies, or to use bleeding or other evacuations." Yet this physician breasted the current of popular opinion, and adopted a moderate evacuating course, which proved much more successful. 



148 

In alluding to this circumstance in the account of that disease, as it prevailed in Dutchess, it is remarked — " It required very considerable firmness to resist the current that set in from every direction against every species of depletion ; hence nurses, old women, and uninformed individuals, soon appeared with hemlocks, essences, cordials, and a vast host of heating sudorifics, with which to lop off the heads of the Hydra Epidemic." Had there been no other opposition than the one just alluded to, to the evacuating mode of treating Cholera, in all probability the silent house of deposit might have been deprived of some of its victims. 

During this suspense and anxiety of the public mind, and contest of opinion, I drew up a paper in which I endeavoured to point out the inflammatory nature of that disease, and suggest a mode of treatment adapted to its pathological nature. It was published in the Republican Herald of Poughkeepsie, over the signature of Medicus, in April, 1813. It was said this essay had considerable influence upon public opinion, and removed some of the strong prejudices against evacuating remedies ; and also it was stated to have in some measure aided in adopting an improved mode of treatment. It was somewhat grati fying to the author to observe, that the doctrines anc remedies proposed were such as to correspond with the principles that formed the basis of several Essays which afterwards appeared, pointing out and recommending a similar mode of treating that disease. 

To show the similarity of some of the features of that Epidemic, particularly as it relates to the blood vessels and state of the blood, and that of Epidemic Cholera — to connect the general plan of treatment, and to record a 



149 

humble, and rather a juvenile production, it is introduced here at length. 

Observations on the Prevailing Epidemic. 

" Much solicitude and diversity of opinion appears to have been excited in the minds of the community since the appearance of the prevalent Epidemic, and medical men have been much divided respecting the method of cure. To endeavour to lead to a uniform and rational method of cure, is the object of this paper. 

" Epidemic diseases are treated of by the great Sydenham, under three general heads : first stationary fevers, or those produced by a peculiar constitution of the air ; they exist for a certain time as the standing disease — preside over all others, or all others are peculiarly affected by them. Of this kind may be enumerated influenza, yellow fever, plague, Epidemic bilious autumnal fevers, &c. The second he calls stationary intercurrent fevers, or those which take place more or less in all years, and at particular seasons of the year, such as pleurisies, quinsies, inflammatory rheumatism, &c. 3dly, symptomatic intercurrents, by which he means those diseases that partake of the stationary and intercurrents combined. 

"When we recollect that the disease which has generally been prevalent in this country in the summer and autumnal seasons for several years past — which has prevailed to an alarming degree in many neighbourhoods, has been the bilious fever, varied according to circumstances and methods of cure, to the remittent, bilious, typhoid, or nervous states of fever ; when we also recollect 



150 

that the diseases which are generally met with in the winter and vernal seasons, are pleurisies, and those commonly called inflammatory complaints — it will be perceived that the prevailing Epidemic partakes of both of these, and is to be referred to the last group, or symptomatic intercurrents, exhibiting mingled symptoms of the two preceding. To theorize, it might be said the predisposition necessary to raise an autumnal disease, was not sufficient to produce it without a more powerful exciting cause than we had in the fall. It has been protracted beyond its usual period. The miasmatic poison has been pervading the system till an exciting cause is added, hence the appearance of the disease at this season. The symptoms of the stationary and intercurrents are not equally united in the different cases, some partaking more of one, some more of the other ; therefore, we meet with it in some cases assuming nearly the character of usual inflammatory disease, and we see it receding from that through the varied grades of excitement to the typhoid state of fever ; so proteform is it in its attack that I have sought diligently for a characteristic symptom ; the only one uniformly present is a redundancy of bile ; if this does not show itself in the commencement, it will in some stages of the complaint. By this time it will appear why it has been called and described by the different names of peripneumonia notha, peripneumonia typhoides, bilious pleurisy, malignant pleurisy, pleurisy in the head, typhus fever, bilious fever, and. many others, either of which, however, appear to be a more correct name than the term of spatted or typhus fever. A name for a disease ought to embrace some leading symptom to be met with in every case — to do that we are induced to term this bilious fever — or bilious fever, with or without pneumonia. We are led to adopt 



151 

this term from observing that some cases have no typhoid symptoms — others no affection of the chest — some have little or no headach — in others the lungs are seized, or the head attacked, or the bowels racked with pain, or typhoid and malignant symptoms appear ; — but in all cases we see more or less bilious affection ; the local, and what has been much noticed as singular pains, are often met with in other bilious fevers. Of the cases which I attended last year, about one quarter of them only had decided affections of the lungs — of those which have come under my care this season about half have been peripneumonic cases. That they are all different grades of the same disease is inferred from having noticed some of the symptoms in every case which have existed in other decided cases, and from the general law of Epidemics, that two febrile Epidemic diseases of different characters cannot exist at the same time. To exemplify this remark, see the writings of Sydenham, Cleghorn, Rush, &c. 

" From this view of the subject it will appear, that it will be proper in the treatment to have recourse to blood letting, or not, as the case partakes more or less of one or the other stationary fevers ; to use the lancet indiscriminately, or withhold it uniformly, will no doubt be injurious. From many facts, we are induced to believe that the disease is much more inflammatory than many have considered it, and that blood letting, in perhaps the majority of cases, is to be enumerated among the most useful remedies. 

" In all the Epidemics treated of by Sydenham, those of warm as well as those of ¦ cold seasons, blood letting is recommended as the first remedy. That which he call& 



152 

the winter fever or per ipneumonia notha, which appeared (1685, corresponds with that form of our disease, and >ne of the best essays on it that we have on record. .Steams, of Albany, calls ours the same, though rar disapproves of bleeding. But if ours is the same, no doubt the same remedies are proper. Bleeding has been used in most of the Epidemics of this country, but when it is done in any of them, it should be early in the disease, for the more the system is excited or depressed by violent inflammatory action, the sooner the disease assumes the typhoid or malignant character, unless the stimulus of the blood is abstracted before that takes place. A few extracts from Sydenham's Essay on his winter fever, are of too much importance not to be included here. " Petechiae (spots) says he, frequently appear, occasioned by an unseasonable use of cordials and hot regimen ; and in young persons, purple spots which are certain signs of considerable inflammation, both in this and all other kinds of acute diseases." Dr. Rush says, "this author derives petechiae from an excess of inflammatory action — the notion of their depending upon the putrefaction of the blood is altogether hypothetical." Further says Sydenham, " sweats produced by heating regimen, afford little relief ; the raising a sweat by medicine in the beginning of the distemper, ordinarily translated the morbific matter, if not to the head at least to the limbs." His treatment was bleeding, followed by frequent purges, blisters, &c. 

11 Within the last few months, the Epidemic appears to have made its appearance in the various encampments of our army, as well as in the different neighborhoods in every part of this and many of the adjoining states. Notwithstanding the prejudice of the day which may 



153 

have influenced many an honest and judicious physician, the surgeons of the army have pretty generally made use of blood letting. Drs. Akerly and Scofield adopted it at Staten Island — Dr. Mann did the same at Greenbush ; a surgeon in the army of the centre, stationed at Buffalo, informed me a short time since, that it had been th general practice there, in the army, and was attendee with almost uniform success. The editors of the Mcdi cal and Philosophical Register, Drs. Hosack and Fran cis, in speaking of the Epidemic, observe — " We hay reason to be satisfied with the opinion we have alread expressed, that it is a disease purely inflammatory, tha the practice, by copious blood letting and other evacua tions, is the only means of counteracting it, and of pre venting the typhoid type, which has been described by many physicians, as characteristic of this disease, bu which only supervenes when the antiphlogistic treatmen has either been totally neglected, or inertly pursued dv ring the first stages." These remarks, it appears, refe to the pneumonic form of the disease. The more I saw of the disease last spring, the more I was convinced that blood letting would be serviceable in many cases, and accordingly commenced its use with decided advantage ; in one case, after one small bleeding, the pulse rose so as to require two more ; the gentleman now holds a commissision in the army. Of those that have come under my care, this season, upwards of forty have been bled, all of which have recovered, except one, a very intemperate, dissipated man. More bleeding in the commencement might probably have saved him. About one half of my patients have been bled ; in some instances, I have taken but a few ounces, in others, I have us«d it liberally and repeated it. 

20 



154 

)" Although there may yet be doubts with some, as to 5 propriety of blood letting, and in some cases, no abt, it would not be serviceable, yet from the nature the disease, which I have attempted to establish, there is an evacuation, about the propriety of which there can be no doubts, that is, the discharging the bilious matter from the stomach and bowels. To bleed without following it by medicines of this kind would probably, in many cases, be worse than not to bleed at all. But when they Kompany each other at the commencement of the disc, the system raises from the oppression which has ie it down, the pulse acquires a more healty action, and the pores of the skin are unlocked. It is best, generally to let the emetic follow the bleeding — where blood letting is used, and that succeded by a cathartic ; or in some instances they may be combined to advantage. Where blood letting is not used, those medicines should commence the cure. I have long been in the habit of procuring daily evacuations from the bowels, in autumnal fevers, agreeable to the practice of Hamilton, (treatise on purgative medidine,) and have seen my patients recovering very soon ; under which, I do not recollect ever to have had a case of protracted typhus, and no deaths, out of not less than 200 cases. Many cases of the prevailing disease, exhibit symptoms similar to the autumnal bilious fever. From this circumstance, and from noticing the large quantities of bile present, I was induced to adopt the same practice in this disease, which I have found generally to answer my wishes, in all cases except where the lungs are affected, and where an expectoration is desired ; in those, the evacuations should be copious in the commencement, and afterwards an occasional discharge procured. " Purges have raised the pulse, they have produced sweating after powerful sudorifics have 



155 

lecL" — [Rush.] With this treatment, gentle sudorifies 1 warm teas will generally produce sufficient perspiion; the remainder of the treatment in the pneumonic es, is that most generally pursued in other cases of 3umonia, such as sudorifies, combined with calomel 1 diluents. " Calomel is one of the best expectorants have. It promotes all the secretions of the body." — r. Hosack's Lectures in manuscript notes.] Many :es, however, will be cut short at once, if the remedies c mentioned, are pursued with vigor in the comncement. 

