SIX, In presenting the accompanying Report, we beg lart of the city proper included within the walls the elevated subrbs of St. Louis and a portion of the suburbs of St. John. The ower town consists of St. Roch's suburb lying near the confluence f St. Charles and St. Lawrence Rivers, and of all the streets ying near the water's edge between the cliffs and the river. The t Lawrence is fresh, not only at Quebec but for a hundred miles jelow. When the Cholera first appeared here, it was among the inhabiants of the lower town that the first cases and the greatest morality occurred. For a history of the state of the atmosphere at Quebec for three months preceeding and during the epidemic, we efer to appendix (I ;) and for a statement of the mortality at the ime place to appendices (X) and (L.) In obtaining the history of the disease, our first object was to scertain facts We therefore sent our circular (see appendix M) o the most prominent members of the Medical profession, but rom the pressure of business few answers could be obtained at the moment, though we are in daily expectation of receiving them. 'hrough Dr. Skey, Inspector General of Hospitals, and Dr. Teser, Health Officer, we found that the Medical Staff at Quebec ere divided, respecting the origin of the disease. Dr. Morrin? ealth Commissioner, Dr. Skey, inspector General, and Dr. Lyons' iperintendent of Emigrant Hospitals, believed the disease 6 imported and under some circumstances contagious. But Dr. Tes* er, Health Officer, and Dr. Hall, resident physician, believed it vas neither imported nor contagious. Our own opinion coincides 'ith those of the last named gentlemen. We could find no proof iat any man sick with the Cholera was landed at Quebec, and pon a reference to the report of the Quebec Board of Health, ich vvill be found to have been the case. — (see appendix N.) 'he physicians who sign that document all agree ; they say li the ndersigned have not as yet been able to discern that any case of /holera had been landed from any vessel in the harbor, before nor ntil several days after its first appearance in the city." Some liysicians thought that the Transit and Carricks (emigrant vesels) introduced the disease. Cases of Cholera did exist, it was scertaiued, while at sea ; but no case had occured for a month >revious to their arrival at Quebec, and these ships were passed as )erfectly healthy at the Quarantine at Gi'osse Isle, 36 miles below uebec. When they arrived in the city, there was no sick man on >oard, nor was a man landed sick from any vessel, until some days ter the disease had made its appearance in Quebec, and the first >erson attacked was not an emigiant, but a native. It may be orthy of remark, that up to the time of our leaving Quebec, no ise of Cholera had made its appearance at Grosse Isle, where pasngers were daily landed. At Montreal it appeared about the same lime ; a sick man was anded from the steam boat Voyageur in the evening, and the folowing morning Cholera had made its appearance in three different ctions of the city. It was supposed that this vessel brought the isease into Montreal, but it was ascertained that when the steam joatleft Quebec, no disease existed at the latter place. The nutn)er of emigrants on board this boat was nine hundred, and in conquence of the great number, two bundled were landed about ne miles above Quebec, and the remainder arrived at Montreal. 'he following is an extract from the Exchange Journal, furnished s by R. Armour, Esq , Editor of the Montreal Gazette I" Sunday, June 10 — The Voyageur arrived yesterday evening, ought up 37 cabin and 550 steerage passengers. She had left uebec Thursday evening, but was obliged to return and land •out 200 passengers, from the danger of having too many on board. " A case of Cholera has been reported to have occurred on hoard the Voyageur, but there are no grounds for the rumour. 7 The patient was sick by consumption, long illness, was subject to the gravel, and not accustomed to fatigue. When he embarked, he was sufficiently well to pay for his passage, he took ill and died, it her before arrival here, or shortly after. The widow attributes s death to fatigue and anxiety about getting his things on board, c was not in indigent circumstances. The only symptoms npoaching to those of Cholera, were a slight vomiting and some amps in the feet before death. The patient is reported to have ken a very large quantity of cold water during his illness ." I (The man's name was Kerr, an emigrant from near Belfast, efore he expired, another of the Voyageur's passengers, named lakee, from Cork, was seized with similar symptoms, and in -enty-four hours expired. Dr. Hubertson assured us on Sunday, at is was undoubted Cholera ; and its existence was slated in a >te from the Health Commissioner to the President of the Board ' Health. I The Cholera was announced in the Quebec papers of the 9th having occurred on the Bth at that place I The Montreal Board officially announced the existence of holera in a bulletin issued the 13th. Cases 71, Deaths 23. The ortality of the disease in this city will be found fully detailed in jpendix (O.) I Nearly a month previous to this date, Dr. Wrn Robertson stated us, that he was called to a case which he would have termed siatic Cholera, had that disease then prevailed as an epidemic at ontreal. The following may be briefly stated as the conclusions to which we have arrived, and we are borne out in them by the papers annexed to this report 11. The disease which we saw in Canada is essentially the same th that which has extended over Asia and Europe, and which known under the various names of Cholera Asphyxia, Spasmo;, Malignant, Epidemic, and Asiatic Cholera. 12. The disease has not been imported but has originated in mada under circumstances favorable to its developement and :rease. 3. These circumstances are to be found in the crowded state of the vessels, the sudden change of diet in the 50,000 emigrants annually landed at Quebec, exposure to fatigue, to a burning sun ? or to night qir, the want of requisite clothing, nourishing iuod and chiefly to habits of intemperance. 8 3. The disease always first attacked and carried off, almost to a man, the grossly intemperate. 4. Particular districts seemed exposed peculiarly to the invaion of Cholera, while others escaped in an unaccountable manner. Ye have already alluded to the comparative mortality of the pper and lower towns of Quebec, and to the ravine in the rear of Montreal. We may also refer to the instances of Grosse Isle and 'rois Rivieres, as cases of exemption. 5. Previous to the appearance of Cholera as an epidemic, in very place we visited, cases would occur, which the physicians vould pronounce to be aggravated cases of common Cholera, 'hose who had previously seen the Asiastic Cholera would proounce decidedly their opinion of its identity with that disease ; isputes would arise, and it was only when the disease appeared s an epidemic, that medical opinions became unanimous. 6. We were unable to ascertain whether any particular profeson, trade or occupation gave any peculiar exemption from the isease. It is however in evidence, that the English soldiers in arrison were not so frequently attacked as others ; and when atacked, the mortality was much less than among the civilian!. 'his may however be imputed to various circumstances; for though these soldiers were exposed to many of the exciting auses of the disease, yet they were well clothed and fed, and lien taken ill were immediately attended to: something too, >erhaps, may be attributed to their regular habits, and to the imiate recourse to bleeding. 7. Women and children were less subject to the attacks of this disease, although they were far from being exempt. It was chiefly among the poorer classes of females, whose business necessarily led them to exposure and fatigue, that cholera made its appear- 8. From what has been previously stated, it will appear why the first cases were nearly all fatal. The exhausted and impoverished condition of the patient, the indecision of physicians, the various and contradictory opinions about the nature of the disease, and the tremendous train of symptoms which seemed for a time to baflfle all medicines, were enough of themselves to swell the number of fatal cases. But to our apprehension, much of the mortality might have been diminished, had previous arrangement! been made for the reception and treatment tf the diseaw. 9 t PWe have reason to believe that many persons among the hier classes brought on an attack of cholera, by the itnpru* use of purgatives. Fear, as one of the depressing passions, nit doubt contributed a great share to the invasion of the disamong this class. 10. Many cases of cholera were distinctly to be attributed to the use of fruit! and raw vegetables, and to the drinking of cold or iced water when the body was heated. 111. The various curative means employed in Canada, are ailed to in detail in the appendices attached to this Report. 12. No system of quarantine, devised by the ingenuity of mai or kept up by the selfishness of fear, has succeeded in arresting tl progress of this disease. We would however recommend the p rification of ships, and more especially by cleansing the person and baggage of persons who may appear to be deficient in habi of personal cleanliness. The streets, alleys, cess pools and privie should be well saturated with lime, and the bodies of all persoi who die of this disease, to be interred with as much expedition a propriety will admit. This latter recommendation has been founc to be attended with great benefit, as it diminishes much of tl fear with which a house or a neighborhood is regarded, when on or more fatal cases have occurred there. [With these brief remarks we conclude, trusting that the circuminces under which this Report is drawn up, and to which we ive already alluded, will explain its conciseness, and apologize r its delay. J. E. DE KAY, T, R. RHINELANDER, Julj 5, 1832. > (A.) Tuesday, 19th June, 1832. Dr. Tibbets was called on Monday, 1 8th inst. at 5 P. M. to attend a man lying in a small building on the edge of the Canal. The man was of a spare habit of body, about five feet ten inches high, and about fifty years of age. He left Montreal on the 11th, and had walked from Whitehall to this town, a distance of about fifty miles ; arriving at the latter place on the afternoon of the 17th. inst. On that night, which was the night immediately preceding the invasion of the disease, he slept in a small unventilated shed, about thirteen feet square, with six or seven other emigrants. As regards his general habits, they were irregular; indulging himself in liquor, at the same time depriving himself of proper food. On the 17th, he was seen with a whiskey bottle in his pocket, and his daughter stated, that he would sometimes drink, but that he did not take much. She also stated, that he had had no watm food since the 15th inst.; but had subsisted on gingerbread up to the time of the disease. She also stated, that he arrived in the country on the 16th of May last. When the doctor saw the man, he found him lying on the floor, exhibiting the following symptoms— "skin livid, appearing like that of a plucked wild pigeon, nails blue, skin cold to the hand, but warm to the sense of the patient himself, the pulse was gone, nausea incessant, though there was no vomiting, except once, and that was caused by irritation of the fauces with the finger, diaphoresis profuse, indeed so much so, as to wet all his bed clothes, great precordial distress, anxiety of countenance, inanimate in his motions, suppression of urine, watery alvine discharges, eye sunken, suffused and lustreless, mental powers perfect, thirst great, no bilious discharges, but what there were, were involuntary, and accompanied with little pain, occasionally there was much agitation, and the body exhaled a peculiar odour, 12 '* Treatment. — Hot cordials, as brandy, peppermint water, &c. ; jlankets were wrapped about him. A large dose of calomel and pium was administered, and venoesection was attempted, but 'ith little success, as not more than \\ was obtained. Notithstanding all the means employed, no warmth could be estabislied. 11 Tuesday Morning, \9ih inst. 6 A. M. — The tongue, which as before moist and furred, now became dry and chopped. The >erspi ration had become less copious, but was cold and clammy, he spasms of the lower extremities, now in a measure, subsided, )ut those of the abdomen continued. The articulation remained le same through the whole course of the disease, not being above whisper. The respiration became more laborious, and continued o increase, until death. At 9A. IM. the patient died ; the disease )eing just eighteen hours in its duration." The doctor thinks that he would have considered this to have >een a case of Common Cholera, had he not known that the Asiatic Cholera was then in the country. The patient's daughter stated, i addition, that her father had been subject to cramps in the ower extremities, and that this attack invaded, in a manner, vhich led her to suppose, that it was only a recurrence of the sual cramps. — No sectio cadaveris. Cases by Dr. Fitch, of Fort Miller. Tuesday, 19lh June, 1832. Dr. Fitch was called four or five days since, to see three palents, aged fifty-four, fifty-seven, and fifty-nine years. They lad arrived at Montreal in the Redwing, and while at sea, endured nany hardships, and were put on an allowance of a pint of water ier diem. They all died from eighteen to thirty-six hours after the incuron of the disease, In one case, the discharges were bilious, in vo others they were white. The doctor does not think they were Asiatic Cholera. Persons had free communication with the paents while sick, and no symptoms of Cholera or any other disase, have yet been developed. Fort Ann, Wednesday, 20th June, 1832. We learned from Doctors Pater and Edward, whom we accidentally met on the road, that they had been called a few days ago. to a case iv the neighbourhood, which resembled Cholera, but 13 Ihich they said was not the true Asiatic. The patient was a mail "very intemperate habits, and had been subject to those " turns," id was very frequently " cramped," and when seized, he stated lat " it felt like one of his old attacks." — he died. (B.) Whitehall, Wednesday, June 20, 1832. I The following is a statement of a case which occurred here, tracted from one of the journals : it is a letter From Capt. Lathrop, dated on board Steamboat Phcenix, Lake Champlain t June 15, (Friday.) A Mr. Lamed, of Troy, died on board my boat this day, about 1 o'clock, while lying at Whitehall, and I succeeded in burying lim at half past 12, on the island north of the dock, without the ssistatice of any person from the town, save Doct. Wright, who as truly attentive, and acted the part of a philanthropist : had ie declined giving assistance, as others did, I must alone have >een physician, nurse, and sexton. A council of magistrates at. Whitehall, pronounced the case to be Asiatic Cholera, in its most arming aspect. The streets were consequently deserted, and many of the passengers destined to the Canadas, returned in the jackets. The particulars of this case are as follows : — On Monday, Mr. L. had a cabin passage to St. John's, on his ay to Quebec. On Thursday, I found him at St. John's, with everal others, that left Montreal, so great was the excitement Tu*ed by the cholera. He at first took passage to Burlington, isliing, as he said, to go by land to avoid the cholera. He had eat fears (f the complaint, and talked of it constantly, and arried a phial of preventive. He was a man apparently of issipated habits, and drank to excess on board the boat.