IDENTITY OF THE ASIATIC, RUSSIAN, AND ENGLISH CHOLERA: ITS CAUSE, SYMPTOMS, PREVENTION, and CURE. I. PIDDUCK, M^ " And David said unto Gad, I am in a great strait ; let us fall now into the hand of the Lord (for his mercies are great) and let me not fall into the hand of man." — 2 Samuel, xxiv. 14. LONDON: PRINTED FOR JOHN WILSON, PRINCES STREET, SOHO. 1831. Di £M? mgra of terror and dread of the approach of malignant Cholera, having received many applications from friends at a distance for information upon the subject, I have, to save time and trouble in writing letters, printed this short Essay for general circulation. Just befor e sending this Essay to press, I have seen, in the Times newspaper of to-day, the opinion which I had formed of the disease, stated by a Correspondent at Sunderland, viz. that the English and Asiatic Cholera is essentially the sams disease. J. P. Great Russell- street, November, 1831. CHOLERA. It is generally admitted, that the most powerful predisposing cause of every epidemic disease is mental dejection. This is the case with respect to intermittent, remittent, and bilious fevers, dysentery, &c. Instead, therefore, of alarming the public mind with fearful narratives of the malignant Cholera, and presenting the disease to the imagination in all the horrors of the Indio-Russian Epidemic, the public safety, resulting from a feeling of con - fidence, ought to have been consulted. The Cholera, as it has actually appeared in this country, should have been accurately described ; the circumstances which might cause it to assume a more terrific character, should have been pointed out ; and the mode of preventing the imminent danger should have been detailed. Unhappily, the warning voice, which sounds the note of alarm, is heard, not by the intemperate and depraved, who are most liable to its ravages, but it is anxiously listened to by the weak and the timid, whose danger is great in proportion, as their terrors are excited and their hopes of security destroyed. Many instances have occurred of nervous persons being made seriously ill by reading the appalling accounts of malignant Cholera ; of its contagious nature ; the horrible sufferings attending it ; and its almost uniformly speedy and fatal termination. It is chiefly for the purpose of quieting these unnecessary alarms, that this essay is published ; in which it is intended to prove, (notwithstanding all the assertions to the contrary,) that the mild Cholera of this country, which has prevailed for nearly four months, is essentially the same disease, and proceeds from the same cause, as the malignant Indio-Russian Cholera; modified, however, by the state of body of the individuals attacked. Besides this, the cause, symptoms, mode of prevention, 4 and the plan of treatment, which has been successfully employed, is laid down. If the disease had been viewed in the light afforded by the celebrated Sydenham, whose accurate observation of the operation of morbific causes upon the body, and whose natural and successful methods of cure have justly entitled him to the appellation of the English Hippocrates, many of the evils, which have resulted from the unqualified and groundless statements of the contagious nature of Cholera, would have been prevented. In the chapter on Epidemic Diseases, he says, " There are various constitutions of years, which owe their origin neither to heat nor cold, dryness nor moisture, but which depend upon some secret and inexplicable action in the bowels of the earth, whence the air is contaminated with certain effluvia, which subject the body to particular diseases, so long as that constitution predominates."* In this short sentence, we have a rational explanation of the origin of spasmodic Cholera, which has travelled from Asia, through Europe, to England, not by contagion above ground, but by under-ground alterations and consequent emanations of certain effluvia from the earth, by which the atmosphere is contaminated. The disease in its advanced stages appears to differ in no respect from fever. It is the powerful efforts of nature to expel the morbific poison derived from the air, which constitute the peculiar characteristics of the disease, and to which patients abroad have so frequently fallen a sacrifice. As there are varieties of small-pox, the benign and confluent ; of typhus fever, the mild and putrescent ; so there are varieties of Cholera, the common and malignant, which differ not in the least, as regards the exciting cause, which is specific effluvia arising from the earth. The difference in the severity of the disease depends entirely upon the previous state of health of the individual attacked. Cholera, therefore, it is contended, has prevailed as an epidemic in London since the month of July last, but has now nearly disappeared. It commenced with the ordinary symptoms of influenza, or "la gripe," as it was called in Paris, which was wholly unlike the common catarrh, and afterwards those of mild Cholera, (Cholerine), were manifested, * Varise sunt nempe annorum constitutiones, quse neque calori, neque frigori, non sicco humidove ortum suum debent, sed ab occulta potius et inexplicabili quadam alteratione in ipsis terrse visceribus pendent, unde aer ejusmodi effluviis contamnatur, quse humana corpora huic aut illo rnorbo addicunt,determmantque, stante scilicet prsefatee constitutionis prsedominio. 