Greenhaw , Cholera 

1262 •838 



?j Surgeon General's Office ?! 











CHOLERA, AS IT RECENTLY APPEARED IN THE TOWNS OF IHrCIXrDIKG 

ILLUSTRATIVE 

of its physiology and pathologic 

WITH A VIEW 

TO THE ESTABLISHMENT OP SOUND PRINCIPLES OF PRACTICE, 

T. M. OREENHOW, 

(<Mf NEWCASTLE UPON TYNE,) 

MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON, &C. &C. &C. 

CAREY & LEA. 

1832. 



GBIGGS & DICKIITSOir, EEINTEKS. 



INTRODUCTION. 

In the following Essay, it is far from my intention to enter upon elaborate or learned disquisitions, or to examine the opinions of authors, on the various topics connected with the disease as it has occurred on the continents of Europe and Asia. My main object will be to exhibit a short, but clear and comprehensive, sketch of Cholera, as it has presented itself to my own notice; together with the results of the various remedies that have been employed since its appearance on the shores of Great Britain. I shall then enter upon a short inquiry into the circumstances w 7 hich attended its commencement at Sunderland, with a view to ascertain its true origin, and shall afterwards examine the evidence, as far as I shall be enabled to obtain such evidence, which bears upon the important question — Is Cholera contagious ? This will necessarily include some details of its progress in Newcastle and the neighbouring district, and probably some conjectures as to its progressive course through the country. In conclusion, a few remarks 



4 

will be offered upon the most efficient measures of precaution in the way of medical police, during the prevalence of the disease in the British Islands. 

As, on an occasion like the present, I consider conciseness and brevity essential to the utility of such an undertaking, I anticipate that all I have to say on these several topics will be compressed within a small compass, and that I shall not require to draw very largely, either upon the time or the patience of my readers. 

But be this as it may, it will be my earnest and diligent endeavour to omit no important circumstance connected either with the Symptoms, the Pathology, or the Treatment of Cholera. And, whatever may be my present opinions on any speculative question relative to the disease, I trust they will be sustained only with becoming candour, and relinquished, not too readily, but without hesitation, on sufficient proof of their fallacy. 

Since I formed the intention of attempting the accomplishment of the objects of this Essay, I have become aware that many, perhaps abler, heads and pens, are already employed on the same subject; and, perhaps, becoming modesty might have induced me to relinquish my design, were it not 



5 

for the consideration that, however numerous may be the efforts, too much cannot be attempted, to resist or modify the progress, or throw light upon the treatment of a disease of unexampled malignity and fatality, in the modern annals of British Medicine. 

With all its imperfections, then, as regards the conception or execution of my little work, I commit it, with perfect good faith, to the candid consideration and criticism of the profession; not doubting that its merits, if it have any, will be acknowledged with liberality, and its faults, of which I doubt not it will contain many, will receive ample indulgence. 

To the several professional friends who have favoured me with information, I offer my best thanks. They are particularly due to Mr. Green, of Sunderland, and to the gentlemen of Gateshead whose communications appear in the Appendix ; but they must not be omitted to several friends in Newcastle who have assisted me in the objects I had proposed to myselfi in drawing up this little Essay. To Mr. Baird, more especially, I must express my obligation, for his full and explicit communication on the subject of the tobacco enema. 

The cases, derived from various sources, which I have introduced, are given in the words of the 



6 

gentlemen in whose practice they occurred; and in the Appendix will be found explanations of the opinions and practice of several of my friends, some of which tend to corroborate, while others are more or less at variance with, the views I have endeavoured to lay open to the profession; these also are given in their own language; I must, therefore, be acquitted of the imputation of suppression, or misrepresentation, to serve my own purposes. Truth, and its legitimate deductions, have been my aim throughout. 

Eldon Square, Newcastle, Feb. 9, 1832. 



CONTENTS. 

CHOLERA— Page 

Name, -¦-'.. . - . . -9 

Description, - - - - - - 11 

Physiology, - - - - - --14 

Pathology, - .. - _ _ -19 

Treatment, ------- 22 

CASES.— I. First Degree, - - - - - 33 

11. Second Degree, - - - - - 34 

111. Third Degree, - - - - - - 35 

IV. Fourth Degree, 37 

Post Mortem appearances, as exhibited in Cases 10, 11, 12, 13, 14, 48 

Miscellaneous Cases, showing various modes of treatment and their results, - - - - 57 

Prognosis, - - - - - - - - 83 

New Remedies, 84 

Mustard Emetic, - - - - - - -85 

Copious hot Injections into the Intestines, - 86 

Tobacco Enema, - -- - - - -86 

Causes of Cholera, - - - - - - 88 

Predisposing, -- - - - - -88 

Natural and acquired, - - - - - - 88 

Efficient Cause, - - - - - . - 93 

General atmospheric agency, - 96 

Contagion, - - - - - - -102 



viii 

CONTENTS. 

Page 

Hints on measures of prevention in the way of Medical Police, - 120 

APPENDIX. 

/. Communications from Dr. Alexander., - - 131 //. — Mr. T. K. Fife, - 132 ///. Mr. Brady, - - 135 IV. Mr. Wilson, - - 139 V. Mr. Baird, - - - 139 VI. Mr. W. Fife, - - 155 VII. Mr. John Fife, - - 157 





CHOLERA. 

The difficulty of designating a disease by a name, at once concise and comprehensive, expressive of its true and essential characters, has been experienced by all nosologists; and there are few instances, perhaps, where criticism might not find many well-founded objections. But with regard to the disease which forms the subject of the present essay, such objections present themselves in peculiar force, not only to the generic term " Cholera" itself, but to all the epithets that have been attached to it, as expressive of its distinctive features. 

That a term, the true meaning of which is, v an undue flow of bile," should be given to a disease, one' of the great peculiarities of which has been thought to reside in the absence of biliary secretion and excretion, is, certainly, to be not less wondered at than regretted. To say the least of it, it is a singular proof of the imperfection of nosological language, and well calculated to lead to practical errors, unless we are made fully aware of. its entire inapplicability. Objections of a similar nature may be applied to all the specific epithets which have been adopted by the various writers on the subject of this disease* To call it "Contagious Cholera," according to Mr. Kennedy, is a complete begging of one of the most interesting and important questions connected with its history. The 

o 



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" Asphyxia" of Mr. Bell, is expressive of a symptom which is present in the most severe forms only of the disease. A similar remark may he applied to the term " Spasmodica ;". and to call it the Asiatic, Indian, or Continental Cholera, might lead to erroneous views as to its origin and mode of extension from one country to another. Perhaps "Malignant Cholera" is the least objectionable epithet that can he applied to it ; hut even this, is expressive of degree rather than of kind, and is only applicable to a particular type or stage of the disease. It would seem, then, that the truly formidable disease which has appeared in our island, so long free from pestilential ailments, has not hitherto received a name which properly indicates either its real nature or the peculiar group of symptoms by which its existence is recognised. It is far from my intention to attempt to remedy this defect, for, in addition to the difficulty of the task which I should impose upon myself, I doubt much, whether, were I to succeed, any material benefit could arise from changing a designation with which the disease has become so familiarly associated, not only to the professional but the general public. But while I propose to retain the generic term " Cholera," notwithstanding its philological inaccuracy, on the principle, that, like many other names, it has become too intimately associated with the thing to which it appertains, to admit of ambiguity or doubt in its application, I would altogether abandon any specific epithet, because none can be found free from serious objection. The disease, whose portrait, since its appearance in England, it is my object to trace, I shall then, simply designate " Cholera," because, by that name, every body will know what is meant; but, to prevent misapprehension, it may be well, in the first place, to attempt some precise definition or concise description of the more striking characters of the disease to which this term is thus conventionally applied, as it has presented itself to our observation. 



11 

That the morbid phenomena to which we have agreed to apply the name of " Cholera," are in their grouping altogether new, or at least hitherto of very rare occurrence in this country, is universally admitted by all the members of the profession, by whom, in their severer forms, they have been witnessed ; and their formidable character, their rapid course and frequent fatality cannot fail to render them a subject of the deepest interest, and worthy of the most profound study of the medical philosopher. 

As an abstract definition, perhaps, the description of Mason Good is, as far as it goes, more accurate and concise than any that has been attempted by other writers ; it stops short, however, of the most striking features of the severest forms of the disease. It is given in the following words : — " The dejections watery; ineffectual retchings, or vomiting of a whitish fluid; spasms successive and violent, often extending to every organ: great despondency and prostration of strength." If to these he had added, " pain at the scorbiculus cordis; urgent thirst; suspension, nearly complete, of the action of the heart and arteries, with its necessary consequence, failure of secretion and of animal heat, as exhibited in asphyxia, cold surface, cold tongue and breath, suppression of the urinary and biliary discharges" — his picture would have been a pretty accurate one. But there are yet other symptoms of a striking and characteristic nature which cannot conveniently be comprised in a definition — the whispering voice; the blueness and wrinkled integuments of the extremities; the livid, shrunk countenance, with the glazed and sunken eye, so expressive of anxiety and suffering, and which add, in so remarkable a manner, to the apparent age of the patient, are circumstances which, if once witnessed, impress the memory too forcibly to be forgotten, and cannot fail to be immediately recognised when exhibited in succeeding cases ; the same may be said of the discharges from the stomach and intestines, which have received the appropriate 



12 

appellation of " congee," or " rice water," and may properly be considered as peculiar to this disease. Of the real nature of these evacuations we shall speak hereafter. They bear no resemblance to the natural secretions of the alimentary canal, and differ wjdely in appearance from any intestinal excretions with which we are familiar. 

Such are the striking and novel features of this remarkable disease ; and in its intensest form, it is surprising with what accuracy they may all be observed, not one of them being absent. In such instances, the observer is frequently at once impressed with a conviction of the utter hopelessness of the case; and the impression is too frequently a strictly accurate one; for when thus strongly marked, few indeed are the cases that do well. 

But there are yet a few circumstances, rather of a negative than of a truly symptomatic character, which ought not to pass unnoticed. While the circulatory and secretory functions are at a stand, the sensorial powers remain unaffected, nearly, if not entirely, to the last. The patient is sensible of all that passes around him; he answers with distinctness and accuracy any question that may be put to him, though it may be in monosyllables only; while his hands are cold and bloodless, he yet retains the sense of touch, and even feels with increased sensibility, sometimes complaining of a painful impression of heat from the application of bodies of moderate temperature. He also occasionally retains considerable muscular strength; and the respiration goes on with ease and regularity till within a few minutes of death. The whole exhibits an impressive picture of the death of one set of organs, while life still maintains its seat in others. But the power of thought, sensation and motion, cannot long continue, unless sustained by the necessary stimulus of the vital stream; and the function of respiration becomes a useless effort when that stream is no longer impelled through the lungs to receive the supply of oxygen gas, so essential 



13 



to the continuance of life, which their action is intended to impart. 

But, after all, the definition of Good, together with the additional catalogue of symptoms which has been enumerated, applies rather to a stage of the disease than to its entire course, though it is true that stage is the most marked and characteristic, and, on a few occasions, it may be the only one which exhibits itself to our notice. It may occur suddenly, without previous warning or appreciable indisposition, and at once arrest the functions of life, terminating fatally with fearful rapidity. But, for the most part, it may be considered as a second, rather than a first, stage of disease, being very generally preceded by a train of symptoms, which, if attended to, give timely notice of its approach. These consist of diarrhoea, often for many days, and general failure of the digestive powers; not unfrequently of headach, pain at the scrobiculus cordis, or some part of the abdomen, and preternatural vascular action. It has sometimes happened that this increased action of the vascular system has given to the patient a feeling of unusually good health, and a greater excitement of animal spirits than was usual to him. In other cases, and more frequently, the patient feels languid, weary, and oppressed before the attack, with a general feeling of undefined indisposition. The first discharges from the stomach often consist of the unaltered ingesta of the last twenty-four hours, showing the failure of digestive action during that period; and the alvine evacuations consist, at first, of the feculent and bilious contents of the intestines, which are presently succeeded by the serous or rice-water discharges peculiar to the disease. 

If the patient struggles through the second stage of the disease, which may be called that of asphyxia, collapse, or of secretory suspension, a new set of symptoms exhibit themselves. The asphyxia gradually yields to vascular reaction, $yhich will probably proceed to an undue extent, proportion? 



14 

ate to the intensity of the preceding train of phenomena. The resistance to the restored circulation will have heen greater in some one organ, or series of organs, than in others. Hence local determinations, congestions, or inflammations will arise; perhaps in the head, characterized by pain, injected conjunctiva?, impatience of light, noise in the ears, delirium, a dry red tongue with an accelerated pulse; perhaps in the mucous membrane of the stomach, which is evinced by continued pain, and tenderness on pressure at the scrobiculus cordis, by frequent vomiting, thirst, absence of appetite, furred tongue, great restlessness and a frequent, sharp pulse; perhaps the peritoneum, or even the mucous membrane of the intestines may be the more immediate seat of inflammatory action, when the ordinary symptoms will be exhibited ; such as local pain and tenderness on pressure, ineffective evacuations of mucous matter tinged with blood, sometimes grumous blood, frequent retchings, quick and sharp pulse, dry brown tongue and thirst. 

If this rapid outline of the disease be accurately drawn, it will appear that we can frequently trace in it three distinct stages, which may be properly called — 1, The stage of irritation; 2, the stage of collapse; and 3, the stage of reaction. But the first stage is neither uniform in its appearance — perhaps I ought rather to say it is not uniformly recognise — nor is it peculiar to Cholera. It is a state of gastric and intestinal derangement, with vascular excitement, .or perhaps, more properly speaking, vascular irritation, which may arise from other causes, and may pass away without being followed by the diagnostic symptoms of Cholera. But during the prevalence of that disease, it is a condition of the system which ought immediately to receive our closest attention, for we know not how soon it may pass into the severest form of the second stage. It is, however, in the second stage of Cholera that the proper diagnostic symptoms exhibit themselves; and these must be considered as residing 



15 

in arrested secretions and defective circulation: for on these appear to depend the peculiar serous or watery evacuations from the stomach and bowels, which usually form the first link in the chain of diagnostic symptoms, as well as the failure of the pulse, the lividity of countenance, shrinking of features, blue and wrinkled extremities, coldness of the tongue and breath, and suppression of urine which follow. However frequent and severe may be the spasms, they cannot be properly looked upon as diagnostic, so frequently do they occur in the ordinary Cholera Morbus of the country. The third stage, or that of reaction, when fairly established, loses entirely every character of a diagnostic nature. It is simply a state of local inflammatory action or general febrile excitement, which might have arisen without being preceded by symptoms of Cholera. The liver and kidneys resume their functions, though it may be in a morbid or imperfect manner, corresponding with the peculiar form of disease that may have established itself when the proper choleric symptoms have passed away. 

It is in the second stage only, then, that the disease can be certainly recognised; and an analysis of the symptoms of that stage will enable us to discover, 

1. Great irritation of the minute nervous expansion of the stomach and bowels, whereby they are impelled to a frequent discharge of their contents. 

2. A peculiar condition of the mucous membrane of these organs, whereby their proper absorbent and secretory functions are entirely suspended, and they permit the profuse serous discharges to drain through them without resistance. 

3. When the serous or watery discharges from the stomach and bowels have become once fairly established, a complete suspension of the biliary and urinary secretions takes place. 

4. A failure of the action of the heart and arteries, often 



16 

so complete as to amount to a total stagnation of the circu-* lating mass, not only in the capilla^, but in the larger vessels; while the blood is changed in quality by the failure of the process of oxygenation and the removal of its thinner parts, and diminished in quantity by the profuse serous or watery discharges from the stomach and bowels. 

5. Consequent and dependant on the arrested circulation, a complete failure of animal heat, as evinced by the cold extremities, and the extraordinary coldness of the tongue and breath. 

6. Spasmodic actions, more or less severe of the muscular apparatus — probably dependant on sympathy with the irritable condition of the alimentary canal. 

A little attention to this analytic arrangement of symptoms will prepare us for inquiring, in the first place, into the physiology of Cholera, and subsequently will enable us to pursue distinct and rational indications of cure. 

If we revert to the order of the phenomena, both in the analysis which I have given, and as they generally present themselves to our notice, we find the irritable condition of the stomach and bowels the first in occurrence; and this is more remarkably the case when we are enabled to trace an earlier stage of disease than that of asphyxia or collapse. In a great majority of cases such a stage may be clearly ascertained to have taken place, and its symptoms — diarrhoea, impaired digestion, headach, pain at the pit of the stomach, or extending over the abdomen, with a quick sharp pulsemore or less strongly marked, are all indicative of gastric and intestinal irritation. This irritation, then, appears to be the primary effect of the efficient cause of Cholera. Whatever may be the true nature of that cause, or the mode of its introduction into the system, (questions which will be hereafter adverted to,) it seems sufficiently evident that its first impression is made upon the nervous expansion of the alimentary tube, and that on this is ultimately dependant the 



17 

series of phenomena which follows. In this respect it bears a strong analogy to the effects of many poisons. In proportion to the intensity of the first application of the efficient cause, and to the susceptibility of the individual on whom it acts, will be the degree of severity of the symptoms immediately and ultimately induced. If the susceptibility be great and the intensity of the agent considerable, the patient will probably be plunged, with scarcely an appreciable interval, into the appalling abyss of the second stage of the disease; yet, even these cases, though overlooked, or with difficulty distinguished, it is probable that a primary stage actually does take place. Its extreme shortness eludes our observation, in a manner somewhat analogous to the rapidity with which the mind pursues a train of reasoning on familiar subjects, and arrives at a conclusion, scarcely aware of having run over intermediate links in the chain of inquiry, although we are fully assured that such must actually have been the case. In other instances the progress is less rapid, the first stage is distinctly marked; we are enabled to trace the succession of symptoms with accuracy, and their dependance upon each other will admit of more deliberate observation. 

In cases of this description the marks of gastric and intestinal irritation sometimes show themselves for many days, in diarrhoea, loss of appetite, nausea, pain at the stomach, with quick and irritable pulse, and the other slight symptoms of indisposition which have been already noticed. The secretions are not yet suspended, and the diarrhoea is, perhaps, rather of a bilious than of a serous nature; the whole train of symptoms are distinctly referrible to the digestive derangement. But, after some time, the length of which is uncertain, the function of the alimentary tube is more completely suspended; although the gall-bladder contains bile, it is no longer admitted into the duodenum; the 

3 



18 

proper feculent matter has been entirely removed; the secretion of the mucous membrane is put an end to: and enormous quantities of serous fluid exude from its surface. All this appears to be the effect of the increasing derangement of its nervous expansion; the same deprivation of nervous energyis rapidly communicated from the extreme branches to the trunks of the nerves, and thence proceeds to the other organs connected with that part of the nervous system; the liver and the kidneys cease to act, and the heart and arteries nearly or entirely forget to impel the vital stream; the blood, thickened in substance and diminished in quantity, stagnates in its channels, the lungs, indeed, act for some time with astonishing regularity, but no blood is transmitted through their substance to receive the vitalizing influence of the inhaled atmosphere; there is no absorption of oxygen; there is no disengagement of carbonic acid gas; there is no appropriation of caloric to the purposes of the system; respiration has become a useless office; so complete is the failure of animal heat that the air which passes from the lungs is manifestly colder to the feeling than that of inspiration, and the tongue becomes proportionally cold. 

The remaining phenomena of the second stage of the disease are clearly referrible to the same train of causes; the deficiency of heat extends more or less over the entire surface, but is more particularly remarkable in the extremities and the face, which feel as cold as those of one already dead. The diminution in the quantity of circulating fluid is seen in the shrinking of the solids, as is evinced in the shrivelled hands, the sharp and aged countenance, and the deep set eye; and its darkened hue and thickened consistence, in the dull and suffused eye, the livid face, the blueness of the extremities, and the Viscid tarry appearance of any quantity of blood that may be squeezed from an opened vein. 

That the spasmodic action of the muscles, first of the extremities, and occasionally afterwards of the trunk and 



19 

jaw, of which the patient frequently complains in the most distressing manner, may, with propriety, be referred to sympathy with the irritable condition of the primss vise, will, I suppose, scarcely admit of a doubt, so accustomed are we to connect the same effect with a similar cause. In the ordinary bilious Cholera of our own climate this is constantly the case, and the fact that the cramps occasionally take place in the first stage, while the diarrhoea is yet of a bilious character, and if not frequently before the suppression of the secretions is evinced by the serous discharges, at any rate antecedent to the complete state of collapse, seems to prove that they are merely dependant on nervous sympathy. They must, therefore, be considered rather as accidental than essential symptoms of the disease, though when present, they seem proportionate in their severity to the intensity of the attack, and must, in consequence, enter into our account in estimating the probability 01 recovery. 

If these physiological views be founded in truth, the phenomena of Cholera must be considered as residing in functional derangement, rather than in alterations of organic structure, and pathological inquiries appear to confirm this conclusion. Of the true nature of the nervous influence we are yet entirely ignorant; our inquiries amount to nothing more than conjecture, and our knowledge is limited to its effects. It is true that organic changes may sometimes be discovered in the condition of parts of the nervous system, which may account for a non-performance of their functions during life, but frequently no greater difference can be perceived than between a magnetic needle in full play, and a similar piece of steel unpossessed of the magnetic power. And such is the case in the post mortem examinations of the sub jects of Cholera. No alterations either in the organization of the neuralgic, or visceral structures, has been discovered to account in a satisfactory manner for the remarkable train of symptoms which characterizes this extraordinary disease, 



20 

and any morbid appearances which have presented themselves must be considered rather as arising from, than as having occasioned, the functional derangements which were observed during life. The truth of this remark, I think, will be corroborated by the writings of every author on the subject, and certainly my own observations have tended entirely to confirm it. In point of fact, with the exception of a distended gall bladder, and an empty, shrunk condition of the urinary bladder, which have very constantly been observed, no morbid appearance, whatever, has been discovered, but what might fairly be anticipated as necessarily arising from the arrest of the circulation during life, and altered condition of the blood already noticed. The blood is found dark and viscid, and collected in the great vessels, congested in the liver and lungs, and probably injecting the vessels of the mesentery and intestines, of their mucous membrane more especially, but occasionally of their serous membrane also. The vessels of the brain and spinal cord have sometimes been found in the same injected condition. We can easily understand how such a vascular condition of viscera should, in case of reaction being established, lead to extensive and acute inflammations, as so frequently happens when the patient passes into the third stage of the disease; and, if reaction have fully or partially taken place at the time of death, we shall, in all probability, find ample proofs of the existence of such inflammation. 

Such are the views which I have been led to entertain of the nature of Cholera, from a pretty extensive observation of the disease in the hospitals established in this place, and a close and watchful attention to its symptoms and progress in a few cases which have come more immediately under my own care. I shall endeavour presently to illustrate fully the truth of those views by accurate notes taken by the bed-side of the patients, at very short intervals. lam not prepared to give numerous cases of this description, but, believing as 



21 

I do, that a few individual pictures are likely to be both more useful and more interesting than numerous sketches less accurately drawn, I trust that I shall be enabled to exhibit portraits of the disease which will be found not unworthy of attention. They will tend also, if I mistake not, fully to confirm the physiological explanation which I have attempted of the phenomena of the disease. 

On the score of novelty, in my opinions, I make no claim, yet I may affirm, that the conclusions at which I have arrived^ are the effect of personal observation, with a mind doubtless prepared, by my previous reading on the subject. I say this, not to avoid the imputation of having been swayed by the opinions of others, but rather as a confirmation of those opinions, when coincident with my own. Mr. Bell, in particular, has expressed physiological opinions very similar to those which I have endeavoured briefly to explain, with this difference, however, that he appears to believe that the first impression of the efficient cause of Cholera is made upon the nervous trunks and ganglia of the sympathetic, whereas I have been led to conclude that it reaches these in a secondary manner only through their minute ramifications in the alimentary tube. The distinction is an important one, since if the effect can be removed while yet confined to the nervous extremities, the affection of the trunks, the ganglia, and the important series of viscera which they supply, will be prevented, and the disease cut short before its most dangerous symptoms have had time to establish themselves. If, on the other hand, the more central portions of this part of the nervous system are, in the first instance, affected by the morbid agent, it is scarcely likely that it should be arrested without extending its influence to the minute ramifications in the several viscera which suffer such extraordinary functional derangement in the well-marked secondary stage of the disease. 

Assuming then, that we have arrived at true and satisfac- 



22 





Tory conclusions respecting the structure on which the first impression of the efficient cause of Cholera is made, and the manner in which the several organs, secretory and circulatory, become subsequently affected, through the medium of the par vagum and its ganglia, giving rise to the remarkable phenomena which may be considered as diagnostic in the second stage of the disease, we shall be enabled to infer certain distinct indications to be observed in conducting its treatment. I shall, in the first place, notice these indications in their natural order, and shall then describe the means by which experience has proved to me they can be best carried into effect. The cases which I shall afterwards relate will form the best comment upon the correctness of both. 

In the treatment of a case of Cholera, then, we must hold in view — • 

1. The necessity of allaying irritation in the nervous expansion of the stomach and bowels. 

2. To excite the vascular system, and to restore animal heat. 

3. To restore the suppressed secretions. 

4. To obtain healthy evacuations from the bowels and kidneys. 

5. To moderate reaction, and obviate congestions, local determinations, or organic inflammation. 

The first indication may be considered as common to the first and second stages of the disease, the three succeeding ones relate principally to the second stage, and the last indication is peculiar to the third stage of Cholera. We will consider them in the order of their arrangement. 

If the supposition be correct, that the efficient cause of this disease produces its primary impression on the mucous membrane of the stomach and bowels, or rather on the extreme nervous filaments with which they are supplied, and that the irritation hence arising is the immediate exciting 



23 

cause of the nausea, vomiting, and purging which ensue, one of the most obvious and efficient means which presents itself to our consideration is the excitement of full vomiting to relieve the inefficient retchings which characterize that symptom of the disease. In this way we shall not only induce a new action in the stomach, by changing the vomiting of irritation into that of excitement, but we shall probably remove undigested matter, if, as is frequently the case, such should remain there, tending to increase irritation, and give a powerful stimulus to the vascular system, to the several deranged organs, and to the skin. Some degree of reaction, a partial restoration of animal heat, moisture of the skin, a relaxation of spasm, and a general feeling of relief, very generally succeed the full vomiting induced by an emetic. The nature of the agent by which this new action of the stomach should be excited will depend upon the group of symptoms which obtain in the particular case. If the stage of collapse have not yet established itself, and if with bilious diarrhoea the patient complains much of nausea and occasional retching, the matter rejected consisting principally of undigested food, we shall probably find a dose of ipecacuanha, with or without antimony, answer the purpose, or even copious draughts of warm water willsuffice to wash out thoroughly the contents of the stomach. Should the patient complain at this time of vertigo, headach, or pain in the abdomen, with an accelerated pulse, the greatest relief will arise from a full bleeding, proportioned, however, to the strength of the constitution, the effect produced upon the pulse, and the urgency of the symptoms. As the blood flows the pain in the abdomen and head will be relieved, and the pulse will become slower and softer ; a manifest diminution of gastric irritation will also result from it. 

When the stage of collapse has set in, and we find our patient cold and pulseless, excitability is greatly diminished, 



24 

and a more powerful stimulus is required to excite the full action of free vomiting. It is in cases of this description that the mustard emetic has been used with considerable benefit. Two drachms of mustard, in a cup of warm water, may be given every ten minutes till full vomiting ensues. Not only do the stimulating qualities of the mustard change the irritation of the stomach into the action of excitement, but they appear to have a considerable influence over the suspended circulation, often inducing a return of pulsation at the wrist, increased heat of the extremities, and a diaphoretic effect upon the skin. After the action of the emetic, the indication of allaying irritation is to be followed up by repeated doses of calomel and opium. lam disposed to think, that both these medicines may be given in too large quantities, especially the opium: it has a tendency to oppress the head, and in large doses, rather to retard than stimulate the action of the heart and arteries. I think 1 have found, that in reference to the present indication, grain doses of opium, repeated every hour, are capable of effecting all the good we can expect from that medicine, while I have not observed any unpleasant results to arise from it; and when conjoined in a pill with five grains of calomel, it frequently succeeds in checking the retchings, and, ere long, the serous discharges from the bowels, while the spasms also yield to its soothing influence. After trying many combinations of opium both in a liquid and a solid form, I have given a decided preference to the present formula. But there are, no doubt, cases depending on the constitution and previous habits of the patient, in which larger doses of opium may be, not only admissible, but absolutely necessary, to ensure the beneficial effects of the remedy. Whether advantage is to be derived from larger doses of calomel, I feel much doubt, but I am disposed to believe, that generally speaking, the dose proposed is not likely to be less efficacious than any larger quantity; and if a greatly larger dose is 



25 

capable of producing any additional effect upon the constitution, there is certainly a hazard of its being an unfavourable one. 

Our second indication is to be effected partly by the means already noticed, by the administration of internal stimulants, by the assiduous application of external heat, by copious, warm, and stimulating injections into the intestines, and by irritating applications and friction to the surface. Perhaps there are few internal stimulants more grateful to the stomach, or more efficacious in their action, than brandy, a table-spoonful or two of which may be given repeatedly either in warm water or gruel. In extreme cases, however, other more powerful stimuli may be exhibited either in conjunction with it, or at intermediate intervals: these may consist of ammonia, camphor, sulphuric aether, or the essential oils. I have not been able to discover that any thing like a specific effect has been produced by any of these; and if any good at all should arise from their exhibition, it must certainly be attributed simply to their general power as stimulants. The external application of heat naturally forces itself upon our attention as an obvious means of exciting the dormant action of the heart and arteries, and of obviating the extraordinary cold" ness which seems to pervade the entire system. It is true* indeed, that I have heard some scepticism expressed as to the utility of this measure, by physicians of great skill and experience in the treatment of Cholera, on the ground that it was totally unequal to the excitement of reaction. lam satisfied, at least, that it places the person in a state to admit of the more ready restoration of the circulation; and that, whether or not, in itself, it may have any effect as a direct stimulus,, at any rate, it gives additional efficacy to the other stimulating measures that may be pursued. I must consider the assiduous and unremitting application of external heat, therefore, as an essential part of our treatment of the stage of coldness and asphyxia. 

i 



26 

For the accomplishment of this purpose, one of the first things to be attended to, is to clothe the person of the patient in a large body dress or shirt of thick flannel, and to envelope him when laid in bed, in an ample supply of warm blankets; heated bodies of any convenient description should also be constantly applied to the extremities, to the spine, and to the pit of the stomach and abdomen. Various contrivances have been made use of for applying heat to the surface. To the employment of the warm or hot bath it has been objected that the exertion and fatigue attendant on its use, are likely to be more injurious by the exhaustion they would occasion, than could be compensated by any benefit arising from the general application of heat that would be obtained; and although warm baths have been found beneficial in India and on the Continent, in this place, they have not been resorted to in the treatment of Cholera. Nevertheless, I know a gentleman who suffered from Cholera, at Archangel, during the last summer, and who was restored from a state of complete asphyxia by being kept in a warm bath, of high temperature, for an hour and a half. lam sufficiently sensible of the necessity of preventing the patient from using any voluntary exertion, and more especially of strictly preserving the horizontal position during arrested circulation, having witnessed the fatal effects of a departure from this rule in the almost immediate death of the patient; but I am yet inclined to believe, that the prejudice against the use of the warm bath is greater than necessary. The patient might surely be placed in, and removed from it, with such quickness and so little disturbance, as to obviate the objections that have been made to it. It is, however, for the most part in hospital practice only, that the employment of this means of restoring the defective heat of the system could be available, since the houses of the poor are seldom provided with the requisite conveniences for preparing a heated bath. Various machines have been invented for introducing heated 



27 

air into the bed of the patient, but the experience of our hospitals has proved their inefficiency, I believe, without an exception, and their use has been almost entirely laid aside. Mr. Wood, a gentleman of considerable ingenuity in this place, has contrived an apparatus consisting of several thin bottles of tinned iron, which are adapted to the extremities and other parts of the body in such a manner, that when filled with warm water and cased in bags of flannel, they ha v& been found to answer in a satisfactory manner the purpose of the external application of heat; but on ordinary occasions, we must content ourselves with heated irons, bricks, bags of sand, flannels, &c* 

Copious, warm, and stimulating injections into the intestines, have been found valuable auxiliaries in effecting this indication. I have seen the restoration of animal heat and the reaction of the vascular system commence almost immediately after the injection of three pints of water, containing a strong solution of soap, and of as high a temperature as could be safely borne, in a patient whose condition appeared hopeless, so complete were the general coldness and asphyxia. This man's case will be related hereafter; his recovery has been complete. The same remedy has been advantageously employed in numerous other cases by several of my professional friends ; occasionally it has contained laudanum with a view to allay irritation — at other times, stimulants, as camphorated spirit of wine or a teaspoonful of powdered mustard. The main advantage, however, seems to be derived from the quantity and warmth of the fluid, which must be thrown with considerable force, by means of Read's syringe, into the intestines. The colon becomes filled with it from the ccecum to the rectum, and it acts as an internal fomentation, or warm bath, to the several organs with which, in consequence of 

* Mr. Brady, of Gateshead, informs me that he has used moist heat with much benefit, in the shape of a large poultice of bran, placed be« tween two sheets, and applied over the entire surface. 



28 

the course of the large intestine, it is placed in contact. Should it he discharged, the injection can he repeated any number of times, till its full effect is produced, with little or no fatigue to the patient. In the case referred to above, it remained fifteen hours. 

An injection of a different description has been employed and recommended by my friend, Mr. Baird. From the analogy which he believed to exist between some of the symptoms of Cholera and those of tetanus, he was induced to try the effect of injecting an infusion of tobacco into the rectum; and the first patient on whom the experiment was made did well, although his case had appeared nearly hopeless. I have not myself made use of this remedy, but have been given to understand that, in other instances, it has, at least, entirely failed, if its effects did not prove unequivocally injurious. We must, I think, conclude that it was in reference to spasm that Mr. Baird was led to make use of the tobacco injection ; but if we have estimated correctly the relative importance of the symptoms, the danger does not arise from spasms but from the arrested circulation and the absence of animal heat. Is it likely, then, that these should be restored by the use of so powerful a sedative as tobacco? In cases of strangulated hernia, we use it to relax spasm indeed (if the stricture on the intestine may be considered as such,) but at the same time to depress the powers of the heart and arteries ; and experience proves that it answers this indication well. We should scarcely anticipate, then, that, in Cholera, it should produce a directly opposite effect. But Mr. Baird still maintains the utility of the measure, and I trust he may favour me with some notes on the subject. In addition to these means of stimulating to reaction, sinapisms to the scrobiculus cordis, to the insides of the knees, and to the calves of the legs, have been found beneficial, and frictions have, without doubt, proved valuable auxiliaries; the dry hand, flannels, or stimulating liniments may be used for this purpose. Friction 



29 

should be immediately applied to the parts affected with spasms, as a ready and efficient means of affording relief. A ligature round the affected limb, will likewise, not unfrequently be found of service. 

If the means already referred to have been employed with success, it is probable that our third indication — the restoration of the suppressed secretions — will have been in a great degree accomplished; this, indeed, is to be considered the surest sign of convalescence, and our anxiety to effect it is, in consequence, very great. If the case be a severe one, and by the unremitting employment of the measures described we have the inexpressible satisfaction of witnessing a decided remission of symptoms— a cessation of gastric and enteric irritation, evinced by an arrest of the serous discharges from the stomach and bowels, a restoration of the pulse and of animal heat, a relief of cramps, and a quietude and general feeling of comfort and composure in the patient — probably several of the pills with calomel and opium will have been given, perhaps to the amount of at least six or eight ; but the opium has now fulfilled its purpose, and its farther use would probably be injurious. Not so the calomel, unless a considerable quantity have been already taken, a full dose, varying from five grains to a scruple (in truth I believe it is a matter of much indifference which) may be given; and to fulfil the fourth indication — to obtain healthy evacuations from the bowels and kidneys — the exhibition of a purgative may soon succeed. Castor oil, lam disposed to believe, will be found the most effective and least irritating medicine of this class; but should it fail, other means ought soon to be resorted to, and injections may be employed to assist their operation. Calomel and jalap, or a purgative infusion with carb. and sulph. of magnesia, may be given at intervals until discharges are obtained from the bowels ; these will probably be found feculent and bilious, and, for the present, we may consider our patient safe, especially, if, as usually happens, urine be dis* charged at the same time, 



30 

Although for the sake of order I have spoken in succession of the several indications to be held in view in the treatment of the second stage of Cholera, and of the means by which they are to be answered, the actual employment of many of those means must be simultaneous. The urgency of the symptoms, and the rapidity with which they end in death if not relieved, will admit of no delay in the use of remedies; and we shall find it necessary to take a leading part in the administration of them ourselves. We must direct, superintend, and assist in, all that is going forward for the removal of the frightful symptoms which present themselves in our patient. It is not a case in which we can rely on the management of nurses, however well disposed to do what we advise : when we have left the patient's room they are almost certain to relax in their exertions. We must, therefore, watch the progress of the symptoms and the effect of the remedies with the utmost vigilance, and be content to perform not only the part of the physician but of principal nurse also. If we should be rewarded for our exertions, continued for many hours perhaps, by seeing our jpatient emerge from the fearful train of symptoms which characterize the second stage of Cholera, our personal attendance will no longer be required with the same degree of constancy, but we must carefully watch the progress of reaction, and be prepared to meet, with promptness and activity, symptoms of local determination or organic inflammation. The analogy between this stage of Cholera and the various forms of continued or inflammatory fever may be considered as complete, and our treatment must be of a corresponding nature. 

It is sufficiently evident that when reaction has once been fairly established, the farther use of stimulants must prove injurious j* their exhibition ought, therefore, to be 

* In a case which occurred in the Hospital established in the Castle, under the care of Dr. Headlara, the death of the patient was distinctly 



31 

discontinued ; and we shall probably find it necessary to resort to bleeding, local and general, assisted by blisters, pur-> gatives, diaphoretics, tepid ablutions, and the application of cold to the head. But the treatment of this stage of the disease, wherein the diagnostic symptoms of Cholera have disappeared, and which may perhaps rather be considered* as consecutive to, than an essential part of it, is not peculiar. Its leading feature is very generally organic inflammation, and the treatment must be conducted on general principles. It must, however, be bold and decided, and throughout, the patient must be closely watched, until convalescence is fully established. It is at the commencement of this stage that general bleeding is likely to prove especially useful in obviating, by anticipation, local inflammations. I have hitherto said little on the subject of this powerful remedy — powerful when employed at the auspicious moment— powerless when attempted to be used at a later or an earlier period. When we are fortunate enough to be called to a patient before the pulse fails, still more before the serous evacuations commence, when he is suffering from the symptoms which so frequently occur in the first stage — nausea or vomiting, purging of bilious matter, vertigo, headach, probably ingested conjunctiva?, pain in the abdomen or at the pit of the stomach, with a quick, sharp, or oppressed pulse, and probably occasional cramps in the legs — a full bleeding will be found of the greatest benefit, not only in relieving the existing symptoms, but in averting the impending horrors of the second stage of the disease; this effect may perhaps yet be produced, although the pulse have become feeble and still more oppressed,, but not when imperceptible. In such cases it expands and increases in strength and freedom as the blood flows. If, how- 

referrible to the imprudent administration of stimulants by his friends when he had arrived at a state of convalescence. " I am certain that congestion in the head was produced by the improper use of stimuli, whilst he was apparently convalescent," observes Dr. Headlam, in a note on the subject of this man's case. 



32 

ever, asphyxia, coldness and blueness of the extremities have fairly established themselves, the attempt to obtain blood is vain ; thickened and stagnant as it is in the vessels, it cannot be made to flow, and if a few ounces be squeezed from the orifices it hangs from them in long strings, accumulating like stalactites, without producing any beneficial effects. On the contrary it fatigues the patient, exposes him to the prejudical influence of cold, and suspends for a time more efficient means of relief. I must, therefore, hold bleeding in these circumstances to be inadmissible, principally because it cannot be accomplished; and the attempt injurious, since it diverts attention from measures of less doubtful utility, because they are really practicable. 

In the preceding rapid review of this remarkable disease, in which I have endeavoured to describe correctly and succinctly the phenomena or symptoms, the physiology and pathology, and to deduce therefrom just principles on which to conduct the treatment, it may, perhaps, be thought, that I have hurried over some parts of the subject in too cursory a manner. It is true, that it would have been easy to dilate, not unfrequently, the contents of a paragraph into a separate chapter; but I was anxious to convey, in as short a space as possible, the impressions which have been made on my mind by a careful observation of, and much reflection on. Cholera, as it has presented itself to my notice since its appearance in Newcastle. It may be objected, too, that I have not preserved that order in my description which might have been expected, having described the second stage, in the first place, and then proceeded to speak of the first and third stages — but it requires little discrimination to perceive that, though a consideration of the first and last stages was necessary, they were in themselves comparatively of little importance — that they were to be considered merely as subservient to the second, which is the really novel and important part of the subject — and that it was by a careful study of this stage only, when taken in connexion with 



33 

the previous and subsequent history -of the health of the patient, that the whole could be rationally considered in relation to each other as a connected series of morbid phenomena. My object is not to explain ingenious theoretical speculations, but to lay down useful practical rules — not to compose a systematic work on the subject of Cholera, but to make known, with the least possible delay, the results of my inquiries, my observations, and my practical experience, for the benefit of those who have not yet had an opportunity of witnessing, but who will, nevertheless, in all probability, soon be required to undertake the treatment of this destructive malady. 

I venture to hope, that the following cases will be found strictly corroborative of the general correctness of the descriptions which I have given, and of the principles of practice which I have endeavoured to establish. 