— At Turlington, he concluded to go on to Whitehall ; and at about o'clock this morning, was taken with great pain, violent cramping )asms, slight vomiting and purging, also bleeding at the nose. c continued to get worse, and before we arrived at Whitehall, which as at 7i his extremities were quite cold. The passengers thought, id said his sickness was caused by excessive drinking. Dr. W. was t once called, and did not leave him at all. He applied warm übbing, and gave him medicine to assuage the pain ; but all to o effect. Doctois Wright and McLeod pronounced him past all id, when they first saw him. He died at 1 U 14 I The following are the further particulars of this case, as far as uld be ascertained :—: — This mm came on board Thursday, 1 P. M. having left ontreal, Wednesday. — He was not only intemperate in his labits, but was excessively overcome by his feais. —He was also bmieriy subject to cramps and vomiting : and sometimes he irew even blood up from his stomach. — Vomiting ceased about le hour after he was seized with the complaint of which he ied ; and lie had but one stool after 4 A. M. — He had spasms of xtremities, loins and sides, and had drank "nine glasses of n," before Dr. McLeod saw him. I When we saw him, which was about 8 A. M the doctor ministered t i net. opii. 3ss. I There was not then much thirst — there was no blueness, but bleached state of the skin — a peculiar anxious expression of untenance — eyes open, though not observing — pulse perceptible, jugh irregular — great dyspnoea -excessive debility— pain chiefly confined to stomach and bowels. In addition to tr. opii. he employed friction, and other external stimuli. The doctor stated he was in doubt, whether he should call it siatic Cholera. Cases very similar, had occurred in this quarter everal years before ; and was he not aware that the Asiatic holera existed in Montreal, he would not have any idea that it ight be that disease. He also stated, that the diseases of that ction of the country were very malignant, and liable to terminate uldenly. And indeed, Whitehall is flanked nearly on all sides, )y a low marshy soil, where a very large mass of organic matter exposed to the direct influence of the sun, affording every cility to the production of a very virulent miasma. (C.) Burlington, (Vt.) 2Ut June, 1832. Gentlemen, I In compliance with your request, I now proceed to draw } an account of the history of three cases of fatal disease which jvc recently occurred in this town, and which are supposed to ive been cases of Epidemic Cholera ; but as this account is conadictory of the reports issued by our Board of Health, in the 15 timber of cases included, it becomes necessary for me to premise c following statement of the grounds on which those reports 3re made. Our Doard was organized on Saturday the 1 6th instant— there as then much excitement in town On Saturday evening, an rishman by the name of Barlow, a noted drunkard, who had been runk all the week, was found in an out-house, almost lifeless It as supposed by the Physician who was called in, that he was toxicated, (which was probably true ) On Sunday morning, the ttending physician found him pulseless, cold, covered with clammy veat, cramps, sighing, livid, in the possession of his senses &c. and vidently in a hopeless state. While the physician was in the house, is attention was called by Mrs. Harrigan. to a little girl of three ears of age, who had complained of being sick early in the lorning, and had passed worms. At that time the child did not jpear to be in any immediate danger. About 9 o'clock, A. M. Sunday ) the Board of Physicians were assembled at the house. Then I saw these patients for the first time : what follows, is om my own observation.] The man (Barlow) was then in posession of his senses, but presented a truly appalling combination f symptoms— his skin livid, cold — bathed in clammy sweat— (to le touch like a reptile,) extremities as if parboiled — pulseless, xcept in the carotid and femoral arteries — respiration slow — eep sighing — countenance like that of a drowned man, with this mportant exception, viz. — instead of the prominent eyes and eneral bloated appearance, the eyes were sunken and the other features contracted. The child was evidently in articulo mortis — livid— pulseless, except in carotids, and perhaps femorals,) — cold— eyes open, unken, looking straight forward, absolutely insensible to light nd to the touch. At intervals she raised the trunk, resting on ler head and feet, like one in tetanus, and uttering at the same moment a shriek, indicative of intense suffering. This child remained cold, livid, &c. and died before 10 o'clock, A. M. ; not ver five hours after the attack. These bodies were both examined about two hours after death. Circumstances, which need not be detailed here, (and to which now regret that we yielded,) induced us to get through with the examination of the child as soon as possible. Nothing was done, herefore, except to lay open the abdomen and thorax. Every hing appearing well in the thorax, on a superficial view, our atention 16 was confined to the abdomen, where we found the small ntestine and stomach of a pink colour throughout. (I say pink, jecause that word answers my purpose better than any oMier vithin my reach.) Eight volvuli were found in the small intestine, om one to three inches in extent ; the involved portion being losely contracted in many places. Several large worms umbrici,) were found in this intestine. (N. B. No volvulus in he ileocolic region.) The other contents of this intestine were not examined minutely. A fluid like rice water was in the stomch, with something that looked like macerated bread. A similar uid was found in the small intestine. [The great intestine had its natural colour — ccccum and inferior art of right colon distended with gas — transverse arch, inferior art of the sigrnoid flexure and rectum very much contracted. The ier and spleen looked natural externally — gall bladder full. Here le examination ended. On laying open the abdomen of the man, the viscera were all bund in their proper relative positions. They were intensely hot o the feel, (we had no thermometer.) So pungent was this heat, iiat I was led to dip my hands in cold water several times, while landling the intestines. The pink colour was deeper than in the ther case, and extended over the stomach and intestines and leir appendages, as well as over the whole abdominal parietes (not seen on the surface of the liver or spleen. The colour was :epest on the inferior part of the small intestine — less distinct on rge intestine. A slight contraction of the small intestine was en in two or three places. Caput coli distended with flatus— ansverse arch, sigmoid flexure and rectum closely contracted. Every part of the alimentary canal was filled (not distended) vith a fluid like rice-water, or more like whey. (This patient rank whey, but the quantity he took would account for but a mall fraction of all the fluid contents of his alimentary canal.) 'his fluid had a sour and very unpleasant odour, (nauseous^) it was, in lort, the very odour which proceeds from the vomit of a drunken man. The small intestine was covered on its peritoneal surface 3 ith a sort of s»ze which accummulated on my hands to such a degree lat I was obliged to wash it off repeatedly. When two folds of le intestine were brought together, and then gradually separated, lis sizy coating was drawn out in fine filaments, two or three nches long. The same size was found on the peritoneal surface of le walls of the abdomen. 17 When the small intestine was held between the fingers, it felt, as 1 nearly filled with worms; but on cutting into it, we found that n's feeling was produced by the folds of the mucous membrane, valvula conniventes) which were much extended in all directions, nd covered by a cream-like substance, which had a considerable egree of firmness till it was scraped off, then the mass, removed •om the surface of the intestine, had about the consistence of ream. This cream-like coating was found in all parts of the astro intestinal mucous surface, except where the adventitious membrane, spoken of below, was found. The mucous surface of the stomach duodenum, and superior part f the jejunum was lined by an adventitious membrane, so strong, lat pieces half an inch wide and one inch long, could be easily ripped off. With very little pains, this membrane might nquestionably have been taken off entire, from the whole surface f the stomach. When scraped with the scalpel, the sound prouced, was much like that produced by scraping an articular artiUige. The oesophagus showed no traces of diseased action, 'he liver was large, light colored, (a drunkard's liver,) apparently Imost bloodless, except in the great veins. Gall bladder, full, not much distended) and not one drop of bile could be forced nto the intestine. No appearance of bile in the intestines- No nge of bile in any of the neighboring parts. I Spleen, natural. (This organ is so various in different individals, in size, and in appearance? that I do not pretend to know s natural state. Bladder closely contracted, (as is usual in post mort examinations) In the thorax, nothing remarkable was noticed, except that the leart was absolutely bloodless in all its cavities. The lungs vere so extensively adherent to the ribs, (old adhesions) liat but a small part of their surface could be seen. In attempting o break up these adhesions, the lungs were much torn, and no urther examination of them was made. Brain perlectly natural — spinal marrow not examined. In this case, as in the other, we did not go into the examination vith the minuteness necessary to satisfy some of the most interesting nquiries ; but in this case, we were absolutely prevented doing as ye would have done, could we have controlled circumstances. With the facts now stated for our guide, we were called upon hy the Board of Health, to say whether these were or were :j 18 S cases of Cholera. Some of the physicians present were iedly of the opinion, that the report should be Cholera — rs thought we were not justified in making such a report; and i no middle ground could be taken, they moved for the report hi find it. (See report for Sunday evening, 17th June.) It was urged in favor of the report, that, from the circumstances of the case, we were in danger of seeing Cholera where it did not exist — that we were bound to look on these cases as we should have ooked on them, had no fear of Cholera existed in this region — hat, with this in view, we could find, in the history of the man's ife, reason enough why he should die of an acute disease of the limentary canal : — that, in the case of the child, there was vidence of incipient gastro entertis, complicated with intio usception of the small intestines — that the whole assemblage of ymptons was indicative, before death, of intro susception. Pas urged against the report, that the assemblage of symptoms,y mptoms, h cases, indicated cholera ; and that the violence of the oms, especially in the child, was inexplicable, except on the besis of cholera. Then the co-existence of two cases ting such appalling symptoms, was urged against the report. The great force of these objections was admitted, and it was stated, by one who advocated the report, that the symptoms and appearances, did, in truth, excite strong suspicions, that these cases were nothing less than cholera — that should another case occur in the same house, presenting similar phenomena, such evidence would be retrospective in its application, and would inquestionably induce all who advocated the report, to review leir decision and change their opinions. It was urged, that in deciding on these cases, we could not avoid putting at stake, our professional reputations, to some extent, decide as we might. B gentlemen who opposed the report, finally consented to to be adopted without amendment. This statement, as you perceive, includes all that I have to say in relation to two of three cases — you will form your own opinion of the nature of those cases. On the next page, you will find the account, (historical) of all the cases suspected to be cholera, &c. Some facts already stated, will be repeated. An account of the post mortem examination of the third case is appended; 19 On Wednesday the 13th of June, an Irish family arrived from Montreal, and took lodgings in the upper story of a house in Water-street. In this house, were then five families, (including the one just arrived.) The rooms on the lower floor were basement rooms, and were in a filthy condition. A child of about eight years of age, belonging to this family, died on Friday, the 15th instant. No physician was called in. One of the town officers having heard that a death had taken place in the family of an emigrant recently imported, went to the house on Friday, (before the burial) with a view of ascertaining, if possible, the nature of the disease. He found some of the inhabitants of the house apparently indisposed to communicate any knowledge they might have had in relation to the subject and they referred him o the mother of the child. She stated that the child " was taken ick on board the vessel, and was sick with a bowel complaint." 'his was all the information received. On Saturday morning, lis family left the house, and went east. The mother was sick vhcm they reached Montpelier, (forty miles from Burlington) which was on Sunday, at about 5 P. M. She died there that veiling, of cholera, according to the report of the Board of lealth of Montpelier. While this family were tenants in this house, a Mr. Barlow, an rishman, of very intemperate habits, was living with Mr. Harrigan l a room below. Barlow was with Harrigan about one week. Me '-iie told that he (Barlow,) was drunk the whole week, and carcely took food till Saturday, when he ate a little veal. On aturday, between 5 and 6 o'clock, P. M. he was found in an outlouse, and supposed at first to be dead. [N. B. It was evident lat he had begun to adjust his clothes, with the intention of using le stool ; but it is supposed he failed in accomplishing his pur)ose.] He died on Sunday at 1 o'clock, P. M. nineteen hours fter he was found in the out-house. [A child of Harrigan, aged three years, slept in the same room ith Barlow, on a bed contiguous to his, oh Saturday night. This nld was seized at five o'clock on Sunday morning, and died at n o'clock — five hours after the attack. On Monday, at four o'clock in the morning, Mrs. McFarlane, an Irish woman, of very intemperate habits, but who had been sober for several days, an inmate in Harrigan's family, was seized, snd died at nine o'clock, P. M. seventeen hours after the attack 20 Here then we have four cases of death in one house, in rapid succession. Of the symptoms presented by the patient first named, we know nothing. The other three presented the symptoms of the prevailing Epidemic Cholera. Some of the Symptoms, with appearances post mortem, in the case of Mrs. JWcFarlan, Symptom 1st — Coldness The skin, when I first saw this patient, viz. 8 o'clock, A. M. was cold, covered with clammy s\veat 5 &c. As soon as it could be prepaid, about noon, she was put nto a hot air bath, and frictions with dry hot cloths were faithully applied — at the same time laudanum and ammonia were dministered, and a galvanic battery of sixty plates was brought 0 act, first from right hand to left foot, then from right to left land The bath was at 80 deg. Farenheit ; the action of the )attery kept up about twenty minutes. She grew much warmer — her abomen, and all the inferior extremities, except the feet ; oon reached the natural temperature, and did not fall so low as at rst, till after death. It was distinctly noticed that the temperalire was not constant for any considerable length of time in the fternoon ; for example — the left arm and the neck was now icy cold nd in a few minutes quite warm ; then cold again. About G \ M. for the space of a quarter of an hour, the whole of the right de was warm, the left side cold. No difference in external cirumstances existed, to account for this discrepancy. At 6i P. M. 1 parts, except the left arm and the neck, felt warm. A therlometer left in the right axilla for ten minutes, stood at 99 deg. r arenheit ; still, although the body felt warm, it felt cold. There as a sort of contradiction in the sensation, which I have no lanuage to express — all I can say, is, that although the skin felt arm, it seemed to be covered by a cold slime — there was the cling as if of a fish or a frog. This body was examined two nd a half hours after death, and then the temperature was not so ow as it was at 9 A. M. — lower than in the body of Barlow. 