" Among the various nostrums and prescriptions which have become fashionable in the treatment of this disease, the hemlock in tea, has perhaps gained the ascendancy ; in medicine there are no half way truths ; a remedy must either do good or hurt ; the only way to ascertain the truth, is to inquire, what are its properties ? To do this, in short, the hemlock contains a large quantity of the principle of tan ; it is astringent, it yields abundance of essencial oil, as appears by the large quantities lately brought to market ; to go no further. All those substances, would be injurious in a disease, where the lancet or the.refringent practice was indicated. 

11 But the injurious effects of forcing sweats with heating things in the commencement of the disease, before evacuations are made, is already shown. (See the quotation from Sydenham on the subject.) After the system is prepared for remedies of this description, I have known it to have a very good effect. 

. "It appears that calomel has found many advocates ; but it is doubtful whether an indiscriminate use of it is 



156 

necessary. In a great number oi" cases where there is no pneumonic affection, they may be cured by the evacuant method, with common sudorifics. In such it appears unnecessary to excite a mercurial action in the system, for the patient will begin to convalesce before that could be affected. The strength is to be supported by wine, bitters, and nourishment ; in many cases a small quantity of wine or stimulants are sufficient, but when the typhoid state approaches, or has commenced, a liberal use of wine will be necessary. 

" In no disease have I found more benefit from blisters, and have applied them to various parts where the local affection indicated, or where they would operate as a stimulus to the system, when that was wanted. It may be objected that blood letting is not a proper remedy, for the want of a full strong pulse, which we commonly meet with in inflammatory diseases. To this I would observe, that in the following states of the pulse, which, says Dr. Rush, " requires the lancet." I have used it with advantage in the commencement of the disease — Ist, a slow, tense pulse — 2d, a soft pulse without much frequency — 3d, an intermitting pulse — 4th, a depressed pulse — sth, a frequent pulse, without much tension — to which I would add a hobbling pulse. The sth variety of pulse is the one I have met with more than any other ; in many instances it may be termed a sharp or spiteful pulse. I have often observed this kind of pulse in the advanced stages of disease, where blood letting had been indicated, and not used in sufficient quantity, or not at all. The blood is generally of an unusual dark appearance, and at the first bleeding frequently does not form the sizy coat ; it often has the colour and consistence of molasses ; in one case it had a dissolved appearance. Blood of tha<?e 



157 

appearances are placed in a scale of inflammatory action above that which has a buffy coat. A symptom which may be of much service in regulating the use of the lancet, is the appearance of a moist white tongue on the first day of the complaint, which, says Dr. Rush, "is a certain sign of an inflammatory disease." In some cases, the tongue has exhibited a colourless, dim appearance — [This appearance of the tongue was very common in Cholera ; it seems finally to be a mark of great morbid action or depression, and would indicate evacuating] — in such instances, it is presumed, bleeding would be improper. Influenced with a belief of the correctness o this view of the Epidemic, I have used and recommende< the same preventive remedies that I have in other biliou fevers, which appear to have answered every purpose — that is, frequently use purgative medicine — temperanc in diet and regimen — a moderate bleeding, if there i tightness in the chest, or any troublesome local pain, am avoid exposure to exciting causes. Under this treat ment, this season, none have died, to whom the write has been called the first day of the disease, and they have submitted to his prescriptions — who have been of good constitution, and had good nursing." 

The result of the two modes of treating that disease as pointed out by several writers, are very different, anc wide asunder. It is stated that about half the case were fatal in some instances under the use of cordials stimulants, &c. and the recoveries were more than T. out of 12 cases under the other — or by a moderately evacuating or refrigerant plan in the early stage of the case, &c. [See the works of Mann, Gallup, Lovel's Reports, &c] 

It is stated by Dr. Gallup, that in some instances 8 out 



158 

of 12 proved fatal by the stimulating treatment — when in the same vicinity, by the evacuating mode, the fatal cases were not over 1 in 12. 

Dr. Lovel, Hospital Surgeon of the Northern Army in 1812, states that in one small village on the northern frontier, where the army was in cantonment, there were 73 deaths (in the village) under the alexipharmic treatment in one month — during the same period, in the army there were but 3 deaths out of more than 100 cases. 

Dr. Mann, Surgeon General of the Army, observes — " The greatest mortality in the army was when stimulants where used; after the evacuating practice was adopted, mortality nearly ceased, and the disease was generally under the control of remedies." He makes several similar statements to those above. 

In Poughkeepsie, those who were on the stage of action at the time, might look back to the solemn and afflicting scenes which occurred here, where generally evacuating remedies were proscribed. 

In one town in this county, the section now forming Hyde Park, where the moderate evacuating refrigerating method was pursued in 1812, the fatal cases were 1 in 12 — and 5 of these occurred before a plan of treatment was settled on. From examining a register of diseases which occurred in the same section in 1813, made at the time, it appears there were 112 cases of the Epidemic, and only 7 deaths. During the same periods, in some places, under the alexipharmic treatment, the fatal cases were one out of two, three or four. 

In various directions we heard of spotted fever, typhus 



159 

fever, cold plague, brain fever, &c. used as a name for the disease — and in many instances remedies seemed to be associated with the name, as identified with debility, gangrene and mortification. [See p. 39 and 76.] 

Dr. Mann says, " Mortal disease, whether from their nature, or bad treatment, must have some terrific name attached to them." 

Again — when the Epidemic of 1832 made its appearance, with unpleasant and painful sensations, it was soon discovered that a general inclination of popular and professional opinion was in favour of a non-evacuating alex ipharmic method of treatment. The use of remedies embraced in the class of alexipharmics were considerec the only proper or suitable ones — they were the orthodox of the time. Evacuating remedies, particularly blooc letting, were condemned in unlimited terms. Scenes and trials, similar to those of 1812, were again presentee and passed in review. 

As human life may be affected by the correctness or errors of the principles and facts contained in this work, it will be necessary to show the practical application of the doctrines and remedies, by stating the results of the two modes of treatment, which will be found in the next 



CHAPTER XI. 

Cases. 

tx. P. aged 14 years, was attacked on the 26th of July, 1832, with diarrhoea, succeeded by vomiting, which soon became severe. At 12 o'clock, M. I saw him ; these symptoms were accompanied with sinking and prostration ; pulse nearly imperceptible ; extremities cold ; skin purple ; features and eyes sunken ; voice sepulchral ; tongue cold ; great heat, and a burning sensation at th stomach; catarrhal affection ; urine suppressed; spasm of extremities. Treatment — injections of warm wate returned much colder — 'external warmth and friction — arm held in a pan of warm water — vein opened as soo as possible, four ounces of blood was drawn, this wa very thick and black ; on standing, it did not chang colour or consistency by exposure to the air ; faintish ness ensued — the patient soon aroused up— the puls came more free — opiates were given to allay the pain — all liquids were rejected as soon as taken ; ice was give which was retained a short time, when all was vomitec up ; the emetic infusion was given, so as to produce fre evacuation from the stomach — the matter discharged was very white and glairy. At 3 o'clock, venesection again repeated to four ounces — the blood still very dark and thick ; the pulse rose after the second bleeding, and the warmth of the skin increased ; the infusion was given in smaller quantities to produce a sudorific effect, and occasionally 



161 

increased to produce vomiting. 8 o'clock, is in a tolerable perspiration ; omitted the moist hot remedies, and used in their stead, externally, dry warm ones, with friction. 

27th, 8 o'clock, A. M. Spasms have abated, and the patient has occasionally vomited ; bowels open ; respiration laboured ; voice peculiar, small and fine ; faceanc tongue still cold ; pulse 100, soft and depressed ; an erect, whitish scurf formed on the tongue ; a florid redness of its substance appeared through the scurf; venesection repeated to eight ounces ; faintishness ensued pulse soon rose, became more firm and full ; the infusion continued with other sudorifics. 11 o'clock, P. M. con tinues much the same— same remedies continued. 

28th, 8 o'clock, A. M. Patient vomited several times and had several stools, which are more bilious ; perspires freely ; has slept considerable ; pain and spasms gone took calomel, James' powder, and jalap, every three hours, in doses sufficient to produce a cathartic effect and continued cold drinks. 8 o'clock, P. M. perspiration continues; inclines very much to sleep ; had passages from the bowels, which are more feculent ; passed no urine ; repeat the medicines ; add spt. nit. dul. and an infusion of senna and manna. 

29th. Has passed urine freely this morning for the first ; has vomited occasionally and had several stools, more natural; fever continues ; inclines to sleep; disposition to faint ; countenance inclines to dull redness ; pulse soft and obstructed ; tongue red on the edges, Covered with a white erect scurf; venesection, six ounces taken away ; blood now florid ; antimonial, sudorific and 

21 



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cetthartic remedies continued. After bleeding, faintishness entirely left him ; his countenance became clear and pale ; perspiration ensued ; repeat the sudorific mecine. 31st, is entirely free of disease, up and walking the room. 