It is quite unnecessary, I conceive, to bring forward many instances of the milder forms of the disease, wherein the first stage only showed itself, and which were so little peculiar in their character, that, except from a knowledge that the severer forms so frequently commenced with precisely the same train of symptoms, they might scarcely be considered as partaking in any degree of the true choleric nature. With a view, however, of proving the connexion between the mildest and the most severe forms of the disease, and the probability that the former might, in many instances, if not checked, have proceeded to a development of the true diagnostic symptoms of the latter, I shall endeavour, by a suitable arrangement of cases, to exhibit the progressive steps of the disease from comparative mildness to the greatest degree of severity; of each of the milder forms, a single case will suffice for the purposes of illustration. 

CASE 

CASE I.— First Degree. 

John Bruce, aged 40. — I was called to this man in the 

5 



34 

night of Dec. 20. I found him under considerable alarm, having been seized with vomiting and purging since retiring to rest; he had also slight spasms in the lower extremities. The vomited matter consisted of the last taken ingesta; the stools were loose and bilious; no other symptoms. He was ordered to take immediately calomel gr. iv., opii. gr. ii., and in the morning, olei recini The pills checked entirely the vomiting and purging, and, after the operation of the castor oil, he remained free from complaint. 

I could easily adduce many cases of this description, but think it needless; the symptoms, the treatment, and the result were so nearly alike in all. A similar observation may be applied to the succeeding case. 

CASE II. — Second Degree. 

Thomas Graham, aged 42. — January 11th, 11, a. m. Has had a slight diarrhoea for some time. A more violent purging, accompanied with vomiting took place this morning; stools watery; complains of pain in the head, and in the abdomen; tongue moist and white; pulse 90. 

Venesectio ad sviii., cap. calomel gr. iv., opii. gr. i. statim. 

10, p. m. Was much relieved by the bleeding; is now free from pain; has had no vomiting or purging since taking the pills; pulse 70, soft; tongue white and moist; cap. olei recini mane. 

12th. Has had bilious feculent stools, and passed urine; slight tenderness in the abdomen, on pressure; applic. hirudines xij. abdomini, cap. statim calomel gr. iv., opii. gr. i., et hor. postea olei recini 

13th. Abdominal pain entirely removed; bowels and kidneys acting naturally ; convalescent. 

The following case appears to me very instructive. It exhibits a nearer approach to the second stage of the disease, 



35 

and shows the benefit of judicious treatment in averting the impending danger. 

CASE IIL — Third Degree. 

Catherine Bogue, aged 42, mother of a large family. 

January 3d, II p. m. Made a hearty supper last night of salted fish; was seized at 2 a. m. with bilious diarrhoea; stools have since been frequent, copious, and watery. During the day she has continued her employment in a wine cellar, and took some soup, with portions of meat in it, at dinner : no vomiting has yet taken place, but she now feels a disposition to vomit; tongue moist, and rather white; skin warm; pulse 86, rather full; passed water, with the last stool half an hour ago; complains of pain in forehead and abdomen, which is tender on pressure; voice hoarse; countenance sunk and expressive of much suffering; has had no cramp, but frequent shiverings in the course of the day. 

Full vomiting was induced by drinking large quantities of warm water, in the course of which the fish eaten at her last night's supper, and large portions of meat were rejected. Three stools rapidly succeeded each other; they were copious and loose, and though the first contained bilious matter, the last resembled gruel or rice water. She was bled to with entire relief to the head and abdomen, and the pulse became softer and fell to 60. She took calomel gr. v., opii. gr. L immediately, and an injection of gruel with tinct. opii. gtt. Ix. was thrown into the rectum. After this she appeared quite comfortable. 

4th. 11 a. m. Has had a restless night; much purging of rice water, and severe cramps in the legs; pulse soft, 96; no pain in head or abdomen; feeling of sickness without vomiting ; tongue moist and warm, rather white ; no urine passed. 

Opii. gr. i. , zingib. gr. ii., ft. pil. 2da quaque hora sumend. Repeat the injection. 



36 

5 p. m. No cramps lately; stools less frequent, and slightly bilious again; urine discharged with last stool, at 4p. m. Repeat the pill if cramps or diarrhoea should return. 

10 p. m. No pain or cramp. The last stool passed half an hour ago, is feculent and bilious; has had occasional cramps in the course of the afternoon; feels perfectly comfortable at present. 

sth, 11 a. m. Has had frequent vomiting and purging, with cramps during the night; no water passed since last report; pulse 96, rather weak; tongue clean and moist; thirst; stools, and vomited matter resembling gruel, with a slight yellow or greenish hue; she is now easy, but feels sick; cap. haust. effervesc. cum tinct. opii. gtt. v., 2da quaque hora, cap. calomel gr. ij., opii. gr. |- omni hora. 

4 p. m. No vomiting, though still a feeling of nausea; cramp and purging less frequent; stools more feculent and bilious; urine discharged. 

10 p. m. Feels quite comfortable to-night; one stool only since last report, of a bilious character ; urine in good quantity ; pulse 84, and soft ; less feeling of sickness ; has taken some sago with relish; omit the pills. 

6th. Convalescent. 

That, but for the bleeding and other means employed, this patient would soon have sunk into the stage of collapse, will, I think, admit of no doubt. The alteration in the nature of the stools was going on when I was first called to her. Of three evacuations which took place immediately after my arrival, the first was bilious, the last devoid of bile ; and the symptoms which soon succeeded, notwithstanding the treatment, prove that the second stage of the disease was fast approaching. Perhaps the tendency to relapse which afterwards showed itself was to be attributed to the calomel having been too soon discontinued. 

I shall now relate a case which points out, in the strong- 



37 

est manner, the mode of transition from the stage of irritation to that of collapse or asphyxia, and the necessity of using decided measures for its prevention. In the treatment of this case, which fortunately did well in the end, I have only to regret that an earlier attempt was not made to draw blood. If successful, as it would then probably have proved, the subsequent history of the disease would, perhaps, have been very different. 

CASE IV.— Fourth Degree. 

Thomas Taylor, aged 31. — December 26th. Was seized at 2 a. m. with vomiting, purging, and severe cramps, principally in the legs. When I first saw him at half past 4, he was vomiting beer, which he had drank since the attack commenced; he complained severely of spasms in the legs and thighs; pulse 90, and feeble: mustard emetic; warm water drank in abundance; full vomiting soon induced, and a stool passed resembling gruel; he became much easier after the' operation of the emetic; the cramps were relieved, and the pulse became fuller and slower; Calomel gr. x. were placed upon the tongue, and washed down with tinct. opii. gtt. xxx. in hot brandy and water; they were soon rejected by vomiting; the pulse became still more improved, and he was inclined to sleep. 

Half-past 5. Return of symptoms: repeat the calomel, tinct. opii., &c; sinapisms to the scrobiculis cordis; the medicines were again vomited: after this he complained much, and became excessively restless: an unsuccessful attempt was now made to draw blood; but he was nearly pulseless, and none would flow. 

6 o'clock. Calomel gr. x., tinct. opii. gtt. xl., sp. ammon. arom. 3ss. were given, but again rejected almost immediately; violent cramps returned, with great restlessness; thirst became urgent, and he wished much for cold water; tongue and breath getting cold; pulse indistinct. At half past six, 



38 

he slept a little, and the pulse improved. Calomel gr. v., opii. gr. i. ; a little rum, which he prefers to brandy, to be given occasionally in gruel. 

8 o'clock. Voice altered to a whisper; hands blue and shrivelled; no pulse; countenance sunk and aged; slight discharge of gruel-like matter from the bowels; has had less cramp; repeat the calomel and opium. 

Dr. Headlam now saw him with me, and advised acid, nitros. gtt. xx. tinct. opii. gtt. x. aq. menthse it was immediately rejected; the pulse became slightly improved; repeat the calomel and opium every hour. 

10 o'clock, an injection of soap and water was given, but it returned immediately without effect: afterwards, one with 01. terebinth, which was not retained. 

1, p. m. Hands very blue; cramps in the back and shoulders; pulse nearly, if not quite, imperceptible; no farther vomiting; no stools; cap. 01. croton. gtt. i.; it produced no effect. 

3, p. m. Blue, cold, pulseless; roused with difficulty to speak; and then in a whisper scarcely audible; very restless; greatly shrunk, and eye sunk deep in the socket; appearance of increased age remarkably striking; a large injection, consisting of three pints of a strong solution of soap in warm water, was thrown into the bowels with great force by means of the stomach pump : in an hour the pulse had become perceptible, heat was restored to the surface; every unfavourable appearance had diminished; and reaction became fairly established : he gradually improved until 9p. m., when the injection not having returned, the pills were omitted, and he took 01. recini and a dose of aperient mixture every two hours. 

27, 8 a. m. Has slept well, and is quite comfortable; skin warm and moist; pulse greatly improved, steady, soft, about 80; blueness of hands continues, though less intense; tongue (which had become dry last night) moist, and red in the centre; voice more natural; two large discharges from the 



39 

bowels, principally consisting of the injection; but the last one slightly tinged with bile, and having feculent odour; is uncertain whether urine has been discharged; has taken gruel and coffee. Cont. mist. purg. In the course of the day the bowels were more freely acted upon, the stools becoming more distinctly feculent; has passed urine repeatedly. In the evening the tongue became red in the centre, and somewhat dry; pulse full, 100; no pain in the head or elsewhere; no very urgent thirst. 

28. Has slept well; pulse softer and slower; no stool: calomel gr. v., pulv. jalap, gr. xij. statim sumend; cap. 3tia. quaque hor. mistur. salin. cum sp. aether nitric. The bowels were freely acted upon, and he was considered convalescent. He went on very slowly, without appetite, and having frequent nausea for about a week; when he vomited a membranous substance of considerable dimensions, resembling the adventitious membrane of croup. At first sight it resembled the mucous membrane of the stomach, with which it had evidently been closely united; from -this time his recovery was rapid. 

The membranous substance rejected from the stomach evidently consisted of the inspissated secretion of the mucous membrane; it was several inches in extent, and exhibited several red patches on its surface, where it seemed to have been in contact with corresponding vascular portions of that membrane. Was it the result of inflammatory action? lam disposed to think it was; and that this patient's recovery would have been more speedy had blood been abstracted soon after reaction commenced. Before the large hot injection was given (which remained in the intestine fifteen hours) his condition appeared more hopeless than I have witnessed in any other case in which recovery took place; nor have I seen any other patient in whom the three stages of the disease were presented to my observation in such well-defined characters. 

The following case exhibits an example of the disease in 



40 

its most malignant form, terminating rapidly in death. The first stage appears to have been short, but, I doubt not, would have been readily recognised, had she been under my observation from the beginning. 

CASE V.— lntense Type. 

Margaret Walker, aged 42, a married woman, the mother of nine children, of temperate habits: she had been confined six weeks ago, since which time her health has been delicate. 

December 25, at 3, p. m. She was attacked with vomiting and purging, but the nature of the discharges could not be ascertained: severe cramps in the extremities from the beginning. I saw her at half past 10, p. m., when she complained much of spasms in the legs and hands; the fingers were much distorted by them; intense pain at the scrobiculis cordisj extremities cold; hands blue and corrugated; pulse scarcely, if at all, perceptible; tongue white, moist and cold; breath cold; speaks in a whisper; face cold and livid; eyes deeply sunk; countenance shrunk, aged, and expressive of great suffering; extreme restlessness, and much complaining; with difficulty she was induced to swallow mustard emetics, which operated at first not very copiously; pulse became more perceptible; and surface warmer; heat was applied assiduously; and friction to relieve spasm: calomel gr. iv., opii. gr. i., camphor, gr. V., 01. menth. gtt. i. statim sumend., sp. ammon. arom. 5i.; a stimulating cataplasm of toasted bread, steeped in vinegar, and well covered with Cayenne and black pepper, was applied to the scrobiculis cordis; legs rubbed with a liniment of sp. ammon. arom. et tinct. opii., to relieve the dreadful spasms, of which she constantly complained. At midnight full vomiting took place, after which she became warmer and more composed: repeat the pills: gruel with brandy given occasionally. At half past 12, she again vomited freely, 



41 

after which the cramps became easier; the surface sufficiently warm; and the pulse more distinct; breath warmer; excessive thirst; asks constantly for cold water. At one o'clock, spasms came on again with severity; cap. tinct. opii. g'tt. xxx.; sinapisms to the insides of the knees; she continued to suffer much from spasms and general restlessness till 9 o'clock, when she expired, after an illness of eighteen hours. 

It is worthy of remark that, an hour before the attack took place, this poor woman had been thrown into great mental distress, in consequence of receiving the intelligence of the sudden death of her sister, from the disease. But her sister died at Hartley, a village about 8 miles distant from her own residence, in Jesmond Vale. No communication, direct or indirect, had taken place; and Walker's was the first and only case that has occurred in Jesmond Vale. It is scarcely necessary to point out the negative value of this fact, in reference to the question of contagion. Had the sisters held communication with each other, the illness of Walker would probably have been attributed, with much confidence and some appearance of probability,, to that cause. I shall probably have occasion to refer to this case hereafter. 

The next case is one of the utmost intensity, and will serve to exemplify two important facts:— l. The uselessness of attempting to bleed when there is no pulse. 2. The danger of raising the patient for the purpose of evacuating the bowels, or, indeed, for any other object. Though death was probably inevitable, I am disposed to believe that the fatigue attendant on both these circumstances hastened the catastrophe. 

CASE Vl.— lntense Type. 

John Robson, aged 46. — December 12th, 2, p. m. Had, the day before, attended the funeral of a person who had 

6 



42 

died of Cholera. At 5 o'clock, a. m., had been seized with vomiting, purging, and severe cramps in the limbs. At 7r7 r he was seen by Mr. Henzell's assistant, who prescribed the application of heat externally, and internal stimulants, consisting of tinct. opii. sp. ammon. arom. and brandy. When I saw him at 2, p. m., his countenance was livid and ghastly ; tongue and breath cold ; hands and arms blue to the elbow ; no pulse at the wrist, or elsewhere ; severe cramps in the legs; great jactitation and excessive restlessness; severe pain and tenderness at praecordia; urgent thirst ; voice altered to a whisper ; a stool lately passed of the rice water character, devoid of bile or feculent matter ; no urine passed since the attack. To allay his thirst brandy and water was given. Heat was continued to the surface; and with the faint hope of restoring the circulation, by relieving the vessels and enticing, as it were, a stream through the veins, an orifice was made in both arms. The blood was squeezed out in drops until about three ounces were obtained from each orifice ; it was thick, tenacious, and black, and hung in strings from the arms ; no stream could be established. He asked for the bed-pan two or three times during the hour I was with him, but passed nothing. After the last attempt he lay back in bed ; his breathing became for a minute or two somewhat laborious, and he then expired. Movements of the eyeballs were observed for a considerable length of time after he ceased to breathe. Although convulsive twitchings of the limbs have been described by authors as taking place after death, I have no where seen recorded a similar phenomenon in relation to the muscles of the eye. 

Two circumstances worthy of notice, as occasionally observable in the disease, were noticed in the following case :—l.: — 1. The possession of considerable muscular strength ; and, 2. A retention of the sense of touch in an acute degree, when the hand was cold, and resembled that of a person already 



43 

' 

i 

dead. It may be observed, also, that the treatment, as in the former case, consisted of opium and stimulants only (as was frequently the case at the commencement of the disease in Newcastle,) and that it proved entirely unsuccessful. 

CASE VIL— iNTENse Type. 

Barbara Taylor, a blind, sober old woman, aged 69, — December 9th, 2, p. m. Has had diarrhoea since the sth instant. Last riight, at 6, p. m., was seized with vomiting and increased purging, with frequent cramps in the legs. 

She is now much exhausted, with a pulse scarcely perceptible ; hands and feet cold ; tongue rather cold ; breath not discernibly so ; complains much of pain and tenderness at the scrobiculus cordis ; speaks in a whisper ; complained of slight cramp in one leg for a short time only during my visit ; passed water last night ; not this morning ; says she has a desire without being able to do so. Had one pretty copious stool during my visit, of the consistence of gruel, with flocculi, and of a reddish tinge. Heat applied assiduously to the hands and feet, and scrobiculus cordis : cap. tinct. opii. et sp. ammon. arom. aa 3i. statim. et repet, post horam. Hot brandy and water to be given occasionally. No blueness of the skin was observed at this time ; the eyes were sunk, but the countenance otherwise natural. 

At half-past 2, the face and surface generally had become colder ; the tongue and breath both perceptibly much v colder. At 3 o'clock she had been taken up three tunes without passing any thing farther from the bowels. 

It is remarkable, that although the pulse was imperceptible at the wrist, she had strength to turn in bed, and to assist herself in rising up; and that although the hands felt as cold as death, they were yet so sensible as to receive 



44 

a painful impression of heat from the application of bladders of warm water, which my own hand could bear with ease. 

At half past six, no material change in the symptoms had taken place. Several slight discharges from the bowels of the same description as before; no farther vomiting or spasms; still quite sensible; no pulsation at the wrist, or in the region of the heart, could be felt. During this visit, respiration, which had hitherto been performed with ease and regularity, became laborious, and she appeared dying. She died at 8 o'clock, having been ill twenty-six hours. 

The following is a case in which a favourable remission of symptoms attended the treatment pursued, but the advanced age of the patient, probably, prevented his constitution from having vigour enough to carry him forward to complete convalescence, and, when flattering hopes of recovery began to he entertained, he gradually sunk, as if from exhaustion ; blood-letting of service. 

CASE VllL— lntense Type. 

Thomas Tate, aged 70, a porter ; habits moderately temperate. 

December 22d, half-past 10, p. m. Diarrhoea commenced on the morning of the 20th, but he continued his employment till this evening ; at 8 o'clock he first complained of cramp in the legs ; since which time he has had several small stools, which were watery, or gruel-like, without odour; passed water with all, except the last; no vomiting; pulse, in right wrist, distinct and soft, 72. No pulsation in left wrist could be felt; extremities cold; hands blue and wrinkled; face rather flushed; eyes suffused; pain in forehead ; tongue red and dry, and, as well as the breath, sufficiently warm; voice whispering ; no pain or tenderness about the abdomen. 



45 

V. S. ad siv.; blood dark-coloured, and flowed more freely after a short time; head relieved by bleeding; countenance no longer flushed. 

External heat applied, and the following pills given : camph. gr. v. calomel pp. gr. iv. opii gr. i., hot brandy and water occasionally. 

Half-past 11. Head continues easy; pulse improved in volume; extremities warmer. Cap. pil. 4ta. quag. hora. warm gruel, with a small portion of brandy, to be given occasionally. 

23, 8, a. m. On the whole he seems a little better; passed several small stools between 12 and 4 o'clock; the latter ones tinged with bile; has slept a good deal; hands still blue and shrivelled; no pain or cramp since last report ; tongue moister ; great thirst ; wishes for cold water ; no urine passed ; no vomiting; has taken a quart of gruel, containing four ounces of brandy, during the night ; omit the brandy. Cont. pil., cap. haust. effervesc. 2da. vel 3tia. quaque hora. Half-past 12, much as before ; no pain ; thirst ; no evacuation ; pulse 96, firm. Cap. statim., 01. recini jrss. 

4, p. m. Two or three feculent and bilious stools; has also passed urine ; seems in every respect better ; much disposed to sleep. ' 

11, p. m. Very feeble; pulse failing; no return of urgent symptoms. 

24, Ba. m. Breathing laborious ; no pulse ; sinking ; he died at 9 o'clock. 

The next case may be added, as evincing, in a decided manner, the beneficial effects of blood-letting in the early stage of the disease. 

CASE IX. 

William Simpson, coal driver, aged 43; had a severe purging for about six hours yesterday, which diminished 



46 

towards evening; it was accompanied by sickness, but no vomiting ; had several rigors after going to bed. 

January 26, 2, a. m. Complains of cramps in the legs ; giddiness and pain in the head ; pain at scrobiculus cordis ; face a little flushed ; conjunctive slightly injected ; pain in back and limbs; tongue white; thirst; pulse 112, sharp; passed urine at nine last night, none since. V. S. ad head and stomach much relieved ; less feeling of sickness ; pulse more comfortable, and reduced in number ; cramps continue. ' 

Calomel gr. v., opii gr. i., statim, 01. recini hora postea. 

10, a. m. Pain and cramps relieved; tongue white; less thirst; pulse 80, soft; several feculent stools ; a small quantity of urine passed. 

3, p. m. Remains free from pains or cramps ; three more feculent and bilious stools ; passed urine again ; pulse 80, soft ; has taken some gruel and toast. 

27. Free from complaint ; bowels and kidneys acting naturally ; convalescent. 

The following cases are adduced in illustration of the pathology of Cholera. On this subject the evidence will be found nearly altogether of a negative character, for no morbid appearances have been discovered to account in a satisfactory manner for the phenomena of the disease. That part of the nervous system on the derangement of which these phenomena may be supposed to depend, has in no case exhibited any morbid change ; nor has any organic alteration of structure been a uniform attendant on the disease. In the dissections which I have witnessed, three circumstances, however, have been noticed, though none of them can be considered as of a distinctly morbid character, nor is it likely that any of them are peculiar to Cholera. 1. The urinary bladder was either entirely or nearly empty. 2. The gall-bladder contained a considerable portion of bile, 



47 



while the intestines were nearly or completely free from that fluid. 3. The spleen was remarkable empty of blood, being unusually small, and having a shrivelled corrugated appearance. I have not seen this circumstance noticed before; future observation may determine how far such a condition of the spleen is a constant attendant on Cholera ; if it should be found so, the circumstance may assist in throwing light upon the physiology of that organ. 

The opportunities of pursuing post mortem examinations have been few, both from the general prejudice against them, and from the quickness with which, in compliance with the recommendation of the Board of Health, the funeral has succeeded to the death of the patient. I am, therefore, obliged to bring forward cases which have already met the public eye through some of the medical journals, having been previously transmitted to the Central Board of Health. In Gateshead not a single examination has taken place, and I regret to say that such scientific researches have been much discouraged by the official agents of government, on the ground of their being attended with especial hazard of contagion. 

Much doubt was entertained as to the identity of the following case at the time of its occurrence, but subsequent acquaintance with Cholera has satisfied my own mind on the subject. 

CASE X. 

Robert Jordan, aged 56, labourer. November 265 th, 2, p. m., I saw this man with Mr. Davison half an hour after the attack. He had had several loose stools; the last, which we saw, resembled gruel and was without feculent odour; had suffered severe cramps in the extremities, which had now subsided, except a slight spasmodic action of the fingers; extremities cold; pulse soft and weak; his appearance resembled syncope; skin rather moist; tongue moist and 



48 

white ; had vomited once only, when some brandy had been given to him ; complained of no pain, or tenderness on pressure of the abdomen; voice somewhat weak ; brandy and laudanum were given, and heat applied to the extremities, &c. Soon afterwards the spasms returned with violence ; the breath and tongue became cold ; the voice became a whisper, and he gradually sunk. He died at 11, p. m., nine hours and a half after the attack. The treatment consisted principally of stimulants and opium. 

Post mortem appearances twenty-one hours after death. — The countenance was remarkably natural; the extensor tendons of the toes more prominent than ordinary. 

The omentum and peritoneal covering of the intestines were much injected and florid; peritoneum shining and moist; no adhesions between the intestines; the intestines not much distended ; rather less so than usual ; no appearance of faeces or bile in them ; small intestines contained a quantity of reddish viscid fluid, resembling raspberry cream in colour and consistence ; the mucous membrane red and preternaturally vascular; colon nearly empty and somewhat contracted ; it contained a fluid of a gruel-like appearance and consistence; the mucous membrane pale, and exhibiting a well-marked contrast with the red and injected appearance of that of the small intestines ; the stomach externally pale and considerably distended with fluid of a dark reddish hue ; the mucous membrane vascular and red, and a portion near the cardiac extremity dark coloured, and peeling off readily. 

The surface of the liver mottled with whitish spots. The gall-bladder much distended with dark-coloured bile; it extended beyond the margin of the liver ; gall-ducts pervious. The urinary bladder contained about an ounce of urine which was somewhat turbid ; its mucous membrane injected. The spleen was small and flaccid, and corrugated on the surface ; the pancreas was natural; the kidneys exhibited no remarkable appearance. 



49 

The pericardium contained two ounces of red-coloured serum; the ventricles of the heart were empty; the right auricle contained black blood; the venae cavae contained darkcoloured fluid blood. 

The lungs were much collapsed within the chest, and contained a quantity of black blood ; they were, nevertheless, lighter than water ; there was no appearance of pleuritic inflammation, nor were there any morbid adhesions in the chest. 

An examination of the head was not permitted. 

The injected appearance of the coats of the intestines was in this case well marked, and, were it constantly observed, might account in a satisfactory manner for many of the symptoms of Cholera. But in other cases these tissues are found perfectly pale, and free from all appearance of disease. Such turgescence of the vessels of the intestines must, therefore, be considered as incidental only. Had the patient survived, it can scarcely be doubted that it would have given a character to the stage of reaction, and that the case would have issued in acute inflammation of these viscera. 

The following case occurred in the practice of Mr. Davison. The treatment consisted of stimulants. I did not see the patient during life, but was present at the dissection, the account of which will be given from my owii notes. 

CASE XI 

Maria Mills, aged 42. Of intemperate habits.— December 7th, half-past 4, p. m. Spasms of the legs and toes ; pulse imperceptible ; cold clammy skin ; tongue thickly coated with a whitish fur, moist, colder than natural ; breath also colder than natural ; breathing laborious ; thirst excessive ; integu-' ments of fingers corrugated and softened. At 10, a. m., th© 

7 



50 

attack commenced with vomiting, purging, cramps in the legs, and coldness of the extremities. The evacuations had not been preserved ; none were subsequently voided ; a small quantity of urine at 2, p. m. At half-past 6no reaction had taken place. At 8 o'clock, the hands and arms had become of a livid hue, nails dark red, tongue and breath colder, breathing more laborious. She was perfectly sensible, and complained of no pain excepting when the epigastrium was pressed ; her voice, previously low, had now become hoarse and almost unintelligible. She seemed to speak with the greatest effort; before death it became more distinct; jactitation, frequently changing her position with great quickness and force; every movement seemed the impulse of some convulsive effort ; thirst unabated. Died at 11, p. m. 

Examination of the body fifteen hours after death. — A degree of blueness not very well marked around the mouth ; a slight shrivelled and blue appearance of the integuments of the fingers ; the legs also were of a bluish colour. Increased vascularity of the peritoneal covering of the small intestine, which retained its natural glossiness ; intestines not remarkably distended. The small intestines contained a gruel-like matter of a reddish tinge, and having flocculi floating in it. Bile, of a yellowish brown colour, was found in the duodenum ; mucous membrane natural. The stomach contained a small quantity of gruel-like fluid; mucous membrane pale, with bluish patches near the pylorus; peritoneal covering preternaturally red ; colon pale in colour, and nearly empty ; mesentery not vascular ; liver nearly natural ; gall-bladder contained dark green bile ; not remarkably distended ; gallducts pervious, permitting bile to flow into the duodenum ; spleen small, flaccid, and shrivelled ; kidneys natural ; urinary bladder empty, and hidden behind the pelvis. 

Pericardium contained no fluid ; heart distended ; both ventricles, right auricle, and venae cavae, contained dark-coloured fluid blood ; lungs nearly natural. 



51 

Dura mater on right side ossified to the extent of an inch in length, by half an inch in width. Vessels, on the surface of the brain, turgescent ; an ounce of serum in each lateral ventricle. 

The following case was attended by Mr. Dawson. It exhibited the usual features of the collapsed stage of the disease. The illness of the patient lasted four days, and miscarriage took place 16 hours before death. She was in the sixth month of pregnancy. The treatment consisted principally of small and frequent doses of calomel. 

The post mortem examination was conducted by Dr.Dubuc, of Rouen. 

CASE XIL 

Isabella Robson, aged 44. — January 14th. Body examined six hours after death. 

Considerable blueness of integuments ; hands wrinkled. 

On removing the calvarium, the connecting vessels between it and the dura mater poured out an unusual quantity of blood. 

On cutting through the muscular substance on each side of the spine, a quantity of fluid blood exuded from its vessels ; the vessels of the brain somewhat turgid ; a portion of the arachnoid on each side, near to the junction of the coronal and sagittal sutures, slightly opaque ; the brain and spinal cord throughout exhibited a perfectly natural appearance ; fluid blood flowed freely from the lateral sinuses. 

In the chest every thing was natural. 

The abdominal organs generally healthy ; the stomach and intestines pale externally and internally ; some bilious matter contained in the duodenum, it became more distinct in the ilium ; gall-bladder contained gall-stones of considerable size ; it was not greatly distended ; gall-ducts pervious; the spleen 



52 

r 

was small, empty, and appeared shrunk ; the kidneys rather small and paler than natural; the bladder shrunk and empty ; the uterus had contracted firmly ; its walls were compact, and of great thickness ; and its inner surface was coated with <dajk coagulated blood. 

For the following case lam indebted to Mr. Dawson. The dissection was conducted by Dr. Guillot, of Paris, from whose notes the substance of the report is taken. 

CASE XIII. 

Mary Lee, aged 42, was nursing a child of 18 months old, and had had diarrhoea for two days. 

January 11. Was seized with watery vomiting, and copious rice water purging ; flocculi in the stools ; pain at the stomach ; cold extremities ; absence of pulse ; complains much, and is very restless ; areola round the eyes ; blue lips ; no cramps. 

Calomel pp. pulvi. zingib. aa gr. ii. omni hora ; hot brandy and water ; heat to the surface.. 

12, a. m. As before; vomiting and purging continue; pain in the epigastrium ; cold ; no pulse. 

P. m. Feels better ; pain in the epigastrium gone ; asks for tea and toast; cont. medicam. 

13, a. m. Died ; intellect remained perfect ; the secretion of milk continued during her illness ; breasts became gorged before death. 

Examination of body ten hours after death. —Venous congestion of the extremities ; parts on which the body had rested of a yellowish colour. 

The spinal cord was exposed through its whole extent ,• the cerebral sinuses gorged with blood ; veins on the surface of the brain much distended ; cerebral substance firm ; ao congestion; when cut into, the medullary patter was 



53 

not marked by any unusual quantity of blood flowing from the divided vessels; the cortical substance was dark-coloured; a small quantity of serum in the ventricles; the cerebellum exhibited nothing remarkable; the vertebral and subclavian arteries were filled with blood. 

The spinal cord was found of firm consistence and appeared perfectly healthy; the nerves all in a healthy state; the eighth pair and the cervical ganglion were particularly examined, but they exhibited nothing worthy of notice. 

The internal jugular vein contained very little blood; adhesions of the lungs, particularly on the right side; they were much congested in the posterior part; but they were every where crepitus; and floated in water; washing restored them to their natural state. 

The heart was large; the ventricles, especially the right, contained black, liquid blood. The vena azygos greatly distended with blood; the same was the case with the venae cavse and the subclavian. 

The aorta also contained blood. 

The stomach presented in the cardiac portion large arbo-* rescent patches; the congestion so great in some places as to give to the mucous membrane a black colour, similar patches were seen towards the pylorus, but no softening of the membrane. The mucous membrane of the small intestines appeared slightly congested in the duodenum; pale in the other parts; it was covered with an abundant grayish mucus, which was easily removed by washing. 

In the large intestine was a quantity of liquid matter which contained much slate-coloured detritus, without fetid odour. The mucous membrane pale and without ulceration. 

The gas which escaped from the intestines did not inflame at the candle. 

Kidneys firm, without apparent lesion; bladder empty, jeontracted, and lined with mucus; liver not congested; the 





54 

vena porta contained little blood; the ramifications could scarcely be traced into the mesentery. 

It is a curious and interesting circumstance, that the secretion of milk was not checked in the course of this fatal disease; at the time of death the breasts had become gorged. The same fact has been noticed in other cases. Mr. Frost mentioned to me a woman whose child was nursed a short time before her death; and Mr. John Fife met with a similar instance. 

Mr. Dawson informs me that he made a post mortem examination soon after the first appearance of Cholera in Newcastle, but of which he did not preserve notes. The lungs contained black blood; the mucous membrane of the stomach was congested; the gall-bladder was full of bile; and the urinary bladder contained a considerable quantity of urine. 

The post mortem examination of the following case was conducted by Mr. James Earle, of St. Bartholomew's Hospital, by whom I have been favoured with the particulars of it. 

CASE XIV 

Robert Forfar, an idiot, aged 11, died with the usual symptoms of the stage of collapse, except that he passed a feculent stool 4 hours before death, containing four large round worms. 

In the chest nothing remarkable was observed; no congestion in the lungs; heart natural; left ventricle /contracted; right flaccid; no blood in either; great vessels contained dark fluid, though thickened, blood; liver had a slightly mottled appearance, otherwise healthy; gall-bladder full of bile, which, according to subsequent analysis, was of natural quality; spleen perfectly natural;* stomach contracted and con- 

* Though Mr. Earle did not notice any remarkable appearance in the spleen, I have since been informed by Dr. Kirk, of Greenock, who was 



55 

taining a small quantity of dark brown mucus; the mucous membrane natural; an elevated ulcer was found at the commencement of the jejunum; ilium contained four or five large round worms; coecum distended with flatus; colon contracted and empty; bladder contained a small quantity, of urine; abdominal aorta contained a small quantity of perfectly fluid blood. 

If we compare the several departures from a healthy condition of organs exhibited in these dissections with each other, and with those which have taken place at Sunderland, we shall find no appearance of a distinctly pathognomonic character. All appears to have been the effect rather than the cause of the deranged or impeded functions which mark the course of the disease during life. The gorged, congested, or hepatized condition of the lungs: the fulness of the great veins, and, occasionally, of the cavities of the heart itself; the injected state of the serous and mucous membranes of the stomach and intestines, and an undue fulness of the sinuses and other vessels of the brain, leading on some occasions to effusions into the ventricles, are all to be attributed to the imperfect state of the circulation. All of them are sometimes absent, and, at other times, some only are present and not very strongly marked. Did the obstructed circulation depend upon such congestion, or accumulation of blood, in any organ or set of organs, it would be a constant and invariable appearance, at least, varying only in degree. The empty, shrivelled state of the spleen, in the three cases in which I have noticed it, is certainly an interesting circumstance. What arguments may be deduced from it in reference to the function of the spleen, I shall not now stay to inquire. The almost uniform emptiness of the urinary blad- 

present at the dissection, that the spleen exhibited the same small, empty, and shrunk appearance, which had excited my attention in other cases. 



56 

der, may safely, I think, be referred to a suspension of the secretory function of the kidneys. That the gall-bladder should not unfrequently be filled with bile, while the duodenum has no trace of that fluid, is a curious and interesting fact, to whatever cause it may be attributed. In all the cases which I have seen examined, the ducts were pervious, but in a dissection reported by Mr. Mordy, of Sunderland, (see Lancet, No. 437,) he records, that the " gall-bladder was distended, and its ducts firmly contracted, so as to prevent any bile flowing on pressure." Dr. Hazlewood, also records a case, wherein the "gall-bladder was much distended, the ducts empty, and pressure on the gall-bladder did not force out any of its contents. The resistance was caused by a contraction, half an inch in length, commencing at the origin of the cystic duct, preventing the passage of a probe and of air from the blow-pipe." It would appear, then, that the absence of bile in the intestines, cannot be entirely attributed to a suppression of secretion, since a supply remains in the gall-bladder. That the non-passage of it into the intestines may arise from the resistance opposed by spasm of the ducts, even in cases where after death no proof of such spasm having existed can be discovered, is perhaps not improbable, especially if in any cases the presence of spasm can be shown to have taken place. But even this must be considered as an effect, supervening upon that produced by the application of the efficient cause of the disease; for the biliary obstruction is not always complete, as in the cases of Maria Mills and Isabella Robson. The brain, spinal cord, and nerves, have not exhibited marks of altered structure; they have appeared healthy in colour, texture, and consistence: we must, therefore, conclude that the immediate cause of the symptoms of Cholera, is not to be found in organic changes of the nervous system. Does it then reside in deranged or suspended function of any portion of it? I have already endeavoured to answer that question. 

The subsequent cases have been obtained from various 



57 

sources. They will serve to show some of the several modes of treatment which have been pursued by different practitioners, and the results with which they were attended. It will be seen that many variations have been adopted in the doses and intervals of exhibition in the use of calomel, which, perhaps, has been the medicine most uniformly prescribed. 

For the details of the following case, in which nitrous acid appears to have been used with advantage, I am indebted to Mr. J. Edgcome, under whose care it occurred^ 

CASE XV. 

I was requested to visit Phyllis Dalrymple, at 8 o'clock on the evening of Friday, the 20th instant. I found she was a poor woman, 62 years of age, living in the Broad Chare, Quayside. Her habits had been regular, and her apartment was remarkably clean. Last autumn she suffered from the common Cholera. She now told me that for many days she had been labouring under diarrhoea, which had become much worse at 3 on the afternoon of this day, attended by considerable vomiting and cramps. For these symptoms she had taken some tincture of rhubarb of her own accord. I found her pulse good, the tongue much furred, thirst considerable, and that the alvine dejections were characteristic, consisting of a clear fluid with a sediment resembling oatmeal. The nausea being very distressing, my first object was to excite full vomiting, and I accordingly administered warm water with salt. So great, however, was the patient's repugnance to swallow a warm fluid, that I could not prevail on her to take sufficient, consequently the nausea was not relieved, and the discharge from the bowels continued painfully profuse. I now administered a grain and a half of opium combined with four grains of calomel, and the pulse being rather full and frequent, I opened a vein in her arm, but syncope soon appearing, I was compelled to desist before I had obtained three ounces of blood. From this period, I believe, the vomiting 

8 



58 

ceased, although the fluid from the bowels passed from her a3 she lay on the bed. In the course of an hour I revisited her, and administered the nitrous acid in the following way: — 

R. acid, nitros. $i. tinct. opii gtt. 1. 

Mistur. camph. m. Sumat cochl. i. amphl. q. q. hora. 

I now left her, ordering such means as might be necessary in the event of her getting worse. In the morning I found that there had been no sickness, no purging of any consequence since she had been taking the medicine, and that she had slumbered at intervals during the night. She had taken about half of the mixture. There was now a violent affection of the head, with delirium; general tremour of the countenance; a brown parched tongue, and constant strong subsultus of the tendons of the arms, rendering it difficult to ascertain the state of the pulse. This last, however, was not in my opinion such as to indicate the abstraction of blood. I directed the head to be shaved, and that a large blister should be applied to it, and ordered immediately a full dose of colocynth and calomel, to be followed at intervals of three quarters of an hour, by a table spoonful of castor oil until the bowels were freely acted on. In the course of five or six hours bilious stools were the result, and I prescribed the following :—: — 

R. hydrarg. submur. pulv. antimonial. aa. gr. x., cons. q. s. ut. ft., pil. v., sumat. i., omni hor. cum cochl. ii., mistur. sequent. 

R. liq. ammon. acet. sp. aether, nitros. s^ ss -» niistur. camph. 3iv. m * 

On the following morning she was considerably relieved in all her symptoms; the same medicines were repeated, and the scalp, to which the blister had been applied, was sprinkled with pulv. lyttce, since vesicles had not yet formed. 

Her amendment was so rapid, that the mercurials were not ordered a third time: occasional doses of castor oil, colocynth, and a diaphoretic mixture have been the only medicines since necessary, and on Wednesday the poor woman 



59 

was decidedly convalescent, the only symptom left being weakness; January 26. 

For the five cases which follow, I am indebted to my friend Mr. T. K. Fife of Gateshead. In the four first, stimulants were amongst the principal remedies employed, and they certainly had a fair trial, but without any good effect. In the last case bleeding appeared eminently useful, in averting the collapsed stage of the disease. In none of these cases was calomel prescribed. 

CASE XVI, 

Margaret Taylor, aged 41, an industrious single woman, living in an ill ventilated low room, in Oakwellgate Lane, was seized at 4 in the morning, December, 25, 1831, with severe purging, and about half-past nine, with vomiting; cramps in the legs and thighs soon followed. At Ip. m., I was sent for; the hands and feet were then cold and livid; there was no pulsation perceptible in the arteries of the extremities; the carotids were throbbing irregularly; voice scarce audible; respiration laborious; face pale, except the nose end, which was of a leaden colour, and deadly cold. She was seen by Dr. Headlam, Mr. Leigh ton, Mr. Brady, and several other medical gentlemen. Carbonate of ammonia, camphor, tinct. opii et capsici and essentia menthae were given internally; the limbs and abdomen were rubbed with dry warm flannels; the skin was frequently moistened with a strong solution of camphor in 01. terebinth, and copious enemas were thrown into the intestine, but the symptoms went on increasing till 6 in the evening, when death relieved her from sufferings too severe to be borne, though of so short duration. 

CASE XVII. 

At 3 the next morning, December 26, I was called to see Isabella Taylor, sister to the above, and near the same 



60, 

age ; they had lived together for many years, gaining a scanty livelihood by spinning in some of the twine yards. 

She had just awoke the person in whose room she was sleeping (on account of her sister's death,) and had been severely purged; vomiting, cramps, loss of voice, feeble and irregular action of the heart, coldness and discoloration of the extremities, followed in rapid succession, entirely resisting the remedies employed, and she sunk about 5, p. m., having taken, during the first 10 hours, three grains of opium, 3y« carb. ammon. emuls. camphorae, s xv i- carb. magnes. 3ij., &c. The utmost attention had been paid to every direction given, in both these cases. 

CASE XVIII. 

December 25th, about 8, p. m., I was sent for by the parents of Mary Wheatly, a girl nearly 12 years of age. She had been purging and vomiting for two hours without assignable cause, and cramps in the arms and legs had just come on. 