12d. Lividity — in all respects as detailed in the case of Barlow, he lips and nails retained most of this livid appearance after it id decreased to its minimum. 3d. Pulse, I could find no pulse in this patient, except in the carotid and femoral (ext. iliac,) arteries, from the time I first saw her, till about 6P. M. ; then I did think, for a few minutes, that I felt some slight pulsation in the radial artery. I opened a vein 21 n the arm, twice ; once about 10 A. M., and again at 6 P. M., not expecting to get blood. A few drachms were drawn, guttatim-— t was bhick, en ma-s», of a rich purple or violet colour when spread on a white earthen vessel, and coagulated, hut imperfectly. 4th. Respiration slow and deep throughout — with sighing. tsth. Sensibility. —Patient was much less sensible to the stimulus f the battery, than 1 was, and I am less affected by it, than lost individuals. 6th. Vomiting and Purging, &c— Vomited and purged early in the morning, a fluid like rice water, (this comparison is certainly very expressive of the appearance of the evacuations,) having a sour nauseous odour, identical with the odour of the contents of Barlow's stomach About 11 o'clock she vomited twice I he same sort of fluid, but mixed with substances just swallowed. Lfter vomiting, she complained of nausea for a few minutes. No tool after I saw her. She said she had passed urine in the bed nee, about noon. 7th. She complained of heat, and of feeling "weak," and of ramp, chiefly in the calves of her legs ; but repeatedly said she id not feel much distressed. Frictions relieved the •' cramp," or the time. There were no very active spasms after I saw her. he complained of heat when her body was coldest ; and full as much before being put into the hot-air-bath, as after. For the ast eight- hours she was disposed to sleep — slept naturally, except lat her respiration was slow and deep. About 6P. M. her sleep eemed more like coma. She became insensible at 8, and died at P. M. [Examination. I was determined to make as minute an examinaon as possible, and was sorry to be obliged to do it by candle ght— certain parts were removed and examined in the morning, /c commenced at 1 1£ o'clock, two hours and a half Post Mort. [Appearance of Body externally. — Eyes a little rolled, up, sunken pupil not much dilated — countenance livid, but not so much so soon after the attack. Limbs livid, firmly contracted. Abdoen warm, (not so warm as Barlow's,) moderately distended. I Internally. — All the organs in place. Whole alimentary canal xcept oesophagus) full, not in uch distended. Some slight conactions in two or three places in small intestine. Transverse eh. Sigmoid flexure and rectum closely contracted. Colour Ink, like Barlow's, but not to the same degree. No change i« 22 olour of oesophagus. This pink colour not visible in the mucous oat, till the cream-like coating was removed. Throughout the tomach and intestines were scattered small linear patches, highly njected, the texture of which was loose. (I cannot describe this ppearance— it is not uncommon, however.) These patches were argest, most abundant, and most highly coloured in those parts, 'here the external surface looked most health)-, so far as colour is oncerned, viz. — in the transverse arch and left lumbar colon, n the rectum and also in the bladder, (which were subsequently xamined by day light, with the aid of a lens,) an appearance was uesented, corresponding very well with the plate and description f Follicular Inflammation, given by Dr. Borner. (See Path. Anat.) In the stomach beside the fluid spoken of in the case of •arlow, we found food absolutely undigested. The whole canal vas filled with fluid, such as has been spoken of. Nothing like bees, nothing like undigested food was found in any part of the ntestines. The caput coli was distended with g^s, having the dour of sulphureted hydrogen, but in all the rest of the canal we bund the same sour, nauseous odour, before alluded to. I The valvular conniventes, as in Barlow ; the same white coating, r mucous surface. But in this case, the cream-like substance ned the whole canal, from cardia to anus — there was no memrane on any part of the mucous surface. Liver, light coloured, enlarged, like Barlow's — gall bladder full, uct closed, as if spasmodically, just at its entrance into the duoenum. It required some considerable force applied to the probe, o overcome this contraction. After the probe was passed, we ould force bile into the intestine, but not before. JNo traces of )ile in any part of intestines ; no tinge on any of the neighbourng parts. Pancreas, kidneys, spleen, all natural. Thorax. — Lungs black all over. This blackness so often seen 1 spots on the lungs, was in this case, extended over the whole urface. In other respects, the lungs appeared perfectly healthy. Vo change in the colour of the mucous membrane of the trachea vas noticeable, but on examination by day light, of the small ivisions, I thought the colour was too high — nothing remarkable, leart empty. Pelvis. — Bladder like the intestines in colour — no coating on its mucous surface. Nothing remarkable about Uterus or Vagina. One Ovary was kiffhlv iniected 23 Brain perfectly natural. When I began, I fully intended to open the spinal column, but by this time it was after two o'clock, and I wa« too much fatigued with the labours of the day and night to dare to proceed any further. The Ganglia of the Sympathetic System in the Thorax and Abdomen, were carefully examined at the time. The Solar Plexus, with all the parts about it, was removed and examined by day light, with the aid of a leus. Ido not know the exact degree of redness which belongs to this part in the healthy human subect, nor can it be known, except by examining bodies of men tilled by violence ; but from what I know of it in brutes, I am lecided'y of opinion that no remarkable change had taken place. The inside of the large arteries and veins was carefully examined, and nothing discovered. I collected a quanlity of the cream-like substance and found it jerfectly soluble in Aqua Ammonia, but strongly coagulated by Vitric Acid. After being dissolved in Ammonia, by the addition of Nitric Acid in excess, it was again coagulated, and assumed a >eautiful lilac colour. I have given a detailed account, and many parts of it will lardly pay you for the reading, but it is possible that you may lid some coincidences between the facts here detailed, and others ollected in Canada and elsewhere, which may give to the most ivial matters a certain degree of interest. This consideration is ie ground of my excuse for going so much into the detail of lese cases I shall add aP. S. containing more definite accounts * the first symptoms and of the treatment, if I can get the acts (from the gentlemen who saw the patients first,) in season, ought not to conceal from j'ou, that the President of our Board, gentleman of extensive practice, and who has spent nearly forty ears in piactice, thinks these cases were not Cholerain any shape ; ith this exception, I speak the opinion of the Physicians of this oard, in pronouncing them all three cases of Cholera. But if c are to take the names of diseases according to their etymolocal import, I should sooner say any thing almost, than Cholera, I mean is, that these cases were, unquestionably, specimens 1 the worst form of that prevailing Empidemic called Cholera, f one thing I am certain, viz : 1 have never seen disease prenting so formidable an array of symptoms before. Most respectfully yours, BEN. LINCOLN, M. 1). 24 Addenda. I learn that Barlow had no purging, and vomited nit once or twice. Mrs. Me Farlan vomited and purged freely n the morning, for a short time. The child vomited freely at irst, and ''went out," as the mother says, twice, whether she pased anything but some worms, does not appear. Calomel and Opium was administered to all at first. Brandy and water and vine whey, to Barlow and the woman. IN. B. I did not consider the contraction of transverse arch, gmoid flexure and rectum, as the result of any morbid action. Je often see these parts contracted, especially when there are no cal matters present. IQuere. — Was the sizy coating or peritoneal surface of intesnesj &c. in the case of Barlow, the result of nrlh'sive inflamaon ? or rather would there have been extensive adhesions, had c lived long enough ? Was the cream-like coating of the uicous surface, an adventitious membrane in its formative stage ? (¦>.) We learned from Dr. Buckley, a very intelligent physician of t. John's, that there had occurred two hundred cases there which >assed under the name of Cholera ; but that in reality there had )een not more than twenty which were fully characterized as siatir Cholera, and that of those, only seven died. On our reuriK which was a week after our first interview with this gentlenan, it was ascertained that the total number of deaths by this isease, had been twelve. He does not think the disease at all ontagious, but dependent on some atmospheric quality. As one mong many proofs, he cited the case of a woman residing about ght or ten miles from the town, who had had no communication ith any emigrant, who had not come to the town for a month )ack, and who was not aware that such a disease prevailed in the eighborhood ; she was attacked with the true Asiatic Cholera nd died. He was in the habit of administering pul. opii gr. iv, >rot. chlor. hydr grij quaqua hora, afterwards increasing the inerval and diminishing the dose pro re nata. He always bled nd did not even hesitate bleeding, when the pulse was impercepti)le ; the chief difficulty he found was in getting the blood to flow ; le stated that what he got which varied from to oij was black, like molasses," and flowed with great difficulty ; but that very 25 frequently, the pulse rose, and animation and heat returned to he system. (E.) Section I. — Cholera is endemic in Lower Canada, from the month of June to the end of August. Now and then, before and fter the time stated, sporadic cases occur, but always of a mild ype. The cases that occur from the end of June to the end of uly, are generally severe ; and, should a thunder shower succeed o a hot day, the cases generally will be as malignant as any of the vorst cases of cholera that ever occurred, be the name what it nay, Asiatic, or even that of a more remote country, and onsequently more imposing. There is one peculiar fact bservable in our endemic cholera, namely, the severe cases are ever to be found elsewhere than among the poor labouring class. have known, in former years, persons of the class mentioned, ie of cholera, having every mark and symptom of the severest Asiatic) cholera, in the space of four hours. Section II. — It is worthy of remark, that every species of isease, for many months past, wore an aspect different from its aturul character, and this abberration from the regular type, ontinued gradually to increase as we approached the coming of ummer. Every case of Catarrh, since November onwards, was nore lingering ; every case of Pleuritis run into the typhoid state ; lere were no cases of pure interitis, the disease was typhus fever, mall pox was irregular in its periods ; during spring and the vinter, every case of measles has been irregular, not running its (bases with the wonted regularity of that disease. The irruption ias come and disappeared alternately for a space of twenty days; ow, it simulated scarlatina, now ogam, roseola ; some times, but arely, uticaria preceded, by three days the more regular disease /c have seen the same case alternate, from one of the before lentioned diseases to another, and finally terminate in Cynanche Vlaligna; in the same family, at the same time, children of ifferent temperaments, but of the same parents, have been all 1 ; the disease of one simulating measles, of another mild carlatina, o!" a third, the worst species of Cynanche Maligna, )ut scarcely accompanied by the usual efflorescence of that isease; during the first weeks of April, infantile diarrhoea, a isease of the warm month;, was commonly to be met with : about 1 26 the middle of .April, cholera (a fact unobserved in former years, among the poor broke out and prevailed partially for a period of tght or ten days. Many cases were mild, but some were severe y id one or two were malignant. Another peculiarity, perhaps not altogether irrelevant, may be iere mentioned, Paronychia is an endemic disease in Lower Canada, from the months of April to July, though cases occur joradically throughout the year. Of this disease, but very few ases have been met with ; and of charbon, not half a dozen cases 1 all. I Such a variation in the natural constitution of man, and a' inter remarkable for severity and long duration of the same eather, were the premonitors of what we were doomed to suffer, > soon as the usual period for endemic cholera should arrive. Section III — About the first of June, diarrhoea became a ommon feature in every disease; and about the same time, a few ild cases of cholera sprung up, and one severe case in St, Louis üburb. As yet there was no alarm, because all was well at rosse Isle. These were merely the precursors of the storm about o assail us. On Saturday, June 9th, au emigrant passenger, on >oard the Voyageur steamer was taken ill of cholera, and died anding the same evening. On Sunday morning, another emigrant jassenger, from on board the Voyageur also, after an evening " dissipation, was taken with spasmodic cholera, and died the cxi day. That same night, (Saturday to Sunday) several natives ere taken dangerously ill, in Campeau street, St. Louis-street, anguinette street, and St. Catherine street. The persons so ttacked were all natives, and had had no intercourse with the )ort, nor even among themselves. Most of these persons died vithin twenty four hours. The disease now rapidly and fatally )read, mostly in the remote ports of the suburbs, and first among ie natives, gradually encroaching on the town, and towards the ecline of the scourge, attacking emigrants in greater numbers iian at the first, (most of these emigrants had resided for a year r more in the town.) The disease now seized on the more veaitiiy population ; nor could we perceive any difference in its e verity between these and the lower orders. Few persons below the age of twenty-five, compared with the great number who had passed that period of life, were subject ta the disease. 