11. S. M. F. aged 14 years, attacked on the 29th of July, with diarrhoea and vomiting ; discharges of a rice water consistence and color. 9 o'clock, A. M. suddenly prostrated and sunken, nearly motionless, except the spasms; pulse entirely imperceptible ; burning sensation at the stomach ; respiration laboured ; skin very cold, and of a purple leaden hue ; eyes sunken, and features contracted; fingers withered and sunken in appearance ; voice small, fine, faint and peculiar ; tongue pale and slimy, with red edges ; urine suppressed ; catarrhal symptoms. Treatment — laudanum and ether given; externally, warm moist clothes and friction ; arms immersed in warm water, and as soon as possible a vein opened; the blood came only by drops, but by perseverance, three ounces was obtained, which was very black and thick ; it remained unchanged in the bowels, and did not attract oxygen by exposure to the air. The infusion was given so as to produce vomiting ; the discharges from the stomach were white and glary. 12 o'clock, becoming a little warm ; pulse still imperceptible ; venesection repeated to three ounces ; omit the fomentations, and employ warm dry friction, &c. gave ice internally, and continued infusion in moderate closes. 3 o'clock, P. M. she has become warm, and sweats some ; pulse just perceptible; vomits occasionally ; venesection again repeated to four ounces ; continue the infusion. 

30th, 6 o'clock, A. M. pulse gaining in fulness, but oppressed; 



163 

venesection again, four ounces taken away ; medicine continued. 12 o'clock, at night, perspires freely; bowels open ; evacuations feculent ; patient faintish — let her have some light nourishment ; tongue more lively red ; pulse still depressed ; skin inclining to coldness, and dull purple ; venesection, four ounces : blood more florid, and runs freely ; continue the sudorifics. 

31st, at 9 o'clock, A. M., her situation improved ; skin less purple ; bowels irregular and somewhat griped ; but more free ; tongue more red on the edges, fur on it, whitish and firm ; gave calomel sudorifics and spt. nit. dulc. ; venesection repeated to four ounces. 9 o'clock, P. M., all her symptoms improved ; continue the medicines. 

August Ist. She has rested quietly ; improved in her situation ; passed urine for the first ; continues in gentle perspiration. Give sudorific medicines and cathartics. 

2d. Continues to improve. The left arm begins to swell from the bleeding orifice ; after this a slow fever continued for several days. An abscess formed in the arm; the matter discharged, and the patient slowly recovered. 

111. C. N. aged 14, on the 27th July, 1832, was attacked with severe rice watery vomiting and diarrhoea; in less than two hours after, he was extremely cold and purple ; his senses were gone. Violent spasms took place, so that it took several persons to hold him. He was speechless ; his eyes were sunken in ; his fingers withered. Application of remidies, friction, heat, and stimulating materials, externally. Opiate and soda in 



164 

large doses, internally at first j then vomiting ; arm im» mersed in almost boiling water ; vein opened, 10 oz, blood obtained, so thick and black as scarcely to run, Gentle vomiting and sweating remedies continued. In three hours opened a vein again, in same way ; blood run freer and more florid ; cathartic medicines now were given ; the vomiting, diarrhoea and spasms ceased. 12 o'clock, M., a general warmth over the skin ; pulse raising tolerably fair; the hot wet applications omitted, dry warm ones and sinapisms were substituted. The bleedings were several times repeated ; so that in all, in 48 hours, he lost 44 oz. of blood, at the end of which time, his senses returned. By a moderate use of sudorifics, cathartics, nourishment, &c, he soon recovered. 

IV. This, and the two next cases were drawn up by the attendant at the time. 

L. L. aged 60, of a slender frame, lived in a house with me near the poor house, when he was taken sick on the 14th of August, 1832. In the morning he complained of great distress in the stomach ; had very copious and frequent discharges of white watery matter from the bowels, with white flaky particles floating in it. He had severe cramps in his arms and legs ; the hands and feet were very cold and turned blue ; his eyes were sunken in ; his face was sunken, cold and blue ; he sunk away, seemed entirely exhausted and appeared to be dying ; he was in this situation when the Dr. came to see him. 

V. On the 16th of Aug., while I was attending Mr. L. L. I was taken sick, by having white watery discharges from the bowels, similar to his ; great pains and distress in the stomach ; severe cramps in my hands and feet, 



165 

they were very cold and blue ; my eyes were sunken In and my skin seemed withered. 

VI. On the 18th of August, L. P. was attacked in about the same way ; distress at the stomach. He had severe cramps, diarrhoea, was cold, sunken, faint, &c. 

M. E. P. 

These cases were treated similar to the others. They all recovered. 

VII. P. B. aged 65, August 10, 1834 ; suddenly attacked with vomiting and diarrhoea. The discharge was of a perfect rice water consistence. Gastric distress ; sinking faintness. He swooned — senseless two or three times. Severe spasms came on ; he got cold, blue ; pulse very small, scarcely perceptible ; eyes sunken. Used venesection 16 oz., blood extremely dark, and remained so in the bowl ; laudanum and soda mixture ; external warmth ; cathartic of calomel ; seidlitz powders. In four hours spasms quieted ; vomiting ceased ; action of pulse increasing. Venesection again, 24 oz. ; blood now more florid ; repeat medicines. After this, diarrhcea ceased j cathartic medicine operated, and on the third \Xtxy iiw w «.o w ojjxiiig **ii^ i vuiii.i 



166 

Kie following is a list of the cases of the Epidemic of 1832, managed under the direction of the author. The symptoms with h they were attacked, carefully noted as they occurred, are set down so that the reader can judge for himself of their character. They are enumerated as they occurred, (as near as may be.) The remedies are named in the order in which they were ased, although that cannot be strictly followed. Some of the general ones only are named. Notes of Explanation. — P. pulse, t. tongue, v. s. blood letting, the figure shews the number of times, infu. infusion, a preparation of the emetic articles, mentioned under the head of emetics. Date. | Init. | act | Ter. | Symptoms and Remedies. July 26 G. P. 12. Cured. Diarrhoea, rice water discharges, vomiting do. gastric distress, burning heat internally, cold blue skin, pulse imperceptible at the wri-t, t. cold and blue, urine suppressed, severe spasms, eyes sunken, fingers withered. — Cordials and laudanum, emetic, v. s. small, 3 times in 24 hours, iniu. cath. sudorific, ice. cold water, 3 more v. s. external moisture, heat, &c. " 27 C.N. 13. Cured. Diar. do. sunk, cold, senseless, spasms, p. imperceptible, gastric distress, blue skin, sunken eyes, fingers withered. — Cordials, laud, external heat and friction, emetic, v. s. 3 times, took 10, 16 and 16 oz. cath. sad. &c. — 29th, senses restored. " 29 A. C. 36. Cured. Diar. very severe gastric distress, sudden cold, sinking faintness, spasms, blue, eyes sunk, fingers withered, p. depressed, t. red. — External heat, friction, infu. v. s. 3 times in 20 hours, 50 oz. taken, laud. In 24 hours sat up : in 48 hours walked the street. " 30 S.M.F. 14. Cured. Reduced with int. fever, diar. rice water, sunk, nearly senseless, cold blue, shrivelled, p. imperceptible, eyes sunk, voice sepulchral, urine and bile suppressed, spasms. — Laud. infu. to vomiting, v. s. small. 3 or 4 times in 24 hours, cold water, cath. sud. external heat and moisture, v s 3 times. * " Mrs.F. 45. Cured. Had int. diar. serous, sinking, faiut, vomiting, cold, purple, voice sepulchral, very delicate, p. imperceptible fingers withered, spasms. — Friction, v. s. after reaction, cal. and dov.powd, opiate, cordial, infu. to vomiting, sud. astrin. wine, external heat. Aug. 1 W.P. 16. Cured. Diar, vom. sunk, shrivelled, cold, blue, p. depressed, t. red, spasms. — Infu. v. s. cath. sudorfics. " 4 F. G. 23. Cured. Diar. gastric distress, t. red, p. depressed, eyes sunk, cold skin. — V. s. cath. astringents, sudorfiics. " " Mrs.W.24. Cured. Diar. and vom. severe gastric distress, spasms severe, t. red, p. nearly imperceptible, sunken, cold, blue, spasms. — Infu. v. s. 3 times, 8, 16 and 26 oz. 50 oz. cath. sud. " 5 W.S. 42. Cured. Diar. gastric pain, t. red, p. depressed, spasms, cold, purple, eyes sunk. — V. s. twice, infn. opiates, sudorifics, astringents. Mrs.P. 42. Cured. Diar. vom. gastric pain, cold, blue, spasms, &c. — V. s. twice, infu. opiates, astringents. 1 " C. S. 21. Cured. As above, vith shrivelled fingers, eyes sunk.— V. s. 3 times, opiates, infu. sud. cath. astr. &c. 