She was constantly tossing herself about; her breathing was oppressed; she was impatient when spoken td, and replied in monosyllables. The hands, feet, and nose were pale and cold, and the pulse feeble, irregular and scarce perceptible at the wrist. I directed warmth with friction to be diligently applied; gave her pulv. ipecac, gr. xv. aquae and after its operation a mixture containing carbonate of magnesia, aq. menthae and tinct. capsici; she also had several times an enema, containing a few drachms 01. terebinth, in gruel. 

The state of collapse rapidly increased, and she died at 4 in the morning 10 hours after the commencement of her disease. 

CASE XIX. 

January 12, 1832. Henry Sibbett, seaman, aged 39. 9, a. m. He arrived from London this day weekend has 



61 

several times had too much beer and spirits, but was quite sober yesterday and perfectly well. 

At 2 o'clock this morning, diarrhoea came on, and the stools continue very frequent; could not see what had been passed, but it was described as very pale and watery; cramps in the legs very severe; has passed no urine since last night; has just been vomiting for the first time since the attack — it appears to be merely some coffee he drank; the pulse at the wrist is feeble and rather irregular, about 68; hands, feet, and face nearly of the natural warmth, but dejection and dread are pictured in the countenance. 

Apply constant friction with dry warm flannels; V. S. ad libitum; only obtained, thick and dark; Pil. ij. cum gr. i. ss. opii. in sing, statim sumend. mixt. camphor, aq. menth. aa carb. ammon. 3i. misce. capiat omni hora. 

A quarter-past 10, a. m. — Has passed, since former visit, about a pint of whey-like stool mixed with the usual white ricey flocculent particles; cramps not quite so frequent. Cont. mistura ut antea. 

Half-past 11. — No vomiting or purging; pulse very feeble, 66; the surface is cooler than natural, and covered with clammy sweat; severe cramps at times, which now affect the abdominal muscles. 

Noon. — About tbnj- aq- tepid, was thrown into the rectum op. syphonis, as he had felt very urgent tenesmus; copious vomiting immediately followed, and the enema was dejected. 

Cramps increasing; pulse sinking; a dark areola round the eyes; nose end cold and livid; breathing laborious; thirst very distressing. 

Some, other medicines were sent but not employed, and after very severe suffering he died about 3 p. m. 

CASE XX. 

December 25th, 1831. — Joseph Laws, aged 24, Oakwell•gate. 

A healthy man, habits tolerably steady. At noon to-day 



62 

he made a good dinner of mutton and potatoes; stomach uneasy all the afternoon. At half-past six this evening felt verysick, and, to use his own words, " not knowing what to do," he eat some cold mutton ! At 7, p. m., feeling himself turn worse, he sent for me. He had been twice purged during the forenoon; had made frequent efforts to bring on vomiting, but without effect, and just before 1 saw him, severe cramps in the legs had come on. The pulse was soft, 90 in a minute. His face was pale, his nose end inclining to a leaden colour. I immediately bled him to the extent of tfeii. then gave pulv. ipecac, gr. xxv. antimon. tart. gr. iss. aquas 5i., which operated freely, emptying both the stomach and intestinal tube. I directed him to be kept warm, and to drink freely of thin gruel. 

Copious perspiration came on, and was kept up for several hours; the cramps became gradually less severe; the pulse fell to 60, and became feeble. 

He continued for two days in a state of great debility; the secretion of urine was very scanty, and his return to health was slow. 

The only medicine he took after the emetic was a mixture, containing camphor, magnesia and aq. mentha3. 

Cases of Cholera were numerous in the neighbourhood where Laws lived: many of them commenced with symptoms similar to his, and the probability is, that had his case been neglected, it would in a few hours have assumed the decided form. 

In the following case, which occurred in the hospital established in the Castle, small and frequent doses of calomel were found of service. 

CASE XXI. 

Mary Ann Cummins, aged 13. 

Jan. 15th. Was suddenly seized with vomiting, purging, and cramps in the legs at 4a. m. Admitted into the hospital at Ip. m. Surface of body cold; face shrunk and livid; eye* 



63 



sunk and surrounded with a dark areola; hands and feet blue and shrivelled. Thermometer in the mouth 80°; tongue covered with a white fur; breath cold; respiratory murmur audible through the stethoscope; frequent sighing; pulse not to be felt at the wrists; in the carotid, weak 108; pain in abdomen; cramps in the legs. 

Hot air bath used; and bottles of warm water applied to the body; friction to the legs and arms with hot flannels. 

A salt emetic, followed by copious draughts of warm water. 

9, p. m. Pulse scarcely perceptible at the wrist; vomiting and purging of rice-water; skin cold; tongue furred; asks constantly for cold water; calomel gr. i. every half hour. 

16th. Vomiting and purging ceased; thirst; coldness; pain of abdomen; pulse weak, felt in the arm with difficulty; cont. calomel. 

17th. Slept well; no pain; passed four ounces of urine; no stool; no sickness; thirst: cont. calomel; enema purg statim. 

18th. No alteration; cont. calomel. 

19th. Bowels much purged; extremely restless; head hot; thirst: apply cold cloths to the head; omit calomel; tinct. opii gtt. x. statim ; olei recini semi hor. postea. 

20th. Passed a better night ; bowels freely opened ; stools feculent ; of a green colour resembling chopped spinnage ; slight sickness and vomiting ; passes urine freely ; an effervescing draught occasionally. 

After this she became convalescent. 

In the following case small and frequent doses of calomel were also employed with advantage ; ptyalism produced ; the case occurred in the Sandgate hospital. 



64 

CASE XXII. 

Jane Marshall, aged 40. Vomiting and purging severe during yesterday. 

Jan. 16th, 7, a. m. Vomiting and purging continue; pulse weak ; eyes sunk. 

Calomel gr. ij. every quarter of an hour. 

Sinapism to the scrobiculus cordis. 

Half-past 2, p. m. Vomiting continues; severe cramps; becoming blue and cold ; pulse failing ; cont. calomel. 

4, p. m. More composed; vomiting diminished; temperature and pulse as before ; great thirst ; arrow root for common drink. 

8, p. m. Vomiting ; no stool ; spasms less severe ; no urine passed. 

Enem. amyli. jfci. cum. tinct. opii. 

11, p. m. Improving; no stool; no vomiting lately; pulse improved ; extremities warmer ; no discharge of urine ; cont. calomel. 

17th, a. m. Has slept in the night ; vomiting less frequent : passed urine, first time since 15th; stools becoming feculent. 

5, p. m. Going on well ; stools more bilious : passes urine ; skin natural ; calomel gr. ij. 2da. quaque hora. 

20th. Purged severely last night; dark bilious stools,' mouth affected by the calomel ; mistur. cretas. tinct. opii. gtt. x. 

22d. Has continued to improve ; convalescent. 

That in this, as in most other diseases, any individual symptom may be absent, will be seen from the following cases, wherein the rice-water character was not observed in the alvine discharges. In the first case the evacuations seem to have resembled the matter found in the intestines of Robert Jordan (see Case X,) and in the second they were feculent ; but as the purging had continued some time in this patient before his admission into the hospital, in Sandgate, where both cases occurred, it is possible that the rice water 



65 









discharges might have ceased. The treatment in both cases was principally of a stimulating nature. 

CASE XXIII. 

Penelope Hughes, aged 49. 

January 16th, 9, a. m. Pulse extinct; fingers very blue; pain at pit of stomach ; vomited a small quantity of transparent fluid ; person cold. 

Enem. amyli. sp. camph. giii., statim injicend. 

Sinapism to the scrobiculus cordis. 

Calomel pp. gr. v., capsici gr. x., statim sumend. 

11, a. m. Pulse scarcely perceptible; nausea, but no 4 vomiting ; no cramps ; one stool of an opaque dirty red appearance. 

Half-past 11. Pulse becoming stronger; still cold. 

Sp. ammon. Co. ji., sp. lavend. Co. s ss -» a( l* menth. statim sumend. 

1, p. m. Has had violent cramps ; very slight discharges from the bowels, of the same colour ; nausea and slight vomiting ; eyes more sunk ; blue circle around them. 

Calomel gr. v., capsici gr. x. m., statime sumend. 

6, p. m. Great restlessness ; groans much : pulse imper^ ceptible ; hands, face, and tongue cold ; stools scanty, having the same appearance ; no urine ; cramps more frequent ; appears sinking ; wished for ale, which was allowed her, made warm, with ginger in it ; cont. calomel and capsicum with brandy. At half-past 6 the purging and cramps ceased. At 7 she died. 

CASE XXIV. 

James Hadderick, aged 62, labourer, a feeble old man. Diarrhoea for seven days ; yesterday morning slight vomiting ; nausea constant ; occasional cramps in hands and feet for four days past. 

January 22, half-past 10, a. m. Tongue cold and brown; 

9 



66 

skin cold; countenance cadaverous; pulse feeble, 100; great thirst ; stools feculent ; has passed urine. 

Enema amyli tfeij., tinct. opii 51., statim injicend. Brandy sp. ammon. arom. si. immediately. Calomel gr. ij., opii gr. \ every quarter of an hour. Enema was only retained five minutes ; external heat ap- 

plied ; feels easy ; enema repeated. 

6, p. m. Pain in the lower part of the abdomen ; no urine passed ; has been subject to gravel ; tongue dry : pulse feeble : has passed a feculent stool. 

Pil. hydrarg. gr. iv;, opii gr. ss., at bed-time. Pulv. rhei. et magnes. in the morning. 

23d, a. m: Has had a better night; three stools; no urine; tongue brown and moist ; pulse feeble ; cont. calomel et opium omni hora ; to take wine and arrow root. 

p. m. As before ; four feculent stools ; no urine ; cont. calomel. 



24th, 10, a. m. Cramps not very severe ; vomited about a pint of transparent yellow fluid ; pulse more distinct ; skin covered with warm perspiration ; face and tongue cold ; pupils contracted ; lips less blue ; half an hour afterwards he complained of pain between the sixth and seventh ribs on the right side. 

Appli. solutio cantharid. sterno, cont. alia. 

Died soon after 4, p. m. 

In the hospital at Gateshead the stomach pump has been used with apparent advantage as a means of removing irritating matter from the stomach. Calomel and opium, in repeated doses, appear to have constituted the other efficient means in the treatment of the following case. 

CASE XXV. 

Frances Steel, aged 5, January 4th, 8, a. m. Has had diarrhoea for ten days ; vomiting and purging of rice water took place at 5, a. m. ; no pulse ; surface not very cold ; 



67 







cramps in extremities ; colour becoming blue ; pain at scrobiculus cordis. Twelve ounces of warm water introduced into the stomach, and a yellowish liquid removed by means of the stomach pump. Sixteen ounces of warm water thrown into the intestines. 

At a quarter before 9 o'clock the patient was much relieved; no pain at stomach, or cramps; pulse perceptible, 120 ; heat applied to the surface. 

11, a. m. Vomiting when liquids are taken ; great thirst; pulse 120. 

Calomel gr. iii. opii gr. } 2da q. hora liq. ammon. 5i- sp. vin. gall. Jiij. cap. gtt. xx. quaque hora. 

12, m. Sleeping. 

3. p. m. Refreshed by her sleep; no pain; thirst; pulse 120; cont. Med. 

5, p. m. Slight vomiting, cap. mistur. effervesc. cum conf. arom. gr. iij. singul. dos. 

7, p. m. Better. At 9, bilious stools took place. 

sth. 9, a. m. Has rested well; convalescent. 

Two other cases are reported, wherein the stomach pump was found beneficial, assisted by the same combinations of medicines; but in neither does the stage of collapse appear to have been very complete; the pulse never having become imperceptible at the wrist. 

Were the object in view merely to empty the stomach of its contents, the use of this instrument might perhaps, be advisable, especially if the action of the stomach itself could not be sufficiently excited; but full vomiting appears to be beneficial, principally as a powerful stimulus to the vascular system, and it is evident that this can only be effected by the active efforts of the stomach itself, and not by its passive dependence upon the agency of the stomach-pump. 

The treatment of the following case was entirely under the direction of Mr. Knaggs, but I had the opportunity of watching its course throughout. If the tendency to recovery had 



68 

not been opposed by the feebleness of age, it is not improbable that she would have done well. An imperfect stage of reaction was effected, as was indicated, especially by the delirium, a symptom unknown in the collapsed stage of the disease. 

CASE XXVI 

Elizabeth Sibbett, aged 73, living in Hillgate. — Has been poorly for fourteen days. Vomiting and purging of rice water since yesterday. Cramps took place early this morning. 

January 26th. 10, a. m. Vomiting and purging; no pulse; hands blue, shrivelled, and cold; countenance shrunk and livid; tongue white, and, together with the breath, cold; whispering voice; severe cramps. 

Mustard emetic, calomel et capsic. aa gr. iij., omni semi hor. postea, brandy and hot water. 

11, a. m. Pulse in wrist more perceptible; skin warmer; cramps ceased; less vomiting: says^she has passed urine. 

3, p. m. Warm; pulse more perceptible; no farther vomiting or purging; cramps frequent; pain at scrobiculus cordis; no urine passed; voice a whisper. Cont. pulv., brandy, &c. 

6, p. m. Pulse improving; no spasms. Cap. sp. ammon. Co. gtt. xxx. in brandy and water. 

11, p. m. Improved ; no vomiting, purging, or spasm; pulse small, but more distinct; hands continue blue; surface warm. 

27th. 8, a. m. Much as before ; scanty, feculent stools. 

11|> a. m. Pulse distinct though feeble, 112; skin warm, less blue ; eyes suffused ; pain at scrobiculus cordis ; no spasms; has passed urine ; feculent discharge from the bowels, Cont. calomel and capsicum. 

28th. 11, a. m. Has had a restless night; two stools and urine passed ; is said to have had delirium in the night ; pulse feeble, but distinguishable; to have frequently gruel with brandy. Olii. recini ?ss. 



69 







28. Subsequent to yesterday's report she continued very restless, with constant delirium, which continued till 6, a. m., when she died. 

In the case which follows, ineffective efforts were also made by a constitution enfeebled by age to overcome the worst symptoms of the second stage of the disease. The beneficial tendency of the plan of treatment pursued was sufficiently exemplified in the partial reaction, and the total relief of urgent symptoms with which it was attended. 

CASE XXVII. 

Cuthbert Hopper, aged 70. Is said to have been failing for some weeks ; during the last fortnight has had frequent diarrhoea, with general feeling of indisposition ; purging commenced at 3 p. m.; had several watery stools; nausea, and oppression at stomach ; no cramps ; a salt emetic was given, which operated freely. 

At half-past 9, p. m. I first saw him ; has vomited repeatedly, and had several watery stools; hands rather cold, shrivelled, and blue ; pulse feeble, 96 ; voice failing ; features shrinking; fulness at stomach; has had cramps in hands and feet ; passed urine half an hour ago ; tongue rather white ; considerable thirst; heat to be applied to the surface; a rice water stool (about a pint) was now passed at a single effort; it had very slight feculent odour, but was perfectly characteristic. 

Calomel gr. v., opii gr. i. statim. 

Enem. calid. cum tine, opii gi., statim injicend. 

10, p. m. Complains much of cramps in the legs; friction and ligatures employed with relief; the injection remains; hot brandy and water to be given occasionally; cont. pil. omni hora. 

10^. Skin bedewed with Cold clammy perspiration; pulse very soft and feeble; vomiting and purging at the same 



70 

instant ; about a third of the injection returned; rep. pil. slatim; sinapism to scrobiculus cordis; more composed. 

11. Complains again of severe cramps which extend up to the groin; face and hands very cold ; pulse more feeble. 

11 J. Pulse imperceptible; tongue and breath getting cold; still complains greatly of cramps; less sickness; progress towards complete collapse rapid and apparently irresistible. 

11J. Tongue rather warmer; pulse just perceptible; quieter; complains of sinapism. 

31st. Half-past 12 a. m. Pulse feeble but perceptible ; no purging, vomiting, or cramps.; extremities warmer. 

l£, a. m. Slight cramps during the last hour ; complains of nausea. 

4, a.m. Slight vomiting; cramps; pain in back and abdomen; injection returned; after this great restlessness; great thirst; tongue again cold; pulse more perceptible, in left than in right wrist. 

Rep. enem. cum tinct. opii et sp. ammon. arom. aa s\j* 

7, a. m. Body warmer; tongue warmer; has been much more composed ; vomiting and cramps nearly ceased. 

8. Warm, and much more comfortable; pulse feeble, but distinct; has taken eight pills, and sago, with small quantities of brandy during the night. 

11. Comfortable; eye rather glassy; disposed to sleep, but eyelids remain considerably open; inspirations slow, 13 in the minute, rather laboured; pulse feeble, but distkict; no stools; calomel gr. v. et hor postea 01. recini 

12;§, Noon. Much the same; has slept a little; pulse remains feeble; skin warm; no return of urgent symptoms. 

Enem. tfeij. cum sp. ammon. arom. ; stat. continue sago, with small quantities of brandy frequently. 

3J, p. m. Has been worse since last visit; stertorous breathing; no pulse: sinking. 

Died at 7 o'clock. 



71 







Dr. White has favoured me with the details of the following very interesting case, in which the three stages of the disease were so distinctly marked. The developments of inflammatory action after the patient had emerged from the stage of collapse, was very decided, and treatment of corresponding activity was required. On the whole I must consider the effect of the remedies employed as strictly reducible to the principles of practice, which I have endeavoured to establish, and as a good exemplification of their correctness. 

CASE XXVIII. 

William Wilkinson, aged 29, a labourer, in the soda and Epsom salts works of Mr. A. Clapham. 

Wilkinson had been but a short time discharged from the Newcastle Infirmary, consequently rather weak, and had been complaining of sickness, as he thought produced by the gases in the factory in which he was employed; he had taken a dose of castor oil during the week without effect. 

On Sunday, the Bth of January, at 9 p. m., was attacked with purging of a common kind; at half-past 4 a. m., of Monday, sickness and vomiting came on. I was sent for, and saw him at Ba. m. I found him with a weak trembling pulse, cold extremities, excessive cramps, pain and weight of prascordia, and feeling, as he described himself, f* all drawn up;" great thirst, continually calling for cold water. There was corrugation of the fingers, but from the dirt which was collected on the hands it was impossible to distinguish the colour of the skin; voice a little altered. I administered a mustard emetic, which produced copious vomiting; a mustard poultice to stomach, and an enema of 4}fo. of warm water with tinct opii sij. hab. cal. gr. xv. opii crudi gr. i.ss. stat. 

I remained with him an hour and a half, and ordered cal, gr. iij. opii gr. i 2da quaque hora, and cold weak brandy 



72 

and water to relieve the urgent thirst. At 11, a. m., I saw him again, in company with Dr. Chawner, of Newark, and Mr. Knaggs, surgeon, of Gateshead; found him greatly altered for the worse. The pulse extinct; voice sunk to a whistling whisper; cold, clammy skin; chilly exudation; breathing quick, and laboured. Mr. Knaggs attempted to bleed him from the arm, but- could not succeed in getting more than Mr. Knaggs, who had seen a number of those cases, agreed with me in thinking this a hopeless one. Ordered him cal. gr. iv. opii gr. i. omni hora; at 4, p. m. much the same; at 11, p. m. slight reaction; the powders and enemas continued; mustard poultices to stomach and legs; vomiting still continues; I observed an obvious amendment before I left him at 1 o'clock, a. m., of Tuesday. At 12, m., I saw him again with Mr. Scott, surgeon to the Cholera hospital, Gateshead; full reaction now established; pulse 96, and moderately firm; complained of great pain of prsecordia and lumbar region; vomiting incessant; cupped; region, epigast. and a mustard poultice afterwards applied. Cal. gr. iv. 2da quaque hora. The enemas, with the addition of a little common salt continued; an effervescent mixture with tinct. opii gtt. xl. 3tia quaque hora, and pulv. rhei. 3ss. zingib gr. vi. stat. Eight o'clock, p. m., patient vomiting a green fluid, and fseces began to appear along with the evacuations; pulse firm; R eal. gr. iij. 3tia quaque hora et cont. mcd. 

Wednesday morning. Vomiting of green matter still continues; evacuations more feculent; pulse firm. 

Emp. lyttas region, epigast. cont. mcd. 

Evening much the same. 

Thursday morning. Still doing well. 

Night. Vomiting ceased; pulse hard and strong;, complains of pain in head and ringing in ears; turgescence of the eye; hair cut close, and cold applications to head; emp. lytte nuchse et venesectio ad cont. mcd. sine opio; pulv. rhei. occasionally. 

Friday morning. Much better; repet. hirudines. cont. 



73 

mcd.; I may merely state that as the fever subsided, ptyalism came on, which was treated with the usual remedies; a slight attack of fever afterwards appeared, which was subdued by the application of leeches, domestic enemas and aperient powders. 

This patient is now quite well. 

The liability to affection of the head in the stage of reaction will be seen in the following case, which is also remarkable in consequence of an exanthematous eruption, which appeared at that period — a similar eruption has shown itself in a few other cases. Ptyalism likewise took place. This effect has also been produced by calomel in several instances, all of which, I believe, have done well; but I apprehend it is to be considered rather as the consequence than the cause of recovery. When death takes place in the stage of asphyxia, it is vain to attempt to produce ptyalism — neither time nor the condition of the system will admit of it: in the third stage it may sometimes be of service in relieving local congestions. The case occurred in the hospital at Gateshead. 

CASE XXIX. 

Alice Wishart, aged 14, December 29th. Vomiting; purging of flocculent stools; cramps; slight blueness of extremities and countenance; pulse small; great debility. Calomel gr. iij. opii. gr. i, every fifteen minutes. Enema aq. calid. jfoiij. tinct. opii. %'i. statim. 

30th, a. m. Purging ceased; slight vomiting; pulse 120, rather hard; no urine discharged. 

8, p. m. Vomiting continues; purging returned. Cont. calomel and opium omni hora. 

31st, A. M. Stools more natural. Cont. 

10£, p. m. Pain in the head; eyes injected; sinapism nuchae. Cont. calomel sine opio. 

10 



74 

Hi. Great irritation from sinapism; to be removed. Appli. empl. canth. nuchse. 

. January Ist, 82, a. m. Pulse distinct; surface rather cold; very restless. Calomel gr. iss., opii. 5, statim sumend. An injection of warm gruel every two hours. V. S. ad 

2, p. m. Pulse sunk; countenance livid; great restlessness; head oppressed. 

Frictions, with liniment camph. Co. 

4, p. m. Hair cut off, and cold applied to the head. Calomel gr. iij. stat. sumend. 

2d. 6, a. m. Surface cold; hands and arms blue; pulse distinct: stupor. 

Frictions continued to limbs and chest. 

3d. Skin warmer and less blue; pulse feeble; stools bilious, though scanty; tenesmus; tongue cleaner; less thirst. Rep. calomel, cap. mistur. cum magnes. et pulv. rhei. bis terve die. 

4th. 1, p. m. Bowels relaxed; pulse firm, 120. 

Rep. calomel 2da quaque hor. haust. eifervesc. ssepe. Went on well till 

Bth. When the head became again oppressed; eyes injected. 

Hirud. xij. temporib. Rep. calomel, ut antea. cap. mistur. diaphoretic cum liq. ammon. a. 3tia qq. hora. 

9th. Mouth sore; an eruption, like scarlatina, has appeared over the entire surface; pain in the axilla; great thirst. 

R. Potassse nitrat. 5y- potass, supert. sij- antim. tart. gr. ij. decoct, hordei ffoi. m. cap. cyath. ter. die. A gargle with nitric acid for the mouth. From this time she improved, and was discharged well on the 14th. 

In one case only have I had an opportunity of witnessing the employment of the tobacco injection, as recommended by Mr. Baird. The patient resided at Gateshead, and was under the treatment of Mr. Knaggs. I regret to add that the case did not terminate favourably. 



75 



CASE XXX. 

Hannah Dobison, aged 54, of intemperate habits. Her health had been delicate for two months. 

January 23d. Has had diarrhoea for two or three days, and in the course of the night complained of cramps in the extremities, especially the lower. At 8, a. m., vomiting took place of dark-coloured fluid with flocculi. At 10, extremities cold; no pulse; countenance livid, sunk, and cold; tongue cold and blue; vomiting and purging of watery fluid, having a yellowish tinge with flocculi; severe cramps in all the extremities; had not passed urine since the preceding night. 

Mustard emetic and warm water; free vomiting ensued; heat applied generally to the surface. 

Calomel pp. gr. iij., pulv. capsici. gr. iss., omni hora; brandy ?ss. every half hour in hot water. 

1, p. m. Heat restored and colour improved, but no pulse at the wrist; cramps less severe. 

2 o'clock. Slight fluttering discoverable at the wrist. 

The tobacco enema injected and remained. 

Contin. calomel et capsicum; no farther purging; vomiting continued; cramps frequent and severe; the pulse did not return; no appearance of reaction; the blue colour returned with general coldness of the surface, clammy moisture, respiration became oppressed; she died at 1, a. m., of the 24th. 

No suspicion whatever of contagion. 

I have since (Jan. 24th) had an opportunity of seeing, with Mr. Baird, the case of a stout man, on whom the tobacco injection appears to have had the most favourable effect. The symptoms did not indicate the severest type of the disease, the pulse being at all times perceptible; but they were, nevertheless, sufficiently marked to show the presence of the stage of collapse. A great improvement of pulse, relief from 



76 

spasms, and a restoration of secretions, appear soon to have succeeded the use of the enema. 

Two of the three following cases, (which occurred in the practice of Mr. T. K. Fife, of Gateshead,) will serve to show the happy effects which have resulted from this remedy. The minuteness with which the first case is related, renders it, perhaps, more valuable. I shall allow them to stand in the order in which I received them, as the inefficiency of the stimulating treatment in the second case is well contrasted with the more successful issue of the others. 

CASE XXXI. 

James M'Ginnes, aged 35. — -Jan. 14, 1832, midnight. Came into the hospital from Pipewellgate. He is a stout Irish labourer, has a wife and five children, and having had very little work for several months, has suffered from want of food, living principally upon potatoes; he has eaten nothing solid for two days, and has been much purged for about a week. 

At 5 this evening, vomiting came on, and has continued, and he just now brought up a few ounces of semi-transparent fluid, mixed with flocculent particles ; the whole resembling thin well boiled gruel. Severe cramps in the limbs, both flexor and extensor muscles being affected, and at times strong contractions of the abdominal muscles. Temperature of the skin nearly natural; no moisture perceptible. Pulse 68 at the wrist, feeble, rather irregular; fingers a little contracted; checks flushed while vomiting. He breathes pretty well, but says he feels a- weight or sense of oppression in the thorax. 

Apply external warmth constantly by means of heated bricks and warm flannels. 

V. S. ad The blood which flowed first was dark and thick in consistence, but towards the end more florid, almost resembling healthy blood; cramps very much relieved. 



77 

Haustus cum pulv. ipecac, gr. xx., antimon. tart. gr. i., aquae m. stat. sumendus. 

This produced free vomiting, during which the pulse improved in strength, hut soon fell to the former feeble state. When vomiting ceased, he took 

Bolus Cum pulv. opii. gr. h, hydr. submur. gr. v., conf. rosae q. s. m. 

Jan. 15th. 1, a. m., pejor. 

Haustus cum pulv. capsic. gr. x., brandy Jvj. m. 

Quarter-past 1. Vomiting and partial return of cramps. 

Bolus ut supra repetatur. 

Habeat misturam effervescentem omni hora vel ssepius. 

Quarter-past 6, a. m. From the report of Mr. Bolton, the hospital assistant, I state, that since the remark last made, there has been very frequent vomiting, indeed every kind of fluid he takes is soon after rejected, and then contains a proportion of flocculent ricy particles, which are heavier than the rest of the fluid, and therefore settle when it stands. He has passed one fluid stool much the same as the fluid ejected in appearance. The pulse has at times been scarcely perceptible; extremities cold, but after free vomiting, he rallies, and the face becomes flushed; has taken the effervescing mixture freely, and warmth has been constantly applied. His wife has been here all night. 

The pulse is now so feeble at the wrist as to be felt with great difficulty; in the carotid it is about 60, and very irregular. The surface is rather below the healthy temperature, the fingers shrunk, and there is considerable anxiety depicted in the countenance; the eyes have sunk; the voice is not much altered; tongue white; his chief complaints are thirst and vomiting; has not had many attacks of cramp, and these of short duration. 

Bibat aquam cum acido. nitric. ji. ; ad J^i. pro potu commun. vice mist, efferves. 

Habeat etiam sulphatis quinniae gr. ij. pro dos. statim et repr. secunda quaque hora. 



78 

Has passed no urine since he came into the hospital. 

Half past 9, a. m. No stool since last remark. 

Sulph. quinniae rejected. 

Capt. hydrarg. submur. gr. x. in forma pulveris. 

Pulse at the wrist not perceptible ; features shrinking, and skin of the face assuming a dark hue; complains of pain extending from right to left hypochondriac region; head a little confused; no sleep. 

Half past 10. pulv. calom. rept. ut supra. 

Noon, ditto, rept. 

Half-past 12. Pulse barely perceptible, irregular; has passed a few ounces of fluid faeces, like thin pus both in colour and consistence. Complains that the pain across the prsecordia gives him great distress; the vomiting is constant, and severe cramps of the muscles of the trunk have come on. 

Appr. hirudines xij. scrobic. cordis. 

The patient seen by Mr. Baird, and also by Mr. Watt, of Glasgow. 

3, p. m. The man is evidently getting worse every hour. Adminis. enema tabaci 3ss., ad aq. ballient. ifoss. infunda per horam; pulse feeble and irregular, scarce possible to number it. Dr. White and Mr. Scott were present when the enema was given. Mistura cum ammon. carb. 3ss., aq. menthae §viij., sacch. commun. 3ss., misce et cap. \ om. hor. 

7, p. m. Mr. Bolton states that he has continued the mixture; that vomiting has ceased, sickness and thirst are abated, that there have been slight cramps in the fingers, and that the pain about the prsecordia is less severe; the pulse is now 80 at the wrist and more regular, the face is flushed, the surface is warmer, and a fine moisture is appearing over the trunk and extremities; the man is looking better, and says he feels quite easy. Contin. mistura. rept. dos. subm. hydr. 

7j, p. m. Has just passed about Jfcss. of thin purulent-looking fluid, the first since the tobacco enema. 

9i, p. m. He is sleeping calmly; pulse at the wrist about 



79 

80, feeble, and not quite regular; has vomited only once since last remark; skin natural in temperature over the trunk; hands and arms cooler. The volatile mixture to be continued unless the pulse rises. 

16th. During the night, Mr. Bolton has seen the patient frequently, and reports that the pulse has varied from 60 to 80, and that at times it has been very indistinct; the patient has had calm sleep at intervals, and the surface has been in general warm; has taken three powders, each containing submur. hydrarg. gr. x., pulv. rhei. £)i.; vomiting has followed each dose. 

9, a. m. Pulse very feeble, and about 80; much inclined to sleep; has still passed no urine, and has less thirst; the vessels of the conjunctiva are finely injected, and there is some approach to low muttering during sleep; keep the scalp and hair constantly moist, with equal parts sp. vini rect., and acid acet. dilut, and give as an enema (op. syphonis) aq. tepid ftji. 01. ricini sss. m. 

10|> a. m. The man looks better, says he has little or no pain; the pulse is still feeble, but more regular; the enema has passed with a slight tinge of brown, probably caused by the tobacco given yesterday. As he inclines to sleep, omit internal medicines, but continue to keep the head moist with the lotion, and if he feels a wish for any kind of food let him have it. 

1, p. m. Patient seen by Mr. Baird. M'Ginnes states that he passed a little urine at the same time with the enema. The pulse is about 80, feeble in the wrist, but more firm 'in the axilla, with some irregularity; let him take 3ij« by measure of brandy, in of the effervescing mixture, about once an hour if awake; and, if the stomach will retain it, give 01. ricini si. half an hour after the second dose. 

A\, p. m. Pulse about 90, and rather improved in regularity; mouth and tongue moist, and he has passed a little urine. Hab. 01. ricini supra prescrip. et cont mist, effervescens cum sp. vini gallic, ut antea. 



80 

8, p. m. Is sleeping on his side, breathing softly, and without any appearance of suffering; the pulse is nearly regular, though feeble, and 84; has had one stool, and passed a little urine at the time; the skin is dry; hands cool, being out of bed, but those parts covered by the blankets are of the natural standard. There is an approach to feculency in the smell of the stool, in colour it is considerably darker than he has passed before, but the exact hue cannot be determined by candle light. He must continue the saline mixture with 3ij. brandy in each dose. 

11, p. m. Sleeping soundly; pulse regular, 92, and more firm ; surface of the healthy warmth, and an appearance of composure in the face. 

17th, 8 a. m. Mr. Bolton reports that the patient has continued to improve during the night, and has taken coffee and toast for breakfast; he has had one alvine evacuation early this morning, and it appears slightly coloured with bile; he also passed some urine at the same time; the pulse is 92, and pretty firm. Omit medicines, and let him have coffee or gruel when he wishes. 

4, p. m. Improving every visit; had broth and rice-pudding for dinner; is free from pain; the pulse 96, and quite regular; the skin natural, and tongue clean. 

8, p. m. Pulse 88, regular and soft ; tongue clean ; a little thirst, and slight uneasiness in the bowels ; has had no stool. Cap. haustus cum 01. ricini et tinctura cinnamoni singulorum 3vi. m. 

18th. Has passed several dark bilious stools, and abundance of urine ; appetite for food has returned, and he only complains of debility. 

21st. Discharged. 

CASE XXXII, 

December 26, 1831, at 5, a. m. Sent for to attend Rachael Wilson, Jackson Street, a delicate woman, aged 32, living in 



81 

an ill-ventilated upper room, used as a school, where her sister and several children also resided. The symptoms of Cholera well marked; vomiting and purging began about 6 yesterday evening, and have continued since; could not ascertain the appearance of what had been passed, from various admixtures. About two this morning, very severe cramps came on, and have returned at short intervals; feels very faint when she is out of bed; thirst great; no pulse at the wrist, scarcely perceptible in the axilla, but in the carotid artery it is 60, and irregular. She complains much of uneasy feelings in the chest, which she cannot describe, but says her breathing is oppressed. Face lead colour, nose very cold ; hands slightly discoloured and shrunk, the integuments drawn into folds ; feet and legs cold. 

Directed warmth to be applied to the feet, legs, and spine. Placed a ligature very high up on the arm, and observing the veins become slightly turgid, I made a large orifice in the most prominent, but did not obtain of blood, dark and thick in consistence. The cramps being very severe, I gave her opii. gr. iij., and soon after emuls. camphorae et aq. menth. fort. sing. ammoniac carb. 5L m. capt. ?ij. omni hora. 

Saw her again at 7, a. m., no improvement. 10, a. m., vomiting less frequent; pulse in the carotid very feeble and irregular, at times dwindling into a mere fluttering for two or three seconds. 

I saw her frequently, but have no remark till half-past 4, p. m., when the word " Melior" occurs in the day book : she had then taken nearly three bottles of her mixture. 

From this time I have no memoranda of the case. I saw her frequently during the evening, and thought her dying ; diarrhoea ceased ; cramps were less severe, but the pulse did not improve. Contrary to expectation, she lingered till the 28th, when I saw her a little before 5 in the morning in articulo mortis. 

11 



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CASE XXXIII. 

December 27. Grace Wilson, sister to the foregoing, complained to me this forenoon that she was purged, and had some cramps in her legs. She was attending her sister, and appeared rather a stronger woman. 

She had a magnesia mixture, and g. ij. of opium. 

28th, at 5 in the morning (when I visited her sister,) she told me she was much better. 

In the evening, the dose of opium was repeated. 

29. Towards evening the symptoms became more decided: vomiting followed immediately any thing was taken, and she was purged very frequently, the stools having completely the characteristic appearance; cramps were frequent. 

10, p. m. Had an enema administered, consisting of infus. tabaci (P. L.) aq. ballient, q. s., and I left directions that the same was to be repeated during the night, if necessary. 



30th. Early in the morning I found her better; the second enema had been given. 1 have no notes of the case after this time. Her recovery was progressive, though slow. During convalescence she took small doses of tinct. cascarillae with benefit. It is worthy of remark, that in this case the resemblance between the stools and well-boiled rice partially suspended in whey, was very perfect, and a medical gentleman from Sunderland, conversant with the disease, procured a quantity for analysis. 



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PROGNOSIS. 

The chances of recovery in cases of Cholera must depend upon the stage of the disease ; the duration of the attack before the employment of judicious remedies; its severity; and upon the age, constitution, and previous state of health of the patient. 

It has been seen that when the patient comes under treatment in the early stage of the disease, before the pulse and animal heat fail, his recovery may be calculated upon with much certainty. The abstraction of blood if indicated, a single dose of calomel and opium, succeeded by castor oil, will frequently restore him to health in a few hours. 

When the more formidable symptoms of the second stage have set in with great severity, the chances of recovery are, in all cases, very precarious; and if the constitution be enfeebled by previous disease, or old age, the case may be considered as nearly hopeless. In childhood, youth, and the vigour of life, an active and diligent use of remedies will often be attended with complete success; and it is in these cases that we are stimulated in our exertions by the satisfaction of witnessing their utility. The warmth of the body is, in the first place, restored; the pulse becomes perceptible, it increases in strength and volume, and the natural colour of the skin gradually returns; the secretions become re-established, and the patient is brought into a state of safety; for, with vigilance, the succeeding symptoms may, with much certainty, be obviated. All this, however, does not go on uninterruptedly. The patient has many uneasy sensations 



84 

during his recovery from the stage of asphyxia; he becomes restless, complains of pain at the stomach, with occasional nausea, or even vomiting. Still there is restored action of the heart and arteries, the functions of life are going forward, and we may fairly anticipate that, under judicious direction, they will lead to the entire restoration of the patient. But when the restorative efforts are opposed by previous organic disease, general feebleness of constitution, or the worn-out energies of age, we must not calculate too confidently upon any imperfect reaction that may be induced. Heat and pulse may return, the former perfectly, the latter in degree only; the spasms and watery discharges may cease; something approaching to natural excretions may even take place, and yet the patient will not unfrequently sink; not from violent reaction, or the development of local inflammation; but from want of energy in the vital powers to carry forward the attempts at restoration which seem so happily commenced. 

The danger of the case is by no means dependant upon the quantity of matter discharged from the stomach and bowels. In some of the worst cases, this is not very considerable, and in some of the most successful, it has been very great. Neither is cramp or spasm a certain criterion. Many fatal cases have occurred, wherein it was nearly entirely absent, or soon ceased. The great danger appears to arise from imperfect or suspended circulation. Let this be restored fully, and the rest is within our control. On this circumstance mainly, then, will rest our judgment as to the probable result of our efforts, though all the concomitant circumstances of the case must be taken into the account. 

NEW REMEDIES. 

The new remedies which have been introduced in the treatment of Cholera since its appearance in England are not 



85 

numerous; but three may be noticed as having some pretensions to novelty, either in their nature or application. 1, Mustard emetics; 2, Copious warm and stimulating injections into the intestines; and, 3. The tobacco enema. 

For the introduction of mustard emetics we are indebted to Dr. Smith, of Newcastle. He had tried it in his own person, when resident in the West Indies, and, being aware of its being used as a popular remedy by the pitmen in cases of asphyxia from choke-damp, he was led to suppose that it might be of service in rousing patients in the collapsed stage of Cholera. His suggestion was acted upon at Sunderland, through Dr. Gibson, with beneficial results, and has since been used to a considerable extent both in that place and at Newcastle. In the cold, blue, pulseless stage of the intense type of the disease, I believe it to be a very valuable remedy in relieving the irritation of the stomach, and exciting reaction; but when full vomiting can be excited by milder means, especially when it can be done by copious draughts of warm water only, I consider it safer to avoid the irritating effects of the mustard. 

The analogy between the asphyxia of Cholera and that occasioned in the coal-mines by choke-damp, is very striking; and it is a general remark amongst the colliers, that no man recovers from the latter unless full vomiting is induced. This indication appears to be best effected by the use of mustard. I have seen a patient who had been exposed to the effects of choke-damp after an explosion had taken place in the pit, who was brought home entirely pulseless, yet his intellect was clear, and his spirits cheerful; he was made to vomit freely; stimulants consisting of brandy and ammonia were given, and heat and frictions were applied to the surface; he afterwards took tea and bread with appetite, and believed that he would recover, but the pulse never returned at the wrist, and he fell into a profound sleep for three or four hours, from which he never awakened. 

The introduction of warm and stimulating fluids into the 



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intestines* can, in itself, have no claim to novelty; it is, therefore, to the quantity, and to the principle on which it has been used in the treatment of Cholera, that I would direct attention. If given in the ordinary quantity of a pint only, the effect is nugatory, or nearly so; but if the patient be in a state of complete collapse, as indicated by the entire absence of pulse and of animal heat, and by the blue shrivelled appearance of the hands, we shall often find a distinct approach to reaction induced by forcibly injecting three or four pints of water of as high a degree of temperature as can be borne with safety, containing some stimulating substance, such as soap, camphor, or brandy, or, if the irritation of the bowels be very great, laudanum. The presence of so large a quantity of fluid in the colon, communicates heat to the neighbouring organs, and has a powerful effect in exciting their action. The coldness sometimes quickly disappears, and a return of pulse soon follows. 

But the remedy which has the greatest claim to novelty is, unquestionably, the tobacco enema, as suggested by my friend, Mr. Baird. Upon whatever principles it acts, it seems in his hands to have been employed with considerable success; he promises me an opportunity of communicating to my readers the results of his experience of this remedy. It cannot be denied, that the prejudice excited against its use, has been considerable, and that a trial of its effects has, in consequence, been shunned by other practitioners. This 

* Though more desirous of ascertaining the true value of remedies than of appropriating to myself the merit of their introduction, I may yet, with propriety, be permitted to notice an error in the last number of the Lancet, in speaking of this powerful means of inducing reaction: " We allude to the employment of copious injections of diluent fluids into the rectum, a measure first practised by Dr. Gibson in one of the Cholera Hospitals in Newcastle, and since repeated with the most encouraging results." The patient in whose case the large hot injection was first employed was Thos. Taylor, (see Case IV.) Dr. Gibson afterwards saw this man, with me, and, I am sure, would be the last to make a claim to which he was not entitled. 