27 Section IV. Much may be said in favour of the idea, that thfe ¦disease is contagious, seeing that it has gradually overrun the east, following the route of great rivers, &c. to the most western confines of Europe; but certainly there are many and strong facts against that opinion. — In Montreal, without a shadow of doubt, the disease existed before we had any intercourse with an infected country. See the Mineive for April .] Several cases broke out in the early part of April ; after which the disease disappeared, and again woke out in a mild form about the first of June, (eight days before he arrival of the Voyageur,) in quarters of the suburbs to the east and north of the town, among natives who had little or no ntercourse with the poit After being more or less confined to he quarters mentioned, it gradually extended in every direction, jut to the town last, and, with the exception of the case on the Oth, to the parts of the town bordering on the port the very last. The disease, in its rage, after ravaging in a signal manner the >oor, extended to all classes, attacking alike those few who had uffered absolute exclusion, and sparing thousands of those onstantly exposed to its fury. A few medical men suffered from, nd one student died of the disease : but the greater number had )een rendered susceptible from over exertion and consequent xhaustion. The clergy, to the number of about thirty persons — nremitting in the zeal of their calling, carrying spiritual succour o all quarters, at all hours, with as much devotedness to the most bject and filthy as to the more wealthy friend, — to a man escaped. Also, the persons in charge of the two cholera hospitals, where were carried the worst cases, the expiring, and many dead,— all scaped. The carters too, — constantly employed to carry the fleeted to the depots, and the numerous dead to the cemeteries, — 11 escaped. Yet it must not be concealed, that where one person ied, another case was likely to occur ; but this was far from being niversal, rather the reverse was the fact. tit would appear as if our usual endemic had been hastened n us ; after which it became augmented by the terrific epidemic, milar to itself, which is now gradually blasting the world. Sf.ction V. — Mode of attack. During the first four or five ays of the epidemic, the patient was subject for the most )art to be attacked in one of the two following modes, Fi;sr, fter a trifling diarrhoea, of several da\s duration to a li w ours only, nausea, quickly followed by vomiting, and an increase, f diarrhoea, would usher him into that, stage of the disease 28 Ilich may be called the second mode of attack. Second, the tient is affected with a slight blueishness of hands and face » metime accompanied by a distressing sensation of weight and irning in the stomach, rapidly followed by vomiting and. arrhoea ; when the vomiting had once come on, the thirst would mmence and be intolerable ; cramps in the limbs and about the cecordia ; bluencss quickly extending towards the trunk; ofuse cold perspiration (if perspiration it be) and loss of voice, he severer cases would terminate in death, in a period from ree to six hours, vvbile some might run on to twelve or more. I After the first four or five days, the mode of attack was not so variable, for while burning thirst, pain at the stomach, cramps, phyxia, perspiration, cadaverous coldness, and aphonia, laracterised the malady, vomiting and purging might be >sent, and yet the case would rapidly run to a fatal rrni nation. About this time and still later, many cases assumed a febrile character, the first pyrexial period of which might be called the choleric stage. But as the danger resides in this choleric stage, and the recovery of the patient wholly depended on arresting some one two of the symptoms, it will be proper in order to found a rational mode of treatment, to analyze these latter. Section VI. — However, before taking up that subject, let us op a moment to examine the matter voided The matter omited, was at first what happened to be in the stomach, after lat it was watery. The alvine discharges were without odour, 1 large quantities, whitish, like rice water or a mixture of •row-root and water, this white substance has been ascertained to )e fibrin. Perspiration abundant, cold, and slightly adhesive as ' mixed with dissolved epidermis— doubtless it also contained brin ; but this last fact has not been decided. Beside the intestinal canal and the skin, all other organs furnished no secretion. Tears, pituita, saliva, and urine, the secretion of which is totally suspended, as to tears, the greatest; anguish of dying in full possession of the intellect, surrounded at at once by all that is endearing and afflicting could not produce them. Some complained of great pain and desire to make water, but the bladder contained no urine, and after death was found to be contracted to the smallest size ; this desire of voiding water might arise from the contraction of the posterior disk of 29 the bladder hard against the internal meatus, which on autopsy was found to be the fact. In this disease, there is reason to believe that every species of srcretinn, in ma. parts of the body is abolished No known function of the intestinal mucous membrane, could form matter like unto that discharged, and as there is no circulation going on in the skin, but. rather a complete state of asphyxia in that part, there can be no secretion of perspiration. We now naturally come to the question — W hence and how come these discharges ? On the skin, certainly not from circulation, for there, there is none — ex nihilo nihil fit: and it is more lan probable, that the capillary circulation of the mucous membrane of the intestines, is equally absent It would appear s if the elements of the body composing the parts nearest to the urfaces, became subject to new affinities, forming new substances icapable of being retained by the membranes, but rapidly* oozing iroughthem. Two facts goto support such an hypothesis— first, 'he abundant new formation transuded, where no circulation xists ; and second, the rapid amaigrissement of the body. This asting of the body is not apparent, it is real; the usual roundness f parts are taken off, and tendons and other salient points become nkingly prominent. (If one were permitted to indulge in speculation, it might no;: )e unworthy to notice an hypothesis of the imaginative Darwin, )y which he erroneously attempted to explain the formation of ropsies He said it was a retrogade motion of the absorbents Hit gave out these collections. Though this assertion is a manifest rror it is no less an error to deny that the absorbents are not, nder cenain circumstances, subject to an inverted action. The European physiologists, with the learned Mekel at their head, deny ie fact. But how easy of proof — whence comes the overwhelming erspiration in Syncope? at a time when circulation, from which is to come, is suspended, And by analogy, is not the intestinal anal, in its wh jle length, from the oesophagus to the sigmoid flexure f the colon subject to have its peristaltic motion inverted ? win len not tiie absorbents.) Section VII. — Treatment, First Symptom. The principal nedium through which remedial means can be applied, is the tomach We are therefore compelled to look to this organ first ; nd, as no remedy ran be of service there unless it be retained, ye must before all -.ther things arrest the vomiting, if there be any, nd suffer the stomach to become perfectly calm before any other 30 medicine or substance be introduced, lest, by so doing, we arouse the evil just subdued. As relates to the stomach, there are two distinct stages in the disease, and on a just appreciation of these, will the success of the practitioner depend. The first is the vomiting, the second is the stage of collapse, or sinking, when all vomiting shall have ceased. Now, as the only known means, i) this disease and many others, is to paralyse the stomach ; we nust carefully bear in mind, while prescribing for the first, not to overdo the thing, lest when we require the energies of the stomach in the second stage, we find them irrevocably lost in a collapse, which is joined to the common sinking of all parts of the body into death, (the sensorium excepted.) Here resides the first and greatest secret in prescribing for a cholera patient ; and which, to the unobserving multitude, has occasioned so much apparant discrepancy in the treatment of different practitioners. In the first stage the most sedative treatment is essential; while, in the second, the very opposite, that of excitation. I How to paralyse the stomach; and consequently to arrest the omiting. Three very particular circumstances are to be borne in lind — first the remedy, second, how to be administered, third, omportment of the patient. After all that has been said, it will c found that every practitioner, from the Ganges to the Vistu'a, as been forced, whatever his preconceived notions may have sen, to look to opium as his Anchor of Hope : but it is to be reretted, that a remedy so good, so perlect, from mal administration lould have been turned into a two edged sword, at once curing id killing the patient. Opium has been given in every form id in various combinations ; this last is the error, as the patholoical state of the stomach will readily account for There is such i inordinate sensativeness at this stage in this organ, that it ill not suffer scarcely the smallest bulk of any substance ; how judicious then, to augment the size of the remedy, by the addion of medicated waters, in themselves useless ; and how much uore unscientific to add a stimulant to your sedative, when the atter effect is the object of the prescription. Let the remedy len be a sedative, and not a stimulant; give opium, and let the ose be concentrated to the smallest size ; give one grain of solid )ium, it must be swallowed dry ; if that be rejected, give a cond, and so on to a third ; it will, rarely happen, if the third circumstance be observed, that a fourth dose shall be required. One grain of opium is so small a body, that the stomach can 31 easily bear if, while the same remedy, given id form of a draught from size alone snail be injurious. 3d. The patient is naturally restless, and any motion of the body is more 01 less communicated to the stomach, and it has been observed times out of number, that the mere turning round of the patient has so acted on the stomach as to set it again in operation. Motion of the body may act on the abdominal surface of the stomach, so as to affect the internal with a sensation of foreign substance, and thus account for the effect. To sum up, for the vomiting stage, uive one grain of opium, and give it dry : give nothing else till all vomiting shall have ceased for several hours, and keep the patient in the most quiescent state possible. During 1 all this time the patient suffers intolerable thirst ; this he must >ear with. Drink will be returned almost before it reach the tomach, and cannot relieve the symptom for which it was given, whilst it gives the patient one more dreadful convulsion, each of vhich hurries him to his end with a tenfold degree of velocity. Sear in mind, that one grain of opium is as effectual in arresting he irritability of the stomach as 'en grains, while the latter dose would not only do the same, but also paralyze the stomach beyond he term of resuscitation. — This abuse of opium too frequently occurred in Montreal. Second Stage. — All is now quiet, and now is the time to give timuli. Small doses of warm brandy, warm punch, aether, or ammonia ; but be careful to choose such as are palatable to the )atient. The second symptom to be analyzed is the asphyxiated; tate of the extreme parts of the body, and also the apoplectic tate, as the French call it, of the more central viscera. This asphyxia is known, as the term implies by the cessation of circulation, and blueness and coldness of the surface. Fortunately it is not difficult to appreciate the indication, though one may not be so sure of its success. The cause is perhaps internal, but unknown : >ut the wet state of the surface, by evaporation, contributes more rapidly to cool down to the term of death. While you are calmng the stomach, take also in charge this last symptom, and treat t thus : — Dry the suiface of the body by napkins, and then still urther dry it, by rubbing the patient over with powdered chalk j and by previously heating the chalk, you will render it doubly useful. For this purpose, chalk was recommended by a gentleman of Quebec* If chalk cannot be had, the best article as a 32 substitute is flour ; but be careful in heating it not lo suffer it to j;row brown, lest by the change of colour, its intransmissibility if caloric be diminished. By fomentations and moist heat, we ire undoing with one hand, what we are attempting with the other. Moist heat i» in the very teeth of natural philosophy; and le who uses it, publishes his deficiency in the collateral branches of his profession. 3d. The third symptom is spasm. In attending to the two ftrtt, as is recommended, we do all that is requisite for the third. Opium, as an antisposmodic, and frictions. All other remaining symptoms are unworthy of notice in this hasty sketch. They are mere concomitants or sequels of the former, and require to be proscribed pro re nata. Should the disease set in in the second stage, of course stimulating emedies are to be given at once ; nor should drink in small quanities be refused, but be given in proportion to the capacity of the tomach ; and for this purpose, the best I have found are small uses of coffee, and a dilute infusion of Colombo. I Should the case run into lever, the indications are prominent nd speak for themselves. (F.) Montreal, Friday, 22dJune, 1832. Drs. Baubier and Vallee called in the afternoon, and volunteered o show us some cases of cholera ; accordingly, we proceeded first o P Hotel D ; eu, (an excellent establishment, the more immediate ttendants being the Sitters of Charity.) There we saw several ases, but they had arrived at that stage of the disease, in which le blueness had disappeared, as also the spasms. Afterwards, we aw with them a woman, about an hour before the fatal termination ; lere was then no pulse — cold extremities— and a purplish blueness >oth in the face and limbs — she had spasms clonic of the muses, of the dorsal muscles, but very little of the extremities. With those gentlemen we also saw several other cases. They think that the pathognomonic symptom is the blueness, as it is called ; but it is rather a mahogany violet. Dr. B. divides the disease into three stages. Ist. That previous to the accession of the spasms. 2d. To the termination of the spasms. 3d. To death or recovery. The leading indication, he says, is to promaximum 33 quantity, be says, is gr.ij. For a stimulating application,! heard him prescribe brandy, one pint — vinegar, half pint mustard, two table spoons full, and pepper, one table spoon full : hese are to be boiled for a few moments, and then industriously rub>ed over the abdomen and extremities, placing also bottles of hot vater to the feet and hands. They are of opinion that the disease s non-contagious. Dr. Caldwell, who was just convalescing from an attack of the cholera, called on us. He stated that every body within the circle of his knowledge, has experienced the effect of he epidemic influence in some way or other. They all feel a ensation of heaviness, oppression and malaise about the prsecordia, with slight colicky pains, or want of appetite, constipation or ooseness of the bowels. Here he prescribes with remarkable )enefit, pil. hydrar, gr.xv. followed in a few hours by tartras )otasae 31J every two hours. This, he says, acts with great efficay n warding off the choleric symptoms, which would othervise supervene. He lauds particularly this salt, and ascribes much of the success which he has had, to its use. He says, that, a connexion with the blue pill, brings away an astonishing quality of fecal matter of great fetor. He also stated that he did not nd much advantage from any treatment, when the disease was nequivocally formed. He also says, the disease chiefly attacks n the night, and towards morning. He cautions particularly gainst the encouragement of the perspiration, as he thinks the yslem very frequently succumbs under that evacuation. The nost characteristic symptom, in his opinion, is the blueness. He lowever speaks in no unmeasured terms, in favor of the contagiusness of the disease. In this particular, he is an exception to very other medical man that we have yet seen, who has had any xperience in this malady. Dr. Caldwell deservedly ranks very ligh in his profession, but unfortunately for his experience in this )oint, he was unable, from an attack of the cholera, to attend to is duties during the greater part of the epidemic. According to appointment, we went with Dr. Baubier to make post mortem examination. We went to the " Emigrant Sheds," which is a building appropriated to the sick of that class : there we saw some thirty-five or forty patients lying on straw, and ex»osed indiscriminately to the open windows and doors.