167 

Aug. 6 J. K. 43. Cured. Diar. vom. spasms, all violent, sunk, insensible, cold, shrivelled, purple, t. red, p. imperceptible, urine sup. 48 hours. — Ext. heat, anod. soda mix. v. s. 3 times, 50 oz. infu.sud. cath. talked in 48 hours! " " P. C. 36. Died. Diar. and vom. gastric distress, p. imperceptible, sunken, cold, blue, t. red — Rode 2 miles after attack; 4 hours before seen, had taken largely of calomel and opium, prescribed by another — v. s. attempted, infusion ex. heat, reaction could not be produced. " " S. C. 4. Died. Attack similar— v. s. emetic external heat and friction ordered ; had no nursing ; remedies totally neglected. " " C. L. 35. Cured. Diar. severe gastric distress, sunken eyes and features, p. depressed, spasms — v. s. opiate, sudorific, cathartics, astringent. She was in the last stage of pregnancy. [ '' C. S. 30. Cured. Diar. and spasms, severe vomiting, cold, shrivelled, sunken, t. red, pulse depressed — v. s. opiates, infusion, cathartics, astringents, &c. " 7 W.A. 50. Cured. Diar. vomiting, spasms severe, pulse depressed, tongue red, eyes sunken, cold and purple — v. s. 50 ounces at 3 times, opiates, infusion, cathartics, sudoiifics, astringents. : " W. P. 40. Cured. Symptoms as above — v. s. 50 ounces at 3 times, opiates, infusion, cathartics, sudorifics, astringents. ' " Mrs. P. 38. Cured. Attack precisely as above — v. s. 40 ounces in 3 times, opiates, infusion, cathartics, sudorifics, asastringents; on the 3d day, a constant vomiting and faintness continued; 10 ounces of blood were taken, which cured that. " 8 Mrs.M. 2ft. Cured. Attack as above — v. s. anodynes, cathartics, sndorifics, astringents. ' " C. B. 4fi. Cured. Diar. gastric distress, spasms, fainting sensation— v. s. 24 ounces, opiates, cathartics, astringents. ' : " J. C. 44. Died. Diar. vomiting copious, spasms, cold, sunken, pulse naarly imperceptible, eyes sunken, shrivelled fingers, very intemperate — opiates, cordials, v. s. 10 ounces, infusion external heat. This was partly attended by another. " 9 Mrs. L.36. Cured. Diar. pain in stomach, severe spasms, tongue red— v s anodyne; cath sud astringents. ¦" " P. N 28 Died In the night foind sunk, out door in the rain ; stupor, spasms, diar cold shrivelled skin— external heat, a little v s infusion, no reaction; no means of nursing, in a poor hovel. ' 10 T. "W 27 Cured Diar sudden, sunken, cold, spasms, tongue red, pulse depressed, ringers withered— v. s 30 ounces in 2 times, opia'es, infusion, cathartics " Mrs N 43 Cured Diar sinking, spasms, cold, tongue red, pulse depressed, gastric distress — v s infusion, opiate, cathartic, sudorific ¦ 11 Mrs P 26 Cured Diarr burning gastric pain, cold, spasms, tongue red, pulse depressed, sinking sensation — v. s. infusion, opia'es, cathartics, sudorifics, astringents ' Mrs. B. 45. Cured Diar vomiting, violent pain, spasms, pulse suspended, tongue pale, cold, shrivelled, eyes sunken— v s 100 ounces at 8 times opiates soda mix inf cath sud calomel astringents, after reaction. 



168 

Aug. 11. J. P. 36. Cured. Diar. and vomiting, spasms, cold, blue, gastric pain, tongue red, fingers shrivelled, intemperate habits— v s opiates, calomel, astringents, cathartics, sudorifics. ' " J. L. 26. Cured Diar vomiting and spasms, suddenly sunk into collapse, blue, cold, shrivelled, eyes sunken voice sepulchral, tongue pale, pulse suspended— v s. twice, infusion, opiate soda mixture, cordial external heat ; he rose up and walked the room in 24 hours " " HL 27. Cured Diar vomiting, spasms, cold, purple— infusion, opiate soda, sudorifics and calomel. : EBL24. Cured. Diar vomiting, spasms, cold, sunken ; the attack was severe and sudden — v s. 100 ounces in six times, after reaction, febrile inflammatory state, severe and obstinate, protracted. : R. T. 26 Cured. Diar. spasms, tongue red, pulse depressed, cold, shrivelled— v. s. 16 ounces, opiate soda mixture, cathartics, sudorifics. " il G. N. 18. Cured Diar violent gastric pain, spasms, cold, sunken, pulse nearly suspended, eyes sunken, fingers shrivelled— vs 3 ounces, infusion, anodyne, soda mixture, cathartics, sudorifics, astringents, &c. [This was one of ten in the same house — all recovered ] ' Mrs T 37 Cured Diar sinking, faint, cold, spasms — infusion, opiates, cathartics, sudorifics. [Intemperate ] : L S. 62. Cured Vomiting and diar spasms all sunken and violent, sunk, cold, senseless— infusion, external heat and stimulants, v s 28 ounces. ' 13 S.V.W 40 Cured Diar gastric distress, severe paki, features sunken, dingy, cold, pulse depressed — v. s 30 oz cathartics, opiates, sudorifics H N. 26 Cured Diar severe gastric sinking, pain of head, eyes and features sunken, spasms, tongue red, pulse imperceptible — Treatment as above. Mrs L 23 Cured Diar suddenly swooned, severe gastric distress, eyes and features sunken — Treatment the same Mrs. F 35 Cured. Diar eyes and features sunken and purple, spasms, gastric pain, tongue pale, pulse imperceptible — objected to v s attempted the cure without it — didnot succeed — had recourse to venesection twice, 30 ounces, emetics, cathartics opiate mixture, sudorifics D L S 25. Cured Vomiting, diarr spasms, gastric distress, tongue red, sinking — v. s. 2 ounces, anodyne, cathartics, (( sudorifics, soda, &c 14 JH0.45. Cured. Diar vomiting and spasms, severe gastric distress and sinking, eyes sunken, deathly countenance, pulse depressed, spasms — v s 60 ounces in 4 times, emetics, cathartics, opiates, sudorifics, &c [The <c case was protracted 12 or 14 day , in a febrile form. « c Cured Diar gastric distress, spasms, cold skin, faintings — v. s. emetics, opiate soda mix. astringents. 16 R. T. 25. Cured Diar gastric distress, sinking, spasms, tongue red, pulse depressed, cold, blue skin, cathartics, „ c anodyne, sudorifics, &c Mrs T. 38. Cured. Diar. gastric sinking distress, spasms—emetics, anodyne, cathartics, sudorifics. 



169 

" " S. H. 28 Cured. Diar. severe gastric pains, eyes sunken, spasms— emetics, anod. cath. sudorifics. " " Mrs. P. 26 Cured. Vomiting and diar. excessive, spasms, cold, sunken — v.s. infusion, anodyne, astringents, &c •• " B. L. 30 Cured. Vom. diar. spasms, cold, blue, fainting, eyes sunken, fingers shrivelled — v. s. 32 oz. at twice, opiates, infusion, sudorifics. " " J. W. 26 Cured. Diar. spasms severe, cold blue shrivelled skin — v. s. vomits, cath. astringents, anod. soda mix. " " C. S. 19 Cured. Diar. gastric pain, cold, blue, features and eyes sunken — v. s. emetics, cathartics, &c. " 17 A.P.G. 1 Cured. Diar. gastric pain, features sunken, cold, blue, p. imperceptible— ex. warmth and emetics. lc " E. R. 22 Cured. Diar. spasms, gastric pain, p depressed — v. s. 2t 24 oz. infu. cath. ext. heat, stimulants. " " B. B. 27 Cured. Diar. gastric pain, spasms, tongue red, skin cold — emetics, cath. sudorifics. " " Mrs.B.L2s Cured. Diar. spasms, sinking, gastric pain, cold, blue — v. s infusion, cathartics sudorifics. " " J. K. 30 Cured. Diar. votn. spasms, t. red, sunken features — v. s. infu. cath. opiates, sud. alk. mix. astringents. " 19 A. M. 8 Cured. Diar. gastric distress, t red, cramps — emetic, opiate, cath. sudorifics, ex. heat. •' " S. L. 14 Cured. Diar gastric pain and sinking, cold, purple — vs. emetic, opiate, soda mix sud. " " J. L. B. 28 Died. Vom. diar. and spasms severe, sinking sensation, sunken features — anod. soda mix astringents, v. s. cath cal. sud stimulants. Sunk into an insensible state. [Very intemperate.] " " J. N. 29 Cured. Gastric pain and sudden sinking, asphyxiated, cold, spasms — cordial, opiate, v. s. cathartic. •' " C. B. 49 Cured. Spasms violent, cold, diar. tongue red, gastric distress, fainting — vs. emetic, cord cath. sud. " 20 R. I. 40 Cured. Spasms and sinking, cold, shrivelled, eyes sunken — v. s. emetic, cordial, astringent. " " R. N. 12 Cured. Cold, gastric distress, diar. tongue red, spasms — emetics, cordials, cath. sud. ' : " E. N. 8 Cured. Diar. gastric pain, spasms, cold, blue — emetic, cath. astring. v. s. sud. " " Mrs.L. 40 Cured. Diar. gastric pain, spasms, cold, p. depressed, t. red — infus. cath. cordial, astring. did not yield, objected to v. s. finally v. s. cath. disease then yielded. " " P. L. 8 Cured. Diar. prostrated, in a state of stupoi, cold pulseless — infusion, ex. heat, friction, cath. sud. " 22 M. W. 65 Cured. Diar. vom. severe spasms — land ether, astring. in 12h. not relieved, then v. s. infu. cath. sud. c£ 25 Mrs.R. 42 Cured. Diar. nausea, cold, dingy, t. red, p. depressed, sinking faintness — calomel, opium astring. were used, the case got worse, the attendant was changed, then v. s. emetics, cath. sud. " " Mrs.B. 64 Cured Diar. vom. spasms, sunken, purple — cordial, v. s. 2 oz. infusion, cath. ex heat, excitants. Mrs.B. 46 Cured. Diar. spasms, gastric pain, tongue red, cold purple — v. s. infu. cathartic, anod sud. astring. " 27 D. W. 33 Cured. Diar. vomiting, spasms, p. imper. cold, purple — v. s. emetic, anod. sud. cath. astringents. : " Mrs.E. 23 Cured. Spasms severe and general, diar. features sunken — anod. cordial, v. s. emetics, sud. " " J. S. 49 Cured. Diar. sinking distress, cold, shrivelled — emetics, cordial, cath. astring. 1 Mrs. J. 24 Cured. Violent spasms, diar. sunken, cold, purple — emetic infu. v. s. cordial, cathartics, &c t{ " A. L. 12 Cured. Vomitinsr diar spacmc cmfticc cathartics &c 