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cannot, however, detract from the real merits of tobacco as a remedial agent; and, surely, in a disease which so often defies our best devised plans of treatment, we are bound to receive with candour any suggestion, however opposed to our previously entertained opinions, and to weigh, in an equal balance, the evidence in favour of its virtues. Mr. Baird deserves some credit for the firmness with which he has persevered in the employment of the tobacco enema, notwithstanding the uncandid outcry that has been raised against it; and should it ultimately prove as useful in the treatment of Cholera as his experience hitherto has led him to anticipate, he will have reason to congratulate himself on having contributed, in no mean degree, to the safety of the subjects of this formidable disease. I believe his claims to originality in the use of tobacco cannot be disputed. 

I have just read with great pleasure the animated " Remarks on Cholera," by Dr. Molison, of Edinburgh, written in consequence of his recent visit to Newcastle, and willingly bear testimony to the great zeal and diligence with which he laboured in the cause during his stay here; nor do I mean to depreciate the value of the means he proposes as principally useful in restoring the circulation, viz. hot dry friction. I believe it to be a very useful auxiliary, but I much doubt the possibility of carrying it into effect, in many cases, in the manner recommended by Dr. Molison. li Attendants to the extent of five or six " are rarely to be had to " devote themselves J? exclusively to this service; and few, indeed, are the patients that can have a medical attendant with zeal and leisure enough to devote himself to the superintendence of their cases in the way that distinguished his exertions, and rendered them so efficient. 



88 

CAUSES OF CHOLERA. 

As in every other disease, an attack of Cholera must be dependant upon the concurrence of two separate causes — a predisposing and an efficient cause. 

Whatever may be the real nature of the latter agent, it is evident, from the limited number *of persons whom it attacks, when compared with the entire population, as well as from the apparently irregular and capricious manner in which they are selected, as regards age, sex, and neighbourhood of residence, that certain conditions of the recipient are requisite to enable it to produce its specific effect. Were it otherwise, upon whatever principles its extension may be accounted for, whether by direct communication from person to person, or by some peculiar atmospheric constitution, it is clear that the whole population must soon fall victims to their universal susceptibility and general exposure to its irresistible influence. 

It is far from my intention at present to enter at large into an examination of the nature of these causes, but I shall endeavour to make a few pertinent observations on each. 

The predisposing causes of Cholera may be properly divided into two classes — natural and acquired. The natural predisposing causes are to be sought for in the peculiar organic structure of the individual. It may reside in an unusual delicacy of the mucous membrane of the.stomach and intestines, dependant, possibly, upon inordinate vascular excitability, or great nervous susceptibility^ and may have shown itself on former occasions, in liability to gastric and enteric derangement from very slight causes, or an habitual tendency to dyspepsia or diarrhoea. 

This peculiar delicacy of structure, evinced in undue irritability of the nervous and vascular apparatus of the alimentary tube, may be confined to an individual member of a family, or it may be common to the whole. Like many other 



89 



organic tendencies or constitutional idiosyncracies, it may be hereditary, and affect, in equal degrees, a parent and his children; or it may be modified by their varying habits and pursuits, its intensity being increased in one, while it is lessened, or entirely disappears, in another. 

Analogous instances of constitutional tendencies to organic or specific diseases, prevailing throughout the several members of families, are familiar to most practitioners. In one, the original delicacy of the organic structure of the lungs leads to the death of many children of the same parents, in rapid succession, fr.om phthisis; in another, the family predisposition to gout is sufficiently conspicuous in the numerous martyrs to that disease which are seen in successive generations. In another family, a hsemorrhagic constitution is remarkably apparent on every trivial occasion. I know an instance of three generations of the same family, who have all been liable to profuse and alarming discharges of blood; and it is a curious fact that it is in the female part of the family only, that this hasmorrhagic predisposition prevails. 

It is well known that entire families are unsusceptible of the variolus, or vaccine disease; and that others, on the contrary, so great is their natural susceptibility, derive little or no protection from future attacks, in consequence of having been already affected with either of these specific disorders. 

Many other examples might be adduced of similar hereditary peculiarities of organic structure; in one case the eye is of peculiar delicacy; in another, the glandular system is very susceptible of disease; in a third, a ricketty tendency prevails. Nor are they confined to morbid predispositions only: a greater perfection of organic function is evinced in a remarkable manner amongst the different members of the same family. The organs of voice, the organ of smell, or of sound, all afford innumerable examples. We are delighted with the power of producing exquisite vocal mo- 

12 



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difications of sound in numerous members of this family — in that, we observe a general talent for the nicest discrimination of musical melody, or harmony; and in a third, the olfactory sensibility is such, that powerful or offensive odours not unfrequently induce immediate indisposition. 

If we reflect upon these and similar well established facts, we shall not find it difficult to conceive that a condition of physical structure, peculiar to individuals, or common to the members of certain families, may exist, which predisposes to, or occasions a ready susceptibility of being affected by, the efficient cause of Cholera. In point of fact such appears to have been, in a remarkable manner, the case in Margaret Walker (see Case V.,) who became affected with the disease shortly after hearing of the death of her sister ; and this principle, when taken in connexion with other predisposing causes which will presently be noticed, will go far, I conceive, to account for the several instances of the disease which have taken place in the same families, either simultaneously or in rapid succession. 

The predisposing causes of Cholera which I have called acquired, are to be found in whatever has a tendency to debilitate moral or physical health; more especially to diminish the healthy tone of the digestive system. It is not easy to draw a definite line of distinction between moral and physical agents in producing this effect. It is evident that they act either in concurrence, or have a mutual reaction upon each other by which the energy of each is increased. But without attempting to trace their connexion very accurately, it may be stated, generally, that fear and all the depressing passions appear greatly to predispose to this disease, especially when combined with physical delicacy of constitution, or previously disordered health. 

Of the powerful influence of fear, in particular in predisposing to an attack of Cholera, some remarkable instances have taken place, particularly in the nurse who died at the Sunderland Infirmary and the Rev. Mr. Scott, of that town. 



91 

Thai the same affection of the mind, combined with grief for the loss of a husband, wife, or child, and probably assisted by other predisposing causes, more especially poverty and its concomitants, has induced the attack in successive members of the same family, admits, I think, of every thing short of absolute proof; for the succession of cases has, for the most part, been more rapid than could be accounted for on any principle of contagion, if, indeed, such an agent exists. The testimony of Mr. Fife, of Gateshead, a gentleman of much intelligence, whose experience of the disease since its appearance in that town has been very extensive, entirely confirms this opinion. " Cholera," says he, "is certainly not communicable, for though it frequently attacks several persons in one family, it is either simultaneously, or in such quick succession, as to preclude the idea of their having received it from each other;" and Mr. Brady, of the same place, observes, that " no principle of contagion could account for such a sudden spread of the disease."* We can only conclude then, that powerful predisposing causes, common to all, were in active operation at the time the efficient cause was called into action. 

It has been generally remarked that wherever Cholera has hitherto prevailed, it has principally attacked the broken down in constitution, the dissolute, the abject poor, those devoid of proper bodily comforts, whether in lodging, clothing or diet, those enfeebled by age, and the inhabitants of low, dirty, crowded, and ill- ventilated situations ; and, with few exceptions, such has been the case in Newcastle. These, then, must be considered as the general predisposing causes of an acquired physical nature; we may add to them exposure to great fatigue, damp, cold, or dietetic excess. A diligent inquiry would, I am satisfied, enable us to discover instances of all these circumstances having led, 

* For the communications with which I have been favoured by Messrs. Fife and Brady, see Appendix. 



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more or less, directly to the attack; but of the effect of the latter cause in particular — dietetic excess — the extraordinaryirruption of the disease at Gateshead, in the midst of the Christmas feastings, offers a most remarkable example. It is true that Mr. Fife, of that place, has been led to doubt the effect of habits of intoxication in producing predisposition to Cholera, as will be seen in his excellent communication on the subject, wherein he observes that " From the great proportion of orderly, sober persons and children of all ages among the patients, I cannot consider drunkenness a powerful predisposing cause, though for the sake of morality, it is well to favour the opinion." But, after all, this only proves that such habits are not the only predisposing causes. Innumerable instances might be brought forward wherein the attack supervened either during the continuance of, or immediately subsequent to, excessive indulgence in ardent spirits. • Such was the case in two of the earliest instances that occurred in Newcastle, those of Eddy and Mills, and others have come under my own observation. Nor will it admit of a question that their habitual use greatly diminishes the healthy tone of the stomach and bowels, and induces an irritable condition of their mucous lining. 

It would appear, then, that the presence of some one or more of these predisposing causes is essential to the occurrence of an attack of Cholera ; and a knowledge of this fact naturally leads us to the most important measures of a prophylactic nature : they simply resolve themselves into the promotion and preservation of the highest tone of bodily and mental health. Let bodily comfort be provided for, by the possession of good lodging, good food, warm clothing, cleanliness, and fresh air ; and let every excess in diet be avoided. Let a firm, confident, cheerful, and happy state of mind be encouraged; let personal fear and apprehension be laid aside, and every depressing passion, as far as possible, be avoided, and we shall greatly narrow (as indeed I believe has actually been done) the susceptibility of our population 



93 

to this destructive disease. Public and private exertions should concur in endeavouring to banish fear and to encourage confidence, to promote temperance and industry, and to supply the deficient comforts of the poor. With the latter object in view much has been done in this place, and, I doubt not, the same will be done elsewhere. If Cholera has led to the loss of many lives, it has not been without its beneficial influence in a moral and political point of view ; and may lead to important results, by drawing the wealthy and the poor into more frequent communication, and restoring that confidence and good feeling between them which has been, of late years, so powerfully shaken; as well as by calling into activity the most useful and honourable principles of action, and exciting the best sympathies of our nature. 

Any inquiry into the nature or essence of the efficient causes of Cholera is attended with so many difficulties, and is so little likely to lead to a satisfactory result, that I shall confine my remarks on this part of the subject within very narrow limits. We can judge of the existence of such a cause only from its effects,' for it undoubtedly possesses no qualities which are cognizable by our senses, nor can chemistry detect its properties by any known process of analysis. It is an invisible, inodorous, intangible poison, capable of producing the most malignant effects upon the human constitution; but how produced, or whence proceeding, is more than we are likely to determine in a satisfactory manner. 

There are, nevertheless, questions connected with this subtle agent, of much interest and importance to the welfare of mankind, and in which the philosophic inquirer cannot but be deeply interested : its slow but steady progress, from east to west, through the great continents of Asia and Europe; the desolation with which its course has been marked; its arrival on the shores of Great Britain, to what cause its appearance amongst us may truly be at* 



94 

tributed; by what laws it is regulated in affecting the human constitution; whether it is capable of being generated in the animal system while sinking under its destructive influence, and thence communicated, either during life or after death, to those who come in contact with the persons of the sick or dead; whether by any chemical agent its qualities are capable of being neutralized or destroyed ; are subjects worthy of engaging the diligent consideration of the most acute and intelligent minds. 

After all that has been written by the various chroniclers of the disease, as it has appeared in foreign countries, it is as needless, as it is contrary to my design, to treat of its history before our own became the field of its more immediate operation, and I shall confine my observations to three subjects of inquiry: Ist. As to its origin. 2d. As to its dependance on atmospheric influence. 3d. As to its communicability from one person to another. 

The assumed capability of Cholera being conveyed by shipping from one country to another, on which our system of quarantine is founded, very naturally gave rise to the suspicion, when it first appeared in the port of Sunderland, of its having been imported from some place on the Continent, where it was known to prevail; and several stories were in circulation descriptive of the manner in which it had thus been introduced. I shall not here repeat any of these tales, suffice it to say that none of them have been in any degree authenticated. That the ships which were blamed for having committed the mischief, 1 were found to have been from uninfected ports, their bills of health clean, and their crews healthy ; in point of fact they were fairly acquitted of the charge; and I believe the conviction is now almost universally entertained by the inhabitants of Sunderland, medical and non-medical, that the disease did not reach that place from any foreign source whatever — It may be farther stated that the first case of Cholera which took place in this part of the country, was at a considerable 



95 

distance from Sunderland, having been at a small village called Team, about 2 miles south-west of Newcastle. This case occurred to Dr. Alexander, of Newcastle, on the 4th of August, 1831. The details are given in the Appendix, No. 1: other cases occurred at Newcastle simultaneously, if not before the regular appearance of the disease at Sunderland; although want of experience of its true characteristics, and unwillingness to believe in the fact, induced medical gentlemen to endeavour to prove that these were not cases of the new disease; yet subsequent observation has sufficiently proved their identity, and, I believe, it is now generally admitted. Such were the cases of Oswald Reay, which occurred in October; of William Armstrong, in the beginning, and of Robert Jordan towards the end of November. On the 7th of December the next case occurred, that of Maria Mills, with which commenced the official reports of the Board of Health of this place. The strictest inquiries respecting the origin of these cases have failed to obtain the slightest evidence of their having arisen from any infected source, and seem to prove, in the most satisfactory manner, that, however the disease may have since extended itself, its commencement in the country was spontaneous, upon whatever causes it may have depended. 

Of the true nature of these causes, it is impossible to do more than form plausible conjectures. Whether they are to be found in miasmatic emanations from the soil, or in peculiar conditions of the atmosphere with respect to moisture, temperature, gravity, distribution of the electric fluid, or other unknown qualities, are questions that may give rise to much curious speculation, but, I fear, will scarcely admit of any thing like demonstrative proof. Nevertheless there are a few circumstances of a remarkable nature which deserve to be held in our recollection. The first of these is the progressive and steady march which the disease has been making from the east of Asia to the west of Europe during a period of fourteen years. Stage by stage has it proceeded; year after 



96 

year, in a broad line of progression, but slightly interrupted in its regularity by an occasional advanced post, or by omitting to occupy a city, a village, or a limited district till a more distant season; setting at naught the precautionary measures of governments, or at best, appearing to respect them during a very limited period only. 

No one, I think, can reflect upon all this without being convinced that some grand general agency has been at work in the original production and gradual extension of this extraordinary disease. To suppose that it has depended upon the accidental communication of man with man, either in the cities whose population it has swept off in thousands with unexampled rapidity, or in the new districts and countries into which it has made its inroads, often at numerous points at the same period of time, would be manifestly to attribute effects of fearful magnitude to causes which might certainly be placed within the control of man, limited as is his knowledge, and small as are his powers of action. But though man may direct a determinate stream of air through a smelting-furnace, and avail himself of the principles of pneumatics for the purposes of art, he cannot control the winds; though he may freeze a few pounds of water by his chemical combinations, and melt it again by his artificial heat, he cannot thaw the icy ocean or change the temperature of a winter's day. He may insulate, a case of small-pox and prevent its communication to the non-infected, but he cannot arrest the course of the efficient principle on which the-extension of Cholera from town to town, from district to district, from country to country depends. He has tried his powers to the utmost, and the result has been utter failure: let him acknowledge, then, the inadequacy of the reasoning on which his attempts were founded, and search for the causes of the wide extension of this disease on principles of a broader and more adequate character than the mere accidental contact of man with man. 

That these causes are really dependant on conditions of the earth, and atmosphere, mutually reacting upon each other, 



97 

is rendered highly probable by the fact that, since the disease appeared in the east, such conditions have actually been coincident with its progress westward. Mr. Orton, in his interesting work on Cholera, has shown that more frequent concussions of the earth have taken place, while unusual conditions of the air as regarded temperature, electricity, moisture, &c, were observed. And it is worthy of remark that, in this neighbourhood, similar departures from the ordinary meteorological phenomena have actually taken place within the last few months. This will be fully shown by the following extracts from the Meteorological Journal of my friendy James Losh, Esq., of Jesmond, in which he has recorded accurate observations three times in every 24 hours, for a long series of years. His long-continued habits of observation have consequently enabled him to draw general conclusions with great accuracy; I shall, therefore, content myself with extracting the remarks with which he concludes, or winds up the observations of each month. But it may be remarked, generally, that the summer has been a favourable one for vegetation; the crops good in quality, and well got in. August being the harvest month, at least a month or six weeks earlier than the average time of harvesting in this neighbourhood; the foliage of the trees was unusually rich; and, according to the observations of Mr. Losh, the difference* either as to time or richness of vegetation, between the northern and southern counties of England was much less distinctly marked than in ordinary seasons. 

October, this year, has been, generally speaking, pleasant and favourable to the country." An important observation follows. " The butchers complain that a larger proportion of sheep are suffering from the disease, called the Rot, than usual, principally those lambed in 1829. This appears to be wholly a disease of the liver, and neither horses nor cows are ever subject to it. The mutton of a sheep having this disease, is of considerably less specific gravity than that of a sound sheep." This is a curious observation, and if confirmed 

13 



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by repeated experiment, may tend to throw some light upon the physiology of disease. 

" The country, generally, is said to he unhealthy, and some alarm prevails as to the Indian Cholera." This was at the time of Cholera being first fully recognised as having made its appearance at Sunderland, and the connexion which seemed to subsist between the first cases and the previously unhealthy condition of the country, is worthy of being borne in mind. 

" November, this year, has been milder than usual upon the whole, though we had several days of severe frost. The nights have been warmer, in proportion, than the days ; and though November is always considered to be a gloomy month, it has this year been more subject to a hazy state of the atmosphere than usual. Towards the beginning of the month, also, there was more thunder, accompanied by more frequent flashes of lightning, than I recollect to have observed at the same season. 

" Whether or not this state of the air may have any connexion with the Cholera, which has lately appeared in our neighbourhood, Ido not pretend to say ; but I am strongly inclined to think that this awful disorder is epidemic, and not contagious, and it would be well if men who have leisure and knowledge sufficient for the purpose, would make minute observations on the state of the atmosphere, and its apparent effects upon animal as well as vegetable life. I well know how apt all observers are to be swayed by their prejudices, particularly in times like these, when it requires a steady mind to resist the effects of panic of various kinds. " 

" December this year has been much warmer, (or rather less cold,) and less subject to violent storms than usual; this is shown very distinctly in the green and spring-like appearance of the pastures, &.c." 

The following observations are curious, and well worthy of serious consideration in estimating the influence of the atmosphere upon human health. 



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" I have not had much opportunity to observe the birds and insects. But fewer birds of passage have shown themselves, and the wild fruits have remained longer upon the trees than is usual. Flies, of all kinds, particularly the common horse fly, have been very frequent; and, in digging and planting, I think 1 have met with more (and in a more perfect state) torpid insects, such as moths, humblebees, &c. than I ever observed before." 

" During the whole of December we not only have not had one clear day throughout, but I believe not one real brilliant star-light night. 

" There has always been a kind of haze in the air, and very frequently a thick mist early in the morning. Hoar frosts, too, with the thermometer three or four degrees above the freezing point, have been very common. 

"The Cholera has continued, and even extended itself, though slowly and feebly, in this district; but I think nothing new or important has yet been ascertained as to its origin or its mode of propagation. It is clearly not contagious, generally speaking, though it may be so under peculiar circumstances: even then, however, it seems to select its victims from those predisposed from poverty, want of cleanliness, or intemperance. It has been observed that the Cholera made its appearance at Newcastle with a south-east wind, whilst the disorder raged at Sunderland ; at Gateshead with a north-west wind; and now again at Edinburgh ( ' Haddingtonl ' ) after the wind has returned to the south-east. I confess Ido not rely much upon these observations, but all facts are worth recording."* 

In reference to the extraordinary calmness of the season, 

* I may notice that the month of January has, for the season, been one of unexampled warmth and dryness, scarcely a frosty night or a shower having occurred throughout; and that the same mild spring-like weather, a few refreshing showers only having taken place, continues u,p te .the present time, February 9th. 



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I should scarcely have thought myself warranted in adducing the sort of hearsay testimony of a person (an experienced seaman) of whom I know little,' — " That we had not had a brisk gale of wind for above four months" — were it not in some degree corroborated by the observation of Mr. Losh and of others to whom I have since mentioned it. 

When we review the preceding extracts, we cannot but admit, that the condition of the weather has exhibited some unusual characters, as to heat, moisture, electricity, winds, and so forth; and that its influence over vegetable and animal life has been in some respects peculiar, without immediately taking into the account the health of the human constitution, But if the sensible qualities of the atmosphere have been thus appreciably different from those of ordinary seasons, we may reasonably infer that many peculiarities in its constitution, of a nature which our means of analysis have not yet enabled us to detect, may have existed; and that on them may, in a great degree, have depended the peculiar •condition of health, whether in the lower classes of animals or in the human race, 

That the atmospheric condition, be it what it may, on which depends the efficient cause of Cholera, has been gradually forming itself in the course of the summer, is rendered yet more probable, when we review the character of the diseases which have principally prevailed, in the neighbourhood, during that period. They have consisted, in great part, of diarrhoea, common Cholera, dysentery, and a form of continued fever, often commencing with these several forms of gastric and intestinal disease. It has been a general remark, amongst medical men, that the ordinary complaints of the season all tended to resolve themselves into the prevalent febrile affection. Throughout the epidemic, a marked determination has been observed to the mucous membrane of the intestines, showing the irritable condition of that tissue, and, in many cases, discharges of blood, sometimes to an extraordinary extent, have taken place. It is worthy of remark 



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that this form of fever has been most prevalent among, if not entirely confined to, the more elevated parts of the town, and to the families of a different class of the community, from those in whom Cholera has taken place; that while the dwellings of the superior grades were visited, very generally, with continued fever, the lower and poorer districts enjoyed an unusual degree of good health; and that since Cholera hecame prevalent, the former type of disease has nearly disappeared, except when it occurs as the sequel, or third stage, of its more formidable successor. These are circumstances well worthy of consideration, and naturally suggest many interesting reflections. Supposing, as seems probable, that considerable analogy exists between the efficient causes of the two forms of disease, we are led to inquire whether the difference is in kind, or in degree only? and why, if they differ in degree only, should the less intense degree affect the better and more comfortable classes, leaving the poorer untouched; and vice versa? 

Whatever may have been the cause of this singular distinct tion, it has not depended upon a mere accident; the line has been far too distinctly drawn to admit of such a supposition, and* it must evidently have arisen out of some well-defined principle, though it has hitherto eluded our powers of discrimination. I cannot hope to elucidate the mystery, but would again revert to the fact that, throughout the season, the mucous membrane of the alimentary tube has been especially susceptible of disordered function. The several forms of dir arrhcea, dysentery, and common Cholera occurred in greatep frequency and severity than in ordinary seasons, and every now and then a case occurred, marked with such unwonted characters, as to lead to a suspicion, at least, of its being the true " Cholera," to which the attention of Europe has been of late years so earnestly directed; nor has this been the case in this district only; it is well known that in various parts of England and Scotland similar cases have occurred, which have generally ended in death. Surely there is some general 



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cause for all this. It is impossible not to connect it in the mind, however vaguely, with the morbid cloud which has settled upon our shores; a cloud which, however baneful its effects when resting upon a particular locality, seems to satisfy itself with a determinate number of victims, and then to pass forward a stage in its uninterrupted career. Sunderland has already, after a visitation of a few weeks, emerged from its influence, and, at Newcastle, its work is probably nearly completed; but, in its onward journey, all must expect to add their portion to the accumulating number of its victims. 

Perhaps there is no question in medical science of such difficult solution, as that which relates to the contagious or non-contagious nature of diseases, those only excepted which are capable of being communicated by inoculation; and, I apprehend, it is nearly hopeless, that all inquirers should, in any brief space of time, be led to embrace the same conclusion as to the possibility of Cholera being communicated from one person to another. It is nevertheless of such moment to the interests of humanity, as well as to those of commerce, that this important question should be set at rest. In the few remarks which I propose offering in respect to it, I am very far from anticipating that I shall be enabled to conduce in any considerable degree to that end. My attempt, indeed, will he limited to a brief citation of facts, upon which either opinion is based, concluding with a few observations on their real value, in reference to the question at issue. The whole will have relation only to the disease since its appearance in England, for, though it cannot be doubted that its essence is the same in every part of the world where it has shown itself, modified no doubt, in some respects, by climate, habits of the people, density of population, cleanliness and drainage of the towns, character of the soil, and tillage of the country, yet the subject has been so amply treated of by many able writers both in India and the European continent, that I shall scrupulously avoid going beyond the limits of our own 



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island. It is true that authors have arrived at different conclusions respecting the question of contagion in other countries, and that a corresponding contrariety of facts has been adduced in support of their respective opinions. It is not for me to determine how they are to be reconciled, though I have doubtless drawn my own inferences from them; but my present determination is to adduce such facts only as have taken place at home. 

In examining this important question, then, I shall set down in order the supposed facts which have been brought forward in support of the doctrine of contagion, and remark upon them seriatim. In doing this, I trust, I shall receive credit for perfect candour: any departure from it will certainly be entirely unintentional. 

It is affirmed — 

1. That cholera was introduced into the port of Sunderland by means of ships from some infected place in the north of Europe. 

2. That its course could afterwards be frequently traced from one individual to another. 

3. That persons employed in the necessary offices about the dead, in placing them in their coffins, and in attending their funerals have frequently been immediately afterwards affected with the disease. 

4. That the disease frequently attacks several members of the same family. 

5. That it has frequently been introduced into other places by persons from infected situations. 

The answers to some of these assertions have been partially anticipated by what has been already stated. But to show the uncertain data upon which the supposed introduction of the disease by importation is founded, I shall introduce an extract from a letter from a medical gentleman at Sunderland, who is an advocate for contagion., together with its refutation from his own pen. " First then," says Mr. Green, " with regard to the origin of Cholera 



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in England (say, Sunderland, for it certainly made its first appearance in this place,) I shall explain to you two or three facts on this head, and then you may draw your own conclusions. In the month of August last (I believe on the 14th day,) a ship from a suspected port, and which had undergone quarantine, passed the Sunderland Roads: two strong and healthy pilots went on board thereof, expecting she was coming into our port, which however, she did hot. The men, in a very short time, descended into their coble to return to the shore. One of them, whose name was Henry (and whose case you may probably have heard something of before this time,) was taken ill of Cholera in the boat before he had time to return to the shore, with every symptom of the disease which has lately been denominated the Asiatic or Spasmodic Cholera, and died in a few hours. The other man was also very soon taken ill in a similar manner, and had a very narrow escape with his life. These, I believe, were the first cases which occurred in this neighbourhood, of the disease which has of late produced such consternation throughout the empire." What follows is nevertheless worthy of especial notice. "It is, however, only fair to state, that a fatal case of Cholera occurred about a mile from this town a few days previous to the cases above mentioned, attended by a medical man of some information, who informs me that his case bore great analogy to, if it was not identical with, the late epidemic which prevailed here^ and is at present prevailing in Newcastle. And one or two other cases, of a very suspicious nature fell under my own immediate notice, which, however, did not prove fatal, and which I concluded Were rather aggravated examples of the ordinary Cholera of this country. Subsequent to the date of the two pilots taking ill, a few scattered cases occurred, with an interval of a week or ten days betwixt each, till four cases happened in one day, and then it broke out in full force. I have been informed that there was no case of sickness on board the vessel alluded to above when the pilots went on board, and therefore they 



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could not receive any infection. This argument, I am of opinion, will not hold good. Granted, there was no case of Cholera on board of the ship at the time, if I may be allowed to judge from facts which have fallen under my immediate observation, I am led to believe that the presence of Cholera on board the vessel at the time, was not essentially necessary for the communication of the disease to healthy persons." I readily acknowledge my obligation to Mr. Green for his communication, and would pay the utmost respect to his opinions; but it cannot be denied, I think, that he is sufficiently credulous as regards the all-pervading power of contagion. At his own request, however, I must exonerate him from the responsibility of the above facts. A few days after the former, I was favoured with a second letter of which the following is a passage. It will show, clearly enough, how much credit is due to the tale of the pilots : — " Since my last communication to you, a farther investigation has taken place relative to the case of one of the pilots (Henry,) and I find the widow and friends of the deceased tell two stories about it, totally at variance with each other ; one of which corresponds with what I stated to you in my former letter, the other is, that he got the infection a fortnight before on board a vessel some distance from this place." From such evidence as this, it is clear that no conclusion can be drawn in favour of the importation of the disease into Sunderland. If it were true that the pilots were taken ill soon after leaving the ship from a suspected port, ought it not to be proved that the disease actually existed in the ship itself, before we can believe that they could have received it from having passed a few minutes on her deck? At any rate, ought it not to be proved that the ship came from a port not suspected only but actually diseased? But what need is there to seek for the disease on board this vessel when Mr. Green himself tells me that " a fatal case of Cholera occurred about a mile from Sunderland, a few days previous to the cases of the 

14 



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pilots;"* and I have already mentioned that in the neighbourhood of Newcastle a similar case had also taken place. Surely, then, there is no good ground fois believing that Cholera was imported into Sunderland from any foreign port ; but, on the contrary, there is evidence of its existence in the country before any suspicion had arisen of its being introduced from abroad. 

The second argument in favour of contagion — that its course could be frequently traced from one individual to another, has also been partly anticipated. It is impossible to examine into all the alleged facts of this description. In many cases I am satisfied, from ample experience, that the persons from whom information is sought will not unfrequently make their information agree with what they suppose to be the wishes of the inquirer — and very naturally so, without imputing to them intentional deceit, when they have no very certain information to communicate. To prove satisfactorily that the disease has actually been communicated from one person to another, it appears necessary to show two things: 1. That communication with the sick has really taken place; and 2. That no other causes were in operation adequate to the production of the disease without the supposition of contagion. Now, that some persons who have had communication with the sick have become ill cannot be denie — to prove the contrary, were it practicable, would be too much; it would be to prove that there is increased safety instead of danger m such communication. , But the true question is, does such communication always or more frequently induce disease, or does the disease never take place without it? To tell us that two nurses died of Cholera, in the hospital, at Sunderland, is nothing. How many escaped? and might not the same women have died from the same 

* Dr. Brown, of Sunderland, assures me that cases of an undoubted character had occurred in the neighbourhood previous to those of Henry and his companion. 



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cause, if they had never been in the hospitals at all ? Were they free from predisposing causes, especially fear or inebriety, or from the general exciting cause, the epidemic slate of the atmosphere? for even the advocates of contagion generally believe that the disease is epidemic as well as contagious. But what has occurred at the four hospitals in Newcastle and Gateshead ? They have been well supplied with nurses; they have each had a resident medical man, whose whole time has been "spent in the chambers of the patients, directing and assisting in all that was done for their relief; and they have been visited by myriads of medical gentlemen, both residents, and visiters from a distance, none of whom have shrunk from the closest and most frequent contact with the sick; but in no instance has the natural consequence of contagion ensued; neither medical person nor nurse, nor any individual employed about any of these hospitals has become ill. If contact with the sick will produce illness out of the hospitals, why has it not the same effect within their walls also ? If contagion pervades the bedding and dressing of Cholera patients out of doors, what charm is there about a. hospital to prevent the same from being the case in its wards also ? but in no case have those employed in removing and washing such articles, become ill in consequence. These are the accredited experimental tests by which the contagious nature of Cholera has been put to the proof, and what is the result ? Why, with one, or, at most, two exceptions, they have all told against it. But in cases of alleged contagion it is necessary to prove that no other causes were in operation adequate to the production of the disease, without the supposition of contagion. In no instance have I been able to discover that such was the case; however sure it was asserted to be, that the patient had been near to, or in frequent communication with one previously ill, it was equally certain, that they were exposed to the generally prevailing epidemic cause, and that one or more of the predisposing causes were also in existence. This sort of 



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negative evidence may possibly be thought conclusive; it is, perhaps, as much as the opponents of contagion could be expected to adduce against it; but, by a rare accident, I am enabled to do more. lam enabled to bring forward an insulated case, occurring in a solitary village, which has neither been preceded nor succeeded by other cases, which amounts to the most positive proof. The case to which I refer is that of Margaret Walker. . She had been exposed to no source of contagion; but probably an original organic predisposition, and previous delicacy of health, assisted by the depressing influence of grief occasioned by the intelligence of the sudden death of her sister, were the powerful predisposing causes which enabled the efficient cause diffused in the atmosphere, (though in too mild a form to affect others in the same locality) to produce its specific effect, and the result was an attack of Cholera of the most malignant kind, of which she died in a few hours. Her husband and nine children resided with her in a single apartment; her funeral was well attended; the usual honours of eating and drinking were not omitted, but no one became ill in consequence. Why? because there was not a sufficient concurrence of predisposing and efficient causes to produce disease; but if contagion had been the efficient cause, could this have been the case? — in so malignant an instance it must surely have been in ample force; but the event proved otherwise. There is yet another argument to be deduced from this poor woman's case. Her sister died at a distance of eight miles from her, and she had no communication with her during her illness; if, however, it had happened otherwise — if she had been taken ill an hour after leaving the death-bed of her sister, instead of an hour after hearing only of her death, what would the advocates of contagion have inferred from such a fortuitous occurrence? Would they not, and with some appearance of reason, have declared that she manifestly received the disease from her dying or dead sister? It cannot be doubted that such would have been their argument, nor would it have been easy to 



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deny its plausibility. In reference to the question of contagion, then, I must consider Margaret Walker's case of the utmost value, as proving — first, the inconclusiveness of the facts brought forward in support of that doctrine, and, — secondly, as affording positive evidence against it. 

The third argument in favour of contagion. refers to the alleged frequency of persons being attacked with Cholera, in consequence of assisting at funerals, or being otherwise placed in contact with the dead bodies of Cholera patients. " Two joiners," says Mr. Green, " to my certain knowledge, were taken ill of it, immediately after measuring the corpses of two different persons who had died of the disease, to make their coffins, who previously were in perfect health, and both of whom died in a few hours' illness. The nurse at the infirmary, too, took the disease, and died in a few hours after assisting in removing the body of a man who died of it." Persons, who have been employed as coffin-bearers, are said to have died in consequence of the close contact in which they had been placed with the dead body. And John Robson, whose case I have related, had attended the funeral of a man, who died of the disease the day before he himself was attacked. But multiply such facts as we may, and authenticate them by the most undeniable evidence, we must yet surely forget that other causes of disease were in existence to account for the attack, before we give our belief to the supposition that it was communicated from the dead bodies of patients, who, it would appear, had not the power of imparting disease during life. There are many circumstances connected with funerals of a nature calculated to predispose to disease, at which it may be enough merely to hint. 1. The exposure to cold and wet when standing around the grave in the church-yard. 2. The eating and drinking, not unfrequently amounting to actual excess, and generally consisting of unusual and unwholesome articles of diet. 3. The crowded and close condition of the dwelling of the dead person at the time of the funeral, evidently tending to increase 



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the intensity of the efficient cause of the disear-e, with which it was previously filled. 4. The moral tendency of such an attendance. It is probable that the mind would be impressed either with grief for the loss of a friend, with a feeling of awe at the rapidity with which his sickness, death, and funeral had succeeded to a state of health and activit} r , or of personal apprehension that a similar fate might soon fall upon himself. But I need not pursue this subject farther; it is evident that many satisfactory modes may present themselves of accounting for the effect without calling in the assistance of contagion. But we may oi<cc more refer to the proper experimental test which has been again and again tried, as in the living subjects of Cholera, to prove the noncommunicability of the disease from the dead. If persons have become infected from casual contact merely, what ought we not to expect in the case of surgeons who have hours in the examination of dead bodies? Who have not only touched and handled the outward surface, but have opened the several cavities, plunging their hands into them, with the greatest freedom, to examine the internal organs, which might be expected to be the more immediate seat of, and, in consequence, more capable of communicating the disease. What, then, has been the result? No instance is recorded wherein one surgeon has suffered from such exposure to the supposed contagious influence of dead bodies. Can we, then, reasonably believe that such power of contagion has any real existence? Surely not. 

The fourth argument in favour of. contagion — " That the disease frequently attacks several members of the same family — refers to a fact of which there is sufficient proof. But the question naturally arises — under what circumstances did this plurality of cases occur? Did the patients become ill at the same time, or at intervals of sufficient length to admit of a reasonable belief that contagion, communicated from one individual, had time to produce its effect on another? With very few exceptions, I have found that the attack has been 



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either actually simultaneous, or with so short an interval as to forbid the idea of the inter vention of contagion. In the cases of a man and his wife, who' died at Walker, the man was seized at 3, and the woman at 7 o'clock on the same inorjiiiig; their child was attacked in the course of the Fame day, and also died. In cases vhich 1 saw with Mr. Knaggs, of Gatcshead, although the most severe symptoms occurred in the daughter, subsequent to their having shown themselves in the father, I found that both had been affected with diarrhoea at the same time; from whence we must conclude that the same cause was brought to operate on both at the same period. It would be easy to multiply such instances. The testimony of Mr. T. K. Fife, of Gateshead, already referred to, appears conclusive. He observes, " Cholera is certainly not communicable, for although it frequently attacks several persons in one family, it is either simultaneously, or in such quick succession, as to pruclude the idea of their having received it from each other; at any rate the progress is much more rapid than that of any other disease propagated by contagion. Among the first 53 cases I attended since, the 25tli ult., 32 were members of different families; and although few efficient means of prevention were employed, the disease, so far as I know, has not spread in any of them." 

In a former part of this inquiry, I have pointed out the great probability of many predisposing causes, whether natural or acquired, being common to all the members of a family; Margaret Walker's case might be again brought forward as a remarkable proof of this fact; and, if residing in the same dwelling, it is sufficiently evident that they must all be exposed to a common atmospheric influence. It must be remembered, too, that the fatigue, anxiety, and grief, arising out of the illness and death of one member of a family may become powerful predisposing causes of disease in a second. On the whole, there is no circumstance connected with the illness of several persons in the same family, which will not 



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admit of a more rational and satisfactory explanation on other principles than those of contagion. 

The last assumption, in proof of the contagious nature of Cholera — " That it has frequently been introduced into other places by persons from infected situations"* — requires, after what has been already advanced, the most positive proof to establish its truth. But although many instances are vaguely spoken of, I have not found it possible to verify any in a satisfactory manner.f There is some equivocation or doubt in 

* In the Scotsman newspaper, appeared the following paragraph: — 

"No new cases of Cholera have occurred in Edinburgh since Saturday, and only one person is under treatment; so that, at this moment, we may be said to be free of Cholera. The reported cases are three, but other two occurred of a milder type, and it is satisfactory to find that all the five cases can be distinctly traced to communication with Musselburgh. The disease rages with extraordinary violence at Musselburgh ; there were no less than 23 new cases and 12 deaths on Wednesday." It is not improbable that many would infer from this paragraph that the five cases had received infection from contact with patients at Musselburgh, but surely the greater probability is that they became diseased from breathing the contaminated atmosphere of that place. If they had received the disease by contact at Musselburgh, why did they not communicate it by contact to others in Edinburgh? Many cases have occurred wherein persons have become ill at places distant from Newcastle, having evidently carried the disease in their system, but without communicating it to others. Such was the case of Brown, a man who died at Haltwhistle, and a person who died at Morpeth a few hours after leaving Newcastle, but no one else became ill at those places. If .contagion had existed how different would have been the result? 

f The circumstances to which the introduction of the disease on Gateshead Low Pell have been attributed, will be found detailed in the Appendix, in a communication with which I have been favoured by a gentleman who resides in that neighbourhood; but it will be seen that the suspected corpse had been buried ten days before the appearance of Cholera in the neighbourhood, and that the latter. circumstance took place simultaneously with the great outburst in all parts of the parish of Gateshead, nor were ample predisposing causes wanting. But according to the opinion of the Central Board of Health (all of whose proceedings 



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the nature of the evidence, or, at about the same time, other cases occur in the neighbourhood which cannot be traced either to communication with the suspected case or with any other imputed source of contagion.* We have seen how imperfect was the evidence on which the introduction of the disease into the port of Sunderland, by means of ships from abroad, was attempted to be established. At Newcastle not even a suspicion of the kind has arisen. And though at Gateshead the first patientf was said to have been lately in that part of Newcastle where the disease prevailed, it yet had no connexion with the fearful number of cases which occurred simultaneously, ten days afterwards, in every part of the town; in nearly fifty different points, cases occurred almost at the same instant. "On the 25th, about one o'clock," says Mr. Brady, "we were assailed by a third and fourth example of the disease, and before the next morning at ten o'clock very considerable numbers had fallen sacrifices to its pestilential ravages. 

" Within a space of twelve hours it spread itself over a diameter of two miles, and appeared to pay but very little distinction to altitude of situation, for the higher parts of the town were laid under its stroke in an equal degree, or nearly so with the lower. Pipewellgate, Hillgate, the banks above 

have unfortunately been founded upon the assumption of contagion,) " It is clearly ascertained that the longest well-authenticated interval between the exposure and the manifestation has been from Jive to six days." 

* Since this was written three cases have taken place within the walls of the prison, a building constructed upon the most approved principles, and in which the prisoners have been completely insulated, the strictest discipline having been observed, and all communication from without carefully guarded against. For a memorandum of these cases lam indebted to my friend, Mr. Fife, of this town, to whose care the charge of the health of the inmates of the prison is committed. — See Appendix, No. 5. 

t For an account of this woman's case, see Mr. Brady's communication in the Appendix. 