— -Men, #omen and children ; the convalescent, dying, and the dead laid n an irregular line along the sides of the building. Only one 34 >atient was vomiting when we entered, and this was accompanied with dejections The substance voided both per anum and mouth was the same ; it was very similar to the first washings of )loody meat, and at each time pain was the concomitant. She was also blue, and had had spasms. We then performed an autopsia, which was done in the open air. The following are the particulars :—: — The man's name was John Robinson, he had recently arrived from New Castle, Eng., and had served as a sailor on board. Just tne week had elapsed from the day of his admission He entered ie hospital with the symptoms of Asiatic Cholera As regards his general appearance, he was pale and extanpuineous, except at the extremities, from the fingers and toes to half way Uj» the fore arm and leg. Lungs healthy —heart much contracted, the left side felt firm and resistant of pressure, the right was more flaccid, but still contracted ; little or no blood was in ithe? of the cavities of that organ, and none in either of the large essels opening into it There was no liquor pericardii. The muscular structure of the heart was darker than natural. The tomach was much contracted ; its mucous membrane was rather ess adherent than proper, and the rugss of the stomach were inected, particularly at the cardiac end. The whole of the gastro mucous membrane, exhibited a phlogosed state. The spleen and ridnies were both congested with blood, otherwise they appeared atural ; except that they, as well as the liver, were softened in exture. The liver was completely and wonderfully gorged, so much so, that upon an incision being made into its substance, the >lood appeared almost to stream from every pore, and the blade of the knife was in a measure concealed by the gush of blood. The gall bladder was much distended with thick black bile — the omentum was vascular and free from fat. The intestines presented an appearance of slight, darkish phlogosis Commencing about six inches from the ccecum and proceeding towards the sto- Each for about two feet in its course, the cleon presented a pecuarly dark, apparently gangerous aspect ; and the convolutions of ie intestines were adherent by a recently formed membrane, but hich was easily overcome The internal surface of this part of ie intestine was much inflamed, and the mucous membrane was isily abraded. I All the small intestines were contracted, and the large ones so uch so, as scarcely to admit a goose quill ; containing in lieu of 35 Eces, a mahogany coloured fluid, very small in quantity. The :treme edges of the valvulse conniventes were much injected, he bladder was empty — the blood was black and thick, no mat' r from what part of the body it flowed. Saturday, June 23, 1832. In the afternoon we called on Dr. William Robertson, a gentleman and \ scholar : he showed us a barometrical and thermomerical table, as also the prevailing winds and diseases for the last bur years. From these it appears, the season has been very backward. The prevailing winds are from the south west. The diseases last winter and spring, have consisted of the exanthemata, nd more particularly typhus. The latter disease and fevers of lat character, had prevailed to an alarming and unusual extent n this city. He states that the cholera is curable in more than, me cases out of ten, if taken in hand in its premonitory stage. Sven those which are the most sudden cases, where the patient rops down, as though struck by an electric shock, you will always nd upon enquiry, he says, that there has been a previous state of isease. He then related his own case, which was as follows :—: — fe stated that he was called from bed one night, and as he wasr jutting on his pantaloons, he felt a sense of burning constriction round the diaphragm, as though (to use his own comparison,) a ord of twisted flannel, wrung out of scalding water, had been. oinid about the diaphragm. He at first attributed the sensation o the tightness of his drawers, seeing that he felt in perfect health he moment he put his foot out of bed : he loosened his under lothes, but found no relief; becoming alarmed upon this, he ook a pill composed of pul. opii grj. pul. carnph. prot. chlor. hydr a grij and jumped again into bed, covering himself up warm. In tie course of an hour or two, this sensation disappeared. He rose next morning, rather languid, but still able to go out. While making his visits, he was seized with cramps of the gastrocnemii : le took what he happened to have in his pocket, pul. opii grj. mmediately drove home, went to bed, and remained there a day or two, until he completely recovered. He states that most cholerics experience some premonitory ensations similar to these ; and that it is during this stage, and he almost said this stage alone, that any good can be done. He exerted all his eloquence to impress on our minds, this important advice ; to the neglect of which, he says, is ottribable much of th* 36 atality which lias attended this disease, \\z :— That when you are called to a man who is said to be very ill, almost dying; and when at the same time, you ore also called to a man who is slightly complaining, you should go to the latter rather than to the former. Ie has made some autopsies ; but he states that there is no appearance which is constantly present in every case. He also gives opium, but it is in small quantities : when there is vomiting, ie prefers the extract, when not, he gives The tincture: for the pasms, he prefers dry heat, as hot sand, hot flannels, &c and not rictions, because they expose the patient to the open air. He, in ccordance with the other medical men, recommends strict bstinence in eating and drinking during this disease. In the iarrhoea, which frequently is a sequel of the cholera, he, ii> reference to calomel or opium, administers the mix. cret. comp. urn. opio. and, he states, with the most marked benefit. He also tated tome, that near a month previous to the appearance of the holera as an epidemic, he was called to a case which he would lave denominated " Asiatic Cholera," were the disease then >revailing. I Dr. Stephenson referred to the following communication for hi? eas with regard to the pestilence : — he entitles his paper Observations on the symptoms, pathology, and treatment of the prevailing epidemic, called Asiatic Cholera. I have seen a very great number of patients labouring under lis disease in its different stages ; and from what 1 have observed uring the progress of the symptoms, and upon dissections after eath, T am convinced that it is a disease of congestion of the viscera, jarticularly those of the abdomen, pelvis, and head I found, upon issection, that the vessel of the nerves of the spinal marrow were orged with blood, not from over-action, but from want of the power f circulation. The mesentery., and all the vessels of the abdomen nd pelvis, were as if dyed with venous blood — the arteries iroughout were much contracted and empty — the surface of the )ody presented a great want of vascular action, as denoted by the 010i 1 and the state of the vessels, this being a necessary consequence n the internal disease. It must not, however be forgotten that le practitioner has to contend with the violent symptoms of aolera, as vomiting, purging and spasms, denoting a great. I /> • -r^ 111 -IT erangement m t lie functions. From what I have said, I conceivr 37 it absolutely necessary for the practitioner, to consider as vitally important the removal of the congestion, while treating the other symptoms connected with cholera. Having given what I consider as the proximate cause of the disease, the next question which iresents itself, is the remote or primary cause of the disease; although my present limits will not permit me to enter upon this übject, yet I cannot disaiiss it without saying that I do consider the disease as epidemic, not contagious. Its attacks are not uniform, or by the same precursory symptoms. n some cases, the first symptom is a discharge by stool of pale luid, resembling dirty water or water gruel. Sometimes the ischarge is clear water, tinged with brown flocculi. These cases are often fatal, because the patients are not alarmed by this ymptom, and frequently send for medical aid when too late. In ome cases the disease is ushered in by a sense of fainting, eferred to the pit of the stomach, and rapidly overpowering the vhole system. In other cases, spasms of the muscles of different rarts of the body, as the extremities, diaphram, &c. are the first warnings of the disease. Again we find the patient suddenly eizt j d with vomiting, more or less violent. In some other cases, 11 the above detailed symptoms attack the unfortunate victim, and jive rise to a very rapid course of disease. In the consideration f the treatment which I recommend, and which I have found minently successful, I shall be as concise as possible, because of ie great pressure of professional duty, and because I intend pubishing at some length, my opinion of the prevailing epidemic. Having been very successful in my treatment of congestive yphus during several years, I have, as far as possible, employed ie same treatment for the present epidemic, bearing in mind the ymptoms of Cholera already spoken of, which require some modification of the treatment ; therefore bleeding (so very beneficial 1 congestive typhus) is a dangerous remedy in this disease, because I" the great and rapid exhaustion of the powers of the system by ie aforesaid choleric symptoms ; yet lam inclined to believe that ceding, within the first fifteen minutes, might be of service. fy trials of the practice, in the present disease, do not not warrant ne to continue it, not having opportunities to resort to it so soon as night be necessary. I have found in congestive typhus, it is of vital mportance to equalize the general circulation, and in furthering iis end, I have derived very great advantage from the internal use ' nitrortQ ( i t lif r snfl t i net it rp of* n^iff'ptirffl in f*r>n sidprsHlo closp? 38 and keeping up the heat of the surface by sinapisms, blisters and dry heat — taking care not to carry these measures too far, because of the injurious effects thus produced, as very frequently seen in the employment of the hot air bath of the late Dr. Armstrong. When the equilibrium of the circulation has be^n established, I have given limited doses of alteratives to re-establish the functions of secretion, keeping in view the analogy between congestive cholera and congestive typhus. I have administered nitrous ether and assafoetida tincture, each a drachm, every hour if the stomach would bear it, until the patient felt better. But as there is frequently an irritability of the stomach, I have often omitted the assafaetida. By this treatment, I have roused the internal circulation and general nervous energy If vomiting were present, I have added to the ether half a drachm of laudanum, ot a grain and a half of opium : the latter I prefer, because of the smallness of volume — subsequently a less dose of ether every hour, as long as the symptoms require its continuance, and the opium pro re nata, — as soon as I possibly can, J interrupt the use of the opium, and generally, two or three grains suffice. While Iliese measures are employed, the external heat is to be raised to nd kept at the healthy standard, by the application of dry lankets, hot bricks, or bottles of warm water applied to the arface. If the first symptom be purging, as above mentioned, (a symptom vhich may continue for several hours, or even days before the Kttient be alarmed,) then ether is to bo used ; and repeated dose? f chalk and opium will arrest the discharge, taking special care itit the patient remain in the recumbent position, and abstain 'rom all solid or fluid ingesta. I have frequently allowed, with dvantage, a small quantity of port wine and water, or brandy and ater, every half hour — if I could depend on the patienr. not taking more — but 1 have frequently found them trespassing in such cases r nd producing dreadful consequences. I have also found benefit rom half a glass of brandy, administered with the first dose of ther, to assist in exciting the internal circulation. When the isease inak-s its attack by any of the other symptoms spoken of, have resorted to the ether, opium, assaioetida and recumbent >osition with external heat, pro re nata. If there be much distress mxluced by spasms, frictions over the coverings are of service— tthe patient must not be exposed, because of the injurious :t thus produced. 39 When the symptoms of the disease have been subdued, it then becomes necessary to restore the functions of the system to the healthy state. Sometimes after the attack, looseness will continue — I have, in such cases, derived marked advantage from the recumbent position, the use of chalk, as spoken of above, and alternated with some of the blue pill and rhubarb. Sometimes constipation supervenes, — a much less troublesome symptom ; in such cases, I have given two or three cathartic pills, composed of colocynth, jalap and submurias hydrargyri, repeated every three or bur hours until thejbowels were moderately moved, either alternating or following up with five or six grains of blue mass and rhubarb, to produce a healthy secretion. It is proper to state, that I have used as an auxiliary to assist in checking the frequent discharge rom the bowels, injections of laudanum and starch every hour, sometimes with, and sometimes without apparent benefit. In fine, by the foregoing treatment, I have saved every case of cholera to which I have been called, toithin one hour after the attack j when no collateral circumstances have baffled my efforts, such as much cold fluid taken, cold water and vinegar, cider, the nostrums of apothecaries; and when the patients have closely adhered to my directions. I believe several medical gentlemen of this city have adopted the same general pathological principles of the disease, although, as is quite consistent, the means may be modified by different practitioners. J. STEPHENSON, M D. Professor of Surgery and Anatomy, in the University of M'Gill College, and, for the past ten years, one of the Physicians of the Montreal General Hospital. P. S. — I have found benefit to the patient, after the symptoms lave subsided, by allowing a tea spoonful of very strong coffee, or very strong tea, without milk, to be taken every half hour, and, after a short time, a similar quantity of good beef tea (bouillon) to gradually restore the tone of the stomach. J. S. To the Editor of the Montreal Gazette. Sir, — You are welcome to make use of the following communication, being the result of unfortunately too extensive experience. We conceive it our duty, (now that we feel grounded,) to publish the method, that we have adopted, for arresting the 40 scourge that has desolated our city lately j and which, .through the medium of your paper, may be the means of affording a enow lodge to the world at large, of that plan of treatment that las been so successful in our hands. To those who know us we need not bring any other proof than our own assertion, but as it may reach places where it would retire some authentic corroboration, we shall subjoin Dr. Holmes', )r. Caldwell's, and Dr. iNelson's voluntary attestations — which efleot as much honour on these gentlemen for their candour, as hey are creditable and gratifying to us. II have been trying your remedy, and have already found it eneficia! by several reports. A. F. HOLMES, M. D. II consider the practice the most rational that has yet been dopted, and would most earnestly recommend it. W. C ALDWELL, M. D. II feel it a duty I owe to Dr. Arnoldi, and to the public, to say, iat I experienced great relief from the advice of Dr. A. in the cipient stage of the Cholera, of which disease I was affected, am satisfied that his opinion on Cholera, and his practice in the me disease, are highly scientific. ROBERT NELSON. I Having now so many data to go by of the efficacy of our ractice, in this most direful disease, (Cholera,) and knowing that c mernhers of the medical profession are not agreed upon a :cided or uniform mode of treatment, we take the liberty of mouncing to the public, through the medium of your types, that ir practice consists in ordering a total abstinence from all [uids, (and solids of course) from the moment the person feels mself under the influence of any symptom threatening Cholera, r which sufficient time is gained to obtain proper medical advice, nr prescription is simply one pill, containing one grain of fresh lium and seven of calomel, which is to be swallowed dry, with* t the aid of any liquid, if possible. The use of all beverages, ; then insist upon being most strictly abstained from, until every mptom has subsided, and something like hunger has returned, few instances have we had occasion to repeat the pill, unless 