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Aug. 28 S A R. 10 Cured. Sinking, prostration, cold, senseless, diar.— ex heat, friction, emetic, sud " " D. G. 17 Cured. Vom. sudden prostration, cold, pale, spasms — v. s. infusion, cath. " 29 J. D. 24 Cured. Diar. and gastric pain, pulse depressed — Treatment as above. " " H P. 22 Cured. Diar. gastric pain severe, cold, purple, faintish — do do c " L W. 19 Cured. Sinking, faint, diar. pain at stomach, purple— anodyne, sudorifics, infusion, cathartics " D. H. 55 Cured. Diar. spasms, sinking distress, cold, blue extremities — v. s. emetic, anodyne, cathartic, sud. ¦' " E R. 22 Cured. Diar. spasms do do do do Sept. 1 C G. 21 Cured. Sudden attack, violent spasms, diar. sinking, cold do do " " D. E. 22 Cured. Diar. distress do do do do 2 Mrs L. 26 Cured. Severe attack do do do do " 3 NBL 35 Cured. Diar. sinking prostration, gastric distress, cold — v. s. infus. cal. Dover's powders. [Intemperate.] " " W. T. 28 Cured. Gastric pain do do do do " Mrs.E. 40 Cured- Diar. do do do do : " MrsJ. 34 Cured- Gastric distress, spasms, diar. sinking, faintness — infusion, cordial, stimulants. 4 N. C. 25 Cured. Diar. spasms, gastric pain, tongue red, cold, shrivelled — v. s. emetic, cath. sud. astringents. " " E. R. 22 Cured. Do. do do (2d attack) do do " 9 D. E. 46 Cured. Diar. gastric distress and spasms, cold extremities — Treatment as above. ¦' 11 W. G. 47 Cured. Gastric distress, sinking, purple, cold diar. — opiate, external heat, cathartics, sud. ; M. S. 19 Cured. Diar. gastric sinking, spasms, t. red— emetic, cordial, cath. sudorifics, then v. s. cath. ' C. S. 28 Cured. Severe diar. do do v. s. emetic, opiate. " " Mrs.E. 40 Cured- Severe diar. do do anodyne, cordial, infusion, cath. ¦ : 12 N. L. 34 Cured. Diar. do do vs. anodyne, sudorifics, astring. " Mrs.T. 48 Died. Vom. diar. spasms, blue skin, sunken, stupor — infu. cordial, v. s. twice, cath. [Intemperate.] ' 15 D. E. 40 Cured. Diar. sinking, spasms, cold blue skin — cordial, anodyne, infus. v. s. cath. sudorifics. " 16 S. H. 24 Cured. Diar. do do do do Nov. 2 H. B. 36 Cured. Vomiting, diar. and spasms severe, faint, cold purple — v. s. infu. anodyne, cathartic, sud. astringents, ex. heat. [This case occurred after the disease was over, and it was a solitary one.] BARNAGAT CASES. Sept. 5 D. C. 29 Cured. Diar. spasms, gastric pain, purple — astringents, cathartics, sud. || v G. H. 4 Cured. Diar. p. nearly imperceptible, torpid state, blue, cold — v,. s. infusion, cath. anodyne, sud. P. L. 30 Cured. Diar. gastric distress, spasms, t. red — cathartic, anod. sud. " P. A. 60 Cured. Symptoms as above do do 2 6 J.AL. 30 Cured. Symptoms as above do do 



171 

" " Mrs.V.X 55 Cured- Vomiting, diar. spasms, sinking, faint, purple, eyes sunken— v. s. infusion, anod. cathartics, sud " •' T.P.S. 60 Cured- Do do do remedies the same " 7 W.BL-40 Cured- Diar. do do do " " M. L. 42 Cured- Do do do do " 9 J. P. 46 Cured- Do do do do " " H- S. 45 Cured- Diar. sinking, spasms — emetics, anodyne, sudorifics, astringents. " 14 C R. 44 Cured- Diar. vomiting spasms, sunk into a cold blue state— infusion, vs. cordial, cath. sud. astringents. " 15 M.V.X.29 Cured- Diar. gastric pain, spasms, p. depressed, cold, purple — infusion, anodyne, sudorifics. " 17 P- H. 10 Cured- Do do do do do '•' " W. L. 30 Cured- Do do do do do " 20 J. R. 19 Cured- Diar. sinking, spasms, gastric pain, blue cold — v. s. emetics, anodyne, sudorifics. ' •' A.V.X.65 Cured- Similar attack, very severe do do " 25 Mrsί. 55 Cured- Do do do do do " " A. F. 25 Cured- Do do do do do " " A.V.X 50 Cured- Do do do do do : " J. R. 52 Cured- Vomiting, diar. spasms, fully collapsed — v. s. infusion, anodyne, cordial, sudorifics, ext heat, &c. [This man had a similar attack in 1834, of which he died ] " 30 B. L. 35 Cured. Diar. sinking, faintness, spasms, &c— emetics, anodyne, cordial sudorifics. 



172 

"During the prevalence of the Cholera in Poughkeepsie in the summer of 1832, I was attached to Dr. SherrilPs office, as a student, and assistant practitioner. I saw much of the disease at different times, as it appeared in the County House, and also cases that were called Cholera in this village, attended by other physicians — and was acquainted with the description of Cholera of different authors. I also saw many of the cases included in the list of those attended by Dr. Sherrill and myself, and thought them to have been attended with similar symptoms, and to have been the same disease as other cases that were reported as Cholera by the Board of Health. And futhermore, when the Cholera broke out in Barnagat in the autumn of the same year, after six cases ha( terminated fatally, (as I was informed,) the inhabitant engaged Dr. Sherrill and myself to attend all that migh be attacked with the disease. I took the immediat charge, subject to the council of Dr. Sherrill. The mos of the villagers had the premonitory symptoms, and ther were over twenty full formed cases, and a number o those sunk into the stage termed collapse ; and of a those cases that we had the charge of throughout, ther were no deaths. I also drew up a list of the cases that were attended by either of us, from notes taken by Dr. Sherrill. The foregoing I believe is a correct transcript of the list. 

D. L. STARR." 



173 

VIII. Mrs. P. aged 60, Aug. 10 1834 ; was seized with gastric distress and fainting ; rice water vomiting, diarrhoea and spasms came on ; she fainted to helplessness ; was cold, blue, and pulseless. External warmth was applied ; laudanum and soda mixture given ; venesection 12 oz. ; emetic. Reaction came on ; venesection repeated to 24 oz. Now the spasms, vomiting and diarrhoea all left her. Cathartics and sudorifics, with occasional anodynes effected a cure. 

IX. J. D. aged 30, had been affected with diarrhoea, on the river, two days ; just able to get home. Vomiting, diarrhoea, and spasms, severe ; rice water discharges pulse small, scarcely perceptible ; eyes sunk ; cold skin blue features ; fingers withered and cold. He was ble( three times ; lost in all 60 oz. of blood. At first the bloo( run very slow, it was black and thick ; it was draw only by means of hot bathing the arm and friction. A the subsequent bleedings, it was more florid and thin ; i ran more freely. Remedies similar to the above effected a cure. 

X. August 25. As this is an interesting case, it is added here. It was one among many violent ones, which occurred at Barnegat, in 1834. P. A., a boatman, aged 65, had diarrhoea two or three days, on the river, with which he just arrived home. Vomiting and spasms took place ; gastric distress ; sunk down, faint ; cold, purple, eyes sunken ; features hippocratic ; blue skin ; fingers withered ; tongue red ; pulse extremely small. Remedie — used laudanum and soda to quiet the stomach ; venesection, 16 oz. followed by an emetic and cathartics ; external warmth. Pulse rose, warmth returned. In twelve hours he was bled again, to 24 oz. ; cathartics 



174 

Isudorifics continued ; vomitings and spasms ceased; rhoea and distress in head and stomach continue — really out of the collapsed state. On the 27th, he : to bleeding at the nose, which was excessive and • continued ; the attendants declared he lost 3 pounds lood in 24 hours. After this, he had very little more lisease except weakness, from which, by the use of rishing cordial stimulant remedies, he soon recovered. 

XI. The following case which occurred at Barnagat on the 24th of August, 1834, will show the rapid manner in which the Cholera will run its course to violent symptoms, collapse and death. 

Mrs. C. F. aged 39, of healthy constitution — good tidy, comfortable liver. On the night previous she hac been with me attending some very sick patients ; in the morning about 6 o'clock, as I was about leaving, she told me she had a moderate diarrhoea and uneasiness o the bowels — some remedies were recommended which she had by her. By 12 o'clock, M. the alvine discharges became excessive, thin and milky — unable to restrain them ; by 3 o'clock she began to sink and get cold and purple. A messenger was sent for medical aid six miles — it was 6 o'clock when I arrived — (too late) — she was t perfectly collapsed, cold, blue, shrivelled, eyes en and cramped, pulse scarcely perceptible. By external applications and friction, blood letting in moderate quantity, vomiting, opiates, soda, &c. the warmth returned to the skin, the diarrhoea ceased — the pulse rose moderately, and the symptoms were generally favorable. At 10 o'clock a severe spasmodic structure seized across the chest, producing asphyxia. She died in a few minutes. 



175 

XII. E. H. aged 20. This case furnishes an instance; of a recovery from a very protracted state of collapse. In 1834, when the Epidemic broke out in the village, among others this person went out of the place half a mile. On the 16th of August was attacked with diarrhoea, which progressed to a state of confirmed collapse, with spasms, &c. The sinking and depression was not so violent as to destroy life directly. The treatment had been astringents, sweating remedies, cordials, opiates, calomel, &c. She continued rather failing, and was finally given up as incurable. On the 29th was brought to the village, when I first saw her ; it was stated she had been six days in this state — she now had extreme soreness and distress at the stomach ; rejected almost whatever was given ; diarrhoea thin and watery ; her whole appearance remarkably changed ; her visage was ghastly, her face blue, the eyes sunken, the skin cold, the hands cold, purple, and fingers withered ; pulse creeping along, but just perceptible. Remedies used — small bleedings several times repeated — anodyne soda mixture, repeated several times in small doses — gentle and repeated cathartics with sudorifics — external heat and fomentation — stimulants to the skin, &c. By the use of this treatment she gradually improved, and in about 10 days was dismissed cured. 