15 



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Pipewellgate, Oakwellgate, the lanes leading from it, Jackson's Chare, Nun's Lane, Wreckinton, Gateshead Low Fell, Low Team, situations as different in their external characters as can well be conceived, were all indiscriminately exposed to its fury, and I do not think the cases were one whit milder in the more elevated than in the lower parts of the town," and he afterwards adds, " That it is virulently epidemic, a glaring proof has been afforded to my mind by the way in which we have been here visited by the disorder in question" — " no principles of contagion could account for such a sudden spread of the disease;" and, in point of fact, such has been the case in every other place where the disease has shown itself. Attempts are made to trace the first case from some suspected source; proofs of it are assumed upon the most uncertain evidence, but the farther progress of the disease baffles all calculation, and the contagionist is obliged to seek shelter in the admission that it is both epidemic and contagious. But before we acquiesce in this conclusion, I would inquire whether one of these suppositions will not suffice to account for the facts? It appears that contagion is not equal to their explanation, unassisted by atmospheric influence. Let us ask, then, whether they can be accounted for on that principle alone? That an epidemic condition of atmosphere, passing in a progressive line of march, generally speaking, from east to west, settling for a time over this place, like a malignant cloud, and then proceeding, in its onward course, to a neighbouring village or more distant town; pervading, during its sojourn in each, every dwelling, and co-operating with whatever predisposing causes it may meet with, in the production of disease, either in single persons or more numerous individuals, as the case may be; affecting them either at the same point of time, or successively as their relative degrees ©f susceptibility may admit of; the severity of the attack in each being referrible to the same rule, forms altogether a catenation of causes and effects, at once simple, intelligible, and philosophical, to which the mind gives a ready assent. 



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We do not hesitate to admit its truth, because it easily accounts, in a satisfactory manner, for all the phenomena of the case, and is entirely consistent with the principles of common sense. If a person in a new place have the disease a week or ten days earlier than others, we can understand that his greater susceptibility has enabled the efficient cause to produce its effect on him while yet not sufficiently concentrated to affect those less susceptible; the edge of the cloud (I use a figure here merely by way of illustration) has only yet reached the locality; in a few days, however, it rests there in its utmost density, and the natural result ensues; fifty victims sink at once under its influence, between whom no communication could possibly have taken place; day after day, in defiance of all the laws of contagion, it attacks fresh and distant subjects, being guided by predisposition alone: at length, as if satisfied with the number of the slain, it passes off nearly as suddenly as it commenced its ravages, and begins the work of destruction in a new situation. Here, again, attempts, and very ingenious ones, no doubt, are made to discover how the first patient became infected, but as soon as this is supposed to be fairly made out, a tremendous and general outbreak of disease obliges the contagionist once more to call in the assistance of epidemic influence, and though he cannot relinquish his theory it necessarily becomes an inferior agent in the affair. 

But at the village of Newburn, situated on the Tyne, five miles from Newcastle, where the disease has appeared with greater virulence, and committed ravages, compared with the extent of the population, to which its previous progress in England can bear no comparison, I have been unable to learn that any attempt has been made to account for its introduction by contagion. Every dwelling was visited by the disease nearly at one time, and, out of a population of about 500, more than 40 persons have fallen victims to its resistless malignity, within the space of ten days.* Here, in- 

* The exact population of the village of Newburn was, before the 



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deed, it is truly worthy of the name of pestilence. But we may hope that its course amongst these afflicted people is nearly over; for it usually happens that the duration of the attack is short in proportion to its severity. Such has been the case at Dunston, a low village on the flat margin of the river, about two miles west of Gateshead; where, in about a fortnight, it selected twenty victims, and has since nearly, if not entirely, ceased. The attack at Gateshead was short and severe: at Newcastle it has been less concentrated, and of longer continuance. In both towns, as well as in the neighbouring villages where it has prevailed, it has chiefly shown itself in the neighbourhood of the river, and seems to be pursuing its course along its margin, not, however, in a very regular manner. On the north side it has now extended from North Shields to Newburn, inclusive, not having omitted a hamlet in the space between, a distance of thirteen miles. On the south side, Gateshead, including a space of two miles to the west and an equal distance to the east, bounded in the latter direction by Felling, in the former by Dunston, has alone been hitherto visited by Cholera; but the communication in every direction is free and constant. South Shields,* 

commencement of the disease, 550, and the deaths have exceeded, in all, 60 persons. 

* At length a few cases of Cholera have taken place at South Shields and the neighbouring colliery. In reference to the cases of Cholera at South Shields, I have been favoured with the following note from Dr. Macann. It will be observed that he admits the influence of contagion, but conversation with him convinces me that it is in a very limited degree only. That the efficient cause of the disease produced its effects in these patients elsewhere than at South Shields, appears sufficiently evident. The question then arises, supposing that cause to have been contagion, why did not the seven cases at South Shields communicate the disease to others, either before or after death, with whom they were placed in contact"? The inference is clear and irresistible — that "as an epidemic the disease had not yet appeared in South Shields," and until it shall so appear contagion is inoperative; it is an agent devoid of activity. It only becomes active when its assistance is not needed, when 



117 

which has constant intercourse with Sunderland to the south, a distance of six miles only, and with North Shields separated by the river only, has not yet been visited by the disease. How is all this reconcileable with contagion? — the question is easily asked, but most difficult to answer in a satisfactory manner. 

Our reasons, then, for rejecting the doctrine of contagion, in reference to Cholera, resolve themselves into the fact, that it is utterly unequal to account for the phenomena which attend the progress of the disease; that it introduces into the subject a thousand discrepancies and embarrassments; whereas, when we lay it aside, all becomes harmonious and intelligible, consistent and philosophical, agreeable to the laws whereby Nature acts on other occasions, in which she is ever content with one efficient agent, when competent to the accomplishment of her purposes. 

Perhaps the following summary of the arguments by which the non-communicability of Cholera, from one person to another by means of contagion, appears firmly established, may not be devoid either of interest or utility. 

1. That there has been no proof adduced of the disease having been brought to Sunderland by shipping. That, on the contrary, the suspected vessels have neither come from diseased ports, nor have they had cases of Cholera on board. 

all the phenomena of the disease can be safely referred to the " Epidemic." 

"Up to the present day not more than seven cases of Cholera have appeared in South Shields, according to the reports furnished to the Board of Health at that place, and in all of them there is strong reason to believe that there had been previous communication with infected persons beyond the limits of the places, or who had come from infected places. But, as an epidemic, the disease has not yet appeared in South Shields, nor do bowel complaints in any form prevail there at present, according to the accounts furnished to me. 

Feb. 10. "P. MACANN, M. D." 



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2. That there is the best reason for believing that cases of Cholera had occurred in different parts of the country, and at some distance from the sea, before it made its appearance at Sunderland at all. 

3. That, although cases have occasionally occurred, having such proximity to each other, both as to time and place, as might lead to a suspicion of contagion, yet they would always admit of a different and more probable mode of interpretation; consistent with the broad fact, which is totally irreconcileable with contagion, that numerous cases have occurred simultaneously at distant points, where no communication could by possibility have taken place. 

4. That, when several members of one family have been attacked, it has usually been either so precisely, or nearly, at the same point of time, as to forbid the belief of one having communicated the disease to another. And that the true principle of the occurrence of such plurality of cases is to be found in the common existence of predisposing causes, natural or acquired, and a common exposure to the efficient cause of Cholera. 

5. That in the hospitals at Newcastle and Gateshead, where, were there such an agent as Contagion, it must have been present in its most concentrated form, no case has occurred of illness arising from attendance on the sick, either in the persons of the nurses, the resident apothecaries, or the attending, or numerous succession of visiting members of the medical profession. 

6. That the notion of persons being infected by the dead bodies of Cholera patients appears equally unfounded, since such suspected cases are referrible to other causes; and those most exposed to contact with the dead, as medical men, in pursuing post mortem examinations, have not, in any instance, suffered. 

7. That the principle of contagion is acknowledged to be unequal to the explanation of the manner in which the disease 



119 

extends itself, without the assistance of an epidemic condition of the atmosphere. 

8. That an atmospheric agency — of more or less intensity, and of greater or more confined extension, which visits different places in succession, generally leaving, partially or entirely, one place before it arrives at another whose distance is not very considerable — appears solely and fully equal to the production of the phenomena which attend the progress of this extraordinary disease. 



120 

HINTS 

ON MEASURES OF PREVENTION IN THE WAY OP MEDICAL POLICE. 

If we review the localities which have been the greatest sufferers from Cholera, we shall, with few exceptions, find them in towns, low, dirty, poor, and crowded with population; and in villages ill ventilated, and replete with all the nuisances which are so often found within and around the habitations of the poor in this district: in both, the immediate neighbourhood of the rivers and streams have been most rife with the disease. In Sunderland, a dirty, I may say with propriety, a filthy, part of the town, where poverty and misery seemed to have prevailed to an extraordinary extent, was nearly the only district visited by the disease. At Monkwearmouth, situated on the opposite side of the river, the cases were few, not more than six or eight in all; and in the upper parts of the town and Bishopwearmouth, a few scattered cases only occurred.* It is well known that Newcas- 

*Mr. Green informs me that " it happened that not more than six or eight cases of the disease occurred in Monkwearmouth, where there are about 10,000 inhabitants. In Bishopwearmouth there are about 18,000, where perhaps only six or eight people sickened of it ; whilst in the parish of Sunderland there are about 17,000, where almost all the cases occurred." 

I have since been informed by my friend, Dr. Brown, of Sunderland, that these calculations have been found not strictly accurate; and that the entire number of cases in each of the towns of Bishopwearmouth 



121 

tie and Gateshead occupy opposite banks of the Tyne, being connected by a bridge. The quarter of the town wherein the first cases of Cholera took place in Newcastle, is densely populated with, generally speaking, the poorest and most dissolute parts of the community, and is not only closely adjacent to, but scarcely elevated above the level of the river. The houses are old, low, crowded together in narrow lanes and courts, in such a manner as to preclude, as far as human ingenuity can accomplish it, those changes of atmospheric air which are essential to health. They are filthy, damp, and crowded to excess with inhabitants, a large family occupying a single apartment only, and frequently ten or twelve persons sleeping in a room not more than four yards wide. Such is the character of Sandgate, the lanes running from the Quay, and the Close. It is true that the disease has not entirely confined itself to these situations, and that it has, in a few instances, reached the upper parts of the town. Such cases, however, have been comparatively few, and even they have occurred in situations contrived rather to preclude than to encourage a circulation of fresh air — in blind alleys, close courts, and narrow lanes. One or two exceptions only have shown themselves to the truth of this general observation. In the neighbouring town of Gateshead the same circumstances have generally obtained. Hillgate, Pipewellgate, and their vicinities, narrow lanes bearing a close resemblance to Sandgate, and the Close, in Newcastle, have principally suffered. But the first outburst of the disease on Christmas day affords a striking exception. At once, and almost in equal degrees, the efficient cause appears to have been called into active operation throughout the parish of Gateshead. In its onward course, nevertheless, it seems to have returned, in a great degree, to its more usual choice of localities; and Dunston, a poor village, situated on ground closely adjoin- 

and Monkwearmouth amounted to about 18 or 20. This, however, does not affect the general principle. 

16 



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ing to the river, having a sluggish, tributary stream running through it, and so low as scarcely to be at all. above its level (being frequently actually under water in cases of floods,) became, in a short time, the scene of its devastations. Its visit to this village, was as short at it was active; in a few days it destroyed about 20 persons out of a small population not exceeding 400.* It may be remarked, that they were principally old, and dissipated or debilitated subjects. It has since crept down the river to Felling, also situated principally on its margin. 

The villages on the north side of the Tyne which have principally suffered, are similarly situated. Dent's Hole, in particular, is a dirty narrow lane, filled with mud and filth, which rise in accumulated heaps above the thresholds of the houses; it runs along the margin of the river, and is overhung by its more elevated banks. Bell's Close, Lemington and Newburn, to the west, all have more or less of the same character. The latter seems particularly adapted for the reception of such a disease. The village is low, near the river, and surrounded by hilly ground on every side. The houses (cottages principally covered with thatch) are low; the doors generally very low, and windows small ; having clay, brick, or stone floors. On the beams above frequently hang sides of bacon and the like, in such a manner as to impede progress through the apartment. The beds are often extremely close 

* I find that the actual number of deaths in this village has amounted to 23. It is worthy of remark, that the village of Bensham, which is situated on a pretty high hill between Gateshead and Dunston, has escaped altogether from any visit of the disease. At least one case only has occurred which has borne any resemblance to Cholera, and it is generally believed that the man died from excessive intoxication. The disease has since made its appearance with great virulence at Svvalwell, a low, dirty village, situated at the confluence of the Derwent with the Tyne; it is principally inhabited by workers in iron. The airy village of Wickham, situated on the hill between Dunston and Swalwell, has escaped with a single case only. 



123 

from their construction, having, like those described by the poet, "a double debt to pay;" they are dirty and crowded with occupants. Dung-hills are permitted to accumulate on the outside, and on entering the dwellings you are assailed with an offensive, stithy odour, showing how ill they are adapted for thorough ventilation. The people, too, it is said, in addition to the usual evils of poverty, are much addicted to spirit-drinking. The vicar of this village fell a victim to the disease; but he was of very advanced age, and, it is affirmed, entertained great personal apprehensions. It is, I believe, the only case wherein the disease has shown itself in the more elevated ranks since it appeared in England. To the eastward of Newcastle, in addition to Dent's Hole already noticed, Walker, Howdon Pans, and so on to North Shields, all occupy similar situations in reference to the river. But though the rule is a general, it is not an absolute, one. Cases have occurred farther in the country — Seghill, Hartley, Houghton-le-Spring, and some other places have suffered, and are suffering under the scourge. Hartley, in particular, severely. In all these places, however, some, if not many of the predisposing causes already noticed are to be found in ample degree. It would appear evident, then, that Cholera has a tendency to pursue in its progress the direction of rivers; not, however, as has been supposed, because they form the principal media of human intercourse. In Newcastle, the streets of communication between the upper and lower parts of the town are the means of intercourse, but the disease has not travelled along them. It has not unfrequently leaped, as it were, from station to station, on. the margin of the river, between which there is no direct road; evidently showing that it was independent of human intercourse. We must, therefore, conclude, that, in pursuing the course of rivers, it is guided by other causes than those of intercourse amongst the inhabitants: in point of fact, this is much more frequent with those living at a distance from the river and each village on its margin, than between these villages themselves. 



124 

Whether it may depend upon the greater weight of the efficient principle which produces Cholera, keeping it in a great degree in the lowest situations, as in the celebrated "Grotto del Cani," in Italy; or upon any attractive power in the stream; or upon the presence of more intense or more numerous predisposing causes only, I will not attempt to determine. The fact, however, appears undeniable, and we may perhaps deduce from it some practical rules of importance, with a view to the prevention or mitigation of the visitation in other places. 

In addition, then, to the means of a general nature already noticed for preventing or diminishing the predisposing causes, it would seem that particular attention ought to be directed to those parts of towns and villages immediately contiguous to rivers or streams of whatever magnitude. The removal of dung-hills, and other sources of atmospheric deterioration, wherever situated, is, no doubt, of consequence; but it is yet more essential to keep the air as pure as possible in the situaiions referred to, and when such situations are particularly crowded, dirty, and ill ventilated, it becomes a question of moment how far it is possible either to remove entirely, or in part, the population to one of greater salubrity. It is a fact worthy of holding in our remembrance, that while Dent's Hole has been the prolific nest of the disease, and the scene of many deaths, placed as it is on the low margin of the Tyne, Byker, a village within half a mile, but having the advantage of a mucfh higher elevation, has not produced a single case of Cholera.* Where circumstances forbid the idea of either removing or thinning the population, care may yet be taken to render the houses not only cleanly, but capable of more perfect ventilation, by opening additional windows; and it would be well, if practicable, to give these an aspect in the 

* I regret to find that this is not now strictly correct. One case Ims occurred in the village of Byker, but it was a mild one, and the patient has recovered. — January 30th. 



125 

opposite direction to that of the river; thorough windows would, probably, enable ventilation to be carried to the most perfect extent. In the construction of new buildings, care may be taken to place them in favourable localities, in reference to the channels of rivers, &c, and to construct and arrange them in such a manner as to promote a complete system of ventilation. Where the inhabitants of single rooms are very numerous, it would be found good economy to supply additional accommodation in the way of lodging to their superfluous inmates. lam satisfied that such arrangements will be found well worthy the attention of committees, &c. in our great towns, who may be charged with the duty of devising measures for the prevention or mitigation of this formidable disease. No doubt, difficulties must be encountered, and expenses incurred, in providing any considerable number of new dwellings for the ill-lodged poor; but if done with efficiency, the saving of human life will often be considerable; and it is better to anticipate the evil, than to do afterwards what will not cost less, but cannot then be attended with the same advantage. I understand that it is intended to destroy the entire village of Newburn with a view to its reconstruction upon principles better adapted for health. Had this been done a few months ago, how many lives might not have been saved. It is, however, from the experience of what has taken place there and elsewhere, that other districts, where the visitation of Cholera may, with considerable certainty be anticipated, ought to learn wisdom. 

In selecting situations for Cholera hospitals or houses of recovery, care should be taken to make choice of the most elevated and airy: they ought not, however, to be far removed from the centre of the district to which they are attached; for, without doubt, patients are liable to suffer seriously from being carried to a considerable distance from their own places of residence. It is of importance, too, that the 



126 

method of conveyance should be of the easiest and least fatiguing description. For this purpose a litter, carried by means of poles, on men's shoulders, is found to answer best. The patient is laid into it in a horizontal position; he is entirely passive, both in being placed in and removed from it, and he escapes the shaking and fatigue that would necessarily attend any wheeled* conveyance. When placed in the litter, he should be enveloped in an ample supply of warm blankets, and it would be well to increase the heat about his person by the application of Mr. Wood's tin vessels of warm water. 

But, notwithstanding the best means that can be devised for the easy and comfortable conveyance of Cholera patients to the hospitals, the removal must certainly be attended with unavoidable disadvantages, w r hich always render it a question of importance, whether their chances of recovery shall be increased or diminished by such a measure? In deciding this question, no reference should be made to the hazard of contagion: unless I have greatly erred, such hazard has no existence; the welfare of the patient ought alone to engage our attention, and our decision must depend upon the following considerations. 

1. The stage of the disease. If the first stage only has shown itself, the patient may be removed with comparative safety; if the stage of collapse have set in, and especially if in an intense form , the danger of removal must necessarily be great, and ought not to be incurred, unless the danger of remaining in his own house should be yet greater; this must 

* In confirmation of the importance of attending to this subject, I mayadduce the opinion of Mr. G]enton, who has had the principal charge of the patients admitted into the hospital in Sandgate. It is given in a note to Mr. Fife, and refers to the case of a boy removed from the prison, who afterwards died in that hospital. "If Mr. Fife has any power to prevent future cases from being removed in the car, Mr. Glenton will feel obliged by his doing so. The conveyance is deadly, and the boy himself, on reaching the hospital, said, it had destroyed him." 



127 

depend upon — 2. How far the patient can be supplied with the necessary comforts and nursing, if permitted to remain at home. If his house be comfortable, and well provided with proper supplies of blankets, &c, or if any deficiency in this respect can be readily supplied; and if his family are likely to prove attentive and efficient nurses, the idea of removing himto a hospital ought then to be entirely abandoned; for, without doubt, his chances of recovery would be greatly diminished by such a step. If, however, from deficiency of accommodation, and the absence of comforts and of proper nursing, his residence appears unfit for the efficient employment of the requisite remedial measures, more especially if the deficiency will not admit of being immediately supplied, then, and then only, can his removal to a hospital be considered advisable; and even then it becomes a choice of two evils, in which the relative force of each ought to be fully considered. If the hospital is distant, and the weather unfavourable, the danger of removal must be imminent, and nothing but an extreme case of domestic discomfort can render it justifiable. Many cases, however, may doubtless arise, wherein the propriety of removal is indisputable. 

On the whole, it is well worthy the attention of Boards of Health and Committees appointed to visit the houses of the poor, to aim rather at supplying the proper comforts and nursing at home, than to remove the sick to hospitals. If they are enabled to accomplish this with any degree of perfection, they will certainly contribute in a much greater degree to the preservation of life, than by the best hospitalarrangements that can be devised. It is an undoubted fact, that the relative mortality in hospitals has been greater than in private houses, and I apprehend it distinctly arises from the disturbance, fatigue, and exposure attendant on the removal of patients, and the consequent delay in the use of remedies. 

It will be found of the utmost moment, to be prepared with an adequate supply of medical attendants for the villages 



128 

where Cholera may presently be expected to show itself. It seems nearly certain that many lives have been lost from the impossibility of obtaining proper professional assistance. Even in G-ateshead, where three or four medical gentlemen only, reside, this was the case; but in many of the villages the absence of remedial assistance has been severely felt; many persons having died without receiving a single professional visit. There are many army surgeons unemployed. Would it not be well for government to place a number of these in every populous district, in readiness to be employed wherever their services might be needed? They might even be required to visit, at short intervals, the houses of the villagers and, by minute inquiries, ascertain whether any were affected with the earlier symptoms of disease. In such cases, the immediate use of proper remedies would generally ensure recovery ; whereas a few hours' delay might probably prove fatal. We know that such a scrutiny is commonly observed in the army with the best effects. 

The cases admitted into our hospitals, perhaps, have not been sufficiently numerous to warrant us in drawing any general conclusions from them, and it is extremely difficult to obtain accurate information from other sources. Nevertheless, I am disposed to believe that the chances of recovery at the different periods of life, as shown in the following tables, may be considered as consistent with general experience. There were admitted into the four hospitals, 

19 cases under 10 years of age, of whom 9 died, or 47| per cent. 

79 cases from 10 to 50 years of age, of whom 35 died, or 44| per cent. 

20 cases above 50 years of age, of whom 16 died, or 80 per cent. 



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SANDGATE HOSPITAL. 

MALES. FEMALES. Under Under Above Under Under Above 10 50 50 10 50 50 Died . . 23 1 4 4 — 10 4 Recovered 32 4 7 1 3 15 2 Total 55 5 11 5 3 25 6 

CASTLE HOSPITAL. 

MALES. FEMALES. Under Under Above Under Under Above 10 50 50 10 50 50 Died 8 — 3 1 — 3 1 Recovered 4 — 2 — — 2 — Total 12 — 5 1 — 5 1 

ST. JOHN'S AND ST. ANDREW'S HOSPITAL. 

MALES. FEMALES. Under Under Above Under Under Above 10 50 50 10 50 50 Died 8 — 4 1 — 3 — Recovered 7 — 4 — — 3 — Total 15 — 8 1 — 6 — 

GATESHEAD HOSPITAL. 

MALES. FEMALES. Under JUnder Above Under Under Above 10 50 50 10 50 50 Died 21 6 7 1 2 1 4 Recovered 15 2 4 — 1 7 1 Total 36 8 11 1 3 8 5 

The relative chances of recovery in patients admitted into hospitals, compared with those treated at home, may he estimated, I believe pretty accurately, from the following facts : — 

Of the entire number admitted into hospital, amounting to 118, 60 died, or 50f per cent. 

17 



130 

Of the entire number of cases reported in the towns of Newcastle and Gateshead, up to this day, February 9th, amounting to 1330, 437 died, or 32 T 9^ per cent. 

It is important that the greater mortality in the hospitals should be attributed to the right causes. There can be no doubt that, as regards the proper comforts, nursing, and medical superintendence, the hospitals, for the most part, have the advantage over the private dwellings of the poor. It appears unquestionable, therefore, that to the delay in the use of remedies, and the unavoidable disturbance and fatigue attendant on the removal of patients, must we attribute the less favourable results of hospital treatment. This ought to excite serious consideration. If the averages be correct, of the 118 patients received into the hospitals instead of 60, 39 only would have been lost, had their cases been attended to at home* 





APPENDIX. 

No. .1. 

Dr. Alexander's Case of Cholera, which occurred in the Neigh* bourhood of Newcastle, in the beginning of August, 1831. 

Newcastle upon Tyne, January 29, 1832. 

Dear Sir, 

As you again apply to me for a " Memorandum of the first case of Cholera" that came under my care, I hasten to send it. It is perhaps interesting, as going far, I think, to aid in establishing the fact, that our present scourge is not of foreign origin, but, in reality, the growth of the country; and when I think of its characters, and compare them with those cases I have seen since declared to be the Cholera, I cannot help coming to the melancholy conclusion, that the disease is endemic, that we are not at all indebted to our continental neighbours for it. The subject of the present case was one who had had no communication with any foreigners. 

In the village of Team, one mile and a half above Gateshead, on the same side of the Tyne, I visited on the 4th of August, last year, Mr. C, aged 66, "a steel runner" by business, an employment which exposed him to excessive heat, and consequently to the necessity of taking heavy potations " to promote perspiration," but which he unfortunately gave into too much.— He had had, two days previous to my seeing him, more than his usual quantum, in the company of some friends, whom he left with the intention of returning home; but being intoxicated, he lay down on the road, and in that state was exposed to rain the greater part of the night. From this he never recovered, but 



132 

complained of general pains, exhaustion, oppression on the chest; after this, vomiting and purging came on. When I saw him there was hardly any pulse to be felt at either wrist, which was marble cold; eyes sunk, with a livid appearance round both them and the mouth; features, in general, contracted; breath cold, giving* one the idea of a key-hole exposed to the north wind; tongue of an unnatural flabby look; thirst intolerable; breathing short and oppressed; voice weak; vomiting incessantly alight-coloured fluid at first; afterwards changing to a light pea-green; purging quantities of a material resembling rice gruel, which never changed; excruciating spasms, forming balls in his legs, thighs, and arms; agonizing pain in the abdomen, with every effort at vomiting and purging; in the intervals complete collapse; passed no urine from the time I saw him up to his death; intellects clear to the last. 

The treatment consisted in endeavouring to raise him from the state of prostration, by the use of the diffusible stimuli, and to bring up his pulse, support the strength, &c. His vomiting, however, was so constant, that nothing in the way of either medicine or nourishment could be retained so as to act in any way, or give him a chance of recovery. The fluids ejected upwards acquired a deeper hue, till they became at last black as ink, the blueness of the whole body also increased, till he resembled a leaden-blue mummy. A moment or two before his death he gave me a nod of recognition, and gradually expired without a struggle. 

I am, Dear Sir, 

Yours, most faithfully, 

J. ALEXANDER. 

To T. M. Greenhow, Esq. 

No. 11. 

Letter from Mr. T. K. Fife 

Gateshead, January 11, 1832. 

Dear Sir, 

I received yours, of the 3d instant, at a time when reply was impossible, every moment being occupied by more arduous duties, 



133 

than I had ever been called upon to perform, and even now I shall be obliged to content myself with a few short remarks, without any attempt at arrangement. 

Cholera is certainly not communicable,* for although it frequently attacks several persons in one family, it is either simultaneously or in such quick succession, as to preclude the idea of their having received it from each other; at any rate the progress is much more rapid than that of any other disease propagated by contagion. Among the first 53 cases I attended, since the 25th ult., 32 were members of different families; and although few efficient means of prevention were employed, the disease, so far as I know, has not spread in any of them. 

Lieutenant-Colonel Creagh, at his first introduction to the Gateshead Board of Health, stated, I know not upon what authority, that during the life of the patient, the danger of contagion was only trifling, but that it became very great after death, and most earnestly requested that there might be no attempt to obtain post mortem examinations; and, Mr. S. Bullen, sent here by our Government to receive and inspect the medical reports, appears of the same opinion. He heard it casually mentioned on Monday last, that leave had been obtained, when he immediately appeared alarmed, begged that no attempt might be made to examine the brain or medulla spinatis, adding that from them nothing could be learnt, and finished by relating the danger some of the Sunderland medical gentlemen got into, by the mob, finding out what they were about. The lower class in Gateshead have been very much on the alert upon the subject, so that hitherto nothing has been done. The absence of bile in the intestines appears to me the first deviation from health, and the gradual, though marked change in colour, which takes place in 

* It is a fact worthy of being- recorded to the honour of Mr. Fife, while it affords a convincing 1 proof of the sincerity of his belief in the non-contagious nature of Cholera, that, after a nurse, whose fears had been strongly excited, had actually fled from her charge of the first patient admitted into the Gateshead Hospital, he visited the chambers of the sick accompanied by Mrs. Fife, for the purpose of re-assuring- the people and removing their groundless and mischievous apprehensions. Such a proof of humanity and sound judgment is equally honourable to both- 



134 

the stools, indicates the mischief which is going on. In the early stage of the diarrhoea, they are ochery, becoming paler as it goes on, and at length assuming the rice water appearance, characteristic of the disease. I have never observed the slightest yellow tinge in the skin, nor in the serum, so usually seen where blood is drawn during obstruction of the bile-ductsj consequently it appears connected with want of secretion. 

In treating Cholera, it is vain to seek for specifics. Bleeding freely early in the disease, ipecac, cum antim. tart. gr. i. ad. iij. whenever the stomach contains food 5 external dry warmth ; warm weak fluids internally; calomel, opii. emulsio camphorse, and carbon, ammoninae, form, I think, the most useful remedies. In two severe cases the progress of the disease was arrested, and the life of the patient saved, to all appearance, by the tobacco enema, recommended by Mr. Baird. In both copious vomiting followed its use, and, contrary to expectation, re-action took place. Mustard has had an extensive trial, but I have not yet heard the ratio of success. Of the 53 cases I mentioned, 22 were decidedly malignant, of these 13 died, and one has died of fever, preceded by diarrhoea only, with slight rigors, and no appearance of cramps. 

From the great proportion of orderly sober persons and children of all ages, among the patients, I cannot consider drunkenness a powerful predisposing cause, though, for the sake of morality, it is well to favour the opinion. 

It is frequently difficult to say positively whether pulsation is perceptible at the wrist or not: I have several times found the opinion of observers differ, but I think the point may be settled by requesting the person who thinks he feels it, to ascertain its rate, while another does the same with a finger on the carotid. The disease is totally distinct from its namesake of this country. 

I remain, Dear Sir, yours truly, 

T. K. FIFE. 

To T. M. Greenhow, Esq. 



135 

No. 111. 

Letter from Mr. Brady of Gateshead. 

Esteemed Friend, 

In spite of all my efforts to economize my time, I find I am still a bankrupt, and am not able at present to meet, in full, the demand made upon me, and which I promised to fulfil in "the course of to-day. Thou art fully aware of the sudden nature of the irruption of the fearful disease on this side the Tyne, and wilt give me credit for sincerity, when I tell thee that it was utterly impossible to preserve notes of the numbers of cases which fell to our lot. I believe I have attended about 100, and this all in a space of 17 or 18 days: in this state of things whatever information I could hand thee, would be cursory and in degree unconnected, and even this I find I could not achieve, until I had established something like order among the papers I have laid aside from day to day, during its prevalence amongst us. On the 15th of last month, the first case occurred, marked with all the formidable symptoms attached to the disease; viz. extreme coldness of extremities, pulseless wrist, blueness of countenance, particularly of the lips, which were distinctly purple; the tongue also of this patient was definedly blue; rice water dejections, and vomiting of same kind of fluid; cramps of legs and feet; great anxiety of countenance and prostration of muscular energy. This patient lived from the time that we first saw her about 18 hours, and never rallied from the stage of collapse, although, as in many fatal cases that I have witnessed, the pulse became distinguishable some hours previous to its complete extinction. The habits of this woman, Mary Hymers (age 50,) residing in a dirty entry in the Bottle Bank, were depraved in the extreme, and she had been intoxicated on the previous evening. We adopted, in this instance, the full stimulating system represented as having been so efficient in India and on the Continent; and which I am now fully of opinion is a baneful practice. She had the strong essential oils, laudanum and brandy, &c. This poor woman had been in the habit of collecting rags in Newcastle, and had been on the north side of 



136 

the river the day before her attack, but I cannot make out that she was in any infected district, or had been in any way exposed to contagious influence. T. K. Fife and Mr. Knaggs saw the case with me, and united with me in opinion that it was a true instance of Cholera Spasmodica. 

On the 24th a second case occurred in the person of Eliza. Thompson, alias Hales, aged 46, living in a dirty lane on the north side of Pipewellgate. The symptoms here were much the same as in the former woman ; she also died in the stage of collapse; her habits had been of more temperate character than those of Mary Hymers, but she had been out of health for some time previously. We could not trace any infectious cause in this case, as she had hardly been out of doors for some days. The hot air bath was used in this instance, but without any decidedly good effect; as it did not produce any apparent increase of heat about the extremities. T. K. Fife was present with me during one of my visits. 

On the 25th about one o'clock we were assailed by a third and fourth example of the disease, and before the next morning at 10 o'clock, very considerable numbers had fallen sacrifices to its pestilential ravages. Within a space of 12 hours it spread itself over a diameter of 2 miles, and appeared to pay but very little distinction to altitude of situation; for the higher parts of the town were laid under its stroke in an equal degree, or nearly so, with the lower; Pipewellgate, Hillgate, the banks, above Pipewellgate; Oakwellgate, and the lanes leading from it, Jackson's-chare, Nuns-lane, Wreckinton, GatesheadLow Fell; Low Team; situations as different in their external character as can well be conceived, were all indiscriminately exposed to its fury; and I do not think the cases were one whit milder in the more elevated than in the lower parts of the town. 

Having instanced these two examples, I must not dwell farther, than just observe, that they may be taken as pretty fair specimens, of those which succeeded them, or vice versa. The treatment, however, has varied much. I have since, always avoided powerful stimulants, except they have been absolutely indispensable. In those cases on which I can glance with the greatest satisfaction, the plan of treatment I have adopted has 



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been as follows: — To obtain blood, if I possibly could; if not, to administer a mustard emetic, and then again attempt venesection: in one instance, or indeed two, I succeeded after the copious emesis when I could not before. Much has been said against moist heat: I differ from this opinion in toto: two cases I could instance, in which the external application of bran, steeped in boiling water, effected in a couple of hours, what hot bricks have failed to do in twelve; and I am firmly convinced that that distressing symptom, cramp, is much more effectually relieved by damp hot applications than by dry ones. My plan has been, to make up a peck or two of bran, into a poultice with boiling water, to spread this thickly between two sheets, and to enclose the lower parts of the body, and particularly the extremities, in this bran bath. The patient generally experiences great comfort from this application, and I have not often known it fail to relieve the cramp, which forms so glaring a feature of this malady. 

After I have obtained copious vomiting, I then administer 8 or 10 grains of calomel with 1 of opium, and follow it up every hour, with about half that dose. Large injections of hot water and laudanum I have seen beneficial; particularly, if, after these have been rejected, a suppository of camphor and opium be inserted into the rectum. Turpentine injections I have given up, never having seen any benefit accruing from them. In the stage of collapse, I do not think that nitros acid possesses any virtues to recommend it to our notice; but I quite consider it a valuable remedy, in the spasmodic sort of retching, which every now and then recurs after warmth has been restored, and the secretions from the bowels checked. In these cases I have been much gratified with the sedative effects of scruple doses of diluted acid, in camphorated mixture. Specifics, however, neither have, nor, I believe, ever will be discovered, for this dire disease: true to its text, it begins, continues, and ends in its own way — in fact, from commencement to termination, it is " sui generis." You must see it to know it, and you must see many cases, before you can theorise upon its nature. I might also observe, that if you would theorise upon such a disease, you must be allowed rather more leisure than has fallen to the lot of medical men in Gateshead. 

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With respect to its contagious or non-contagiotis character, I think there cannot be much doubt on the subject: instances have occurred, in which it would be very difficult to trace it to any other source. My own views on this point are, that a contagious species of diarrhoea, subject to contingent circumstances, has pervaded many parts of the town for some weeks past: and but few cases of Spasmodic Cholera have occurred on this side the Tyne, in which a diarrhoea of two or three days' standing, was not found to have ushered in this new disease. This diarrhoea is, generally speaking, very tractable, and yields to minute doses of calomel, rhubarb, and laudanum. I am fully satisfied that many of these cases, by prompt remedial measures, have been snatched, as it were, from the jaws of this dreadful destroyer. 

From what one has seen and heard, one must conclude, that either shortly before or after death (perhaps both,) this disease has the property of disseminating itself among surrounding individuals, and that its propagation or otherwise, depends upon the predisposition of those exposed to its influence. 

That it is virulently epidemic, a glaring proof has been afforded to my mind by the way in which we have been here visited by the disorder in question — no principle of contagion could account for such a sudden spread of the disease. 

As to post mortem appeai-ances, I have not examined a single body, so must leave that to others. 

We have, according to the last census, a population of 16,187". 369 cases of Cholera have occurred in our borders, of which 128 have died. lin 126 died. 

The leading topics in thy letter have now been cursorily glanced at, but I much fear, in so incoherent a manner, as scarcely to merit thy notice. To speak the whole truth, I have entered more at large than my engagements just now justify; but it is a subject in which I take much interest, and I felt, as I proceeded, as though I could hardly keep my notions within the narrow bounds of my brain, without putting them into black and white for thy perusal. I feel, however, that they are almost unworthy thy attention. 

With every sentiment of esteem, 

I am thy sincere friend, 

To 71 M. Greenhow, Esq. HENRY BRADY. 



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In a subsequent note, Mr. Brady informs me . that 49 of his cases were " Cholera Spasmodica Acuta," of whom 29 died and 20 recovered; and that the remainder were cases of "very suspicious diarrhoea:" — they all recovered. 

No. IV. 

I have been favoured with the following account of the appearance of Cholera on Gateshead Fell, by Mr. Wilson, a gentleman who resides on the spot. 

"Morgan, a blacksmith, died 15th December, at Springwell, of Malignant Cholera, after 12 hours' illness. His corpse was brought down to his father's house on the Low Fell, where it remained nearly 24 hours, having been interred about 2 o'clock the next day. From the time of the body's arrival at the father's cottage until the interment, many of the female neighbours were sitting over the body. No cases of Cholera occurred until the night of the 25th December, and the following day, when ten cases appeared, of whom five died on the latter day. Four of these deaths were in the families of Worley and Soulsby, living in cottages nearly adjoining that of Morgan's father. Out of the eight deaths that took place, on the Low Fell, seven were in these cottages. The other was Mary Cuthbert, who kept a small shop in a cottage at some distance. She died on the 26th of December, and was one of the early victims. Gateshead and the Low Fell were attacked at the same time. Worley's family were very poor, and destitute of both food and proper clothing. Soulsby was poor and kept a disorderly public house." 

No. V. 

Mr. Baird has favoured me with the following communication, in which he explains the reasoning by which he was induced to make trial of the injection of tobacco into the intestines. Although one of the cases wherein it appears to have been employed with advantage, that of M 'Guinness, lias been already 



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related as it was furnished to me by Mr. T. K. Fife, of Gateshead, I think it would be injustice to Mr. Baird to mutilate his paper by any omissions; and the evidence of Mr. Fife will perhaps be received as a corroborative proof of the accuracy of Mr. Baird's history of the case. I trust other practitioners will be induced to put the virtues of tobacco as a remedy in Cholera to the proof; and, however the opinions I have formed of the rationale of the disease may differ from those which he entertains, I shall sincerely rejoice if experience should prove that it deserves the confidence which has been placed in it by the gentleman in whom its use has originated. 

Mr. Baird's Opinion respecting the Pathology and Treatment 

of Cholera. 

As my views respecting the nature and treatment of Spasmodic Cholera differ materially from all the speculations with which I am acquainted respecting this singular malady, I consider it necessary briefly to state the reasons which induced me to adopt the practice detailed in the following cases. 

When this disease invaded our shores, my mind became interested in coming to some conclusion upon what principle the development of so extraordinary a malady depended. I could not make up my mind to its infectious origin, having observed many circumstances to militate against that hypothesis.. My train of reasoning led me to conclude, that the disease in question was conveyed by some peculiar state of atmospherical influence. What that state or condition of the air is, which can produce effects so striking upon human life, I have no means of demonstrating; but it appeared to me that the impression made upon the predisposed victims, arose from some peculiar state into which the great nerves of the body were put; so that they became unable to maintain that healthy control over the muscular and secreting organs of the animal economy, upon which the continuation of life is known to depend. 