41 rfie patient's stomach did not retain the first, (and which was inifortnly occasioned by the fluids present in the stomach at the ime,) and in the course of a few hours, we generally followed up )y an ounce of epsom salts, dissolved in half a pint of water, and a wine-glass full taken every hour. The subsequent treatment r aried according to the peculiarities of the case, and could be egulated by the judgment of any practitioner, keeping strictly n mind the yet remaining irritability of the stomach as to fluids. Our exertions have been too frequently paralysed by the absurd nactice of taking laudanum or opium pills previous to sending or advice. The peculiarity of our plan, and to which we ascribe our whole success, consists in obtaining the arrest of the urgent ymptoms by the least possible dose of opium, and absolutely doing nothing. The plan is too simple to be generally credited, jut hundreds have experienced the efficacy of it ; and we would trongly recommend, at least, the first trial to every medical man. The plan of sweating the patient we have had too frequent occasion to lament and discountenance, but we nevertheless do every thing in our power to restore heat to the extremities, by the application of bottles of b< iling water, hot bricks, &c &c. in the usual manler ; frictions with hot dry flannels, (sometimes in desperate cases, sprinkled over with mustard.) In short, dry heat in any manner whatever, and this we find most speedily successful when the body tself is but slightly covered. The spasms are best relieved by (eeping the patient in one posture, the slightest motion being apt o induce them We candidly acknowledge that when the blue stage, copious sweats, and cold extremities have set in, before nedical aid is called for, we consider the case hopeless; but even under the most appalling circumstances, the perseverance in the above injunctions has occasionally been attended by favourable esulls. Our injunctions therefore, are, that no medicine be kept in the possession of any individual lor the purpose of being taken s either as a precautionary step, or before calling in medical aid. That no person feeling indisposed take medicines from any body but a professional man. That a correct detail of all the symptoms be given by any intelligent messenger to the doctor. That no person should rely on the efficacy of any of those drugs that are vended as specifics ; every one of our fatal cases have been preceeded by the exhibition of these drugs, or the 6 42 twin pills, so generally supposed to be the first step towards the re, the folly of which cannot be too strongly reprobated. That when a person has once put himself under the care of i medical man, he should continue to follow his perscriptions olehj. The interference of friends has been attended by the most fatal consequences, and that of professional men not less so, exclusive of the indelicacy and want of consideration that should übsist between the members of the profession : as it is but right hat he who has the responsibility should, at least, have the management. D. ARNOLDI, FRANCIS C. T. ARNOLDI, M. I). June 22, 1832 Tuesday, June 26, 1532. We went to see Dr. Arnoldi &Son, and from them we received a orroboration of what they have .here stated. They say by this lan, that they have not los>t one patient, wherein they have been ailed within the second hour after invasion, and where they have md the sole and entire management of the patient. With regard o the contagiousness of the disease, they are undecided, but this lowever they did state — that they did not think the Asiatic holcra would have ever visited Canada, had not the first influice been received at Quebec. The first case of which they leard as occurring here, was in a passenger from a steam-boat om Quebec ; and the first case they were called to, was an old ady living in the upper part of the city, who had eaten a head f salad at night before going to bed. They then had two or iree cases scattered about the town, which proved fatal, but hich had no communication with each other, or the emigrants, !*hey have made but one autopsia, and that was in the man who ied on board the steam-boat ; in him they discovered disease unfilled to the small intestines, there being none in the large, 'he examination was however not minute. In the first three or jur days they state the disease was confined to adults, but that forwards children were ulso attacked. With regard to the emedy employed by the Quack, Stephen Ayres, they say they lave seen it faithfully tried, and in almost every instance, with a *v<'\ result. He says it must have acquired its reputation from eing given to those imagining themselves to have the Cholera: 43 End their minds then becoming quieted, their systems have responded to the tone of their imagination, Case of Cholera. — Elizabeth Challion, a native of Birmingham, aged forty-seven years, a woman of rather spare habit of body, lias )een married seveenteen years, and has had no children. She wns addicted to habits of intemperance for the whole of the latter period of time, her principal drink being gin, impregnated with the hiera )icra. For the last ten or twelve years she had been sick, more or less ; she being afflicted with cough and bowel complaint — her uenstrual discharge took place only once in about three or four months. She had the Asiatic Cholera in one of the worst forms nd most marked manner. It was about forty eight hours that he was sick, and the post mortem examination was instituted bout fifteen hours after death. She had been in this country bout a year. Her general appearance was pale, extremities had not a well narked ecchymosed aspect. Upon cutting into the muscles, they lad nut that dark appearance which was found in the aforemenoned case. The lungs were found much collapsed, though crc>itous; some ancient adhesions were formed There was no iquor pericardii - right side of the heart was soft and flarcid, the eft was hard and contracted ; its external surface was most wonerfully injected— the coronary vessels were as well marked as le most successful injection could shew. W hen cut into, the avities of the heart were found to contain a serous unc agulated lood, of a dark colour : that which the older writers called polypi were also found there. The omentum was also well injected, specially at the most depending edge. The internal surface )resented one of the most beautiful specimens of gastritis that ould be imagined. The patches of varied extent, presented the ifferent shades between a bright vermillion and a dark crimson ; )ut I did not observe that they were more frequent in one than le other end of that organ. In the upper part of the duodenum, le appearances were similar in one respect to those observed !>y Annesley, viz. : a secretion of a yellow, flocculent substance, from le mucous membrane. The vermillion was not here so conspiuous. The whole tract of the small intestines exhibited a state f recent intense phlogosis, varying in colour from the stomach ; 44 ulcerated tnucoui membrane, differing in length, from one third of an inch to two and a half inches The/glands of Peyer and Bruner were inflamed and prominent : the coecum was found also injected on the internal surface, as was also the remainder of the alimentary canal, though not so intense. The calibre of the large intestines was much diminished, and these contractions, in a measure, were evident through the whole of the canal, only in a very slight degree. The small intestines presented on their peritoneal surface, a purple colour. The contents of the stomach consisted of a dirty yellowish green pultaceous fluid, of not quite the thickness of molasses. In the small intestines, this same fluid was found, though it had lost the green, and assumed a brownish appearance. The liver was pale, marbled and exsanguineous, except in the large vessels, which bled freely upon being cut ; in its size, it was very little, if any, altered. The gall bladder was distended with liile, dark coloured, and just about as thick as molasses. The pleen and kidnies had undergone little or no alteration ; the inernal surface of the bladder had also an injected appearance. The uterus was natural, as regards its size, but was congested and red on looking at the peritoneal coat. The mesentery was als^ injected in different and irregular parts. Friday, June 24, 1 832. The steward of the' Emigrant Sheds' told me that he had seen the Eiisease in Asia, and was there when it broke out in 1817, he being hen attached to the army. He stated that he was then steward if the cholera hospital in the East Indies. He said that the best prophylactic he had ever seen used, and it was that which he himself employed, was to keep the bowels regular by purgatives, taken. at regular periods, and about a glass of brandy per diem. While there, I took a minute of a case. — Thomas Craig, born in Scotland, aged forty-four years, a man of large size, and plethoric habit of body, though far from being bloated in his appearance ; lad been in this country two years, and was, at the time he wag aken ill, mate of the British America, steam boat, though recently ie had been engaged in one of the Durham boats. — He was taken 1 on Saturday, about 7 P- M. being seized with vertigo, diarrhea, nd pain and cramps of the extremities, with vomiting and thirst. Upon minute enquiry it was found that he had been accustomed o take three or four glasses of ardent spirits a day, and had for 45 he last few days been suffering under a looseness of about three imes daily. He was brought into the hospital about 9P. M. laving the symptoms above mentioned, with blueness of the nails and an ecchymosed appearance of the feet and legs, from the knees lownward ; and of the hands, from the elbows. His dejections were like broth, not bilious at all- His tongue when I was there, 11 A. M.) was fiery red on the edges ; the centre and whole surace had a yellowish brown thick coat of fur, and there was much actitation. The steward had given him tr. opii gtt. xxx. and that s all the medicine that he has taken. The cramps came on about every fifteen or twenty minutes, and he cal's out to be rubbed over he gastrocnemii, which is done with the stimulating mixture of >randy, vinegar, &c, before mentioned. (6 P. M.) — He is no >etter ; the symptoms remain as before, except that the pulse has jeeome less strong. No medicines have been administered in addition. He died at 4 o'clock next morning. Monday, 25th June — We proceeded to the autopsy at 7, three lours after death The dark colour of the hands had, in a great measure, disappeared ; that of the feet remained, as far up as the cnee. In the spine, the thecae of the vertebrae were very vascular, and fluid was effused beneath that process of the dura mater, rather greater in quantity than natural The fluid was aqueous, trans)arent, and slightly viscid ; there was no ramoliisement of the chord. The dura mater of the brain was very much injected with lark purple blood, and the substance of the cerebrum was upon the cut surface studded with red points, very numerous, shewing that here has been great determination to that organ The left lobe of the cerebellum was much more viscular than the right ; indeed he latter could scarcely be declared abnormal. The muscles of he body, when cut, evinced great vascuUnty, by pouring from its evered vessels, much dark blood The lungs were collapsed more than the fi.st but less than in the second autopsy before mentioned, very much congested, but crepitous. There was an aneurismal dilatation of the whole heait little liquor pericardii, and both the auricles and ventricles contained much black thick )lood ; the left cavities were fuller than the right. The mucous nembrane of the bronclnoe was also injected. The omentum was, as was found in the other autopsy, much coloured ; but more especially at the inferior edges. In the stomach, tlie mucous membrane was found thickened and darkened, shewing that there had been former disease ; but in addition to this, there were found 46 traces of recent inflammation in the brighter and fresher red of several spots of that membrane. The inner surface of the duodenum was covered with that yellow cheesy matter, alluded to by Annesley, in his •' Diseases of India." On its exterior (:oat, as well as on that enveloping the whole of the small intesines, there was a bright r.ed net work of vessels. On the lower wo or three feet of the ileori however, this red assumed a deeper cast, and presented a light dirty purple colour* The peritoneal coat of the large intestines was much darker than usual, presenting rather a black cast. The internal surface of the small intestines, was vascular, and the lower part of the ileon was more particularly so. But the onus of the disease appeared to have been situated in the large intestines ; their mucous membrane was in several places similar in colour to the dark purple plum — and its adhesion to the muscular coat was very slight, and was very nearly approximated to the gangrenous state. The right lobe of the liver was pale, though marbled in some parts ; the left lobe was much more congested, pouring forth much more blood when cut into. The gall blader was distended with bile, apparently natural- The small intestines contained a small quantity of thick dirty yellowish fluid, but contained much fetid gas. The large intestines contained proportionally much more of a muddy, thick fawn coloured fluid. The bladder was empty. Mesentery not particularly vascular. The spleen and kidnies natural. Thomas McAvoy, born in Ireland, age thirty years, has been engaged on rafts for twelve years, in Canada, on the Grand River. He is a large, full sized man, of apparently usual good health. He has been accustomed to take five or six glasses of ardent liquor a day, for a long time. On Sunday noon he was attacked by cramps, and a blueish red colourization, with coldness of the hands and feet, vomiting and purging of a "broth like" fluid, great debility, and precordial anxiety with a sense of tenderness in the abdomen, the fingers and toes were pinched and wrinkled between the joints. Nothing was administered to him but a few Irops of tr. opii, as usual, and stimulating frictions very slovenly )erformed, to the extremities. He died Tuesday succeeding, fter about thirty-six hour's sickness ; and about fifteen hours ifter death we proceeded to the autopsy. This was, as usual, Emed in the open air. His general appearance : — body legs and arms, to hips and shoulders, were purplish blue ; not tynjpanitic, muscles stiff. The muscles were dark and 47 lull of blood ; the spinal chord was itself natural, but its envelopes ere much injected ; the venous sinus of the vertebra was much distended with black blood. The liquor pericardii was >out of the usual quantity, but it was thick, like oil ; the right uricle and right venticle were both msirh distended, with a dark molasses-like blood ; the leA cavities contained little or no blood : le coronary vessels were distended, by blood, to their full size, nd this injection appeared to extend to the capillaries of those essels; the pulmonary arteries were also full; the parieties of le aorta and large vessels were themselves also injected. Along le right edge of the heart, several vascular spots appeared, milar to an ecchymosis. (The lungs were collapsed and crepitant ; no adhesions — the yer was pale and marbled on its exterior surface, but its interior chibited some slight marks of congestion. The gall bladder as much distended with bile. The stomach was larger than natural, and contained about zij f a yellowish brown thick fluid ; the vessels on the exterior urface of the stomach, were injected, and the large vessels of le omentum were beautifully injected, running to the lower >order, and sending out branches on either side, until at the xtreme edge, it was one mass of dark injection. [The mesentery also evinced its vascularity by the fulness of its issels. The bJadder wa» empty, spleen and kidnies normal, he stomach, when opened, exhibited the daik thickened state 1 the mucous membrane, which was exhibited in one of the ormer cases. In different places on that surface were found >ots, perhaps more abundant &t the caidiac end, of vascularity esembling in appearance, a recent ecchymosis under it. At the >y!oric end, a pin was found, passing between the mucous and luscular coat, each end projecting into the cavity of the abdolen. The exterior surface of the intestines, exhibited a vivid ed appearance, which was perhaps, rather increased about the ermination of the ileon. The internal surface of the small ntestines, was much injected, and exhibited beautiful ramilicaons of vascularity ; such also was the state in the large intestines, but it was of a daiker hue, and it was very much diminished as it approached the rectum. In the small intestines was found a light dirty yellow coloured molasses-like substance ; this was darker in the large intestines, but not so plentiful, because the capacity wa» 48 very much reduced on account of the firm contraction of the coats. In the brain, the meninges were very much injected. The substance of the brain exhibited, on its cut surface numerons red toinis : this was not so much the case with the cerebellum) and ot at all, with regard to the medulla spinalis. («.) Eie Board of Health of New- York having determined to send emission to Canada, to investigate the origin and nature of pidemic then raging in ihat province, two gentlemen were selected for this honorable service. To have accomplished this task to its fullest extent, would have required the labor of many weeks; but the danger was imminent for our own city, and it was of the utmost importance to furnish the required information with the least possible delay. Dr. Devan and myself accompanied the commission as far as Montreal. At this place, Dr. Devan occupied himself with tatistical researches respecting the epidemic, whilst I was engaged n studying the disease itself. The result of my observations are annexed in the form of a report. The name alone of cholera produces terror; the dread of it disperses the population ; and the panic which precedes it, is one of its most murderous weapons. Differing from other epidemics, it very rarely attacks without previous notice : it is preceded by evident symptoms, which are readily combatted. In what then, consists the disease? The solution of this question would naturally conclude this report; but I have been forced to anticipate the exposition of my opinions, by admitting a peculiar morbid principle, which I cannot define, but which can hardly be called in question. This principle is every where active : it seems to have a more particular affinity for intemperate, uncleanly people, worn out by debauchery, — and it is among this class, that it commences and extends It then attacks the more elevated classes, and those first attacked, are always victims. When the mortality has become great, the disease loses its intensity ; this is in accordance with what we saw in Canada, and which has been observed every where in Europe 49 It scarcely ever commences without a premonition of several hourg nd even days. These are diarrhea, with or without pain in the tomach or abdomen ; nausea, vertigo ; weakness and a feeling f exhaustion ; sleep continues sound, and even more prolonged ian usual ; an error or excess in diet ; a fit of passion ; a change f temperature, &c. have been with most patients, the signal for ie commencement of choleric symptoms. Most usually, in the ight, a sharp colic pain, accompanied by an abundant stool, ccurs immediately ; a vomiting ensues of half digested matter, bllowed by cramps in the calves of the legs and the thighs, the eet, and at a later period, in the upper limbs. Copious vomitings nd purgings succeed with rapidity ; the excretions are watery and ansparent ; a burning thirst succeeds ; the pulse which at first is evelloped, becomes small and thready, and finally disappears* "he temperature of the body, and more particularly of the xtremities, rapidly lowers; cold and abundant sweats appear; ie face becomes sharp and anxious; eyes hollow ; lips blueish ; ongue and breath cold ; the secretion of urine is suppressed ; pain ccurs in the epigastrium, but that arising from cramps, seems to ccupy the attention exclusively ; sometimes, all the muscles of ¦o trunk become spasmodically affected ; a blueish color appears n the hands and feet, sometimes extending over the whole body, espiration alone seems but little disturbed ; but finally becomes ore accelerated — less profound ; and death closes the scene. After this brief sketch, we now propose to submit a more particuar examination of the various symptoms which occur in Cholera. n speaking of the premonitory symptoms, diarrhea was mentioned s one of the most constant. In some cases, 1 have observed the iarrhea to be suspended upon the invasion of the disease, and omiting alone atise, and vice versa. The vomiting does not lways consist of transparent fluid, but is sometimes greenish, and yen brown. When this occurs, the symptoms generally are milder. The cessation of all evacuations, is not, invariably, a good symptom. The tongue of cholera patients is flat, (rarely pointed ;) whitesh in the centre ; rose-colored on the edges ; and cold to the touch. The pulse is not always an unerring index. I have observed it o rise perceptibly a few moments before death ; and I may add hat the pulsations of the heart are always less than the pulse would seem to indicate. The discoloration varies in intensity, and 9 one of the least constant symptoms. In the first case which 7 50 ors. Baubien and Valle showed us, the discoloration was general and of a slaty blue. The capillary veins were gorged with blood The woman died within an hour alter our first visit ; and exhibited a more distinct example of discoloration than I have ever seen since. This discoloration is owing to the engorgement of the venous capillary vessels ; and I have often traced it from its commencement to its distinct blueish hue. Many die without any blueish tinge whatever, but merely a slight discoloration. The skin becomes cold and covered with an abundant transpiration. It appears as if soaked in water ; this appearance is always constant. I The breath is always cold in the state of collapse ; the respiration commonly not affected ; but after some time, it becomes more equent, and less deep upon the approach of death. [Upon questioning patients with regard to the seat of their comlaints, there is a great variety in their answers : some refer their pain > the heart ; others to the stomach or abdomen, while many have no am whatever. An unquenchable thirst is the most constant symptom, and if gratified, unless in small quantities, is followed by vomiting. The nteilectual faculties remain clear and unclouded, until the last moment. I have never seen the choleric symptoms last more than hree days, nor less than ten hours. When the violence of the symptoms abate, I have never, except in a very few cases, noticed a full and perfect convalescence to take place. More commonly, the following appearance takes place . — Jactitation ceases, and the body remains in a torpid state. The pulse becomes distinct ; the face flushed ; the conjunctiva inected ; the tongue coated in the middle, and more or less red on the edges ; sometimes red all over, dry and contracted ; the epigastrium painful ; tremor in the limbs; intellect confused, with occasional delirium ; very frequently coma ensues — and death closes the scene This sequel of cholera has been named the typhoid state, and destroys as many as cholera itself— more particularly, when it attacks the Irish emigrants, who are in the habit of drinking to excess; and even in the hospitals the first thing they take after the symptoms have ameliorated, is rum or brandy in large quantities. Under the influence of these irregularities of diet, the choleric symptoms sometimes re appear, and carry the patient off rapidly: 51 at other times the stomach appears to possess sufficient powerb oft resistance, and coma supervenes. Results of Autopsical Examinations. In pursuing these examinations, I endeavoured to investigate thfe pathalogical alterations without reference to any thing which I might have previously read ; it was desirable also to study th 6 effects of the disease upon persons who had died in different stages of the disease Some of them had taken no medicine, except a small quantity of opium. External appearances. — Stiffness of the limbs, occurring a fe\t hours after death ; sometimes the muscles were contracted as in life ; fingers always beat and stiff; abdomen flattened. H*ad — Sinus of the dura mater engorged with thick black llood, whatever may have been theduration of thedisease Theexernal meninges exhibited no change. The arachnoid opake in many places, particularly among those who sunk under the consecuive disease Its base transparent in those who died in a stiort timP 4 *ia mater always injected, and sometimes in a manner not to be quailed by artifical means. The ehoroid plexus presented the nppearance of a minute net-work; The ventricles contained an unusual quantity of serous fluid, particularly among those who ied under the consecutive disease. This serosity was sometimes ose colored. The cerebral mass appeared generally to be firmer han usual. Spinal marrow commonly natural, occasionally pink. The arachnoid membrane opake in many places ; the substance f the spinal marrow slightly firmer than usual. In one case which had died in thirty-six hours, with violent cramps, there was a distinct softening opposite the third dorsal. In examining the great nervous foramina, I never noticed any great alteration ; but t may be necessary to add, that I never completely dissected the great sympathetic* I examined however, very frequently the semi-lunar plexus, but could never find that it w.is more red than in its normal state. I have no doubt .hat it participates in some de- Eec in the general venous congestion of the capillaries, but I nnot affirm that its internal substance was altered in color or nsistence. * Most of these autopsical examinations were made on the bants of the St, fjawrence, in the open air, and often surrounded by an ignorant besotted popula 52 Chest. — Pleura healthy, with the exception of some slight ailliesions Lungs collapsed, crepitant, containing little blood. No serosity in most cases in the pericardium. The cardiac veins much injected ; the cavities empty in some cases— in others filled with very thick blood and coagulated lymph. The left cavities requently empty. The pulmonary arteries contained clots of fi>rine; the veins and aorta filled frequently with black blood. The diaphragm presented a natural appearance. Abdomen — Stomach contracted, externally the coronary veins well defined, and filled with black blood. Internal surface covered vith a viscid gray mucus, with a slight greenish tint in some individuals. This mucosity was at times very thick and adhered so strongly to the mucous membrane as to be separated with difficulty. J'he membrane itself softened reddish, often thickened at several joints, and decidedly inflamed. This morbid secretion was common to almost all which 1 examined, whatever might have been he duration of the disease I did not find that the inflammation was greater at the cardiac than at the pyloric orifice. Small Intestines. — General appearance reddish, and contracted n several places. In one individual who had died of the conseutive disease on the eighth day, I remarked many processes ormed by membranes of a new formation. In most cases, the uodenutn and end of the ileon was reddish brown the latter frequentf a livid blue color. The internal surface of the intestines was ark red in the duodenum ; the mucous membrane inflamed, but olerably consistent and little thickened. The jejunum was like vise red, but presented no well marked traces of inflammation, xcept in two cases where the gastro-intestinal irritation was exlibited in the highest degree. The ileon often covered with small elevated points, more or less ark colored and surrounded with a reddish ring. These are inamed mucous follicles, which are much altered in some cases, >ut not constantly so in all. The last part of the internal surface f the small intestines, frequently presents a livid reddish brown ppearance, as if it had been soaked in blood for several days, 'his color did not disappear after repeated washings, and I emarked it in cases which were examined an hour after death. When the mucous membrane was detached, the subjacent parts ere found to be gorged with blood, the membrane itself presered its color, although it was not quite of so deep a hue. 53 I cannot undertake to say that it was inflamed, its consistence was not altered, and even its semi-transparency remained unchanged. tThe large intestineswere generally contracted ; externally more r less rose colored, sometimes white. Throughout the whole extent, its internal surface was echymosed, and frequently, the mucous membrane was thickened in several places. At times, I (bund the characteristic excretions of this disease in the intestines, >ut more frequently I found them empty. The peritonium I never saw inflamed but once ; the mesentery and epiploon was always strongly injected even into the venulae. The liver presented a great variety of appearances, sometimes t was a dark brown, oftener it was curiously mottled. It contained no unusual quantity of blood. The gall bladder contained a very thick dark colored bile, and in some cases much distended, mt in others the quantity was diminished. The pancreas and spleen offered no change. TJie kidneys and sretus contained no urine ; the bladder contracted and empty, carcely exceeded in size a small egg. Such were the patholo;ical changes, observed in those who had perished by ths disease. The examinations were usually made a short time after death, and o this cause may be attributed the fact, that the cerebral mas» was more firm than in those which are examined eighteen or twenty ours after dentil. (HO As an attach £ to the Medical Commission from the city of Newfork, (Drs. Rhinelander and De Kay,) to investigate the Cholera prevailing in Canada, I entered upon the field of observation, ot only undecided with regard to the proper mode of combatting lie disease, but also unprejudiced as to its contagiousness. On >oth those points, we are happy to say, our minds are now reolved. We think there remains not a doubt, that the choera is an atmospheric disease ; that it is one, dependant upon a omething in the air we breathe, both for its origin and termina ion : a something which has as yet escaped the investigation of the meumatic observer, but the existence of which, we as well as all who resided in the choleric region, have felt. As regards he treatment, it is based not only upon the united experience of hose who have administered to the living, but it is derived from he appearances fewnd in owr own autopsical examinations. These 54 points, however, we leave to be discussed by older and ablei hands than now wield the pen ; and to them we resign the pleasire of presenting an array of facts, which ought, and doubtless will, supersede the speculative doctrines of the closeted contagionist, and confirm the hesitating practitioner in the course to be pursued in the event of the spread of that awful scourge among us. Ours be the humbler, though perhaps not less useful task, to point out the precautionary means to mitigate, if not to prevent an attack of this awful pestilence. It cannot have escaped the attention of every reader of the journals, that at Montreal this disease has committed most extensive ravages, and with more than usml malignity. But there are reasons for such an event, which should quiet our apprehensions, and make us hope a more happy issue out of the ordeal which hreatens us. In that city (to use round numbers,) there are about 30,000 inhabitants, and of these, about 3,500 have been attacked, and 1,500 laid low in their giaves by this fearful pestilence. It mist, however be taken into consideration, that there are only eventeen or eighteen physicians for this entire population, and 'iat during the prevalence of the epidemic, from md spusition, not more than twelve of them were able to attend to their duties. t becomes, therefore apparent to