XIII. M. C. aged 20, Aug. 14, 1834, had beensevera months complaining of a cough and affection of the lungs attended with irregular intermittent fever; during th Epidemic season she was suddenly attacked with sink ing, faintness, distress of the stomach, nausea, water diarrhoea, spasms, cold hands and feet, eyes and coun 



176 

She was treated by warm applications externally, anodyne, soda mixture, bleeding to 12 ounces, followed by purgative medicines ; the violent symptoms were arrested ; medicines were now given to promote sweating, with an occasional anodyne, cordial supporting nourishment, by which she gradually recovered and regained her health. 

Having furnished an exhibit of the cases treated on what may be termed the evacuant plan, it will be proper to give a slight view of those managed on other methods. It was stated that the whole number of cases according to the best information obtained, of what might be termed fully formed cases of the Epidemic in 1832, were 400. That number may by some be considered overrated, and it may fall short ; if it is about correct, that will leave 278. By referring to a memorandum which happened to be preserved by a young gentleman, it appears that out of these there were over 165 fatal, who were afflicted with prominent marked symptoms of the Epidemic. 

In the public bulletins there were reported from an office attached to the Board of Health, 43 cases and 31 deaths. These had great advantages of public assistance in the management. 

Three or four deaths in the whole probably took place, who had little or no attendance. 





177 

appeared to be very different. Among the patients in the village in which the method detailed in the preceding pages was pursued, there were 2 deaths out of 30, who were affected with full symptoms, similar to those enu^ merated in the cases drawn out at length. 

The following voluntary statement will furnish a view of the disease as it prevailed at the place mentioned : 

" We, the subscribers, inhabitants of Barnagat, in the town of Poughkeepsie, hereby certify, that the Epidemic Cholera made its appearance in our village on the 4th of August, 1834, and continued to prevail among us from that time till the 10th of September, when all the villagers who had not already fallen were compelled to re move ; that, exclusive of numerous cases in which there were present diarrhoea, and many of the milder symptoms, there occurred during this interval about forty cases of what is termed fully formed Cholera; that so many violent cases, occurring within so short a space of timg, produced great consternation and distress, and required much nursing, and laborious medical attendance ; that the latter was chiefly rendered by Dr. Sherrill, with the aid of his assistant, Dn Todd ; that several families whose members were ill of the disease, were very poor, and unable to provide themselves with the ordinary comforts or even necessaries of sickness ; and that by his unremitting attention, they received strict medical assistance ; that of the efficiency of his services, the sutn scribers cannot but form a high opinion from the fact, that out of about 35 patients whom he attended, five only proved fatal — two of these having been females in that critical state which always, in spite of skill, makes their 

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recovery very doubtful — they had abortions. Two died without attendance — one was an infant. 

WILLIAM B. LAWSON, THOMAS P. LAWSON, 

JOHN MATTHEWS, 

WM. J. VAN KEUREN, 

JOHN M. LAWSON, PETER FERDON, 

WHITMAN A. FERDON, 

ROBERT FERDON, DAVID FORMAN, JOHN HOFFMAN." 

Besides these there were five other deaths, not attended by him. 



CHAPTER XII. 

On Means of Prevention of Epidemic Cholera. 

Suggestions to Corporate Bodies and Individuals. 

From the course ,of examining the subject of Epidemic diseases, and particularly, Epidemic Cholera, which has been pursued in the preceding pages, it will appear that there is some general, natural causes, which operate in producing a strong predisposition to the production of Cholera ; which, perhaps, cannot be altogether guarded against, or controlled. But there are many local causes of the disease, or the generating means of them, existing in a country, a city or village, which it is in the power of corporate bodies and individuals to guard against. It appears that .the material, which is the immediate exciting cause of the disease, is in some measure produced by substances of animal and vegetable matter, united wifeh water and fluids of different kinds, collected together, and aoses upon by heat and cold, undergoing a ratting and decaying operation; or to speak more chemically, they are in a state of fermentation, putrifaction, and decomposition. 

By this process, airs and gases of an unhealthy, impure nature, are formed and thrown off, which are unfit for breathing, or to support animal life. These are diffused through the atmosphere, so that all persons residing in 



180 

those places, or in the vicinity of them, are more or less impregnated with a matter injurious to a healthy state of the system ; therefore, when an additional exciting cause is added to the general predisposition, which has a tendency to produce the complaint, or work out a change or sudden varied action in the habit, active disease is brought on. 

Diseases of* an Epidemic, malignant nature, and particularly those of hot seasons and climates, are more apt to prevail in those places, where there is the greatest quantity of filth and foul air collected. Though to this rule, there are some exceptions : for there are some instances, where the Cholera has prevailed in dry, airy, and apparently healthy places, or parts of a village. 

The more immediate duties to which public bodies may direct their attention, is to the regulating and cleaning streets, side walks, gutters, sewers, cellars, back yards, privies, &c. all which, are situations in which those collections of filthy material that have been referred to, may be collected, and become the immediate sources of miasma. 

Particular attention ought to be directed to those parts of a village, and narrow streets, commonly inhabited by a dense, indigent, pauper population. Much might be done there, particularly in hot seasons, when there is danger of disease, to thin out the inhabitants of these places from small crowded houses ; to make others clean up their places ; white wash, wash the floors, and even their bedding and clothing. In such places, there frequently lie lurking, the dormant seeds of disease. Many of those places really emit nauseous, sickening exhala-* 



181 

tions. Some public aid might be given the poor, to aid them in cleaning and ventilating their places ; or a bounty might be offered them, to encourage cleanliness and ventillation. Those bounties would not be lost to the general mass of the wealthy population who may be taxed to pay them, for by it, they would purchase a more salubrious atmosphere, and perhaps preserve their own healths ; and might enhance their business and value of property, by gaining a reputation for a healthy and salubrious location. 

The various Sources and causes of those materials of filth and putridity, are too numerous and easily discovered by the eye of intelligence and observation, to require further enumeration. 

One of the most important subjects of consideration for a village or city, is to procure a good supply of pure wholesome water, by having plenty of good wells, or some other resource for the purpose, and to take measures lo prevent the water from being injured or spoiled by having it contaminated by impure and filthy matter being drained into it from gutters, stables, grave yards and privies. It is not uncommon to have a well and a house of private retreat side by side, and perhaps a stable adjoining, the leakings from which settle into the earth, searches the way through, and finally are mingled with the water. 

This may, in some measure, be remedied by removing the Cemeteries out of the bounds of villages, and in hot weather by spreading lime or cloride of lime over those in them, and by adding a small quantity of one of those articles to all recently opened graves before they are 



182 

filled up. Vaults ibr places of retirement may be protbited altogether, by a plan suggested by Jesse Torrey, . in his essay on the means of preventing Malignant isease, and by Dr. Platou in his Treatise on Yellow ;ver, which consists in causing tubs or boxes to be used those places instead of vaults, and frequently having 3m taken out and the contents deposited in some suitable place. In some places, it is said, a class of men make this their business. This would render those places of retreat less disagreeable to the olfactory nerves, particularly in hot weather. Some cities have adopted this plan. It is said to be the case in the city of Washington, the capital of the United States, and in the city of Paris. This excreted matter makes an excellent manure, and it has been converted to profitable purposes. 

A valuable acquisition to a village would be to procure a stream of active running water, to run through it or near it, not only for convenience and a protection against fire, but for the preservation of health, provided stagnations and filthy collections are guarded against. It has often been observed, that during sickly seasons, those persons who resided near the banks of active running water, with dry solid banks, have escaped the disease. It may be owing to this circumstance that there were few or no cases of Epidemic Cholera in the north part of this village, near the rapid flowing waters of the Fall Kill ; while along the stagnant and still water of the mill pond, in the east end of the village, with muddy banks, the Cholera prevailed with great severity. Active running water clears its course, carries off the decaying matter, and if miasma is formed it is carried along with the current and wafted away. 

Another subject of important consideration, to which 



183 

are expected, is to make some provision to meet the emergency beforehand, by having some place provided for the reception of those who it may be necessary to move from their residences, where they may be more comfortably situated than in a temporary shantee on the cold ground, with very little means of nursing or making them comfortable. Some confusion and considerable expense might be avoided by a plan of this kind. 

In regard to moving patients who are seized with the disease, and have progressed to the stage of collapse there seems to be no great danger in moving those wh are laboring under the premonitory symtoms ; but when they are in a state of collapse, if it can be avoided, they had better not be removed into the open air, and joltec about. When this is the case, it generally injures them and they frequently die. At this period they ought to be kept quiet and warn. The body requires rest an< to be kept covered up in bed. Warm applications ough to be used to the skin, and internal remedies used to check the disease, which had better be done on the spo if it can be done. After the disease is checked, anc reaction brought about, if that can be done, then the patient can be moved, with more safety, to a Hospital or some other desirable place. In such cases if any of the persons are to go away, a part of the well ones had better go. It would be very proper for the corporation to furnish a comfortable close carriage, well fitted up* to carry the sick in, who it might be required to mote. That would be much more safe and comfortable ; and in this way the panic on the public mind might be avoided, by seeing carts loaded with the sick drawn through the streets. 