I believe that a modified state of atmosphere, such as I have hinted at, is long presiding over the devoted spot before the burst of Cholera takes place, and that this modified state gives 



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rise to gastric affections, and many of the different types of feverj renders chronic complaints more intractable, and is unfavourable to convalescence. Thus, it would appear, that the early approach of this state of malaria, places the constitution of such as are predisposed to be attacked, in a state of morbid action, which the efforts of the vis medicatrix naturae, with the assistance of art, is capable of bringing back to health again. "Whereas the crisis at which I have attempted to show Cholera develops itself, evinces its influence upon the predisposed, by striking at once the primum mobile of life, and in the worst cases rendering reaction impossible, unless that stage of asphyxia can be removed by art, or sometimes, under very favourable circumstances, by the efforts of the constitution. An opportunity occurred of practically exhibiting the truth of my theory, if there was any foundation for it, by autopsy on the body of a man who expired after a short but severe attack of this disease. He had all the external evidences of Cholera, such as coldness of the surface, vox cholerica, cold breath, cessation of pulse in the extreme arteries, corrugation of the skin of the hands and fingers, blueness of the nails, eyes sunk, with the palpebrse black and drawn within the orbits, lips and countenance very livid. He had no vomiting, indeed we were unable to excite it by any means. There was no purging, although before I saw him he must have had profluvium from the bowels, as upon dissection they were quite empty. This man lingered about six or seven hours after I saw him, without any change in his appearance. The body was inspected next morning after his decease. The stomach was observed to be full of fluid, resembling water gruel, with two or three brown portions resembling some kind of food. The gall-bladder was distended with olive-coloured bile, but it was prevented flowing into the intestines by spasmodic action during life having rendered the ducts' impervious. The large intestines were spasmodically contracted and empty. The urinary bladder was firmly contracted upon a small quantity of urine. My previous theory was thus to a certain degree confirmed by this examination, and I have since observed from the reported examination of two dead bodies at Sunderland, that the gall-ducts were discovered to be impervious by strong spasm. I was 



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therefore led to infer that the action of the ventricles of the heart was arrested by spasm; and that the general suspension of the secretions must depend upon the branches of nerves distributed to the different organs being in a similar condition. Having, as I supposed, discovered the source upon which all the phenomena in Cholera appeared to depend, it became necessary to adopt some other mode of treatment than such as had hitherto been recommended. This simple manifestation of collapse and atony had too much influenced both writers and practitioners in their means of relieving the victims of cholera: now, it is very evident that in a person full of health previous to being so suddenly plunged into a state of collapse, as patients are in cholera, the transition cannot arise from direct debility, but must depend upon some indirect cause; and as soon as that cause is removed the organs will be ready to act, as their healthy functions are not destroyed, but merely arrested. With these views I could not avoid the impression that incalculable mischief had arisen from the adoption of remedies founded upon error, videlicit, the apparent collapse of the patient. The quantity of stimulants, and the excess of calomel which entered into the treatment of the worst cases of Cholera was a plan, in my mind, much to be regretted. And here I would observe, that unless spasm existed, the quantity of calomel exhibited must in far more cases than it has done, have produced manifest impression upon the secretion it. was meant to stimulate. This circumstance becomes, therefore, a proof of the probable correctness of my opinion of the pathology of Cholera. To this I may add another, which is, that if my idea of the disease had been at variance with the fact, the powerful remedy I have adopted, must of necessity have hurled the patient into the grave; but the cases which I have appended will convince the unprejudiced, that not only does it act with perfect safety, but it is a curable agent when properly administered. The remedy which I considered most likely to meet the views which I have described, was the tobacco infusion to be administered as an enema; how it has answered will be learned by a perusal of the cases. I have stated the formula which I used, but since I have obtained greater confidence in the practice, I am not afraid to give larger doses, when it is indicated by the severity 



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of the cramps or other circumstances. The effects produced are not alike in every subject, but generally they may be looked for in the following succession. The first change which takes place after the exhibition of the enema is restoration of the circulation, as evinced by the increase of volume in the pulse, and restoration of the livid parts to a more healthy hue.. The cessation of cramps next ensues, and afterwards the suspension of vomiting and purging. Last of all, the re-establishment of the biliary and urinary secretions. I have almost invariably remarked, that after the spasms are relieved, the bladder recovers its sensibility, and there is urgent desire to pass urine long before any has been secreted. I consider the vomiting and purging to be some vicarious exudation which is set up by the system to relieve, the blood from the excrementitious qualities during the embargo laid upon the secreting organs, and that it ceases according to the renewal of their functions. The violent desire for cold water during the disease, seems to show that the exudation has been too indiscriminate and in excess. A number of speculations has existed since the origin of this disease, as to the advantage of injecting the veins with different fluids, to alter the state of the blood which is congested in the venous- circulation. A moment's dispassionate consideration must demonstrate the futility of such an idea. The reason of the blood being left in the state we find it in the veins, arises from the ventricles of the heart being placed in an almost perfect state of systole when spasm occurs, and if we may believe that the blood is returned to the heart by some hydraulic principle, that action must cease when there is no perfect vacuum formed to promote it. You might, therefore, distend the veins by heterogeneous fluids, or alter the colour of the blood by oxygenated salts, but still there 

it will remain. Unless you have an arterial circulation through the lungs, all attempts to alter the blood in the veins consequent upon asphyxia are useless, and the lungs, during the presence of true Malignant Cholera, are inoperative as evinced by the cold breath, because the action of spasm has rendered the pulmonary 

circulation impossible. 

Lest my remarks should become too much extended, I must now draw to a conclusion. I have endeavoured to describe the 



144 

most material points which have governed my views, of treatment; and I hope when my opinion of the pathology of this singular disease has been perused, my deductions will not appear unscientific, nor my practice empirical or rash. One thing which escaped my memory, and I may mention it here, is that the use of the tobacco has in my opinion very much mitigated the severity of the symptoms consequent to severe attacks of Cholera, which are so hazardous to the patient; and that comparatively little medicine has been necessary afterwards. 

Newcastle Tyne, Feb. 3, 1832. 

Case I. 

Case of very malignant Cholera, in which blueness and all the other symptoms were well marked, cured by the administration 

of the Tobacco Enema. 

Ralph Crow, aged 65, was taken ill about 6 o'clock in the morning of the 28th December, 1831. A medical friend invited me to see him about 12 o'clock at noon, when I happened to be in Gateshead, where the patient resides. He was at that time very ill, indeed, and his condition appeared certainly hopeless. His eyes were sunk, the palpebrae black, and drawn within the orbits. His nose and lips livid; tongue, white and cold, and his voice quite gone, indeed the whisper could, with difficulty be understood. The skin of the hands and fingers was much sodden, and the nails very blue. Pulsation was not to be felt at the wrist, and the surface of the whole body, was completely cold; the secretion of urine, was entirely suspended; he was suffering from cramps in most of the muscles; there was incessant vomiting, and frequent dejections from the bowels of pellucid fluid, mixed with flakes resembling boiled rice. I had felt desirous for a day or two previously to observe the effects of a moderate dose of the tobacco infusion, in the form of enema, in this intractable complaint. I availed myself of this opportunity, although a formidable instance to begin with. Half a drachm of tobacco prepared with half a pint of boiling water was administered; this was retained in the intestines. In a few minutes the skin became, warm and a clammy moisture was observed upon it. He vomited after it very copiously two or three times; I thought at the time this might have been occasioned by the 



145 

tobacco, but it is possible that the vomiting was not particularly increased, but owing to my being some time with him, watching the progress of the enema, the quantity ejected would appear greater, than if I were looking in at intervals. About a quarter of an hour after giving the enema, the pulsation at the wrist was evident, I cannot refrain from expressing my obligation to my medical friend in Gateshead, who was so obliging as to repeat the injection in the evening, because he observed the advantage of the practice in the morning. This he did of his own accord, as nothing passed betwixt us respecting any repetition, the unfavourable state of the patient rendering it probable that it would not be required. It was observed at both times, that as reaction took place, the colour of the integuments, and particularly the lips, became changed to a more healthy hue. 

December 29th, 12 o'clock. Revisited the patient, whom I found much better. The warmth and natural hue of the skin had in a great measure returned; the countenance was improved; pulsation at the wrist distinct and regular; vomiting and purging had ceased; tongue warm and less white; muscular spasms relieved, and he had enjoyed some quiet sleep. Proper remedies were now exhibited to act upon the secretions, which all went on progressively improving. This man during many days retained the appearance of having recovered from a dreadful state of disease, but completely recovered his strength at last. 

Case 2. 

Case of Malignant Blue Cholera, wherein the Tobacco Enema was administered with effect at the time, but the patient sunk sometime afterwards. 

Ellen Douglass, aged 55, a very fat woman, whose occupation was to sit at a stall for the sale of vegetables, &c. , in a cOttfirfed filthy street in Newcastle, was attacked with symptoms {of Cholera on the 2d January, 1832. The early symptoms Were extreme and sudden profluvium from the bowels; afterwards the constant rejection from the stomach of fluid resembling rice and water, with frequent dejection of a similar fluid from the intestines. A medical gentleman was applied to in the night, but did not visit her. She was visited by me about ten o'clock of the 

19 



146 

following day. She was complaining of violent pain in the hypogastric and epigastric regions, and in the back; her countenance was very much sunk and livid ; the hands and fingers sodden; the cellular substance of the arms was condensed and inelastic, resembling dead integument. The pulse was imperceptible at the wrist, but might be felt beating feebly in the carotids; she had passed no urine for some time; the body was very cold, and she suffered severely from cramps and spasms in the abdominal muscles, and in those of the extremities; her tongue was white and resembled white leather, and the breath was cold. An injection containing half a drachm of tobacco in infusion, was immediately administered. About fifteen minutes after the injection was thrown up, pulsation became very perceptible at the wrist; slight perspiration was observed about the central parts of the body, and the countenance became impi-oved in appearance; she still was ejecting large quantities of fluid from the stomach. One hpur and a half afterwards she had vomited some yellow fluid mixed with white sediment. The pulsation and perspiration still continued; she was ordered to take five grains of calomel every hour. 4 o'clock, p. m. The spasms have returned; pulse more feeble; atill complains of constant pain in the abdomen. I attempted to bleed her from the arm, to unload, if possible, the venous circulation. By constant friction up the course of the vein, I succeeded in getting away about four ounces of very black thick blood guttatim. Three scarifications were applied to the abdomen, but the blood stood in the incisions like tar; a common fomentation was directed to be applied over the abdomen; the tobacco enema was again exhibited, which produced a little faintness at the time, from which she soon recovered. 

Nine o'clock, r. m. Her countenance is better, but the pulse not quite so good; still suffers from cramps, although not so severe; pain of hypogastric region and back, but it has abated in the prsecordia; she has vomited very little: has felt frequent desire to empty the bowels; a small quantity of thin dark fluid evacuated. Having experienced much desire to pass urine, I placed my hand over the hypogastric region to ascertain the state of the bladder, and was astonished to find every thing about her wet and cold. Upon inquiry, I found it arose from the 



147 

flannels used for fomentations, which having been applied once hot, as directed, were absurdly left to cool since four o'clock, until I discovered them. Capt. olei recini sss. statim, et post, horam incipiat capere si. misturse 2da. q. q. hora. confect; cum aromat. 3y« spir. aether, nit. aquae cinnam. sviss. To be allowed milk and coffee in small quantities. 

January 4th. She has had no vomiting all night; towards morning passed two small fluid bilious stools; continues to complain of pain in the hypogastic region; I was prevented seeing her until 11 o'clock, when I found her sinking rapidly, and she soon after expired. I had taken a catheter with me, to introduce, as I understood from my assistant, who brought me the report in the morning, that she expressed a very anxious desire to pass urine;' finding her so near decease I did not attempt it. The blood drawn yesterday was coagulated, very dark, and devoid of serum. 

Case 3. 

Case wherein the Tobacco Enema was successfully administered. 

William Lambert, aged 26. Has been out of health nearly a week, with disordered stomach and bowels. Symptoms of Spasmodic Cholera made their appearance this morning, January 14th, 1832. He was visited by me about midnight. I was informed that he had been taking medicine during the day, prescribed by a medical gentleman who had seen him at the period of his seizure. He was vomiting incessantly large quantities of pellucid fluid, mixed with white flakes, and passing a homogeneous fluid from the intestines. He complained of violent pain in the epigastric region. Pulse very feeble; tongue white; skin cold and dry, especially at the extremities; countenance sunk and livid; dark areola round the eyes; great pain and oppression of the head; tunica adnata injected; pupils contracted. Has passed no urine during the last sixteen hours. I attempted to administer medicines by the mouth, but they were rejected violently, almost before they reached the stomach, with the fluid contents thereof. Two scruples of tobacco infused in nearly a pint of boiling water injected. January 15th, a. m. The vomiting ceased about an hour after the exhibition of the enema, and has not returned hitherto; neither has he been purged; has 



148 

not passed urine. Pain and oppression of head continue. Pulse regular, and although rather feeble, yet much firmer than it was last night. Temperature of body comfortable. Fifteen grains of calomel have been taken at intervals, since the enema was administered. Applic. hirudines, viij. pone aures. capt. pulv.; 2da. q.q. hora. Calomel cum pulv. rhei. aa. gr. v., aloes gr. ij., preteria habeat mist; diaphoretic. Eight o'clock, p. m. Four leeches only were applied. I, therefore, opened the jugular vein on account of the head, but was able to withdraw no more than half an ounce of thick blood. A large blister was applied betwixt the shoulders. Hot fomentations were directed to the denuded scalp. 

16th. Has vomited about a pint of green-coloured fluid; has had no alvine evacuation, nor any disposition to pass urine. Head relieved, and he has no uneasiness in the epigastric region. A dose of castor oil was given. 

9 o'clock, p. m. He rejected the oil soon after it was taken. Has not passed any thing from the bowels, nor any urine; head much relieved; tunica admata still injected; pupils more dilated. Pulse 88, and firm. Capt. pulv. statim c. calomel, gi\ vi. Camphor gr. iij. et rep. post duas horas, manges, sulphat. j^ss. mane. 

17th. Has not passed urine, nor any alvine evacuation. Has again vomited a quantity of green-coloured fluid. Capt. pulv. omni hora c. magnes. calc. gr. v. pulv. rhei. gr. v. aloes gr. 

9 o'clock, p. m. He has taken five powders without any effect, and has not passed urine; pulse sharp and more frequent; vessels of conjunctiva less turgid; head confused, and complains of vertigo. Capt. pulv. 2da q. q. hora c. nitrat. potass, gr. vi. calomel gr. v. pulv. antimonial. gr vi. 

18th. He has taken four powders; pulse 80; tongue clean and moist; suppression of urine still continues, and he has had no alvine evacuations. Has again vomited about half a pint of dark green-coloured bitter fluid; he is distressed with vertigo when he sits up, A common enema was administered this evening, and six of the pil. rhei. comp. were sent to him, to take, two every second hour. 

19th. The bowels have been very much acted upon all last night, and during the day; motions very liquid and dark- coloured; 



149 

the secretion of the urinary organs perfectly re-established. He is much relieved; eyes and countenance more expressive. 

20th. Bowels still acting, and he is passing urine copiously. Tonic and aperient medicines were prescribed. 

30th. Resumed his usual avocations. 

Case 4. 

Case of malignant Cholera treated successfully by the use of the Tobacco Enema. 

I was requested to visit George Liddell, aged 39, living in a court yard, in Percy Street. I saw him at 3 o'clock on Sunday afternoon, the 22d of January, 1832. He was seized with vomiting and purging on the evening of the 19th, which continued up to the time I visited him. Some remedies were tried, but without any good effect. His present appearance is that of a person of 60 years of age. The present symptoms are pain of head and double vision; countenance much sunk; eyes languid and conjunctiva slightly red; lips pale, with a purple blush, and tongue white; voice changed, but not quite reduced to a whisper; abdomen hollow; muscles tense as a board; acute pain in epigastric region; skin of hands and fingers corrugated; nails very blue; pulse 80, very weak and irregular; skin dry; vomiting and purging of white flocculent fluid; suppression of urine; intense thirst; no cramps at present in the muscles of the extre* mities. An emetic was administered, and afterwards a mixture, with ammonia. 

9, p. m. Vomited freely after taking the emetic. V. S. ad sviij.; blood very black; pain of epigastric region somewhat relieved after bleeding, but returned soon after; injec. enema cum tinct. opii siij-> aquse tepid, ffoj.; capt. pulv. ipecac, co. gr. viij., camphor gr. ij., 2da. q. q. hora. 

23d, 10 o'clock, a. m. I employed the remedies of yesterday because so much had been said against the use of the tobacco, and in praise of other means; but this morning I found the patient getting so very rapidly worse, that no farther time was to be lost. His voice is reduced to a whisper; pulse very feeble and intermittent; expression of anguish in countenance, and he makes constant inquiries as to his recovery; jactitation; skin dry, cold, and inactive; frequent vomiting and purging of pellucid 



150 

fluid, mixed with flocculi; constant desire for cold water; has not passed urine. 

1 o'clock, p. m. An infusion, containing half a drachm of tobacco, regularly prepared, was now administered. It was retained about ten minutes, but he could not be prevailed upon to keep it longer; a dose of pills was swallowed containing calomel gr. ij.; pil. rhei co. gr. x. 

Half-past 1 o'clock. The pills repeated, and a draught administered consisting of magnes. rhui. carb. ammon. sodse aa. g. x., aquse siss. He had vomited once, but passed no evacuation per anum; pulse improved, soft, and more regular; tension of abdominal muscles subdued. There was an evident improvement in the colour of the skin and lips, as well as in the expression of the eyes, after the exhibition of the enema, and he said he saw better; blueness of the nails has also much gone off; blood coagulated, contains a very small quantity of yellow-coloured serum. 

6 o'clock, p. m. He has not vomited, and has been purged only once; appearance of skin and countenance improved; pulse 84, and firm; sight better; blue colour of nails quite gone; rept. haust. rheo, &cS et pil. c. rheo et calomel. 

7 o'clock, p. m. He has slept a good deal, and the man who is with him says he is sure he is better, because he lies quiet, and does not toss his arms about as he did; has had another motion; tinge evidently changed. Capt. julip. salin. ; spir. vin. gallic 3ij., 2da. q. q. hora; preterca pulv. c. calomel, pulv. antimonial nitrat. potass aa gr. v. 

11 o'clock, p. m. Pulse 80, with some intermission; abdominal muscles flaccid; hiccough; no vomiting or alvine evacuation; has not passed urine; very drowsy; complexion better. 

24th. Pulse 80; voice stronger; skin has become very red; has passed an evacuation of a bilious tinge, but still containing floe - culi; has taken a pint of the mixture and four powders. The draught, with magnesia, &c, was given early this morning; vomited some bilious fluid. 

12 o'clock. Complains of tenesmus; habt. enem. commun. capt. mist. c. infus. gent. Co. magnes. sulph. tinct. myrrhse 4ta. q. q. hora. 

2 o'clock. Has passed another evacuation entirely bilious. 



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25th. Passed another bilious motion last night, pulse not quite so good; has slept quietly all night; gummy exudation from eyelids, tongue white; to be allowed ale, broth, &c. 

Evening, has taken some coffee; strength improving. Bowels have been moved, and he has passed urine. 

30th. He has been gaining strength since last report. Has a good appetite, and may be considered quite well. 

Case 5. 

Case of Malignant Cholera treated in the Cholera Hospital at Gateshead, wherein the Tobacco Enema was administered successfully. 

James M'Grinness, aged 35, was taken into the Gateshead hospital on the night of the 14th January, 1832, exhibiting all the usual symptoms of a well marked case of Cholera. A very careful report of the case was kept at the hospital, but too long to be detailed here. He was bled after admission; nine ounces withdrawn, described to have been dark coloured and thick. An emetic draught was administered, which produced free vomiting, during which the pulse improved in strength, but soon fell to the feeble state it was in when admitted. A bolus, containing opii. gr. i. , calomel gr. v. , was swallowed. 

15th. One o'clock, a. M.^he is described to be worse, and took a draught composed of ten grains of Cayenne pepper, and six drachms of brandy. Soon afterwards, vomiting and cramps returned. The bolus repeated, and he was directed to take saline julep very frequently. In the morning, at six o'clock, he is described as much worse. Vomiting and purging severely. Pulse scarcely to be felt at the wrist, and he is very cold. Warmth was freely applied, and he was ordered to drink liberally from a mixture of nitric acid and water (si. ad jfoi. ) Two grains of sulphate of quinine were also given in the saline julep every two hours. 

Twelve o'clock, is reported to have taken three doses of calomel, each containing 10 grains since nine o'clock; the quinine rejected; his present symptoms are, great pain across the przecordia; vomiting constant and severe; cramps of the muscles of the trunk have come on; pulse barely perceptible and irregular; twelve leeches applied. A tobacco enema, recommended 



152 

by Mr. Baird, who saw the patient about one o'clock, was administered at three o'clock. 

7 o'clock, p. m. He has been taking an ammonia mixture at intervals; vomiting has ceased; cramps have disappeared, except slightly in the fingers; pain about the prsecordia less severe; pulse 80, and more regular; face flushed; surface warmer, and a free moisture is appearing over the trunk and extremities; the man is looking better, and says he feels* quite easy. A dose of calomel administered. / 

9 o'clock, p. m. Passed about half a pint of thin fluid; he is sleeping calmly; has vomited only once since last remark; skin natural in temperature over the trunk; hands and arms cooler. 

January 16th. The patient has passed a good night; has taken three powders with calomel gr. x. pulv. rhei. 9j. but vomited each of them. 

9 o'clock, p. m. Pulse 80 and feeble; drowsy; has not passed urine; the vessels of the conjunctiva finely injected, and there is some approach to muttering during sleep: an evaporating lotion to be applied to the head; a warm injection administered. 

1 o'clock, p. m. The patient states that he passed a little urine with the enema; pulse 80; to take effervescing mixture with brandy. • 

4 o'clock, p. m. Pulse 90 and firmer; mouth and tongue moist, and he has passed urine. Capt. olei ricini stathn. 

8 o'clock, p. m. Sleeping on his side, breathing softly; pulse 84; has passed an evacuation and some urine; stool feculent. 

17th, 8 o'clock, a. m. Much improved, and has taken coffee and toast for breakfast; has had one alvine evacuation early this morning, and has passed urine; pulse 92. To omit medicines, and to take coffee or gruel when he wishes. 

4 o'clock, p. m. Has been improving every visit; he took broth and rice-pudding for dinner; pulse 96, and regular; skin natural, and tongue clean; no pain. 

8 o'clock, p. m. Pulse 88, and soft; complains of slight uneasiness in the bowels; no evacuation; olei ricini Jvj. statim. 

January 18th. He has passed several dark bilious stools and abundance of urine; appetite for food returned, and he only complains of debility; left the hospital quite well. 



153 

Cask 6. 

Thomas Horn, aged 47, living in the Castle Garth, had beeii labouring under diarrhoea for two or three days, and the night before I saw him had drunk rather freely of ale, which brought on vomiting. I was called to him on Sunday evening, betwixt ten and eleven o'clock, January 29th, 1832. Two medical friends accompanied me. We found him in the following situation — countenance dejected; pulse very feeble, particularly inthe left arm; tongue white and cold, as well as the breath;-vomiting and purging of the usual kind of fluid; cramps of the extremities; dark areola round the eyes, which are sunk in the sockets; lips purple; complexion livid; hands and fingers sodden; skin cold; passage of urine doubtful. The tobacco enema was exhibited cold at eleven o'clock, and retained with some dif j ficulty. In a short time I observed to my friends, that the colour of the lips had changed to a more florid hue; the change in the pulse was not so decided, but at the left wrist it was evidently improved* 

January 30th, 10 o'clock, a. m. He has occasionally vomited some dark fluid through the night; has passed some dark fluid! from the bowels; has had no more cramps; pulse frequent and rather feeble; complexion still better; has perspired freely; tongue warm, white; has not passed urine; voice hoarse; expresses himself much better. 

1 o'clock. Has passed two olive -coloured feculent motions, smell very offensive, besides some urine. 

February 3rd. This patient has continued improving: his bowels have been regulated by proper medicines; he has slept well and has passed urine freely. This is, however, the first day that the desire for food has been observed. He is now taking some tonic medicine, and expresses himself quite well. 

I have it in my power to produce other cases which would still more tend to bear me out in the view I have taken of Cholera, if judging by the result may be admitted. I can conscientiously say, that I have never exhibited the tobacco enema but with advantage, and, therefore, I think it unnecessary to write more upon the subject. 

20 



154 

Anxious as I am to do ample justice to the merits of Mr. Baird's remedy, I cannot permit myself to withhold the following testimony in its favour:-— 

Qateshead, February 10, 1832. 

Dear Sir, 

Dr. Kirk, of Greenock, having unexpectedly carried part of some memoranda I had made respecting Cholera, with him to Edinburgh, I am precluded sending you a copy of the minutes of the fifth case in which I have used the tobacco enema. Having mentioned it in a letter to Dr. Abercrombie, of Edinburgh, written at the time the man was i 11.,, and of which I have a copy, I will transcribe what I then stated respecting the effects of the tobacco enema generally, and in Brown's case in particular. 

\ ' The tobacco enema was suggested to me by Mr. Baird, of Newcastle, and tried in a hopeless case with decided benefit; in another bad case in our hospital, both publicly; and in three others in my practice. In all five it allayed the cramps, in three of them it lessened the purging, and in four the vomiting was much relieved. In all five the safety of the application was proved. Three of the patients are well, one still has consecutive fever; the last is now under treatment, and has rallied since the enema was administered, though the event is still uncertain. In all of them I gave infus. tabaci ph. 1. , which contains Jss. of the tobacco. As the safety has been proved, it deserves farther attentive trials, especially as it has succeeded when every other plan was deemed hopeless. 

" Postcript — February Ist. I lost the post by attending closely to the case mentioned as still under treatment; I had to repeat the enema as the man was getting worse; copious vomiting ensued; respiration became more free; the pulse returned to the wrist; the hands improved in colour, and I left him at 2 in the morning in a state of perspiration; saw him again at 8, a. m. much improved; had slept about an hour; no cramps; no vomiting or purging; pulse 90 at the wrist, and he will probably have consecutive fever." So far the letter, and I can now state that the patient is well; reaction was kept within bounds by the usual remedies. 

In conclusion, I must state, that the above-mentioned five 



155 

cases are all in which I have seen the tobacco enema used, and all the patients are now perfectly well. 

I remain, Dear Sir, 

Yours truly, 

T. M. Greenhow, Esq. T. K. FIFE. 

No. VI. 

Newcastle, Feb. sth, 1832. 

My Dear Sir, 

According to your desire, I send you a copy of my reports, as sent to the Board of Health, of the cases which lately occurred in the house of correction. 

Of the treatment I have nothing to add, as they were all removed to the Cholera Hospital, soon after the disease became manifest. I have merely stated the leading symptoms as they occurred, from which you will draw your own conclusions, and, should you consider them of sufficient importance, to deserve notice in the work in which you are at present engaged, they are very much at your service. Wishing you success in your laudable undertaking, 

I remain, my Dear Sir, 

Very truly yours, 

WILLIAM FIFE. 

T. M. Greenhow, Esq., Eldon Square. 

Thos. M 'Lagan had been confined in the House of Correction about three weeks; he was taken ill on Saturday morning, the 21st of January: complained of pain in his stomach and bowels, accompanied with vomiting and purging; tongue clean and moist, pulse moderate, and skin warm; as he had gone to the water closet, his evacuations had not been noticed. 

22d. Vomiting and purging continue; his stools have something of the rice water appearance; pulse more feeble, and countenance rather sunk: finding his symptoms not yielding to the usual remedies, it was thought advisable to remove him to the Cholera Hospital. 

January 9,Zd, 1832. 

This patient recovered. 



156 

Jas. Chilton has been confined in the House of Correction since the 2d of December: he was one of those who waited upon Thos. M 'Lagan on Saturday and Sunday last: he was seized in the course of last night with vomiting and purging; and when I was called to him at 7 in the morning, he complained of great pain and sickness at stomach, cramps in his legs, and giddiness, his countenance much sunk, pulse at the wrist indistinct, and extremities cold. 

A mustard emetic, with warm water, was given immediately; with good effect; after which a dose of liq. opii sed. in warm brandy and water; he was then sent to the Cholera Hospital, 

January o,4th, 1832. 

This patient died at 5, p. m., on the same day. 

P. S. Soon after M 'Lagan was sent to the hospital, Chilton underwent ablution, and had a complete change of clothing before he was permitted to associate with the other prisoners. 

Geo. Guy has been in the House of Correction about a fortnight. On the 28th ult. had a febrile attack, which, in a few days, yielded to medical treatment. At nine last night (Feb. Ist) he was seized with cold shivering, giddiness, vomiting, and purging, accompanied with severe cramps in his arms and legs. 

When I saw him he was somewhat easier; his last evacuations had not been preserved, but they were described as having been very watery and profuse. His pulse was moderate, and skin warm; but he complained much of pain across his stomach, which felt tense and tender to the touch. 

Under all circumstances, it was thought advisable to remove him to the Cholera Hospital, which was done accordingly. 

February 2d, 1832. 

This patient recovered. It is worthy of notice that he had no communication with the former cases. 

In the case of M'Lagan there was nothing materially different from several others in the prison, which had done well under the ordinary treatment, except in the degree of severity and rice water appearance of the stools. 

For some months past, bowel complaints, in various forms, had 



157 



been very prevalent in the prison; in some, pain with vomiting and obstinate constipation 5 whilst others were suffering from dysentery, diarrhoea, and Cholera; but by early attention they generally soon got well. 

From a belief in the commonly received opinion, amongst practitioners here (who had seen much of the disease,) that neglected diarrhoea for several days often preceded Cholera, I particularly desired to have the earliest intimation of all such complaints amongst the prisoners; and I firmly believe, that by early attention and prompt measures, the disease has in many instances been arrested in the beginning, which in all probability might otherwise have proved serious. 

WILLIAM FIFE, 

Surgeon to the Gaol and House of Correction. 

Newcastle, Feb. 2, 1832. 

No. VII. 

The following observations, with the accompanying cases, are from the pen of my friend, Mr. John Fife. Having been employed to attend the poor inhabitants of the village of Newburn, his opportunities of seeing the disease have been great; and I cannot but consider the cases detailed as valuable illustrations of the principles of practice which I have attempted to establish; nor is it otherwise than highly gratifying to me to perceive that in many particulars he has been led to adopt views of the disease very similar to my own. 

The letter to Dr. Macann furnishes a necessary part of Mr. John Fife's communication. 

February 10th, 1832. 

Dear Sir, 

To the best of my recollection it was about the 20th of December that I mentioned to you my intention of injecting the veins for the purpose of exciting reaction in the collapse of Cholera. I was deterred from the attempt by ascertaining the danger of jthe introduction of air, and I then had recourse to the substitute 



158 

you adopted— filling the intestines with hot water. To this I have added various stimuli, and frequently large opiates, with great advantage, which you will find, on examination of the following cases, &c. 

Yours, very truly, 

JOHN FIFE. 

T. M. Greenhow, Esq. 

Letter from Mr. Fife to Dr. Macann 

Newcastle, February 5, 1832. . 

Sir, 

Incompliance with your request, I frow proceed to describe the treatment I have adopted, and its results, in the cases of Cholera Asphyxia under my care in Newcastle and the neighbouring villages, including Newburnf but it is important to notice in the first instance, one feature of the disease, adverted to in your report from Grateshead, and dated January 18th, viz., the occurrence of premonitory diarrhoea, and also the fact that in 579 cases, the treatment of which I have directed, collapse never came on till after profuse serous discharge from the bowels. 

The success with which I have employed stimulating enemata, must appear in the comparatively small number of deaths, amounting only to 97, and including many cases of persons advanced to old age, or reduced by other diseases: indeed these applications seldom failed to produce reaction, in its most salutary form attended by less congestion than that which followed collapse of longer dliration, in which stimuli had been withheld, or where the most diffusible stimuli were given by the mouth. 

Permit me to make another general observation, the correctness of which is borne out, not only by the acknowledgments from many strangers of distinguished talent who saw my practice, and also by the cases themselves, viz., that the violence of reaction is in proportion to the duration of the collapse, and not the quantity of stimuli employed during the collapse. 

Ist. Diarrhoea, when watery, but tinged with healthy secretions, I have arrested at once by opium, and in 19 instances out of 20 convalescence has followed ; but if the disease has advanced one step farther the dejections being colourless? calomel, in 



159 



repeated doses, has been given till it restored secretion, while the discharges have been moderated by opium, and the pulse softened, if necessary, by bleeding. 

In some instances I have known the Diarrhoea Cholerica cease spontaneously, after continuing many days, and terminate in health. 

2nd. Vomiting, purging, and cramps, generally follow a neglected diarrhoea, and when I find such symptoms on my first visit, a mustard emetic is given, followed by copious. draughts of warm water; the patient is placed in bed between blankets and in a flannel shirt, the room freely ventilated, frictions applied to the limbs, gentle percussion on the. right hypochondrium, and should tenderness be detected on pressure, or the pulse feel firm, blood is taken to the extent the pulse can bear; calomel and opium are then used as mentioned above, heated plates applied to the epigastrium and feet, and diluents allowed. 

3d. Collapse comes next in order, unless, the pi'ofuse discharges are restrained; and in this state, I object to large opiates by the mouth, and also to general bleeding; but frequently give immediate relief by throwing into the intestines, from a forcing pump, between two and three pounds of hot water, six ounces of brandy, and one, or occasionally two, drachms of laudanum. — But should any tendency to stupor appear, a drachm of mustard, or half an ounce of spirit of camphor is substituted for laudanum and brandy. It often happens that such injections are retained long, and, therefore, if at the expiration of two or three hours' reaction is not evident in returning pulse, the first injection is allowed to pass off through a tube introduced into the rectum for that purpose, the syringe is then applied to it, and another enema administered at a temperature as high as the patient can bear, and consisting sometimes of hot water alone, or with laudanum, if irritability of the stomach and bowels continues. The first enema which returns through the elastic tube is always astonishingly reduced in temperature. 

It is in this stage of Cholera alone that I have found brandy a valuable medicine, even by the mouth, and the most favourable change has often followed its liberal use. 

I have often vesicated the epigastrium with a cloth suddenly taken out of boiling water, when pain is much complained off 



160 

di*y heated plates, or bottles containing hot water have been constantly used with great advantage. 

4th. Reaction, unless closely watched, is more frequently fatal than collapse; on the one hand, congestion in the brain, on the other, sudden and exhausting return of vomiting and diarrhoea threaten imminent danger; small and repeated doses of calomel and opium have appeared to me the most efficient in moderating the latter; and converting the bed into an inclined plane, topical or general bleeding when the pulse can bear it,-large or repeated doses of calomel frequently relieve the head without acting upon the bowels for many hours. 

Blistering the head or back of the neck, mercurial frictions and sinapisms to the feet have not rendered very evident service, while the most striking advantage has generally resulted from careful attention to posture, nice regulation of the pulse, low diet, and frequent application of leeches to the temples; mild aperients succeed calomel and opium, when the bowels do not act for twelve hours, or when scanty, dark feculent dejections are passed, urgent thirst complained of, or tension of the abdomen observed; under these circumstances, castor oil and laxative enemata are always useful. 

In children, congestion of the head is generally simultaneous with reaction, and of so marked a character as to resemble hydrocephalus; such head symptoms are equally conspicuous when the vomiting and purging stop spontaneously, when stimuli (which they seldom require,) have been withheld, and when opium has not been used. 

At Newburn, therefore, and in other situations where I could not see the same case frequently, the attendants were directed to continue the calomel and opium, consisting of four parts of the former, and one of the latter, every four hours until the purging ceased or changed; sometimes to give minute doses of brandy and water till the pulse became perceptible, but no longer, and then immediately to apply leeches to the temples. 

It is in this stage that the pulse sometimes rises under depletion, and, therefore, that its repetition is so often necessary, and the most oppressive congestion of the brain that I have treated, has generally occurred from two to five days after reaction, and> consequently, as long after stimulants had been discontinued. 



161 

Such cases have been saved by being treated as if for hydro* cephalus. 

sth. Relapse has occurred with me as often after the mild, as after the severest forms of Cholera, and I have generally traced it to some imprudence in diet or exposure to cold. The same treatment has been adopted as at first, but modified in proportion to symptoms. 

The period of the incubation of the morbific germs of Cholera seems to vary from four hours to eight days. 

My assistant, Mr. Atkinson, who resided at Newburn sixteen days, was threatened \ Mr. Rowel had an attack; the rector died of Cholera, and, of seven nurses sent up from Newcastle, five were attacked and two died. 

Many circumstances convince me that the effluvia from the excretions of an individual having Diarrhoea Cholerica may communicate to another, predisposed, the most developed form of the disea.se, and, when we know how long persons sometimes continue their ordinary occupations, and travel with Diarrhoea Cholerica, the gradual march of the malady is at once accounted for. 

Let me not forget, however, in such speculations, the propriety of confining myself to facts, and the public duty incumbent on me to give any farther explanation that may be required. 

I have the honour to be, Sir, 

Your obedient servant, 

JOHN FIFE. 

GENERAL REMARKS. 

Distinguishing peculiarities of the Diarrhoea Cholerica. 

Although the general prevalence of Cholera Asphyxia in a district may reasonably excite alarm in those who have bowel complaints, and caution in their medical advisers, yet it is important to mark, in the most emphatic manner, those peculiarities which characterize the Diarrhoea Cholerica at an early period, -in its most insidious and chronic form, and whilst timely and judicious treatment may yet bring immediate security. 

No diagnostic is to be found in the sudden or gradual appearance of the diarrhoea, as it varies in duration from three 

21 





162 

hours to as many weeks* before the more developed symptoms show themselves: one instance has occurred under my own observation, which clearly proves that the more chronic, though distinct form of Diarrhoea Cholerica, may, occasionally, without medical treatment, terminate in health. 

If the premonitory diarrhoea be chronic, the dejections are slightly coloured by the ordinary secretions, but the quantity of serous fluid is enormous, thrown out sometimes with forces not because the coats of the intestines are irritated so much that they are excited to contract by the distention; there is generally no pain, no tenesmus, no fever, but that kind of giddiness, which often accompanies the action of a purgative; a pearly sclerotica, sunken eyes, ghastly countenance, depression of spirits, and a most remarkable diminution in the violence of the pulse. 

It seems necessary to the formation of Cholera Asphyxia, in all its formidable array of symptoms, that those profuse serous discharges should be thrown off, as the degree of collapse is generally proportioned to them; but I have often been told by the confused attendants, and even by the whispering patient, while in the state of collapse, that there had not been much previous purging; and invariably in such instances I have discovered, on closer examination, that the contents of the bowels had been first expelled, and then followed by many quarts of the peculiar fluid, having an odour resembling the white of a fresh egg, presenting an appearance like that of rice water, and giving an orange stain to turmeric paper. 

The accounts of Cholera which have poured into this country from the northern parts of Europe, have contributed to delude the general observer, and the less experienced medical practitioner, with the idea, that to obtain a profuse perspiration, with comfortable warmth, was to cure the Cholera. In some of the most rapidly fatal attacks I have ever seen, the skin has been warm, though the pulse was absent; and for some hours before death, the bed-clothes have been so wet with perspiration, as to diffuse the most nauseating odour. 

Now and then a case has presented itself to me, in which occasional paroxysms of pain in the bowels have accompanied Diarrhoea Cholerica; and in such cases the discharge of watery fluid has been less profuse, the pulse fuller and firmer; the tongue, 



163 

instead of being white, moist, and cold, has appeared red and dry. But I now describe an exception, and, at the same time, a form of disease, in which the lancet is peculiarly demanded. 

The terrible malady, which is the subject of these remarks, is now too generally known to render useful, any description, however graphic, of its more advanced stages; but it may be proper to point out some marked distinctions between the fever of reaction and the common typhus of this country; distinctions arising not so much from the presence or absence of certain symptoms, as from their existing in different relative proportions to each other. For instance, the pulse is slower in the reaction from Cholera, the intellect less confused, the breathing more oppressed, the scl erotica less injected, the skin less hot, perspiration more profuse, and thirst more importunate; the sudden appearance of stupor, apoplexy, or violent delirium about the fourth or fifth day of reaction, more frequent and dangerous; tendency to a return of vomiting and diarrhoea, which is watery, though deeply tinged with secretions, enforced by the use of calomel, contribute to characterize the fever of Cholera. 

Those peculiarities of character in Cholera Asphyxia, which have suggested to me a tolerably successful mode of treatment, are the following: — 

1. That in the stage of diarrhoea, it may be arrested by opium alone, and, in a majority of instances, convalescence ensues. 

2. That the collapse has never, to my knowledge, taken place, till after profuse watery discharges. 

3. That in one or two cases of collapse, with suffocating dyspnoea, when I have used the lancet, serum was scarcely to be found in the blood: it resembled tar, and was so viscid, as to obstruct circulation. The same peculiarities have been noticed by other practitioners who have bled more frequently. 

4. That the action of the heart, carotid, axillary, and inguinal arteries, exceeds, beyond all proportion, that of the smaller vessels; and even when the pulse at the wrists is imperceptible, the heart and large vessels often labour violently. 

5. That no urine is secreted during the collapse: it is, therefore, evident that the aqueous part of the blood has passed off through the coats of the intestines, and the remainder is too viscid to circulate. 



164 

Emetics, opium, calomel, stimuli, bleeding, and purgatives, have each their appropriate place, in which they may arrest the Worst forms of Cholera Asphyxia; but reverse their order, or apply any one of these powerful agents when contra-indicated, and the most disastrous consequences generally follow. 

The difficulty of persuading empirics of this truth, will generally prove equal to their ignorance; and it may be constantly observed, that the most enthusiastic nostrum-mongers are persons who have never faced the disease. 

TREATMENT. 

The cases annexed, and a short memoir which I addressed to Dr. M'Cann, sufficiently illustrate the treatment pursued by me in this disease; a mode of treatment having success for its recommendation, and supported also by therapeutic science, because it has consisted in promptly and vigorously answering each indication which became evident; although I am not aware that the means by which, I have obtained reaction in some of the worst stages of collapse; viz., the use of stimulating enemata had ever before been employed. 

Good effects have resulted from the use of hot water injections, directed by Mr. Greenhow; and also from the tobacco enema, repeatedly used by Mr. Baird; but I adopted the stimulating injection with the intention of restoring to the circulation the fluid lost, and applying the most diffusible stimuli at once to the centre of nervous sympathy. 

In numerous cases where the sufferers exhibited no sign of life except intelligence, heaving of the chest, and violent cramps, within a few minutes after the administration of the stimulating enema, the countenance has become less pinched, the voice stronger, the breathing more free, and the pulse again perceptible at the wrist, after having been lost for hours. 

I have selected the following cases as best calculated to exhibit the severest forms of Cholera. 

Case 1. 

W. H., waterman; robust in form and appearance; temperate in habits; aged 23; from Bell's Close; consulted me on the last day of December, 1831, for symptoms arising from a former in- 



165 

jury in the back: his urine was alkalescent, and he was ordered tinct. ferri muriat. 

January 3d, 5, a. m. Purging, vomiting, cramps. Six hours elapsed before I was brought to him. He was vomiting in an imperfect and convulsive manner; moaning constantly; pulse imperceptible; surface cold; tongue white, moist, and cold, countenance shrunk, ghastly, and livid; fingers corrugated and livid; the dejections resembled rice water, and the quantity was enormous. 

11, a. m. The mustard emetic was given immediately, which produced full vomiting; half an hour after there was no improvement in his symptoms, although dry heat and frictions had been diligently applied. Hydrarg. submur. 9i. opii. gr. ij. were given, and the following enema: Liq. opii. sedativ. Batley. %i. spt. vini gall. aquae calid ftjij. 

Half an ounce of brandy every hour. 