every one, how many must lave perished for want of the regular and assiduous care of leir medical attendants ; and also, what numbers must have unk without hating seen the face of a physician. That such is le fact, we have not only been told by the medical gentlemen lemselves, but many corroborative instances have come to our wn immediate knowledge. Moreover, the moral and physical ondition of the recently landed emigrants and lower classes of anadians, has rendered them peculiarly obnoxious to the disase, by causing them not only to become dupes to quacks and leir preventive nos'rums, but to yield themselves up to their espondent fears, and consequently to intemperance. Now in the city of New-York, there are upwards of seven hunred physicians to its population of 200,000 ; and consequently, yen were the disease to attack a number of our own citizens, omparatively as large as at Montreal, it will readily be seen that 1 may be attended to, more especially as appropriate hospitals re to be provided for the destitute poor. These things are menoned with the sole desire of doing away the apprehensions of the jeople, and inspiring public confidence : if we can succeed in this, 55 ie disease will be disarmed of its terrors, and consequently o( much of its mortality. For if there is any one rouse more than not her, that pr* disposes to an attack of thin Epidemic Cholera, is the fear of it — And this is a truth which should be giaven n letters of brass on the minds of the people. What is it that makes the panic struck fugitive from this disease more liable to s attack, t^an the attending 1 physician, or the ministering servant f God. It is, fceteris panbus,) solely because in the latter, there a calmness of mind and disregard of danger, which holds the isease at bay. We would not however be understood to say, that onfidence is a never failing shield, but we would impress upon ie attention of the reader, that the state of the mind produces a more powerful effect upon the system, than almost any other one ause. It is probably well known to all, that an old man named tephen Ayres, or the " Cholera doctor," as he was more popuarly called, has wrought miracles among the Canadian populaon. Clothed in the garb of poverty, with unshaven beard, and eading two or three emaciated horses, he paraded through the reets of Montreal, holding out an instantaneous cure* for the peslence. His appearance struck the superstitious fancy of the ower classes, arid by restoring many imaginary cholerics, by actng on their diseased mind, he acquired an ascendancy over their leas which nothing could shake — he was soon followed, and reered as a Saint. By his presence, and the possession of a stolen )iece of his tattered garments, despondency left them ; and with ie full persuasion that they had ever ready at hand, a specific for ie dreadful disorder, they returned to their daily occupations, onfidence entered their breasts, and cheerfulness gladdened their bodes. This disease at that city, has attacked a larger proportion of lie filthy emigrants and superstitious Canadians, than of the upper lasses ; and one of the most prominent reasons of that, in our pinion, is that they are more the subjects of superstition, peronal uncleanliness and intemperance. It is true, many of the pper classes have suffered from the disease, but upon minute enquiry it was found that the fear of the malady had taken firm lold upon them, and its consequent effect upon the functions of he system had laid them mote open to the action of the causes of the cholera, than would otherwise have been the case. But * This was a mixture of charcoal, hog's lard and maple sugar, equal parts, which mi exhibited by table spoons full. 56 there arc other passions, such as anger, which though not so coustant in their duration, yet in their flashes act upon the circulation mil other functions of the human frame, and cause the system to espond to their tone, and become more exposed to the action of he pestilential poison. Therefore, he who wishes to avoid every >ossible cause, will maintain an equable and composed state of of mind. With regard to the other non-naturals in the division of hygiene, we must remark, that here are to be found the more immediate exciting causes of the Cholera. Intemperance holds out a most pressing invitation to an attack of this disorder, and this is a fact that drunkards will have to onfirm, if this scourge prevail to any extent in our city, perlaps full two thirds of those whom this besom of atmospheric origin has already swept from off the stage of life in Canada, vere addicted more or less to the frequent use of ardent liquors ; nd the intemperate among us cannot certainly expect a lest ratio of their number to fall victims. But there is intemperance in eating, as well in drinking, and it may extend to the qunnity, as well as nature of the food. There is nothing which can nore contribute to an invasion of this disease, than cucumbers s they arc commonly prepared with vinegar and pepper ; gooseerries, currants, muskmelons, watermelons, green corn, unripe ruit, &c. The different articles of confectionary, as pies, tarts, cc creams, &c. may we think, without any injury to the alimentry canal, be denied entrance there. Ice water drinks, we think not only unnecessary to slake the lirst, but very injurious to the tone of the stomach. When t becomes necessary to drink, we deem the addition of some jood port, or any other of the wines, to be by no means inconstent with health, and it will be found that thirst will be quench* d equally well, if the person take a mouthful, and hold it there en or fifteen seconds, swallowing it gradually, and repeating lis a few times ; as though at one breath, he threw into his tomach a pint of fluid. In other respects however, we think it absolutely necessary iat during the presence of this epidemic influence in our country, s little change as possible, be made in our wonted food. Let lim who is accustomed to a moderate indulgence in the pleasures f the table, not too suddenly break through that established outine. If any alteration be contemplated, let it be submitted 57 to the judgment of the physician. For the stomach, becoming habituated to the reception of certain articles of food, which afford a stimulus to its action, will not brook a violent change without deranging every part of the system which sympathizes with it ; and this derangement, breaking up the chain of resistance which the body naturally offers to sickness, of course lays it open to the invasion of disease ; and as the Cholera is the one which during the prevalence of the epidemic influence, bears the greatest sway, it becomes probable that he who makes the sudden and great change in his diet (and we may add in the quantity of his exercise and sleep,) will be in imminent danger of an attack of this dreadful disorder. With regard to dress, we would recommend the application of a thin flannel roller about the abdomen, and woollen to the feet ; by these means, we will retain the action to the surface, which might in the absence of such external excitement, be directed to the internal organs. In other respects, we should dress to suit the temperature By the frequent change of our linen, and the use of the bath and flesh brush, we will excite the perspiratory functions, and thus aid nature in the course she naturally takes to ward off the injurious effects of heat &c, and promote a considerable item in favour of health, cleanliness. Most of the Canadians and Emigrants whom we observed labouring under the symptoms of Cholera in the British provinces, were very uncleanly in their skins. We saw a female who had not washed herself for six weeks, nor changed her clothes during the whole of that period, and in whom consequently, perspiration was much interrupted, seized with the Cholera — she died in a few hours. How far the want of cleanliness contributed to her death, we cannot say ; but that it impeded the perspiration which was necessary to her health previous to her attack, we cannot doubt. But still, act as we will, with all our precautions, we cannot ex>ect with certainty to remain in the possession of perfect health ; >y the adoption of the above mentioned means however, we will >c conscious, that we have done all that lies in our power, to ward off the evil. It is a fact well authenticated, not only by the observations of European writers, but also by the concurrent testimony of all who have been within the sphere of this epidemic influence, (not even excepting ourselves; that all who respired the air of the choleric regions, experienced some effect of this pestilential S 58 poison ; but it is mostly when apprehension and self neglect ar What is the duration of the disease, and in how many instances in your practice has it proved fatal ? 10. What are the appearances which have been observed on dissection ? 111. Do you consider the disease contagious, and on what rounds do you base your conclusions ? 112. What effect has been observed from the firing of cannon,, urning of tar barrels, and other means of purifications? J R RHINELANDER, M. D. JAMES E. DE KAY, M. D. (W.) Board of Health, Quebec, June 24th, 1832. Doctors Rhinelander and De Kay were introduced to the ioard by Dr. Skey, as members of a Commission authorized by le State of New- York, to proceed to Quebec to make inquiry elative to the Asiatic Cholera ; these gentlemen having brought letter to this effect, addressed to his Lordship the Governor-in- Chief. Resolved. — That this Board invite the members of the Commission to join in this sitting, and that this Board offer to them all the aid in their power towards effecting their object. Resolved. — That the Civil Hospitals be opened to them at all times, that the Health Commissioner, the resident Physicians, and the prescribing Officers of the Hospitals, be instructed to afford them all the information in their power ; and that the Secretary 65 of this Board be instructed to furnish the Commission with all such printed documents as have been published by the Board. Resolved. — That the Health Commissioner, the resident Physicians, the Health Officer, and Dr. Lyons, be called on to make statements of such facts as may have come to their knowledge respectively, respecting the knowledge and treatment of the Asiatic Cholera in this city, and that they be requested to make their communications before noon to-morrow. Board of Health, Quebec, June 29th, 1832. The following Report was read : — The undersigned appointed by the Board of Health to investigate and report upon the introduction and treatment of the Cholera now existing in this country, have agreed to the followng report, which they respectfully submit: — The disease on its first appearance in this city, exhibited all he characters of that commonly called the Asiatic or Spasmodic Cholera. It commenced about the Bth inst. in boarding houses and taverns in the Cul-de-Sac, a low, uncleanly and ill ventilated >art of the city, crowded with emigrants of the lowest description, vith sailors, and other persons of irregular habits. About the fourth day of the disease, (the 12th) it showed itself in the more elevated parts of the city, among the wealthier classes of society, and persons of sober and regular habits, who could have had but little, if any, direct communication with the people among whom the disease had first appeared. About the same date, (the 12th) the disease was observed in various parts of the city, and in several neighbouring Parishes, some few miles distant, having a constant intercourse with it. The cases continued to increase in number until about the 16th r 18th, (being the Bth or 10th day of the disease,) when they >egan to subside both in number and violence, the disease still >revailing more extensively in the ill ventilated parts of the city )ove mentioned. About the period of its greatest prevaence, (the Bth or 10th day of the disease,) the number of cases ere estimated to be between two hundred and fifty and three lundred in the course of twenty-four hours. I The undersigned have not as yet been able to discover that v case of cholera hns been landed from any vessel in the Q 66 harbour before, nor until several days after its first appearance in the city. They deem it necessary to add, that some Parishes in the neighbourhood of Quebec have continued free from the disease until lately, and that no case appears to have yet occurred at Three Rivers, an intermediate and populous town between Montreal and Quebec, where the steam-boats with emigrants 'rom Quebec generally touch. t Since the appearance of this malady, only two soldiers have en attacked in Quebec, and those while on duty ; the rest ing closely confined to their quarters. I The symptoms were the most violent at the com men cement, md continued so until about the 16th or 18th, when they began o mitigate in severity as the cases diminished in number. In the treatment of this disease, recourse has been had to nlmost every remedy favourably reported of by European practiioners, and they all have had for a time their advocates ; some referring stimulants, others opiates, while others satisfied themelves with an intermediate plan of treatment. The whole of the medical practitioners, with one accord, greed however in the application of external stimulants, such s oil of turpentine, mustard, warm applications and frictions ; alomel and opium, has been much relied on by many. Practiioners speak with confidence of blood letting at the onset of the isease, and before an approach to collapse has been recognized. Sweating has been much practiced, and decidedly with advantage, when collapse has not taken place. This is indicated by a pulse. ess wrist, dejected countenance, blue extremities, tongue and )reath cold, and a sunken voice, feeling to the patient as if it )assed through the ears. [Some instances have been noticed, and also observed by our telligent clergy, as well as by ourselves, where in some mild rms of the disease, nature effected a cure by copious perspira>n, encouraged by warm drinks and extra clothing. IThe undersigned, with one accord, have found purgatives jurious if used before perspiration, or blood letting had been isorted to, to allay the irritable state of the stomach and >wels, and then only the milder purgatives should be employed, ich as calomel, or blue pill, guarded with minute doses of opium. 67 and carried oil after a few hours, with rhubarb combined with soda and carbonate of ammonia. (Signed) JOS. MORRIN, Health Commissioner. \V. A. HALL, Resident Physician. X. TESSIER, Health Officer. WM LYONS.. Superintendant of the Emigrant Hospital. Quebec, 25th June, 1832. L Ordered. — That the paid Report, be forthwith communicated Doctors Rhinelander and De Kay. (Certified.) WM. ROSS, Ass. Secy Board of Health, Quebec. (O.) I The Board of Health issued last evening an amended report f the cases which have occurred since the first appearance of the disease on the 10th ; which is as follows. Cases. Deaths. From the 10th to the 15th, - 1328 175 16th, - - 381 86 17th, - - 474 102 18th, - - 261 128 19th, - - 337 140 20th, 165 94 21st, - - 151 76 22d, - - 109 32 23d, - - 83 31 24th, 51 21 25th, - - 44 33 26th, - 27 23 3411 970 The number of burials in the Protestant grounds to Saturday, at 1 P M. was 283, of these, 90 were residents, 140 strangers or emigrants, and 53 whose names, sex, or residence, are unknown. 68 The following statement will show the number of burials in the same grounds during the summer seasons of the last four years j and point out the comparative mortality of these months. 1828. 1829. 1830. 1831. (lie, - 33 25 22 60 ly, - 23 33 50 70 igust, - 33 46 58 68 ptember, 25 20 29 51 114 124 . 159 258 I The burials at the Catholic ground, amount to 644 up to Mony afternoon. This is of all diseases, and the clerk of the ound tells me that not more than 500 or 520, are attributable cholera. I suppose about 50 to 70 have been buried on the Common o* St. Anne, near the Emigrant Shed. or the COMMISSIONERS EMPLOYED TO INVESTIGATE THE ORIGIN AND NATURE OF THE EPIDEMIC CHOLERA OS tIUWAIDA. Published by Order of the Board of Health- JULY SI, 1832, NEW- YORK : PRINTED BY PETER VAN PMIT