5 sparing no class, but chiefly confined to the adult population. The symptoms were precisely those of Indio-Russian Cholera, except in severity ; without the slightest resemblance to the English autumnal bilious Cholera. Persons were suddenly seized with a sense of sickness, and griping pain in the bowels ; followed by vomiting, first of the contents of the stomach, then of a colorless fluid ; and purging, first of the contents of the bowels, then of liquid stools, destitute of feculent smell or bilious tinge. The countenance was sallow and dejected ; the eyes were sunken, and there was a dark areola round them ; the extremities were damp and cold, and the smell of the perspiration strikingly resembled sour cream cheese ; there was great prostration of strength ; the purging, which was the symptom most uniformly present, ceased and returned spontaneously, but if not speedily removed by appropriate remedies, the other more formidable symptoms of spasmodic Cholera began to appear — blueness and coldness of the surface of the body, spasms of the abdominal muscles, and cramps of the extremities. The threatened degeneration of the disease was not prevented till the alvine evacuations had re-acquired the feculent odor and bilious tinges which rarely happened without the administration of minute doses of calomel. If, as before stated, the disease be occasioned by poisonous effluvia, arising from a secret and inexplicable alteration in the bowels of the earth, of which a rational doubt cannot be entertained, all the sanatory regulations to prevent the spread of contagion, can no more stem the torrent of Cholera than they can prevent the extension of intermittent, remittent, or any other fever, confessedly not of a contagious nature. In certain seasons, (in the winter of 1828-9 for instance,) intermittent fevers prevailed epidemically in various parts of the country, Kent in particular, and whatever was the nature of the disorder with which the person was attacked, it rarely failed to assume an intermittent character ; which was precisely the case with regard to Cholera, during the months of July, August, September, and October last. If the secret cause which produced the disease be inexplicable, the next circumstances to be explained, if possible, are — Ist. The mode in which the effluvia are communicated to the body. 2d. What state of the body is least favourable to their reception. . And this involves the question of the best means of prevention. The primary operation of the secret cause or morbific effluvia, 6 evidently is upon the stomach and bowels. It may therefore be inferred, that they are conveyed into the system not indirectly by cutaneous or pulmonary absorption from the atmosphere, but directly into the stomach, through the medium of the food, solid and liquid, especially the latter, which readily absorbs poisonous effluvia of all kinds. The great purifying agent is Fire, and fire is the most powerful agent in the prevention of Cholera, as well as of every other epidemic disease. During the prevalence of an epidemic, no solid food should be eaten or liquid drank, which has not immediately before been subjected to the influence of fire, for the purpose of expelling the poisonous effluvia from the food before it is received into the stomach. The state of body best prepared to resist the operation of the morbific effluvia, is that of perfect health. Whatever, therefore, tends to debilitate, should be carefully avoided, and whatever tends to strengthen the body and invigorate the mind, should be sedulously observed. The Debilitating Causes are — ? 1 . Crude, indigestible food, which not only affords inadequate nourishment, but irritates and weakens the tone of the digestive organs. 2. Intemperance in eating and drinking, especially of ardent spirits. 3. The habitual use of purgative medicines, particularly of the saline class. 4. Deficiency of warm clothing. 5. Inattention to personal and domestic cleanliness. 6. Close-confined ill-ventilated apartments. 7. Sedentary habits and want of daily exercise. 8. Fear, particularly of an attack of the disorder, and other depressing passions. The Invigorating Causes are — 1. Nutritive food, fresh cooked, in moderation. 2. A somewhat confined state of bowels. 3. Frequent warm bathing of the whole body, and the occasional use of the vapour bath. 4> Warm clothing night and day. 5. Daily exercise in the open air. 6. Lighting fires in every room in the house, particularly where provisions are kept ; and removing all sources of bad smells from drains, cesspools, &c. 7. Confidence in the preventive and remedial measures enjoined by the faculty. 