Expressed himself immediately easier, and in 15 minutes he was free from vomiting, purging, and cramps: the pulse became distinct, the surface warmer. 

Rice water for beverage; brandy omitted. 

£, p. m. Pulse distinct, but feeble; no return of vomiting or purging, but slight cramps; much difficulty experienced in keeping up the temperature. 

A tube was introduced into the rectum, through which above a pint of the injection returned, almost cold: the syringe was then applied, and the enema repeated, producing the same feelings of comfort. 

10, p. m. Quite relieved. Enema retained. 

4th. Some sleep during last night; pulse 90, distinct; several feculent evacuations, but no urine. An enema of warm water given; haust. purg. 

sth. Night restless; two feculent evacuations; no urine in the the bladder; pulse 90; headach. Applic. hirud. xii. temporibus; Emp. lyttae nuchse: four hours after which a pint of urine was passed. 

Bth. Complains of headach. V. S. ad 

9th. Convalescent. 



166 

Case 2. 

Mrs. H., aged 50. Naturally feeble, and subject to extreme dyspepsia. 

Jan. 13, at 8, a. m. The bowels discharged their contents by one effort; after which several choleric dejections passed. 

12, m. Vomiting and cramps came on. At 2, I found her with a wiry pulse of 100, and complaining of much pain in the hypogastrium. V. S. ad under which the pulse rather sunk. Opii. gr. iss. hyd. submur. gr. v. were given and ordered to be repeated in half doses every four or six hours. Should profuse discharge from the bowels continue, emp. lyttae epigast. 

R. Spt. vin. gal. liq. opii. sedativ. gr. xl. aq. calid jj^ij. ft. enema. 

4, p. m. Symptoms removed; pulse 90. 

10, p. m. Continues well. 

14th. Some sleep during the night; several dark feculent dejections. Haust. aperients. 

15th. Approaching convalescence. 

18th, 2, p. m. Without any evident cause, the most profuse purging^ of dark green watery dejections, and vomiting of a similar fluid since 6, a. m. ; countenance sunk, livid; pulse gone. The stimulating enema was given every three hours; viz. three times; and after each, the pulse became for a few moments perceptible, and most distinct after the last. Contrary to the strictest injunctions, she then got out of bed without assistance, fainted immediately, and expired in a few minutes. 

Case 3. 

L., aged 27, Newcastle. 

Jan. 27th. Diarrhoea for four days; vomiting and cramps for three hours; pulse nearly gone; surface cold, shrunk, and livid; the vomiting imperfect. A mustard emetic given. Hydrarg. submur. gr. x., and the following enema: — R. Spt. camphor. sss. liq. opii. sedativ. %i., aquae calid fj^ij. m. In a few minutes the pulse rose; symptoms subsided before night; he was bled from the arm, and stimuli were of course withheld. 

29th. No return of symptoms. 

31st. Convalescent. 



167 

Case 4. 

R. D., aged 9, Lemington. 

Jan. 22nd. Vomiting, and rice water purging for 12 hours; no* pulse; countenance livid and shrunk; the eye glassy and sunk, yet calm and intelligent; fingers corrugated and cold. Hydrarg. submur. gr. v. opii. gr. iss. statim. Heat applied to the surface. Aware that I could not see the case within 24 hours, I directed the calomel and opium to be continued in half doses every four hours till the purging changed or ceased; and a teaspoonful of brandy every 20 or 30 minutes till the pulse returned, then instantly to discontinue the brandy and apply 8 leeches to the temples. 

23d. Some sleep; had about two ounces of brandy,* and three doses of calomel and opium; leeches done well. 

25th. Recovered. 

Case 5. 

Mrs. C, large and well formed, aged 50, Newcastle. 

Jan. 31. Seen at noon; had vomiting, purging, and cramps for 4 hours; had taken a mustard emetic; countenance ghastly, shrunk and livid; tongue white, moist, and cold; pulse imperceptible; surface below the ordinary temperature; perspiration most profuse; voice almost inaudible. The tongue and muscles of the throat so violently cramped as to render deglutition very difficult. 

Had passed, in the opinion of the attendants, about 10 quarts of serous fluid. Hydrarg. submur. 9i. statim. brandy si. 

An enema consisting of liq. opii. sedativ. %\. spt. vin. galL sviii. aqua calid tfeijss. 

In about ten minutes a slight pulse was felt at the wrist for about 20 seconds. The epigastrium was then vesicated with hot plates; frictions on the limbs; gentle percussion on the right hypochondrium. 

Half-past 1, p. m. Cramps and jactitations less violent; surface warmer; perspiration profuse; no pulse; occasional vomiting, but 

* I have seldom found it necessary to give such stimuli to children, as reaction in them takes place more readily. 



168 

not the calomel. The returning injection through the tube almost cold. To be repeated, but with the addition of sss. spt. camphor and without the liq. opii. 20 minutes after, a slight flutter in the pulse. 3, p. m. No improvement. Enema drawn off and repeated without the opium. 5, p. m. Dead. 

THE END. 



JUST PUBLISHED BY CAREY & LEA. 

PRIVATE MEMOIRS of NAPOLEON BONAPARTE, from the French of Mi Fauvelet dk Bourrienne, Private Secretary to the Emperor. Second American Edition, complete in one volume. %.* This edition contains almost a fourth more matter than the previous one, as in order to render it as perfect as possible, extracts have been given from the Memoirs from St. Helena, Official Reports, &c. &c. in all cases where they differ from the statements of M. de Bourrienne. " This English translation, which has been very faithfully rendered, is still more valuable than the original work, as upon all points where any obliquity from other published recitals occurs, the translator has given several accounts, and thus, in the form of notes, we are presented with the statements obtained from Napoleon's own dictation at St. Helena, from the Memoirs of the Duke of Rovigo, of General Rapp, of Constant, from the writings of the Marquis of Londonderry, &c\" — U. Ser. Jour. " Those who desire to form a correct estimate of the character of one of the most extraordinary men " that ever lived in the tide of time," will scarcely be without it. The present edition possesses peculiar advantages. The peculiar advantages of position in regard to his present subject, solely enjoyed by If. de Bourrienne, his literary accomplishments and moral qualifications, . have already obtained for these memoirs the first rank in contemporary and authentic history. In France, where they had been for years expected with anxiety, and where, since the revolution, no work connected with that period or its consequent events has created so great a sensation, the volumes of Bourrienne have, from the first, been accepted as the only trustworthy exhibition of the private life and political principles of Napoleon. " We know from the best political authority now living in England, that the writer's accounts are perfectly corroborated by facts." — Lit. Gaz. " The only authentic Life of Napoleon extant. — Courier. "This splendid publication that literally leaves nothing to be desired." — Atlas. " These volumes may be read with all the interest of a romance." — Courier. " No person who is desirous rightly to appreciate the character of Bonaparte, will neglect the perusal of this work; whoever 1 Wishes to know, not merely the General or , the Emperor, but what the man really was, Will find him well pictured here." — Times. " The completest personal recollections of Napoleon that have appeared." — Morn. Post. " As a part of the history of the most ex-1 traordinary man, and the most extraordinary times that ever invited elucidation, these memoirs must continue to the latest ages to be records of invaluable interest." — Lit. Gaz. 

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MISCELLANEOUS. An HISTORICAL INQUIRY into the PRODUCTION and CONSUMPTION of the PRECIOUS METALS, from the Earliest Ages, and into the Influence of their Increase or Diminution on the prices of Commodities. . By William Jacob, Esq. F. R. S. In Bvo. " Mr. Jacob's Historical Inquiry into the Production and Consumption of the Precious Metals is one of the most curious and important works which has lately issued from the press. The influence of the precious metals on the industry of mankind is acknowledged to be great; though, perhaps, the notions respecting the precise mode of its operation were obscure, and undoubtedly the history of its effects had never been traced with accuracy and ingenuity. Mr. Huskisson, who had maintained a friendship with Mr. Jacob for more than five-and-twenty years, first put the author on the investigation ; it is one of the minor obligations which the country owes to that, enlightened statesman." — Spectator. " It was written aY the suggestion of the late Mr. Huskisson, and displays the fruits of much industry and research, guided by a sound judgment, and embodying more learning than is usually brought to bear on statistical or economical subjects. We recommend the book to general attention." — Times, Sept. 2, 1831. NARRATIVE of a VOYAGE to the PACIFIC and BEHRING'S STRAIT, to co-operate with the Polar Expeditions : performed in His Majesty's ship Blossom, under the command of Capt. F. W. Beechey, R. N. in the years 1825, 26, 27, 28. In Bvo. " The most interesting of the whole series of expeditions to the North Pole." — Quarterly Review. " This expedition will be forever memorable as one which has added immensely to our knowledge of this earth that we inhabit." — Blackwood' 's Mag. " Captain Beechey's work is a lasting monument of his own abilities, and an honor to his country." — Lit. Gaz. A GENERAL VIEW of the PROGRESS of ETHICAL PHILOSOPHY, chiefly during the Seventeenth and Eighteenth centuries. By Sir James Mackintosh M. P. InBvo. " This, in our humble opinion, is the best offspring of the pen of an author who in philosophical spirit, knowledge and reflection, richness of moral sentiment, and elegance of style, has altogether no superior — perhaps no equal — among his contemporaries. Some time ago we made copious extracts from the beautiful work. We could not recommend the whole too earnestly."— National Gazette. HISTORY of ENGLAND, by Sir James Mackintosh. Octavo edition. In the preas. %* Th« first volume of this edition will contain the same matter as the first 3 volumes of the ISrno edition. 

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MISCELLAN EOUS. MEMOIRS of the LIFE of SIR WALTER RALEGH, with some account of the Period in which he lived. By Mrs. A. T. Thomson, With a portrait. " Such is the outline of a Jife, which, in Mrs. Thomson's hands, is a mine of interest; from the first page to the last the allention is roused and sustained, and while we approve the manner, we still mure npplaud the spirit in which it is executed." — Literary Gazelle. "In all respects a most appropriate volume for the Cabinet Library. We shall take an opportunity in another notice, to give some of the many interesting passages in the volume lhat offer themselves for quotation." — N. Y. American. " Mrs. Thomson has written a very interesting book. It takes what we are inclined to think, a just, and at the same time, favorable view of Ralegh, and is occupied beside with many entertaining and illustrative anecdotes." — Craftsman. " Presents in a concise but succinct style the variety of incidents connected with the life of the distinguished subject of the memoir." — National Journal. "The book is unquestionably the best Life of Ralegh that has ever been written." — Album. " This is a piece of biography which combines the fascinations of romance with the deeper interest that attaches to historical narrative." — Southern I'atriot. ELEGANT LIBRARY EDITIONS OF THE FOLLOWING WORKS. WORKS OF JOANNA BAILLIE. COMPLETE IS ONE VOLUME, BvO. In the press. WORKS OF HENRY FIELDING. IN TWO VOLUMES BvO., WITH A PORTRAIT. WORKS OF TOBIAS SMOLLETT. IS TWO VOLUMES BVO., WITH A PORTRAIT. hi the press. SELECT SPEECHES OF THE RIGHT HONORABLE GEORGE CANNING. EDITED BY ROBERT WALSH, ESQ. WITH A BIOGRAPHICAL AND CRITICAL INTRODUCTION, BY THE EDITOR. M ONK VOLUME BtO. In the press. SELECT SPEECHES OF THE RIGHT HONORABLE WILLIAM HUSKISSON, AND OF THE RIGHT HONORABLE WILLIAM WINDHAM. EDITED BY ROBERT WALSH, ESQ. WITH A BIOGRAPHICAL AND CRITICAL INTRODUCTION, Bt THE EDITOR. liX ONE VOLUMK BVO. In the prex?. 



MEDICINE, SURGERY, &c. SURGICAL MEMOIRS of the CAMPAIGNS of RUSSIA, GERMANY, and FRANCE. Translated from the French of Baron Larrsy. In Svo. with plates. A MANUAL of MEDICAL JURISPRUDENCE, compiled from the best Medical ; and Legal Works; comprising an account of— l. The Ethics of the Medical Profession ; 11. Charters and Laws relative to the Faculty; and 111. AH Medico-legal Questions, with the latest Decisions: being an Analysis of a course of Lectures on Forensic Medicine. By Michael Ryan, M. D. Member of the Royal College of Physicians in London, &c. First American edition, with additions, by R. Eglerfield Griffith, M. D. In Svo. "There is not a fact of importance or value connected with the Science of which it treats, that is not o be found in its pages. The style is unambitious but dear and strong, and such as becomes a philosophic theme." — Monthly Review. " It is invaluable to Medical Practitionors, and may be consulted safely by the Legal Profession." — Weekly | Dispatch. DIRECTIONS for MAKING ANATOMICAL PREPARATIONS, formed on the basis of Pole, Marjolin, and Breschet, and including the new method of Mr. Swan : by Usher Parsons, M. D. Professor of Anatomy and Surgery. In 1 vol. Bvo. with plates. "It is compiled and prepared with judgment, end is the best and most economical companion the student can possess to aid him in the pursuit of this delightful department of his labors." — Host. Med. <$- Surg.Journ. Sept. 27, 1831. "This is unquestionably one of the most useful works on the preparation of Anatomical Specimens ever published. It should be in the hands of every lover of Anatomy ; and as attention now is more directed to the formation of museums, it will be found a very valuable book. Nothing is omitted that is important, and many new formulae are introduced, derived from the author's experience, and from rare books, which he has had the industry to collect." — N. Y. Medical Journal, Angus!, 1831. A PRACTICAL GUIDE to OPERATIONS on the TEETH, by James Swell, Dentist. In Bvo. with plates. PRINCIPLES of PHYSIOLOGICAL MEDICINE, including Physiology, Pathology, and Therapeutics, in the form of Propositions, and commentaries on those relating to Pathology, by F. J. V. Broussais. &c. ; translated by Isaac Hays, M. D. and R. E. Griffith, M. D. In Bvo. ELEMENTS of PHYSIOLOGY, by Robley Dunglison. In 2 vols. Svo. with numerous illustrations. (In the press.) PRINCIPLES of SURGERY, by John Syme, Professor of Surgery in' the University of Edinburgh. In Bvo. PRACTICAL REMARKS on the NATURE and TREATMENT of FRACTURES of tub TRUNK and EXTREMITIES; by Joseph Amesbury, Surgeon. In Bvo. with plates and wood-cuts. (In the press.) 

MISCELLANEOUS. GREEK and ENGLISH LEXICON. By D. Donnegan. Abridged for the use of schools. In 1 vol. royal 18mo. containing nearly 600 pages. This work is printing on a handsome distinct type, and will contain as ranch matter as many of the larger lexicons ; but owing to the form in which it is printed, will be sold at such price as to be within the reach of all students. It will offer more advantages to the young student than any other lexicon now in use. The vocabulary is more extensive and complete — comprising not only words found in the classics, but also such as are found in the writings of Hippocrates and the Greek Physicians. The meanings attached to words by the several writers are also given. Words are given in alphabetical order in every poetical and dialectic variety. The conjugation of verbs and flection of nouns are more complete than in other lexicons ; — the meanings of words fuller and more correct — there being first a primary and then a secondary meaning, each distinguished from the metaphorcial and idiomatieal. Phrases are also given when they note any peculiarity in signification. The etymology of words is only omitted where it is confused or disputed. There is nothing left out which the young student would find necessary in studying the Classics,, and which would enable him to understand the true meaning of a word. In short, in this work the essential advantages of a good Dictionary are combined with those of a good Grammar — advantages not found in any Greek and English lexicon now used. ELEMENTS of MECHANICS. By James Renwiok, Esq. Professor of Natural and Experimental Philosophy, Columbia College, N. Y. In Svo with numerous engravings. "We think this decidedly the best treatise on Mechanics, which has issued from the American press, that we have seen ; one, too, that is alike creditable to the writer, and to the sta^te of science in this conntry. — American Quarterly Review. TREATISE on CLOCK and WATCH-MAKING, Theoretical and Practical, by Thomas Reid, Edinburgh Honorary Member of the Worshipful Company of Clock- Makers, I,ondon. Royal Bvo. Illustrated by numerous plates. MILLWRIGHT and MILLEITS GUIDE. By Oliver Evans. New Edition, with additions and corrections, by the Professor of Mechanics in the Franklin Institute of Pennsylvania, and a description of an improved Merchant Flour-Mill, with engravings, by C. & O. Evans. GEOLOGICAL MANUAL. By H. T. Db la Beche. In Bvo, with numerous wood-cuts. "A work of first-rate importance in the science to which it relates, and which must henceforth take its place in the" library of every student in Geology.'" — Phil. Magazine. " Mr. De la Beche's Geological Manual is the first and best Work of the kind, and he has performed his task with a perfect knowledge of all that has been ascertained in Geology, and with considerable judgj raent and taste in the manner of doing it. So much | geological science was never before compressed in so [small a space." — Spectator. 



THE PEOPLE'S LIBRARY. " The editors and publishers should receive the thanks of the present generation, and the gratitude of posterity, for being the first to prepare in this language what deserves to be entitled not the ENCYCLOPAEDIA AMERICANA, but the people's library." — JV. Y. Courier and Enquirer. Just Published, by Carey Sf Lea, And sold in Philadelphia by E. L. Carey fy A. Hart ; in New-York by G. $¦ C.ty H. Carvill ; in Boston by Carter $¦ Hendee ; in Baltimore by E. J. Coale, § W. fy J. Neal ; in Washington by Thompson fy Homans ; in Richmond by J. H. Nash; in Savannah by W. T. Williams ; in Charleston by W. H. Berrett; in New-Orleans by W. M'Kean ; in Mobile by Odiorne fy Smith ; and by the principal booksellers throughout the Union. VOLUME 9,-COBTTAIJNING ABOUT 1,500 ARTICLES, (To be continued at intervals of three months,) OF THE ENCYCLOPAEDIA .AMERICANA: A POPULAR DICTIONARY OF ARTS, SCIENCES, LITERATURE, HISTORY, AND POLITICS, BROOGUCT BOWN TO THE PRESENT TIME, AND INCLUDING A. COPIOUS COLLECTION OF ORIGIXAL ARTICLES IX AMERICAN BIOGRAPHY: On the basis of the Seventh Edition of the German CONVERSATIONS-LEXICON. Edited by FRANCIS LIEBER, ASSISTED BY EDWARD WIGGLESWORTH and T. G. BRADFORD, Esq.rs. IN TWELVE LARGE VOLUMES, OCTAVO, PRICE TO SUBSCRIBERS, BOUND IN CLOTH, TWO DOLLARS AND A HALF EACH. EACH VOLUME CONTAINS BETWEEN 600 AND W0 PAGES. 

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" The variety of topics is of course vast, and they are treated in a manner which is at once so full of information and so interesting, that the work, instead of being merely referred to, might be regularly perused with as much pleasure as profit." — Baltimore American. " We view it as a publication worthy of the age and of the country, and cannot but believe the discrimination of our countrymen will sustain the publishers, and well reward them for this contribution to American Literature." — Baltimore Patriot. " It reflects the greatest credit on those who have been concerned in its production, and promises, in a variety of respects, to be the best as well as the most compendious dictionary of the arts, sciences, history, politics, biography, &c. which has yet bsen compiled. The style of the portion wa have read is terse and perspicuous; and it is really curious how so much scientific and other information could have been so satisfactorily communicated in such brief limits." — JV*. Y. Evening Post. "Those who can, by any honest modes of economy, reserve the sum of two dollars and fifty cents quarterly, from their family expenses, may pay for this work as fast as it is published; and we confidently believe that they will find at the end that they never purchased so much general, practical, useful information at so cheap a rate." —Journal of Education. " If the encouragement to the publishers should correspond with the testimony in favor of their enterprise, and the beautiful and fajtnful style of its execution, the hazard of the undertaking, bold as it was, will be well compensated ; and our libraries will be enriched by the most generally useful encyclopedic dictionary that has been offered to the readers of the English language. Full enough for the general scholar, and plain enough for every capacity, it is far more convenient, in every view and form, than its more expensive and ponderous predecessors."—American Farmer. "The high reputation of the contributors to this work, will not fail to insure it a favorable reception, and its own merits will do the rest." — Silliman's Journ. " The Encylopsedia Americana is a prodigiouί improvement upon all that has gone before it ; a thing for our country, as well as the country that gave it birth, to be proud of; an inexhaustible treasury of useful, pleasant, and famili ar learni iig on every possi ble subject, so arranged as to be speedily and safely referred to on emergency, as well as on deliberate inquiry; and better still, adapted to the understanding, and put within the reach of the multitude. * * * The Encyclopedia Americana is a work without which no library worthy of the name can hereafter be made up-"' — Yankee. ______ 



ENCYCLOPAEDIA AMERICANA. 

" The work will be a valuable possession to every family | or individual that can afford to purchase it ; and we take j pleasure, therefore, in extending the knowledge of its , merits." — National Intelligencer. " This work appears to improve as it issues from the i press. The number of able writers, who contribute ori- | ginal matter in all the departments of literature and sci- j ence is amply sufficient to give it celebrity and high character. To men engaged in the active pursuits of life — whose time is precious — this popular dictionary is a most i valuable and ready mode of reference. It embraces brief I views and sketches of all the late discoveries in science — 1 and the present condition of literature, politics, fee. &c. ' Every merchant's counting-room — every lawyer's library 3 — every mechanic — every fanner ought to possess a copy , of this useful and valuable work."— Courier. "From the specimen which has already been given, we ; have no hesitation in saying, that in regard to intelligence, skill, and faithful diligence, it is a work of the very highest order. We know of no similar publication that can bear any comparison with it for the rich variety of valuable information, which it condenses within so small a compass. It is free from all the narrowness of English prejudice, it contains many important and interesting details which can be found in no English production, and is a work which could be written by none but German scholars, more than two hundred of whom were employed in the original compilation." — Boston Observer. " This cannot but prove a valuable addition to the literature of the age."— Mcr. Advertiser. " The vast circulation this work has had in Europe, where it has already been reprinted in four or five languages, not to speak of the numerous German editions, of which seven have been published, speaks loudly in favor of its intrinsic merit, without which such a celebrity could never have been attained. To every man en"a< r ed in public business, who needs a correct and ample book of reference on various topics of science and letters, the Encyclopaedia Americana will be almost invaluable. ' To individuals obliged to go to situations whore books are I neither numerous nor easily procured, the rich contents of these twelve volumes will prove a mine which will amply repay its purchaser, and be with difficulty exhausted ; and we recommend it to their patronage in the full conviction of its worth. Indeed, it is difficult to say to what, class of readers such a book would not prove useful, nay, almost indispensable, since it combines a great amount of valuable matter in small compass, and at moderate expense, and is in every respect well suited to augment the reader's stock of ideas, and powers of conversation, without severely taxing time or fatiguina attention." — dm. Daily Advertiser. '¦The department of American Biography, a subject of which it should be disgraceful to be ignorant, to the degree that many are, is, in this work, a prominent feature, and has received the attention of one of the most indefatigable writers in this department of literature, which the present age can furnish." — Boston Courier. " According to the plan of Dr. Lieber, a desideratum will be supplied; the substance of contemporary knowledge will be brought within a small compass ;— and the character and uses of a manual will' be imparted to a kind of publication heretofore reserved, on strong shelves, for occasional reference. By those who understand the German language, the Conversation Lexicon is consulted ten times for one application to any English Encyclopaedia.''— National Gazette. "The volume now published is not only highly honorable to the taste, ability, and industry of its editors and publishers, but furnishes a proud sample of the accuracy and elegance with which the most elaborate and important literary enterprises may now be accomplished in our country. Of the manner in -which the editors have thus far completed their task, it is'impossible, in the course of a brief newspaper article, to speak with adequate justice " — Boston Bulletin. "It continues to be particularly rich in the departments of Biography and Natural History. When we look at the large mass of miscellaneous knowledge spread before the reader, in a form which has never been equalled for its condensation, and conveyed in a style that cannot be surpassed for propriety and perspicuity, we cannot but think that the American Encyclopaedia deserves a place in every collection, in which works of reference form a porlUon.'i Southern Patriot. " By far the best work of the kiad ever offered for gale in this country." — XJ. S. Oar.. 

More than half of the volumes of this work are now before the public, and the reception they have met with is the best evidence that the publishers have fulfilled the promises made at its outset. They have now only to promise, for the editors and themselves, that no exertion shall be spared to render the remaining volumes equal to those already published, and thus sustain the reputation it has acquired. The subscription is large, and increasing ; and in those quarters where its circulation is greatest, and where it is best known, there is a constantly increasing demand. The publishers invite the attention of those who may not already have possessed themselves of it, or may not have had an opportunity to become acquainted with its merits, to the following account of the original work, upon which it is based, and which is termed by the Edinburgh Review — THE WORLD-RENOWNED LEIPZIG CONVERSATIONSLEXICON. • It was intended to supply a want occasioned by the character of the age, in which the sciences, arts, trades, and the various forms of knowledge and of active life, had become so much extended and diversified, that no individual engaged in business could become well acquainted with all subjects of general interest; while the wide diffusion of information rendered such knowledge essential to the character of an accomplished man. This want, no existing works were adequate to supply. Books treating of particular branches, such as gazetteers, &c. were too confined in character ; while voluminous Encyclopaedias were too learned, scientific, and cumbrous, being usually elaborate treatises, requiring much study or previous acquaintance with the subject discussed. The conductors of the Conversation Lexicon endeavored | to select from every branch of knowledge what was 1 necessary to a well-informed mind, and to give popular views of the more abstruse branches of learning \ and science ; that their readers might not be incom\ moded, and deprived of pleasure or improvement, by ignorance of facts or expressions used in books or con¦ versation. Such a work must obviously be of great ; utility to every class of readers. It has been found > so much so in Germany, that it is met with every¦ where, among the learned, the lawyers, the military, 1 artists, merchants, mechanics, and men of all stations. _ The reader may judge how well it is adapted to its object, from the circumstance, that though it now consists of twelve volumes, seven editions, comprising [ about one hundred thousand copies, have been , printed in less than fifteen years. It has been translated into the Swedish, Danish and Dutch languages, | and a French translation is now preparing in Faris. In the preparation of the American edition, no ex, pense has been spared to secure the ablest assistance, t and the editors have been aided by many gentlemen , of distinguished ability. | The American Biography, which is very extensive, 1 has been furnished by Mr. Walsh, who has long paid particular attention to that branch of our literature, and from materials in the collection of which he has - been engaged for some years. For obvious reasons, 1 the notices of distinguished Americans are confined to deceased individuals : the European biogra,. phy contains notices of all distinguished living char-3 acters, as well as those of past times. f The articles on Zoology and iho various branches ' of Natural Science, and those on Chemistry and Mineralogy, have been prepared expressly for this . work by gentlemen distinguished in the several dei partments. I In relation to the Fine Arts, the work is exceedingly 1 rich. Great attention was given to this in the German work, and the Editors have been anxious to render it, , by the necessary additions, as perfect as possible. To gentlemen of the Bar, the work will bo peculiarly valuable, as in cases where legal subjects are t treated, an account is given of English, French, Gar' j man and American Law. 



CABINET CYCLOPJiDIAj CONDUCTED BY THE REV. DIONYSIUS LARDNER, LL.D. F.R. S. L. & E. M.R.I. A. F.L.S. F.Z.S. Hon.F.C.P.S. M. Ast. S. &c. &c. ASSISTED BY EMINENT LITERARY AND SCIENTIFIC MEN. Now publishing by Carey and Lea, and for sale by all Booksellers. 

This work will form a popular compendium of whatever is useful, instructive, and interesting, in the circle of human knowledge. A novel plan of publication and arrangement has been adopted, which presents peculiar advantages. Without fully detailing the method, a few of these advantages may be mentioned. Each volume will contain one or more subjects uninterrupted and unbroken, and will be accompanied by the corresponding plates or other appropriate illustrations. Facility of reference will be obtained without fetterinc the work by a continued alphabetical arrangement. A subscriber may omit particular volumes or sets of volumes, without disintegrating his series. Thus each purchaser may form from the "Cabinet" a Cyclopedia, more or less comprehensive, as may suit his means, taste, or Kofession. If a subscriber desire to discontinue the work at any stage of its publication, the volumes which he riay have received will not lose their value by separation "rom the rest of the work, since they will always either i>e complete in themselves, or may be made so at a trifling expense. The purchasers will never find their property in this work destroyed by the publication of a second edition. The arrangement is such that particular volumes may be re-edited or rewritten without disturbing the others. The " Cabinet Cyclopaedia. " will thus bo in a state of continual renovation, keeping pace with the never-ceasing improvements in knowledge, drawing within its circle from year to year whatever is new, and casting off whatever is obsolete, so as to form a constantly modernized Cyclopaedia. Such are a few of the advantages which the proprietors have to offer to the public, and which they pledge themselves to realize. Treatises on subjects which are technical and professional will be adapted, not so much to those who desire to attain a practical proficiency, as to those who seek that portion of information respecting such matters which is generally expected from well-educated persons. An interest will bs imparted to what is abstract by copious illustrations, and the sciences will be rendered attractive, by treating them with reference to the most familiar objects and occurrences. The unwieldly bulk of Encyclopedias, not less than the abstruse discussions which they contain, has hitherto consigned them to the library, as works of only occasional reference. The present work, from its portable form and popular style, will claim a place in the drawing-room and the boudoir. Forming in itself a Complete J.ibrary, affording an extensive and infinitely varied store of instruction and amusement, presenting just so much on every subject as those not professionally engaged in it require, convenient in size, attractive in form, elegant in illustrations, and most moderate in expense, the "Cabinet Cyolopjlddia" will, it is hoped, be found an object of paramount interest in every family. To tha heads of schools and all places of public education the proprietors trust that this work will particularly recommend itself. It seems scarcely necessary to add, that nothing will be admitted into the pages of the " CabinetCyclop.edia" which can have the most remote tendency to offend public or private morals. To enforce the cultivation of religion and the practice of virtue should be a principal object with all who undertake to inform the public mind ; but with the views just explained, the conductor of this work feels these considerations more especially pressed upon his attention. Parents and guardians may, therefore, rest assured that they will never find it necessary to place a volume of the "Cabinet" beyond the reach of their children or pupils. Considerable progress having been made in this work, the publishers wish to direct the attention of the public to the advantages by which it is distinguished from other similar monthly publications. It is not intended that the Cabinet Cyclopaedia shall form an interminable series, in which any work of 

interest which may present itself from time to time can claim a place. Its subjects are classified according to the usual divisions of literature, science, and art. Each division is distinctly traced out, and will consist of a determinate number of volumes. Although the precise extent of the work cannot be fixed with certainty, yet there is a limit which will not be exceeded ; and the subscribers may look forward to the possession, within a reasonable time, of a complete library of instruction, amusement, and general reference, in the regular form of a popular Cyclopaedia. The several classes of the work are — 1, NATURAL PHILOSOPHY; 2, The USEFUL and FINE ARTS ; 3, NATURAL HISTORY; 4, GEOGRAPHY; 5, POLITICS and MORALS ; 6, GENERAL LITERATURE and CRITICISM; 7, HISTORY; 8, BIOGRAPHY. In the above abstruse and technical departments of knowledge, an attempt has been made to convey to the reader a general acquaintance with these subjects, by the use of plain and familiar language, apjropriate and well-executed engravings, and copious examples and illustrations, taken from objects and events with which every one is acquainted. The proprietors formerly pledged themselves that no exertion should be spared to obtain the support of the most distinguished talent of the age. They trust that they have redeemed that pledge. Among the volumes already published in the literary department, no less than four have been the production of men who stand in the first rank of literary talent, — Sir James Mackintosh and Sir Walter Scott. In the scientific department, a work has been produced from the pen of Mr. Herschel, which has been pronounced by the highest living authority on subjects of general philosophy, to contain " the noblest observations on the value of knowledge which have been made since Bacon," and to be " the finest work of philosophical genius which this age has seen." The following is a selection from the lit-l of Contributors. The Right Honorable Sir JAMES MACKINTOSH, M. P. The Right Rev. The Lord Bishop of Cloyne. Sir WALTER SCOTT, Bart. JOHN FREDERICK WILLIAM HERSCHEL, THOMAS MOORE, Esq. >#? B. BIOT, Member of the French Institute. ROBERT SOUTHEY, Esq. Poet Laureate. The Baron CHARLES DUPIN, Member of the Royal Institute and Chamber of Deputies. THOMAS CAMPBELL, Esq. T. B. MACAULEY v Esq. M. P. DAVID BREWSTER, LL.D. J. C. L. SISMONDI, of Geneva. Capt. HENRY KATER, Vice President of the. Royal Society. The ASTRONOMER ROYAL. DA VIES GILBERT, Esq. M. P. S. T. COLERIDGE, Esq. JAMES MONTGOMERY, Esq. The Right Hon. T. P. COURTENAY, M.P. J. J. BERZELIUS, of Stockholm, F. R. S., &c. The Rev. G. R. GLEIG. T. PHILLIPS, Esq. Prof, of Painting, R. A. Rev. C. THIRLWALL, Fellow of Trinity College, Cambridge. ANDREW URE, M. D. F. R. S., &c. &c. &c. 



DR. LARBNER'S CABINET CYCLOPiEDIA. 

VOLUMES PUBLISHED. I. IL— HISTORY of SCOTLAND. By Sir Walter Scott. 111. VI.— HISTORY of ENGLAND. By Sir James Mackintosh. In 8 Vols. Vols. I. and 11. IV— OUTLINES of HISTORY. V— HISTORY of the NETHERLANDS. By T. C. Grattan^ Esq. VII. VIII. XII.— HISTORY of FRANCE. By Eyre Evans Crowe. In 3 Vols. IX.— MECHANICS. By Capt. Kater and Dr. Lardner. X.— A PRELIMINARY DISCOURSE on the OBJECTS, ADVANTAGES, and PLEASURES of the STUDY of NATURAL PHILOSOPHY. In 1 Vol. By J. F. W. Herschel, Esq. XL— BIOGRAPHY of EMINENT BRITISH STATESMEN. XIII.— HYDROSTATICS and PNEUMATICS. By Dr. Lardner. XIV.— HISTORY of the PROGRESS and PRESENT SITUATION of the SILK MANUFACTURE. XV.— HISTORY of the ITALIAN REPUBLICS. By J. C. L. Sismondi. XVI. XVII. XVIII.— HISTORY of MARITIME and INLAND DISCOVERY. In 3 vols. VOLCMES IK IMMEDIATE: PSEPAKA" TIOW. HISTORY of ENGLAND. Vol. 111. HISTORY of the PROGRESS and PRESENT STATE of the IRON MANUFACTURE. LIVES of EMINENT BRITISH LAWYERS. In 1 Vol. By H. Roscoe. Esq. The HISTORY of the WESTERN WORLD. In 4 Vols. Vol. I. The UNITED STATES of AMERICA. Two volumes of this work, nearly ready, will complete the History of the United States to the present time. The two remaining volumes will be devoted to South America and the West India Islands. A HISTORY of IRELAND, to the UNION. In 2 Vols. By T. Moore, Esq. A PRELIMINARY DISCOURSE on the USEFUL ARTS and MANUFACTURES. By the Baron Charles Dumn, Member of the Institute of France and of the Chamber of Deputies. A HISTORY of the MOORS. In 3 Vols. By Robert SOUTKEY, Esq. LIVES of the MOST EMINENT LITERARY MEN of ALL NATIONS. In 8 Vols. By Scott, SOUTHEY, MoOItE, MACKINTOSH, MONTGOMERY, Cunningham, and a!! the principal Literary«|Ki(i Scientific Confiri-hniors to the Cyclopaedia. A TREATISE oa ASTRONOMY. By J. F. W. Herschel, Esq. GEOGRAPHY. In 4 Vols. By W. Cooley, Esq. author of the " History of Maritime Discovery." LIVES Ob- thk MOST DISTINGUISHED BRITISH NAVAL COMMANDERS. By R. Southey, Esq. LIVES of the MOST DISTINGUISHED BRITISH MILITARY COMMANDERS. By the Rev. G. R. Gleig. A TREATISE on OPTICS. By David Brew- STER. The HISTORY of GREECE. In 3 Vols. By the Rev. C. Thirlwai.t,. LIVES of EMINENT BRITISH ARTISTS. By W. Y. Otley, Esq. and T. Phillips, R. A. Professor of Painting to the Royal Academy. A TREATISE on ELECTRICITY and MAGNETISM. By M. Biot, Member of tho French Institute. 

" BOOKS THAT YOU MAY CARRY TO THE FIRE, AND HOLD READILY IN YOUR HAND, ARE THE MOST USEFUL AFTER ALL. A MAN WILL OFTEN LOOK AT THEM, AND BE : 1 TEMPTED TO GO ON, WHEN HE WOULD HAVE BEEN FRIOHTENED AT BOOKS OF A LARGER SIZE, AND OF A 3 MORE ERUDITE APPEARANCE." — Dr. Johnson. "We advisedly call the Cabinet Cyclopaedia a great undertaking, because we consider, that in its effects on • the tone and habits of thought of what is known by the; phrase, ' the reading public,' it will be, if carried through j in the spirit of its projection and commencement, one of the most invaluable productions of modern literature. * * " But these advantages, eminent as they undoubtedly " are, are not the sole nor the chief recommendations of the Cabinet Cyclopaedia. Neither is it on the extreme - cheapness of the publication, nor the federal independence f __jf W e may so speak— of its several volumes, that we l rest our prediction of its influence on the tone of thinking of the present, and on the literature of the next gen- I eration— but on the promise, amounting almost to a moral certainty, of the great excellence of its execution. A multitude of persons eminent in literature and science in the ' United Kingdom are employed in this undertaking; ana,, indeed, no others should be employed in it ; for it is a truth - that the profound and practised writer alone is capable of - furnishing a ' popular compendium.' " What parent or guardian that throws his eye over the list of its contributors but must be rejoiced by meeting ' the names of those who are in themselves a guarantee , of intellectual and moral excellence f"— Literary Gazette. ' J " The plan of the work appears well adapted to the purpose it is proposed to fulfil — that of supplying a series of publications, embracing the whole range of literature and science, in a popular and portable form ; while the excellence of the execution is guarantied by the judgment displayed in the selection of writers. The list of authors employed in thi3 ambitious undertaking comprises some of the most eminent men of the present age."— Atlas. „ " The Cyclopaedia, when complete, will farm a valuable work of reference, as well as a most entertaining and instructive library. It is an essential principle in every part l of it, that it should be clear and easily understood, and that an attempt should everywhere be made to unite ! accurate information with an agreeable manner of conveying it. It is an experiment to try how much science may be taught with little crabbed or technical language, and how far the philosophical and poetical qualities of 1 history may be preserved in its more condensed state. It - possesses also the most indispensable of all the qualities 1 of a work intended for general instruction — that of cheapi ness. Whatever the plan might be, it was evident that the grand difficulty of Dr. Lardner was to unite a body > of writers in its execution, whose character or works af* forded the most probable hope that they were fitted for n task of which the peculiarity, the novelty, and even the J prevalent relish for such writings greatly enhance the flif- < r iiculty. We do not believe, that in the list of contribu> tors, there is one name of which the enlightened part of the public would desire the exclusion. "In science, the list is not less promising. The names of the President, Vice-Presidents, and most distinguished r Fellows of the Royal Society, are contained in it. A treatise on astronomy, by Herschel ; on optics, by Brevvs> ter; and on mechanics, by Lardner; need bo only recom, mended by the subjects and the writers. An eminent I Prelate, of" the first rank in science, has undertaken a noble subject which happily combines philosophy with religion. Twelve of the most distinguished naturalists of the age, Fellows of tho Linnxan and Zoological Societies, are preparing a course of natural history. Others ¦ not less eminent in literature and science, whose names it is not needful yet to mention, have shown symptoms of an '. ambition to take a place among such fellow-laborers." — . Times, " The topics, as may be supposed, are both judiciously selected and treated with ability. To general readers, and as part of a family library, the volumes already pub lished possess great recommendations. For the external " beauties of good printing and paper they merit equal commendation. — Bait. American. i " The uniform neatness of these volumes, their very moderate price, and the quantity of information which they contain, drawn from the best and most attractive . sources, have given them deserved celebrity, and no one who desires to possess such information, should hesitate a moment to add them to his library." — Fed. Gazette. "This excellent work continues to increase in public favor, and to receive fresh accessions of force to its corps of contributors." — Lit. Gazette. 



LARDNER'S CABINET CYCLOPEDIA. 