184 

fiut it is a matter of considerable doubt whether there is as much advantage in moving away patients from where they happen to sicken, for the mere purpose of taking them out of the thicker part of the population, as has been supposed, unless it may be for the purpose of having them medically attended and nursed, and that can generally be done in the family, with the aid of public assistance, better and at less expense, than by furnishing and fitting up an extra Hospital. If the cases are not very numerous, they may all be managed in this way. To prevent the disease from spreading, a great part of the well persons might, for a short time, leave the place long enough to have it thoroughly cleansec and ventilated. It is to be borne in mind that the dis ease generally originates in such cases, from the contain mated state of the atmosphere in the local place, more than from a few persons who are affected with it, anc as all are predisposed to it more or less, various exciting causes may bring it into action. 

As there is evidently a diminished quantity of oxygen or vital air in the blood of those who are laboring under the disease, and there seems to be evidences of there being a deficiency of it in the atmosphere in those infected places, or the atmosphere is so saturated with the matter of disease, that the proportion of vital air in a given quantity of the atmosphere is much diminished* Thereforej substances containing oxygen, or which will impart oxygeri to the air, should be distributed in those places. By the means which corporated bodies possess, it would be an easy matter to establish the decomposition of some materials which would form volumes of oxygen to distribute and diffuse in the atmosphere, particularly in houses or in Hospital wards. For some account of those 



185 

articles, and the means of* procuring gas from them (see page 134-35) but more full directions may be obtained from works on chemistry. 

With those principles in view, and preventive means founded upon them, it will appear to be improper to burn substances in rooms and about patients, with an intention of burning up the miasma or poisonous matter. In doing this around a patient in a state of collapse, one of the most important agents of relief is destroyed. The use of disinfecting agents, such as lime, chlorine, &c. will be noticed a little further along. 

In this Epidemic Cholera the poor have often been referred to as being the most general subjects who were attacked with it. Perhaps the greatest proportion of cases do take place among them, and the reason has been explained — because among them there is generally the most concentrated quantity of miasma, and they are the most exposed and acted upon by exciting causes. But many melancholy facts show that the most cleanly, the elevated in society, the rich, and particularly the voluptuous, are attacked with the disease, and fall victims to it. 

Advice to Individuals to prevent attacks of Cholera. 

When this disease prevails, and there is a general disposition in most people in a place to be affected with some symptoms of it, some will no doubt be severely afflicted, let the care and means of prevention be what they may ; but there are certain modes to pursue, and means to use, which reason, experience, and good common sense show to be best calculated to prevent individuals from being attacked. Those means will be enu- 

24 



186 

merated. Some of the causes of being made liable to take the disease, are — 

In crowded and close rooms there is likely to be collected a variety of matter to render the air impure ; and the continual breathing of the same air destroys its healthy nature very fast, which renders the inhabitants of those abodes liable to the attacks of disease. Again, those are more liable to be attacked who are exposed to cold and bleak situations, to wet and storms, and extremes of temperature, to fatigue, to excess of eating or drinking, or taking too largely of indigestible matter into the stomach. 

When it can be done, the best way to avoid attacks of Cholera when it is confined to a small place, is to go away from it, and fix the residence in some more healthy spot, but that is frequently impossible to do, and particularly so when the disease extends largely over a place or country. 

When the disease may be expected, or when it prevails, particular care should be taken to clean away and remove all the dirt, and filth, and stagnant water out of the houses and yards, and the streets ought to be kept clean. If there are any collections of water of a stagnating or impure nature about the house or place, they had better be drawn off and and cleaned out ; be careful to remove water, mud, or any putrifying matter from cellars. Houses ought to be opened frequently and ventilated; clothes and bedding should be changed and washed often ; scrub, clean, and whitewash rooms often. Where the houses are crowded with persons, part of them had better go away to some other residence. 



187 

These are the best means to avoid liability to attacks of the Cholera, as far as preventatives in management goes. Many articles of medicine have been used about persons, and taken by them, with an intention of preventing attacks of the disease. The public have been amused and excited, and also have been imposed upon by being offered a multitude of remedies of all descriptions and kinds to prevent attacks of Cholera and to cure the disease ; some of them have been perfectly useless", and many of them injurious. 

The principal use of these articles are to neutralize or destroy the poisonous or injurious properties of the miasma or infecting matter, or to place the habit of the body in a situation not to be so liable to be affected with it. The articles which are found best calculated to correct or destroy the injurious properties of the infecting material are lime, soda, alkalies, chlorine, carbon, &c. Those to regulate the functions of the system and render it less liable to be acted upon, are gentle purgative medicines, to moderately promote the regular secretion of bile, and to evacuate that and the crudities and foul matter from the bowels, and such medicines as quiet irritation and slight pains, and those calculated to restrain diarrhoea, when that commences. 

The lime, alkalies, and chlorine, maybe used in a variety of ways. Lime is used in whitewashing, and may with advantage be spread about a place. Alkalies or potash are used in soap and lye in washing, scrubbing, and scouring. Chlorine is a matter which is abundant and extensive in its existence and operation ; it enters into combination with several articles ; it exists in a state of vapour or gas, and it is united with a solid substance. 



188 

It exists the most abundant in muriatic acid, (spirits of sea salt,) and in common salt. This, like alkalies, has a powerful property of destroying or neutralizing acids and corrosive, septic and putrifying matter, and for this purpose it has been used very much to correct or destroy infectio — as it has been supposed that this matter which produces Cholera and other Epidemics may be of an acid septic nature. It may be very easily used in the following manner — setting several teacups in a room, put a tablespoon full of common salt in each of them, pour into each half a tablespoon full of oil of vitriol, (sulphuric acid,) an effervesence immediately takes place, a quantity of vapour or gas rises and fills the room — this is the chlorine gas. As soon as the acid is poured on the salt, the room should be shut up for an hour or so, and no one allowed to go into it. It is unsafe to breathe this gas, (see chapter on asphyxia.) For the discovery and use of this gas by Dr. Smith, the British Government gave him a very large sum of money. But this preparation after all, is not found to answer without cleaning and whitewashing, and using other means to promote cleanliness and ventilation. 

The following simple method of obtaining this gas, is extracted from an Essay on the means of preventing malignant disease, by J. Torrey, jr. 

" Take a cup or basin and put therein 1-4 lb. of black oxyde of manganese, upon which pour a teaspoon full of muriatic acid — there will soon rise gas sufficient for the disinfection of a large room ; with the addition of a little acid daily, and a gentle shaking of the manganese, the preparation will serve a fortnight. To sprinkle the 



189 

lighter part of the composition about the premises, gives a more speedy and general effect." 

Chlorine united with lime, known by the name of chloride of lime, has latterly been more generally used. This is supposed to answer a good purpose. It is to be used by spreading it in and about houses and premises in moderate quantities — some caution is requisite in using it. A large quantity used at a time has a tendency to obstruct breathing, and produce a sinking, fainting sensation, which may bring on an attack of Cholera. I have seen some instances where it appeared to be very injurious, and erases that seemed to be unfavorably influenced by it. Although the chloride of lime and chlorine gas has been freely used to destroy foul air and miasma, it is a matter of doubt whether it is advisable to use it freely in houses among the sick. Spreading it in the seats of putrifaction and noxious fermentation, it undoubtedly is useful, but when it comes in contact with the lungs, it may be injurious. Therefore a considerable caution ought to be observed in using it. 

When the local or general causes cannot be avoided, care should be taken to keep the habit of body, and particularly the bowels, in a regular uniform healthy state, avoid extremes in eating or drinking, moderately and frequently eliminate the poisonous miasma and bile from the system, by often taking some gentle purgative medicine before mentioned ; for this purpose take magnesia and rhubarb, calomel and rhubarb, magnesia and Epsom salts, castor oil, pills of aloes, rhubarb and soap, &c. — dress warm, and keep up a free or easy perspiration. During the prevalence of the Cholera, the mode of living had better not be materially altered, but the 



190 

lantity of the food should be very much lessened ; it is ; quantity or bad quality of the food that has a good bad effect in those cases, more than the kind of the icle. The diet had better be confined to vegetables d pastry, or milk, and use less meat than common ; Did much spirits, wine, and ardent stimulants. The vegetables should be of good ripe quality and well cooked; those of very difficult digestion should be avoided. Every person can tell what disagrees with the stomach, or what sets best on it ; cabbage and green corn are generally the most indigestible. It appears to be erroneous to abstain from good vegetable diet, and the use of ripe fruit. If the disease is in its nature what it is shown to be, and what many observers now consider it, of an inflammatory nature, and a common location of it on the inner surface of the stomach and bowels, then those articles are best calculated to dilute and neutralize the fluids, to render them mild and bland, to promote healthy secretions, to obviate irritation and inflammation, to carry off thot impurities of the blood, and to prevent irritations inflammations in the stomach and bowels — there, a moderate and daily use of good ripe fruit during the prevalence of Cholera, on the whole would be rather beneficial, on the same principle and theory that fruits are recommended and found beneficial during the prevalence of autumnal Epidemic diseases, and during the prevalence of yellow fever, &c. God, in his wise dispensations, when he suffers pestilential diseases to pre^ vail, also furnishes them with an antidote. The season of ripe and succulent fruit, and the season of bilious and autumnal fevers, and generally the prevalence of Cholera accompany each other- 





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of persons being attacked with Cholera after taking some indigestible vegetable — it no doubt is so ; and the same may be said that they are attacked after taking spirits, after eating a hearty or common meal, or after taking a plain dish of tea, or while in bed, when nothing material has been taken. A large or even a common quantity of diet, when the stomach and bowels are in an irritable state, may excite them to a diseased action, and when the Cholera prevails, it requires but a very small matter to do that. But the advisable course is to use means to prevent the irritable state taking place as much as possibl — and that course is to use light, diluting, mild, succulent diet in moderate quantities. 