7 8. But above all, perfect confidence in the tender mercies of Jehovah, who does not willingly afflict the children of men. Lastly, Those persons who have passed through the disease in its mild form, are not liable to an attack of malignant Cholera. But it may be asked, if Cholera has prevailed in London so many months, why has it not assumed a more malignant form? Simply, because in all those circumstances which respect the health and strength of the body, and perhaps the energy of the mind, we are more highly favoured than other nations. Great as the distress and misery are, which we witness in the abodes of the poor in the large cities of this country, their diet is superior perhaps to that of the poor in the cities of any other country in the world. The black bread, the train oil, the sour-krout, and the raw vegetables, of the Russian peasant, will bear no comparison with the wheaten bread and butter, or cheese, oatmeal, potatoes, &c. which constitute the diet of the lower orders in. England. That the Cholera may assume a more malignant aspect as the winter advances, and the privations of the poor are increased, should the Cholera constitution of the air continue, is more than probable. But hitherto, this has not been the case in London, even in St. Giles's, where there is a combination of all the causes, which are said peculiarly to favour the development of the disease. The Symptoms. , The phenomena of Cholera are precisely those which are produced by the reception of other morbific poisons into the stomach. There is a sense of great depression, a sudden sensation of uneasiness in the region of the stomach, the act of vomiting and purging, which is the natural effort to expel the offending cause, ensues, and a cold sweat breaks out. If these natural efforts to expel the poison be ineffectual, and owing to the sedative influence of the poison they are rarely effectual, unless they are aided by timely and judicious measures, the poison is absorbed into the circulation, and exerts its deliterious influence upon the blood, destroying the vital principle, and changing its sensible qualities. The blood becomes black and viscid, and being incapable of circulating through the capillary system, it accumulates in the lungs, liver, spleen, and 8 large veins of the body. The veins of the brain and spinal marrow also become gorged with dark blood, which is the cause of the spasmodic and convulsive actions of the body. A similar state of the cerebral and spinal veins is observed when an animal is bled to death by opening the jugular or femoral veins. Death, in those cases, is preceded by similar convulsive and spasmodic actions of the extremities. Or these symptoms may arise from the direct influence of the morbid poison upon the nerves and muscles of voluntary motion. If the natural efforts be assisted, and the poison be expelled in limine, the patient speedily escapes ; but if the body be previously enervated by the causes above enumerated, the patient sinks under the natural efforts, or in the stage of collapse ; or if the poison be absorbed, the stage of reaction, as it is called, takes place, and fever of the typhoid type is developed, dangerous in proportion to the concentration of the poison and the previous debility of the patient. Treatment. The indications of cure are — Ist. To dilute the morbific poison and favor its expulsion. 2d. To assist the natural efforts to effect this object. 3rd. To induce free perspiration. 4th. To support the vital energies internally by diffusible stimulants. sth. To quiet the disturbance which has been created in the alimentary canal. For the purpose of diluting the poison and favoring its expulsion, the patient, at the commencement of the disorder, is to drink plentifully of very weak warm broth, made by boiling a chicken or one pound of lean veal or mutton in two gallons of water. As soon as the action of the stomach and bowels a little subsides, pills composed of one or two grains of calomel and five grains of rhubarb, made up with aromatic confection, are to be given, and three hours after the pills, a desert spoonful of castor oil in mint water. Three hours after the operation of these medicines, if the pain or uneasiness in the stomach and 9 bowels be not removed, let the calomel pills and the castor oil be repeated in the same order. To promote a free perspiration, without which a solution of the disease rarely, if ever, takes place, let a blanket, folded of a proper width, and wrung out of boiling water, as free from moisture as possible, be wrapped round the patient's abdomen and loins, and then covered with several blankets to prevent evaporation, and increase the sudorific effect of the epithegm. To quiet the disturbance in the alimentary canal, after the poison has been expelled, three table spoonfuls of chalk mixture, ten drops of laudanum, and thirty drops of nitrous sether, administered every three hours, answers the purpose very well. But if medical aid be not called before the spasms have commenced, the extremities have grown cold, and the vomiting and purging have ceased, it is necessary to resort to diffusible stimulants at once. Besides the hot blanket above described, a mustard poultice should be applied to the pit of the stomach. Worsted stockings, filled with hot salt or sand, should be applied to the