By the same rule and doctrine, I would recommend a free use of mild diluting cooling drinks, such as lemonade, soda water, port wine and water, small beer, or cold water. These mild drinks dilute, cool and float the miasma out of the system. The practice of depriving persons of cool drinks, and of preventing patients from water or other drinks, while labouring under an attack of Cholera, is a cruel and injurious practice. When symptoms of disease takes place, these remedies ought to be used to correct them. If there is pain or uneasiness of the bowels or diarrhoea, take a few drops of laudanum and peppermint with a little soda ; the soda and laudanum mixture mentioned in the second stage of treatment, (p. 131,) or the astringent opiate pills noticed on p. 130, are very good ones. A teaspoon full of the mixture may be taken 3or 4 times a day ; the common chalk mixture of the shops, or the one mentioned at page 130, or some similar preparation, will answer a good purpose. If the disease continues or increases, a brisk cathartic better be taken, or if there is much nausea or disturbance 



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of the stomach, let an emetic be taken. After the operation of the cathartic or emetic, the anodyne soda mixture or astringent mixture may again be taken. Some of the purgative medicines before noticed will be proper in this state of the disease. If there is considerable distress or weight at the stomach or soreness of the bowels, or feverish excitement, blood should be taken — use means to promote perspiration; proper medicines for this purpose are small doses of ipecacuanha, tartar emetic, pulvis anti. monialis, (James' powder,) warm herb tea. Application of warm fomentations to the skin, &c. If the symptoms are more severe it is safer to obtain medical advice. Keep the mind and tone of the system as near uniform and in equanimity as possible. 

Probably the best external applications in addition to those to promote general cleanliness and regularity in the habits are, frequent washing with soap and water ; rubbing with some stimulating wash or lotion, such as infusion of mustard, spirits of camphor, &c. and rubbing with dry flannel ; oiling the body has been practiced in many places to guard against plague and yellow feverit might be useful in Cholera. 

Avoid exciting causes — dispel fear and agitation of mmc l discard the idea that the disease is contagious. Confidence and hope should be inspired by medical men and by members of corporate bodies who have charge of the sick, and by nurse attendants. An opinion being given, or spreading abroad that the Cholera is in its nature fatal or incurable, has a very injurious and depressing effect, and may add much to the increase of the disease, and contribute to its fatality. Numerous facts prove that the opinion of the disease being incurable, is 



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unfounded and erroneous — for although the Cholera, like yellow fever, spotted fever, and other violent diseases, is a very severe disease, and many cases of it do and will prove fatal — yet, like other Epidemic diseases, thousands who are attacked severely with fully formed Cholera, have recovered. 

I The fear of" contagion, or of catching the disease, often ters friends and neighbors from affording necessary d humane assistance to those attacked. This is an xraeous fear. Recollect that in a contaminated atmosere, where the disease has broke out, all are equally ble to take it, if they equally exposed to exciting uses. Calmly and fearlessly attend to all the duties out the sick and afflicted, that their situation and your blic duties and benevolent feelings would require or ;tate. 

If the violent symptoms come on sudden, or have taken place, such as vomiting, urgent diarrhoea, or cramps, cold purple or blue skin, and a sinking fainting sensation, use all the means usually resorted to by outward remedies to produce warmth of the skin and sweating For this purpose, the best remedies are clothes wrung out of hot water and applied to the body ; hot bricks with vinegar and water poured on them and appliec warm ; bathing by immersion in warm water, hot mustard and other stimulating applications, moderate frictions to the surface if there are spasms — bleed as soon as possible. If the blood circulates torpidly, as it usually does in this situation, it will be best to immerse the arm in a milk pan of very hot water before it is tied up, and let it remain there while the blood is running. If the 

25 



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pulse is suspended, the quantity of blood taken should be small, and the operation repeated in a few hours. If the blood runs freely, a full quantity of 20 or 30 ounces may be taken to advantage ; if there is great irritation at the stomach or vomiting, give an emetic of salt and water, ipecac and mustard seed in infusion, or tartarized antimony, with one of the otliei- articles may be used. After the vomiting is over, or if it is thought best not to give an emetic, give the laudanum and soda mixture before named, or solution of morphine, or the salt of morphine in powder. After the stomach is quieted, give purgative medicines, so as to produce a purgative operation from the bowels. 

Medical advice had better however be obtained. During the prevalence of Cholera in a city or village, it would be well for every family to have hot water or hot bricks always in readiness, or some preparation in forwardness so that they can soon be procured. In a great number of cases similar to those of the last description, the emetic, the bleeding, and the hot external applications may put an end to the violent symptoms. Opiates had better be given either before or after the bleeding, so as to relieve pain and quiet the cramps, but they ought not to be relied on in the cold, sinking, or collapse state of the patient, without being accompanied by free evacuations from the blood vessels or the bowels or both, and they should be omitted as soon as the urgent symptoms of pain are relieved. Opiates in large or repeated doses have a tendency to restrain or lessen the reacting powers of the system ; in this sinking state of the vital functions the heart and the arteries require to be relieved as much, as possible from their load and torpor, and to be aided in their powers of reaction. 



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It is the general received opinion of those who have seen much of the Cholera, and had a great deal to do with it, that it is not a contagious disease, or not likely to be taken by persons going where it is, or attending or nursing those who have it ; and experience has shown that quarantine regulations and prohibitions, with a view of preventing the disease from entering a place, have proved unavailing and unsuccessful. Police regulations or cordons of military force cannot prohibit the spread and wafting influence of the atmosphere nor the extremes of temperature, nor the influence of the solar rays. 

The disease may be brought on, or excited to action by intemperance in drinking or eating, by irregularities or excesses of any kind, by sudden check of perspiration, by exposure to cold and dampness applied to the feet and legs, by quantities of indigestible food taken into the sto mach, violent purgative medicines, long costiveness, neglecteddiarrhoea, or that treated solely by opium & astringents, fear and sudden excitement, depression of spirits and despondency. All of which should be as much as possible avoided. 



CONCLUDING REFLECTIONS 

Having gone through the examination of the subject o the Epidemic Cholera,, which was proposed when this work was undertaken, although it has extended beyonc an expected length, and having endeavored to answer the questions propounded at page 38 ; if that task has been performed to the satisfaction of the reader, or in such a way as to tend to alleviate human affliction or prolong life, some compensation will be derived for the labour of the undertaking. 

From facts and maxims thus gathered in store, if they are of value, some few may be culled which may prove useful, should it fall to our lot again to have to engage in a similar course, and thus may operate like beacons thrown out to guide the way for those who may succede us in encountering similar scenes. 

Although the Epidemic of 1812 to 1813, was a disease not so rapid in its progress, nor generally so precipitate in its attack, yet it was more extensive in its spread over the country, more protracted in its nature, more complex in its symptoms, and quite as difficult in its management as the Epidemic Cholera. Yet the former, like the latter, required a mode of treatment adapted to the nature of the disease and peculiarities of the case, and that to be used in the early stage with promptness and decision A short delay or considerable error may fail in eithei case. Notwithstanding we have seen written orders issued under the sanction of corporate authority, that 



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" bleeding was inadmissible" — no disease has prevailed in this county for thirty years which has been more immediately and decidedly affected by blood letting, and none where there was a greater number of violent cases that have been more under the influence of remedies than the one under examination. 

|)uring the prevalence of such violent diseases there many circumstances which have a tendency to renrnany cases fatal, independent of the generally nail, et necessary fatality of the disease. The attack y be so violent that some of the internal vital organs y be destroyed at once ; — the patient may not obtain per aid as soon as the case requires, and the disease y make such rapid progress as to fatally derange le of the vital functions ; — the constitution of the patient may be delicate, sickly, or affected by intempe«ice, which renders it more unable to stand the shock disease; — the patient or the friends may refuse to comply with the use of such remedies as may be of essential use to their safety ; numbers of instances might be referred to where obstinately refusing to lose blood has proved fatal. Among the poor it is sometimes impossible to obtain nursing and other means to do with ; in such cases, the hand of charity may be extended with a benevolent grace. 

The bold and terrific character of this modern Epi demic was calculated to unfold the nature of the anima economy, and to call forth the greatest energies of the professional mind to attempt to divert the force of the shock from the intended victim. For while it has car ried along in its current the poisonous miasma, and swept from the stage of action numerous members of the human 



198 

liee — it has had a tendency to show in some measure c identity of the nature of Epidemic disease, and unirmity in the operation of nature's laws. The virtues ' some remedies founded upon the ancient dogmas of lys gone by have proved of utter inutility ; and with any, subjected to their exclusive use, have gone down oblivion together. 

IBy calmly reviewing the scenes of trial and danger -ough which we have passed, it is right and proper to 3t back a look, and offer up expressions of thankfulss and gratitude to the All-wise Disposer of events, for from sharing the fate of some who passed review before us. 



INDEX. 

Page, Preliminary Observations, 3 Chapter I. — History of the Cholera as it appeared in Poughkecpsie in 1832 and 1834, - 9 " II. — Dissertation on the Atmosphere, 30 " 111. — A Discourse on the general cause and nature of Epidemics, 37 " IV. — On the Pathology of Epidemic Cholera, - - 64 " V. — An explanation of the nature and cause of Collapse, 88 " VI. — Asphyxia, explanation of the cause and nature of it, - - 94 " VII. — Symptoms of Epidemic Cholera examined and explained, - 102 " VllL— General Plan of Treatment, - 115 " IX.— Plan of Treatment, - 130 11 X. — Sketches of Medical History and results, 143 XL— Cases, - - 160 11 XII.— On the means of prevention, - 179 Advice to Individuals- - - 185 



ERRATA. 

rl9 for corporation read town* 28 for six read eight. 24 after oxygen add and* 15 for mash read marsh. 28 for cases read causes. 12 for jaundicm read jmmdiced