feet and legs, hands and arms, and twenty or thirty drops of genuine cajeput oil, or essential oil of peppermint, a teaspoonful of magnesia, and three table- spoonfuls of warm water shaken well together in a phial, should be administered every hour. In the mean time, a general vapor bath, in which the head is included, should be got in readiness, in case the other means fail to restore warmth and elicit a free perspiration. The strength of the patient should be supported by warm broths, sal volatile in camphor-julap, or warm brandy and water. Of the utility of blood-letting I cannot form an opinion ; the above-mentioned method of treatment having been successful in every case in which it was employed, though bleeding, when the patient is robust, may easily be conceived to be an efficient mode of restoring freedom to the circulation, before the stage of congestion or collapse is fully established. Blood-letting might be advantageously practised when the patient is seated in the vapor bath. Although there is nothing novel in the mode of procedure here enjoined, it is of importance that the principle upon which it is founded should be rightly understood, and that our remedies may be adapted to the disease as it is actually presented to our observation, in this country. With the utmost deference and respect for the opinions and practice of those medical men who have witnessed Cholera in all its malignancy, in India and Russia, I would remind them of the aphorism of Celsus : — "Differrequoquepro natura locorum, 10 genera medicinse ; et aliud opus esse Romae, aliud in /Egypto, aliud in Gallia." I am aware he adds, " Quod si morbos ea causae facerent, quse übique esedem essent, remedia quoque übique eadem esse debuisse." Contending, as I do, that the disease is everywhere the same, and admitting that the remedies for its cure are also everywhere the same ; yet the treatment certainly requires to be modified according to the violence of the operation of the morbific poison ; according to the state of the constitution of the individual attacked, which depends upon his habits in regard to diet, &c. and to the climate in which the epidemic appears. However necessary such vigorous measures, which are recommended, may have been in other countries, and however necessary they may hereafter become in this country, as the disease assumes a more formidable character, they are at present calculated to do more harm than good ; either by overpowering the sick, through the violence of their operation, or by inducing a reaction no jless destructive than the disease itself. I speak now with reference to the enormous doses of calomel, opium, camphor, &c. which have been successfully administered in India. Instead, therefore, of blindly following in the wake of those who have steered safely through the waves of the epidemic as it has raged abroad, let us carefully and attentively watch its progress in this country, and apply our remedies to the existing evil, and not to a disease presented to the imagination. In this respect the example of Sydenham should be our guide. "In the midst of so much darkness, my first care, as soon as any new Fever begins to spread, is to wait a little and to proceed very slowly, especially in the use of powerful remedies, in the mean time carefully observing its nature and progress, and the means by which the patient was either relieved or injured, that those might be speedily employed and these rejected."* One good effect has been produced by the fear of Cholera, — the sympathies of the rich have been called forth in behalf of the poor and the destitute ; let not our exertions be relaxed by feelings of personal security, but let us rather evince our gratitude to God for the comparative lightness of our visitation by contributing to * In hac itaque tain spissa rerum caligine, nihil mihi prius est, guam quando novse Febres grassari incipiunt, cunctari paulisper, et ad magna praesertim remedia non nisi suspenso pede ac tardius procedere ; diligenter interim illarum ingenium atque morem observare ; quibus itidem prsesi- diorum generibus segri juventur vel lsedantur, ut quamprimum his repu- diatis, illis utamur. 11 the comforts of that class who have the greatest cause for apprehension ; and by providing for the sick and needy, that the " Lord may deliver us in the day of trouble." And why, we may enquire, have we been visited so lightly ? "It is of the Lord's mercies that we are not consurrcd, and because his compassions fail not." Oh ! may his long suffering lead us to repentance, unto salvation not to be repented of. May we nationally (and be it remembered a nation is composed of individuals) " humble ourselves under the mighty hand of God, that He may exalt us in due time." May we bow down in submission to Jesus, the prince of peace, — " and confess Him to be Lord, to the glory of God the Father." For he alone it is " who forgiveth all our iniquities and healeth all our diseases, who redeemeth our life from destruction, and crowneth us with loving kindness and tender mercies." END. Diggens and Jones, Printers, Leicester Street, Leicester Square.