"OF THE MANY WORKS WHICH HAVE BEEN LATELY PUB- H LISHED IN IMITATION, OR ON THE PLAN ADOPTED BY THE SOCIETY FOR THE DIFFUSION OF USEFUL KNOWLEDGE, DR. LARDNER'S CYCLOPAEDIA 13 BY MUCH THE MOST VALUABLE, AND THE MOST RECOMMENDED BY DISTINGUISHED n . c ASSISTANCE, SCIENTIFIC AND LITERARY." sv Edinburgh Review. sa bii HISTORY OF EBfCSiAKO, By Sir James g", Mackintosh. In 8 Vols. Two Vols. pnl>» eh Hslicd. of " [n the first volume of Sir James Mackintosh's His- M tory of England, we find enough to warrant the antici- inn pations of the public, that a calm and luminous philoao- to phy will dift'usu itself over the long narrativo of our Brit- uj ish History." — Edinburgh Review. an "In this volume Sir James Mackintosh fully developes fcr those groat powers, for the possession of which the public vis have long given him credit. The result is the ablest com- ov mentary that has yet appeared in our language upon some bii of the most important circumstances of English History." of — Atlas. " Worthy in the method, style, and reflections, of the author's high reputation. We were particularly pleased „ with his high vein of philosophical sentiment, and his occasional survey of contemporary annals."-— National Gazette. __ " If talenis of the highest order, long experience in politics, and years of application to the study of history and the collection of information, can command superiority in a historian, Sir James Mackintosh may, without rcacih:g this work, be said to have produced the best history of this country. A perusal of the work will prove j that those who anticipated a superior production, have mi j not reckoned in vain on the high qualifications of the I author." — Courier. w j " Our anticipations of this volume were certainly very M 9 highly raised, and unlike such anticipations in general, 1 they have not been disappointed. A philosophical spirit, 9 a nervous style, and a full knowledge of the subject, ac- cc I quired by considerable, research into the works of pre- p f I ceding chroniclers and historians, eminently distinguish e f I this popular abridgment, and cannot fail to recommend it pc §to universal approbation. In continuing his work as he g I has begun, Sir James Mackintosh will confer a great bene-1 fit on his country."— Lond. Lit. Gazette. cc § "Of its general merits, and its permanent value, it is 0 | I impossible to speak, without the highest commendation, i\ I and after a careful and attentive perusal of the two vol- cl I times which have been published, we are enabled to de- I claro that, so far, Sir James Mackintosh has performed I the duty to which he was assigned, with all the ability j. ( 1 that was to be expected from his great previous attain- t j I ments, his laborious industry in investigation, his excel- h I lent judgment, his superior talents, and his honorable a 8 principles." — Inquirer. a " We shall probably extract the whole of his view of tlm reformation, merely to show how that important topic lias been handled by so able and philosophical a writer, professing Protestantism. — National Gazette. "The talents of Sir James Mackintosh, are so justly and t deeply respected, that a strong interest is necessarily excited with regard to any work which such a distinguished jvriter may think fit to undertake. In the present instance, as in all others, our expectations are fully gratified."— Gentleman's Magazine, " The second volume of the History of England, form- I ing the sixth of Carey & Lea's Cabinet Cyclopaedia, has I been sent abroad, and entirely sustains the reputation of 1 its predecessors. The various factions and dissensions, 1 the important trials and battles, which render this period i so conspicuous in the page of history, are all related with < I great clearness and masterly power."— Boston Traveller. I _ _ i 1 BIOGRAPHY OF BRITISH STATESMEN?. ! containing the laves of Sir Thonnas More, Carainal Wolsey, Archhishop Crwwner, and I,ora Bwrlcigh. " A very delightful volume, and on a subject likely to I incrcanc in interest as it proceeds. * * * We cordially I commend the work both for its design and execution. — 1 Lond. Lit. Gazette. 

HISTORY OF gcOTLANO. By Sir Walter Scott. In 3 Vols. " The History of Scotland, by Sir Walter Scott, we do I not hesitate to declare, will be, if possible, more extensively read, than the most popular work of fiction, by the same prolific author, and for this obvious reason: it combines much of the brilliant coloring of the Ivanhoe pictures of by-gone manners, and all the graceful facility of style and picturesqueness of description of his other charming romances, with a minute fidelity to the fuet3 of history, and a searching scrutiny into their authenticity ami relative value, which might put to the blush Mr. Hume and other professed historians. Such is the magic charm of Sir Walter Scott's pen, it has only to touch the simplest incident of every-day life, and it starts up invested with all the interest of a scene of romance ; and yet such is liis fidelity to the text of nature, that the knights, and serfs, and collared fools with whom his inventive genius has peopled so many volumes, are regarded by us as not more creations of fancy, but as real flesh and blood existences, with all the virtues, feelings and errors of commonplace humanity." — Lit. Gazetle- HISTOKY OF FRAKECE.. By Eyre Evans Crowe. la 3 -vois» HISTORY OF FRANCE, from the- Kestox-tv tion of tlie Botoi-Imhis^ to the Revolution of 1830. By T. B. BEacanTay, Esq. 81. P. Nearly rea«Jy.-" The style is concise and clear; and events are summed up with much vigor and originality." — Lit. Gazette. " His history of France is worthy to figure with the works of his associates, the best of Uieir day, Scott and Mackintosh."— Monthly Mag. " For such a task Mr. Crowe is eminently qualified. At a glance, as it were, his eye takes in the theatre of centuries. His style is neat, clear, and pithy; and his power of condensation enables him to say much, and effectively, in a few words, to present a distinct and perfect picture in a narrowly circumscribed space." — La Belle Assemblee. " The style is neat and condensed ; the thoughts and conclusions sound and just. The necessary conciseness of the narrative is unaccompanied by any baldness ; on the contrary, it is spirited and engaging." — Bait. American. "To compress the history of a great nation, during a period of thirteen hundred years, into three volumes, and to preserve sufficient distinctness as well as interest in the narrative, to enable and induce the reader to possesa himself clearly of all the leading incidents, is a task by no means easily executed. It has, nevertheless, been well accomplished in this instance."— JV. Y. American. f "Written with spirit and taste."— U. S. Gazette. "Could we but persuade our young friends to give ' these volumes a careful perusal, we should feel assured of their grateful acknowledgments of profit and pleas-1 ute."— JV". Y. Mirror. \ "At once concise and entertaining."— Saturday Bui letin. THE HISTORY OF THE BfETHERIiAKDS, s to the Battle of Waterloo. By T. CV Gratlf tan. rt "It is but justice to Mr. Grattan to say that he hag h executed his laborious task with much industry and proportionate effect. Undisfigured by pompous nothingness, and without any of the affectation of philosophical profundity his style is simple, light, and fresh— perspicuous, smooth,' and harmonious."— iff Belle Assemblee. ' " Never did work appear at a more fortunate period. '* The volume before us is a compressed but clear and im"» partial narrative"— Lit.. Gaz. " A long residence in the country, and a ready access to o libraries and archives, have furnished Mr. Grattan with iy materials which he has arranged with skill, and out of — which he has produced a most interesting volume."*— Gent. Mag. 



GARDNER'S CABINET CYCLOPAEDIA. "It is not easy to devise a cure for such a state of thing 9 (the declining taste for science;) but the most obvious remedy is to provide the educated classes with a series of works on popular and practical science, freed from mathematical symbols and technical terms, written in simple and perspicuous language, and illustrated by facts and experiments, which are level to the capacity OF ordinary minds."— Quarterly Reviom. PRELIMINARY DISCOURSE ON THE OB- j JECTS, ADVANTAGES, AND PLEAS- j URES OF THE STUDY OS 1 NATURAL j FSSILO SOPHY. By 3. T. W. Herscliel, j A. M. late Fellow of St. Jofon»s College, j CanVbriclge. "Without disparaging any other of the many interesting and instructive volumes issued in the form of cabinet and family libraries, it is, perhaps, not too much to place at the head of the list, for extent and variety of condensed information, Mr. Herchel's discourse of Natural Philosophy in Dr. Gardner's Cyclopaedia." — Christian Observer. " The finest work of philosophical genius which this age has seen." — Mackintosh's England. " By far the most delightful book to which the existing competition between literary rivals of great talent and enterprise has given rise." — Monthly Review. I " Mr. Herscnel's delightful volume. * * * We find scattered through the work instances of vivid and happy I illustration, where the fancy is usefully called into action, j so as sometimes to remind us of the splendid pictures i which crowd upon us in the style of Bacon." — Quarterly j Review. " It is the most exciting volume of the kind we ever met with."— Monthly Magazine. " One of the most instructive and delightful books we have ever perused."' — V. S. Journal. A TREATISE ON MECHANICS. By Capt. Kaier, saaA tlie Rev. Rionysiiis Larches-. "With «.uin.crois.s engravings. "A work which contains an uncommon amount of useful information, exhibited in a plain arid very intelligible form." — Olmsted's JVat. Philosophy. "This volume has been lately published in England, as a part of Dr. Lardner's Cabinet Cyclopaedia, and has received the unsolicited approbation of the most eminent men of science, and the most discriminating journals and reviews, in the British metropolis. — It is written in a popular and in :elligi'ole style, entirely free from mathematical symbols, and disencumbered as far as possible of technical phrases. 1 ' — Boston Traveller. " Admirable in development and clear in principles, and especially felicitous in illustration from familiar subjects. — Monthly Mag. "Though replete with philosophical information of the highest order in mechanics, adapted to ordinary capacities in a way to render it at once intelligible and popular."— Lit. GaseUe. " A work of great merit, full of valuable information, not only to the practical mechanic, but to the man of science. — JV. Y. Courier and Enquirer. A TREATISE ON HYBROSTATICS AND PNEUMATICS. By tlie Rev. D. Lar&ncr. Witli num.cro'us engravings. " It fully sustains the favorable opinion we have already expressed as to this valuable compendium of modern science. — Lit. Gazette. " Dr. Lardner has made a good use of his acquaintance with the familiar facts which illustrate the principles of science." — Monthly Magazine. "It is written with a full knowledge of the subject, and in a popular style, abounding in practical illnstra- i tions of the abstruse operations of these imporant sciences. — U. S. Journal. {'¦ 

CABINET OF AMERICAN HISTORY. BY T. F. GORDON. "Volumes published* I. 11. HISTORY of the SPANISH DISCOVERIES prior to the year 1520. To fee succeeded. T»y 111. IV. V. HISTORY of AN AHUAC, or MEXICO, from its discovery to the present time. In 3 vols. ' VI. VII. HISTORY of PERU. In 2 vols. ; VIII. IX. HIST ORY of BRAZIL. In 2 vols. &c. &c. | Under this comprehensive title, it is proposed to | publish a General History of America, divided in'o jjarts making together a continuous whole ; yet each, having an integral form, adapted for separate publication. Each portion will be brought down to the period at which it shall be written, and will contain a popular description of the geology, climate and productions, and the civil history of the country to which it relates. No work of this general nature has been pnblishec in the English language. The work of Dr. Robertson is rather a philosophical essay on American history than an historical narrative ; and though originally designed to embrace the whole of the American con tinent, it remains unfinished. It is written also will a bias unfavorable to America and its productions, ii incorrect in many important particulars, and is too much abstracted for popular use. This void in literature might have been proper!} filled by the writers of Spain, Portugal, France, 6i England, but has been supplied for Europe, in a measure, by an Italian, the Cavalier Campagnoni, oi whose meritorious labor much use will be made it the proposed enterprise. The volumes herewith presented, may be deemec introductory to the whole work, since they narrate the history of the discovery of the three great portions of America. In the prosecution of the subject, the existing political divisions will be pursued and connected with former ones, by proper explanations; and where due regard for unity does not forbid, the chronological order will be preserved. Thus, the next succeeding part of the work, now advanced in preparation, will contain thehistoiy of Anahuac, or Mexico: including its ancient annals, an account of its subjugation, and the policy of its conquerors, of its late ¦ revolutions, and of its present constituent states. In the same manner will be treated Central America, Peru, Chili, Bolivia, the United Provinces of La Piata, Brazil, and Colombia. Due attention will also be given to the Independent Indian nations of South America. The history of the remainder of the country will be embraced by the following divisions : — I.. Russian ; 2. British; 3. Spanish; 4. French; s.Danish;. Danish; 6. Dutch America; and 7, the United States and their dependencies. In treating the last division, a separate volume will be appropriated to each State and Territory, the history of which may require it, and " The History of the United Slates" will be confined to the evenis of the Revolution and the operations of the general government. A survey having been thus made of the whole Western Hemisphere, the concluding volume will contain the history of the Indian races, particularly those of the northern part of the continent, with a critical examination of the theories relating to the original peopling of America. The general title of the work is sufficiently comprehensive to include a biography of distinguished Americans, and others connected with American history; and should the public support warrant it, "An j American Biography" may also be published under [it, in a cheap and popular form. 





CABINET LIBRARY, 

No. I.— NARRATIVE OP THE LATE ' WAR IN GERMANY AND FRANCE. IS! By the Marquess of Londonderry. With mi a Map. th .' No. 2.— JOURNAL of a NATURALIST, £ with plates. lai No. 3.— AUTOBIOGRAPHY of SIR WAL- m TER SCOTT. With a portrait be No. 4.— MEMOIRS of SIR WALTER RA- J LEGH. By Mrs. A. T. Thomson. With a portrait. of No. S.— LIFE of BELISARIUS. By Lord m Mahon. ?g No. 6.— MILITARY MEMOIRS of the DUKE of WELLINGTON. By Capt. d. Moyle Sherer. With a portrait. No. 7.— LETTERS to a YOUNG NATURALrST on the STUDY of NATURE » and NATURAL THEOLOGY. By J. L. si Drummond, M. D. With numerous engravings. & IN PREPARATION. i LIFE of PETRARCH. By Thomas Moore. {] CLEANINGS in NATURAL HISTORY, being a Companion to the Journal of a Nat- ll uralist. „ " The Cabinet Library bids fair to be a series of great value, and is recommended to public and private libraries, f, to professional men, and miscellaneous readers generally. It is beautifully printed, and furnished at a price which will place it within the reach of all classes of society." — i American Traveller. i " The series of instructive, and, in their original form, B expensive works, which these enterprising publishers are now issuing under the title of the " Cabinet Library," is a fountain of useful, and almost universal knowledge ; r the advantages of which, in forming the opinions, tastes, ¦ and manners of that portion of society, to which this varied information is yet new, cannot be too highly estimated." — National Journal. " Messrs Carey and Lea have commenced a series o ( Duplications under the above title, which are to appear monthly and which seem likely, from the specimen before us to acquire a high degree of popularity, and to afford t a mass of various information and rich entertainment, at once eminently useful and strongly attractive. The i mechanical execution is fine, the paper and typography ( excellent." — Nashville Banner. ; — — - MEMOIRS OF THE LIFE OF SIR WAIi- , TER RALEGH, with some Account of the . Period in which he lived. By MRS. A. T. THOMSON. With a Portrait. "Such is the outline of a life, which, in Mrs. Thorn- I son's hands, is a mine of interest; from the first page to . the last the attention is roused and sustained, and while we approve the manner, we still more applaud the spirit in which it is executed."— Literary Gazette. JOURNAL OF A NATURALIST. With Plates. Plants, trees, and stones we note ; Birds, insects, beasts, and rural things. "We a»ain most strongly recommend this little unpretending volume to the attention of every lover of nature, 

and more particularly of our country readers. It will induce them, we are sure, to examine more closely than they have been accustomed to do, into the objects of animated nature, and such examination will prove one of the most innocent, and the most satisfactory sources of gratification and amusement. It is a book that ought to find its way into every rural drawing-room in the kingdom, and one that may safely be placed in every lady's boudoir, be her rank and station in life what they may."' — Quarterly Review, No. LXXVIII. "We think that there are few readers who will not be delighted (we are certain all will be instructed) by the ' Journal of a Naturalist.' " — Monthly Review. " This is a most delightful book on the most delightful of all studies. We are acquainted with no previous work which bears any resemblance to this, except ' White's History of Selborne,' the most fascinating piece of rural writing and sound English philosophy that ever issued from the press." — Athenaeum. " The author of the volume now before us, lias produced one of the most charming volumes we remember to have seen for a long time." — New Monthly Magazine, June, 1829. " A delightful volume— perhaps the most so— nor less instructive and amusing — given to Natural History since White's Selborne."— Blackicood's Magazine. " The Journal of a Naturalist, being the second number of Carey and Lea's beautiful edition of the Cabinet Library, is the best treatise on subjects connected with this train of thought, that we have for a long time perused, and we are not at all surprised that it should have received so high and flattering encomiums from the English press generally." — Boston Traveller. "Furnishing an interesting and familiar account of the various objects of animated nature, but calculated to afford both instruction and entertainment."—Nashville Banner. " One of the most agreeable works of its kind in the language." — Courier de la Louisiane. " It abounds with numerous and curious facts, pleasing illustrations of the secret operations and economy of nature, and satisfactory displays of the power, wisdom and goodness, of the great Creator." — Philad. Album. THE MARQUESS OF LOKBONDERRY'S NARRATIVE OF THE LATE "WAR IN GERMANY AND FRANCE. Witli a Map. " No history of the events to which it relates can be correct without reference to its statements."— Literary Gazette. "The events detailed in this volume cannot fail to excite an intense interest."— Dublin Literary Gazette. "The only connected and well authenticated account we have of ths spirit-stirring scenes which preceded the fall of Napoleon. It introduces us into the cabinets and presence of the allied monarchs. We observe the secret policy of each individual : we see the course pursued by the wily Bernadotte, the temporizing Metternich, and the ambitious Alexander. The work deserves a place in every historical library."— Globe. "We hail with pleasure the appearance of the first volume of the Cabinet Library." " The author had singular facilities for obtaining the materials of his work, and he has introduced us to the movements and measures of cabinets which have hitherto been hidden from the world."— American Traveller. "Tt may be regarded as the most authentic of all the publications which profess to Retail the events of the mportant campaigns, terminating with that which secured the capture of the French metropolis."-.^. Journal. " It is in fact the only authentic account of the memorable events to which it refers."— Nashville Banner. " The work deserves a place in every library."—Philadelphia Album. 



MISCELLANEOUS, 

A MEMOIR OF SEBASTIAN CABOT, with a Review of the History of Maritime Discovery. Illustrated l>y Documents from the Rolls, mow first published. " Put forth in the most unpretending manner, and without a name, this work is of paramount importance to the subjects of which it treats." — Literary Gazette. " The author has corrected many grave errors, and in general given us a clearer insight into transactions of considerable national interest." — Ib. " Will it not," says the author, with just astonishment, "be deemed almost incredible, that the very instrument in the Records of England, which recites the Great Discovery, and plainly contemplates a scheme of Colonization, should, up to this moment, have been treated by her own writers as that which first gave permission to go forth and explore ?" — Ib. "We must return to investigate several collateral matters which we think deserving of more space than we can this week bestow. Meanwhile we recommend the work as one of great value and interest." — Ib. " The general reader, as well as the navigator and the curious, will derive pleasure and information from this well- written production." — Courier. "A specimen of honest inquiry. It is quite frightful to think of the number of the inaccuracies it exposes: we shall cease to have confidence in books." "The investigation of truth is not the fashion of these times. But every sincere inquirer after historical accuracy ought to purchase the book as a curiosity : more false assertions and inaccurate statements were never exposed in the same compass. It has given us a lesson we shall never forget, and hope to profit by." — Spectator. HISTORY OF THE HORfHMEN, OR JfOEMASS AND DANES ; from the earliest tlnies to the Conquest of England »y William, of Normandy. By Henry Wheaton, Member of the Scandinavian and Icelandic Literary Societies of Copen3ia» gen. » This work embraces the great leading features of Scandinavian history, commencing with the heroic age, and advancing from the earliest dawn of civilization to the introduction of Christianity into the North — its long and bloody strife with Paganism — the discovery and colonization of Iceland, Greenland, and North America, by the Norwegian navigators, before the time of Columbus — the military and maritime expeditions of the Northmen — their early intercourse of commerce and war with Constantinople and the Eastern empire — the establishment of a. Norman state in Prance, under Rollo, and the subjugation of England, first by the Danes, under Canute the Great, and subsequently by the Normans, under Duke William, the founder of the English monarchy. It also contains an account of the mythology and literature of the ancient North— the Icelandic language prevailing all over the Scandinavian countries until the formation of the present living tongues of Sweden and Denmark — an analysis of the Eddas, Sagas, and various chronicles and songs relating to the Northern deities and heroes, constituting the original materials from which the work has been principally composed. It is intended to illustrate the history of France and England during the middle ages, and at the same time to serve as an introduction to the modern history of Denmark, Norway, and Sweden. LETTERS TO A YOUNG NATURALIST, on the Study of Nature, and Natural Theology. By JAMES L. DRUMMOND, M. D. &c With numerous engravings. "We know of no work, compressed within the same limits, which seems so happily calculated to generate in a young mind, and to renovate in the old, an ardent love of nature in all her forms."— Monthly Review. "We cannot but eulogize, in the warmest manner, the endeavor, and we must say the successful endeavor, of a man of science, like Dr. Drummond, to bring down so exalted a pursuit to the level of youthful faculties, and to cultivate a taste at once so useful, virtuous, and refined." — JVc«7 Monthly Mag. 

PRIVATE MEMOIRS of NAPOLEON BONAPARTE, from the French of M. Fauvelet de Bourrienne, Private Secretary to the Emperor. In 2 vols. Bvo. The peculiar advantages of position in regard to his present subject, solely enjoyed by M. de Bourrienne, his literary accomplishments and moral qualifications, have already obtained for these memoirs the first rank in contemporary and authentic history. In France, where they had been for years expected with anxiety, and where, since the revolution, no work connected with that period or its consequent events has created so great a sensation, the volumes of Bourrienne have, from the first, been accepted as the only trustworthy exhibition of the private life and political principles of Napoleon. " We know from the best political authority now living in England, that the writer's accounts are perfectly corroborated by facts." — Lit. Gaz, ANNALS of the PENINSULAR CAMPAIGNS. By the Author of Cyril Thornton. In 3 vols. 12mo. with plates. The HISTORY OF LOUISIANA, particularly of the Cession of that Colony to the United States of North America ; with an Introductory Essay on the Constitution and Government of the United States, by M. de Marbois, Peer of France, translated from the French by an American Citizen. In 1 vol. Bvo. The PERSIAN ADVENTURER. By the Author of the Kuzzilbash. In 2 vols. 12mo. " It is full of glowing descriptions of Eastern life." — Courier. MORALS of PLEASURE, Illustrated by Stories designed for Young Persons, in 1 vol. 12mo. " The style of the stories is no less remarkable for its ease and gracefulness, than for the delicacy of its humor, and its beautiful and at times affecting simplicity. A lady must have written it — for it is from the bosom of woman alone, that such tenderness of feeling and such delicacy of sentiment — such sweet lessons of morality — such deep and pure streams of virtue and piety, gush forth to cleanse the juvenile mind from the grosser impurities of our nature, and prepare the young for lives of usefulness here, and happiness hereafter." — JV. Y. Com. Advertiser. CLARENCE ; a Tale of our own Times. By the Author of Redwood, Hope Leslie, &c. In 2 vols. AMERICAN QUARTERLY REVIEW, published on the first of March, June, September, and December. Price $5 per arm. *** A few complete Sets of the Work are still for sale. CONSIDERATIONS ON THE CURRENCY AND BANKING SYSTEM OF THE UNITED STATES. By Albert Galla- TIN. SONGS of the AFFECTIONS. By Felicia Hemans. Royal 18mo. 



SCOTT, COOPER, iLWB WASHSffOTOIf nTOWG. 

BY SIR WALTER SCOTT. COUNT ROBERT OF PARIS, a Tale of the Lower Empire. By the Author of Waverley. In 3 vols. "The reader will at once perceive that the subject the characters and the scenes of action, could not have been better selected for the display of the variouί and unequalled powers of the author. All that is glorious in arts and splendid in arms— the glitter of armor, the pomp of war, and the splendor of chivalry — the gorgeous scenery of the Bosphorus— the ruins of Byzantium— the magnificence of the Grecian capital, and the richness and voluptuousness of the imperial court, will rise before the reader in a succession of beautiful and dazzling images."—Commercial Advertiser. AUTOBIOGRAPHY OF SIR WALTER SCOTT. With a Portrait. " This is a delightful volume, which cannot fail to satisfy every reader, and of which the contents ought to be known to all those who would be deemed conversant with the literature of our era."— National Gazette. HISTORY OF SCOTLAND. In 2 vols. " The History of Scotland, by Sir Walter Scott, we do not hesitate to declare, will be, if possible, more extensively read, than the most popular work of fiction, by the same prolific author, and for this obvious reason: it combines much of the brilliant coloring of the Ivanhoe pictures of bygone manners, and all the graceful facility of style and picturesqueness of description of his other charming romances, with a minute fidelity to the facts of history, and a searching scrutiny into their authenticity and relative value, which misht put to the blush Mr. Hume and other professed historians. Such is the magic charm of Sir Walter Scott's pen, it has only to touch the simplest incident of every-day life, and it starts up invested with all the interest of a scene of romance ; and yet such is his fidelity to the text of nature, that the knights, and serfs, and collared fools with whom his inventive genius has peopled so many volumes, are regarded by us as not mere creations of fancy, but as real flesh and blood existences, with all the virtues, feelings and errors of common-place humanity." — Lit. Gazette. TALES of a GRANDFATHER, being a series from French History. By the Author of Waverley. BY MR. COOPER. THE BRAVO. By the Author of the Spy, Pilot, &c. In 2 vols. The WATER- WITCH, or the SKIMMER of the SEAS. In 2 vols. " We have no hesitation in classing this among the most powerful of the romances of our countryman." — U. Stales Gazette. " We could ont break from the volumes, and may predict that they will expite the same interest in the minds of almost every reader. The concluding chapters produce intense emotion." — National Gazette. New Editions of the following Works by the same Author. NOTIONS OF THE AMERICANS, by a Travelling Bachelor, 2 vols. 12mo. The WEPT OF WISH-TON-WISH, 2 vols. 12mo. The RED ROVER, 2 vols. 12mo. The SPY, 2 vols. 12mo. The PIONEERS, 2 vols. 12mo. The PILOT, a Tale of the Sea, 2 vols. 12mo. 

LIONEL LINCOLN, or the LEAGUER of BOSTON, 2 vols. The LAST of the MOHICANS, 2 vols 12mo. The PRAIRIE, 2 vols. 12mo. BY WASHINGTON IRVING. VOYAGES and ADVENTURES of the COMPANIONS of COLUMBUS. By Washington Irving, Author of the Life of Columbus, &c. 1 vol. Bvo. "Of tho main work we may repeat that it possesses the value of important history and the magnetism of romantic adventure. It sustains in every respect the reputation of Irving." "We may hope that the gifted author will treat in like manner the enterprises and exploits of Pizarro and Cortes ; and thus complete a series of elegant recitals, which will contribute to the especial gratification of Americans, and form an imperishable fund of delightful instruction for all ages and countries."— Nat. Gazette. " As he leads us from one savage tribe to another, as he paints successive scenes of heroism, perseverance and self-denial, as he wanders among tiie magnificent scones of nature, as he relates with scrupulous fidelity the errors, and the crimes, even of those whose lives are for the most part marked with traits to command admiration, and perhaps esteem — everywhere we find him the same undeviating, but beautiful moralist, gathering from every incident some lesson to present in striking language to the reason and the heart." — Am. Quarterly Review. " This is a delightful volume; for the preface truly says that the expeditions narrated and springing out of the voyages of Columbus may be compared with attempts of adventurous knights-errant to achieve the enterprise left unfinished by some illustrious predecessors. Washington living's name is a pledge how well their stories will be told: and we only regret that we must of necessity defer our extracts for a week." — London Lit. Oazctte. A CHRONICLE of the CONQUEST of GRENADA. By Washington Irving, Esq. In 2 vols. " On the whole, this work will sustain the high fame of Washington Irving. It fills a blank in the historical library which ought not to have remained so long a blank. The language throughout is at once chaste and animated ; and the narrative may be said, like Spenser's Fairy Queen, to present one long gallery of splendid pictures. — Lond. Lit. Gazette. "Collecting his materials from various historians, and adopting in some degree the tone and manner of a monkish chronicler, he has embodied them in a narrative which in manner reminds us of the rich and storied pages of Froissart. He dwells on the feats of chivalry performed by the Christian Knights, with all the ardor which might be expected from a priest, who mixed, according to the usage of the times, not only in the palaces of courtly nobles, and their gay festivals, as an honored and welcome guest, but who was their companion in the camp, and their spiritual and indeed bodily comforter and assistant in (ho field of battle. — 9/n. Quarterly Review. New Editions of the following Works hy the same Author. The SKETCH BOOK, 2 vols. 12mo. KNICKERBOCKER'S HISTORY of NEW YORK, revised and corrected. 2 vols. BRACEBRIDGE HALL, or the HUMORISTS, 2 vols. 12mo. TALES of a TRAVELLER, 2 vols. 12mo. 



TRAVELS, ABTNUAL.S, &c 

NOTES on ITALY, during the years 1829-30. By Rembrandt Peale. In 1 vol. Bvo. "This artist will gratify all reasonable expectation; he is neither ostentatious, nor dogmatical, nor too minute ; he is not a partisan nor a carper ; he admires without servility, he criticises without malevolence ; his frankness and good humor give an agreeable color and effect to all his decisions, and the object of them ; his book leaves a useful general idea of the names, works, and deserts, of the great masters; it is an instructive and entertaining index." — Nat. Gaz. "We have made a copious extract in preceding columns from this interesting work of our countryman, Rembrandt Peale, recently published. It has received high commendation from respectable sources, which is justified by the portions we have seen extracted.'' — Commercial Advertiser. " Mr. Peale must be allowed the credit of candor and entire freedom from affectation in the judgments he has passed. At the same time, we should not omit to notice the variety, extent, and minuteness of his examinations. No churchy gallery, or collection, was passed by, and most of the individual pictures are separately and carefully noticed." — Am. Quarterly Review. FRAGMENTS of VOYAGES and TRAVELS, including ANECDOTES of NAVAL LIFE ; intended chiefly for the Use of Young Persons. By Basil Hall, Capt. R. N. In 2 vols. royal 18mo. " His volumes consist of a melange of autobiography, naval anecdotes, and sketches of a somewhat discursive nature, which we have felt much pleasure in perusing." " The title page to these volumes indicates their being chiefly intended for young persons, but we are much mistaken if the race of gray-beards will be among the least numerous of the readers of ' midshipmen's pranks and the humors of the green room.' " — Lit. Gazette. A TOUR in AMERICA. By Basil Hall, Capt. R. N. In 2 vols. 12mo. SKETCHES OF CHINA, with Illustrations from Original Drawings. By W. W. Wood. In 1 vol. 12mo. "The residence of the author in China, during the years 182G-7-8 and 9, has enabled him to collect much very curious information relative to this singular people, which he has embodied in his work; and will serve to gratify the curiosity of many whose time or dispositions do not allow them to seek, in the voluminous writings of the Jesuits and early travellers, the information contained in the present work. The recent discussion relative to the renewal of the East India Company's Charter, has excited much interest; and among ourselves, the desire to be further acquainted with the subjects of 'the Celestial Empire,' has been considerably augmented." EXPEDITION to the SOURCES of the MISSISSIPPI, Executed by order of the Government of the United States. By Major S. H. Long. In 2 vols. Bvo. With Plates. HISTORICAL, CHRONOLOGICAL, GEOGRAPHICAL, and STATISTICAL ATLAS of NORTH and SOUTH AMERICA, and the WEST INDIES, with all their Divisions into States, Kingdoms, &c. on the Plan of Le Sage, and intended as a companion to Lavoisne's Atlas. In 1 vol. folio, containing 54 Maps. Third Edition, improved and enlarged. ATLANTIC SOUVENIR, FOR 1832. This volume is superbly bound in embossed leather, and ornamented with numerous plates, executed in the best style, by the first artists. i No expense has been spared in the endeavor 

to render it worthy of the purpose for which it is intended. Embellishments. — 1. The Hungarian Princess, engraved by Illman and Pillbrow, from a picture by Holmes. — 2. The Bower of Paphos, engraved by Ellis, from a picture by Martin. — 3. The Duchess and Sancho, engraved by Durand, from a picture by Leslie. — 4. Richard and Saladin, engraved by Ellis, from a picture by Cooper. — 5. The Rocky Mountains, engraved by Hatch and Smilie, from a picture by Doughty. — 6. Lord Byron in Early Youth, engraved by Ellis, from a picture by Saunders. — 7. Tiger Island, engraved by Neagle, from a picture by Stanfield. — 8. The Blacksmith, engraved by Kelly, from a picture by Neagle. — 9. The Tight Shoe, engraved by Kelly, from a picture by Richter. — 10. Isadore, engraved by Illman and Pillbrow, from a picture by Jackson. — 11. The Dutch Maiden, engraved by Neagle, from a picture by Newton. — 12. The Mother's Grave, engraved by Neagle, from a picture by SchafFer. ATLANTIC SOUVENIR. FOR 1831. Embellishments. — 1. Frontispiece. The Shipwrecked Family, engraved by Ellis, from a picture by Burnet. — 2. Shipwreck off Fort Rouge, Calais, engraved by Ellis, from a picture by Stanfield. — 3. Infancy, engraved by Kelly, from a picture by Sir Thomas Lawrence — 4. Lady Jane Grey, engraved by Kelly, from a picture by Leslie. — 5. Three Score and Ten, engraved by Kearny, from a picture by Burnet. — 6. The Hour of Rest, engraved by Kelly, from a picture by Burnet. — 7. The Minstrel, engraved by Ellis, from a picture by Leslie.—B. Arcadia, engraved by Kearny, from a picture by Cockerell. — 9. The Fisherman's Return, engraved by Neagle, from a picture by Collins. — 10. The Marchioness of Carmarthen, granddaughter of Charles Carroll of Carrollton, engraved by Illman and Pillbrow, from a picture by Mrs. Mcc. — 11. Morning among the Hills, engraved by Hatch, from a picture by Doughty. — 12. Los Musicos, engraved by Ellis, from a picture by Watteau. A few copies of the ATLANTIC SOUVENIR, for 1830, are still for sale. THE BOOK of the SEASONS. By William Howitt. "Since the publication of the Journal of a Naturalist, no work at once so interesting and instructive as the Book of the Seasons has been submitted to the public. Whether in reference to the utility of its design, or the grace and beauty of its execution, it vyill amply merit the popularity it is certain to obtain. It is, indeed, cheering and refreshing to meet with such a delightful volume, so full of nature and truth — in which reflection and experience derive aid from imagination — in which we are taught much ; but in such a manner as to make it doubtful whether we have not been amusing ourselves all the time we have been reading." — JVew Monthly Magazine. "The Book of the Seasons is a delightful book, and recommended to all lovers of nature." — Blackwood's Magazine. 



EDUCATION. 

LESSONS on THINGS, intended to improve Children in the Practice of Observation, Reflection and Description, on the System of Pestalozzi, edited by John Feost, A. M. The publishers request the attention of teachers, school committees, and all who are desirous of improving the methods of instruction, to this work, which is on a plan hitherto unattempted by any school-book in this country, and which has been attended with extraordinary success in England. The following remarks on the work are extracted from the " Quarterly Journal of Education." " This little volume is a ' corrected and re-corrected' edition of lessons actually given to children, and, therefore, possesses a value to which no book made in the closet can lay claim, being the result of actual experiment. The work consists of a number of lessons, divided into five series; beginning with subjects the most easy and elementary, it gradually increases in difficulty, each successive step being adapted to the mind of the child as it acquires fresh stores of knowledge. " Every part of these lessons is interesting to the child, both on account of the active operation into which his own mind is necessarily called by the manner in which the lessons are given ; and also by the attractive nature of many of the materials which form the subject of the lessons. In the first and most elementary series, the pupil ia simply taught to make a right use of his organs of sense, and to exercise his judgment so far only as relates to the objects about him; and accordingly the matter brought before him at this stage, is such that its obvious properties can be discovered and described by a child who has acquired a tolerable knowledge of his mother tongue." OUTLINES of HISTORY, from the Earliest Records to the Present Time. Prepared for the Use of Schools, with Questions, by John Frost, A. M. " The main object of the work is, by giving a selection of interesting and striking facts from more elaborate histories, properly and carefully arranged, with chronological tables, to render the study of general history less dry and repulsive than it has been heretofore. This, we think is fully accomplished. Very great care appears to have been bestowed on the selections, and in arranging the chronological tables, as well as in the classification of the historical matter into parts and chapters. The work will sufficiently recommend itself to all who examine it."— Sat. Evening Post. "To concentrate in one comparatively small volume, a complete epitome of the entire history of the world, ancient and modern, so treated as to present a correct image of it, would seem to be an object to be wished for, rather than expected ; the ' Outlines of History,' however, realize this object."— Asiatic Journal. " We consider that Mr. F has done a service to schools, by the time and labor which he has bestowed upon this work; the marginal dates will be found of great service, but the chapters of questions upon the text, and upon the maps, to illustrate the geography of the history, will especially recommend the work to the attention of teachers."— U. S. Gazette. Philadelphia, July lMh, 1831. "The 'Outlines of History,' I consider an excellent class-book of general history for the use of schools. The questions added by Mr. Frist, are a most valuable auxiliary for the teacher as'well as the pupil. I shall use the ' Outlines' in my school, and cordially recommend it to parents and teachers. S. C. WALKER." Philadelphia, April 30tA, 1831. "Dear Sir,— l have just received a copy of your edition of the ' Outlines of History.' From a cursory perusal, I am disposed to give it a high rank as a school-book. So well satisfied am I with the arrangement and execution of the work, that I intend to put it immediately into the hands of a class in my own school. " Very respectfully, your obedient servant, " Mr. John Frost." " LEVI FLETCHER. 

S. C. WALKER." 

FRENCH AND SPANISH. BY A. BOLMAR. A COLLECTION of COLLOQUIAL PHRASES on every Topic necessary to maintain Conversation, arranged under different heads, with numerous remarks on the peculiar pronunciation and use of various words — the whole so disposed as considerably to facilitate the acquisition of a correct pronunciation of the French. By A. Bolmar. One vol. 18mo. A SELECTION of ONE HUNDRED PERRIN'S FABLES, accompanied by a Key, containing 1 the text, a literal and free translation, arranged in such a manner as to point out the difference between the French and the English idiom, also a figured pronunciation of the French, according to the best French works extant on the subject ; the whole preceded by a short treatise on the sounds of the French language, compared with those of the English. Les AVENTURES de TELEMAQUE par FENELON, accompanied by a Key to the first eight books ; containing like the Fable — the Text — a Literal — and Free Translation ; intended as a Sequel to the Fables. The expression ' figured pronunciation,' is above employed to express that the words in the Key to the French Fables are spelt and divided as they are pronounced. It in what Walker has done in his Critical Pronouncing Dictionary ; for instance, he indicates the pronunciation of the word enough, by dividing and spelling it thus, e-nuf. In the same manner I indicate the pronunciation of the word comptaient thus, kon-tti. As the understanding of the figured pronunciation of Walker requires the student to be acquainted with the primitive sounds of the English vowels, he must likewise, before he can understand t/ie figured pronunciation of the French, make himself acquainted with the 20 primitive sounds of the French vowels. This any intelligent person can get from a native, or from anybody who reads French well, in a few hours. A COMPLETE TREATISE on the GENDERS of FRENCH NOUNS; in a small pamphlet of fourteen pages. This little work, which is the most complete of the kind, is the fruit of great labor, and will prove of immense service to every learner. ALL THE FRENCH VERBS, both REGULAR and IRREGULAR, in a small volume. The verbs elre to be, avoir to have, parler to speak, finir to finish, recevoir to receive, vendre to sell, se lever to rise, se bien porter to be well, s'en aller to go away, are here all conjugated through — affirmatively — negatively — interrogatively — and negatively and interrogativel — an arrangement which will greatly facilitate the scholar in his learning the French verbs, and which will save the master the trouble of explaining over and over again what may be much more easily learned from books, thus leaving him more time to give his pupil, during the lesson, that instruction which cannot be found in books, but which must be learned from a master. NEUMAN'S SPANISH and ENGLISH DICTIONARY. New Edition, in one vol 16mo. 



CLASSICAL LITERATURE. INTRODUCTION to the STUDY op the GREEK CLASSIC POETS, for the use of Young Persons at School or College. Contents. — General Introduction ; Homeric Questions ; Life of Homer ; Iliad ; Odyssey; Margites; Batrachomyomachia ; Hymns ; Hesiod. By Henry Nelson Coleridge. "We have been highly pleased with this little volume. This work supplies a want which we have often painfully felt, and affords a manual which we should gladly see placed in the hands of every embryo under-graduate. We look forward to the next portion of this work with very eager and impatient expectation." — British Critic. " Mr. Coleridge's work not only deserves the praise of clear, eloquent and scholar-like exposition of the preliminary matter, which is necessary in order to understand and enter into the character of the great Poet of antiquity; but it has likewise the more rare merit of being admirably adapted for its acknowledged purpose. It is written in thai fresh and ardent spirit, which to the congenial mind of youth, will convey instruction in the most effective manner, by awakening the desire of it; and by enlisting the lively and buoyant feelings in the cause of useful and improving study; while, by its pregnant brevity, it is more likely to stimulate than to supersede more profound and extensive research. If then, as it is avowedly intended for the use of the younger readers of Homer, and, as it is impossible not to discover, with a more particular view to the great school to which the author owes his education, we shall be much mistaken if it does not become as popular as it will be useful in that celebrated establishment." — Quarterly Review. " We sincerely hope that Mr. Coleridge will favor us with a continuation of his work, which he promises." — Gent. Mag. "The author of this elegant volume has collected a vast mass of valuable information. To the higher classes of the public schools, and young men of universities, this volume will be especially valuable ; as it will afford an agreeable relief of light reading to more grave studies, at once instructive and entertaining." — Wesleyan Methodist Magazine. ATLAS OF ANCIENT GEOGRAPHY, consisting of 21 Colored Maps, with a complete Accentuated Index. By Samuel Butler, D. D., F. R. S. «fee. Archdeacon of Derby. By the same Author. GEOGRAPHIA CLASSICA: a Sketch of Ancient Geography, for the Use of Schools. In Bvo. Extract of a Letter from Professor Stuart of Andover. " I have used Butler's Atlas Classica for 12 or 14 years, and prefer it on the score of convenience and correctness to any atlas within the compass of my knowledge. It is evidently a work of much care and taste, and most happily adapted to classical readers and indeed all others, who consult the history of past ages. I have long cherished a strong desire to see the work brought forward in this country, and I am exceedingly gratified that you have carried through this undertaking. The beautiful manner in which the specimen is executed that you have sent me does great credit to engravers and publishers. It cannot be that our schools and colleges will fail to adopt this work, and bring it into very general circulation. I know of none which in all respects would supply its place." " The abridged but classical and excellent work of Butler, on Ancient Geography, which you are printing as an accompaniment to the maps, I consider one of the most attractive works of the kind, especially for young persons studying the classics, that has come under my notice. I wish you the most ample success in these highly useful publications." 

MECHANICS, MANUFACTURES, &c. A PRACTICAL TREATISE on RAILROADS, and INTERIOR COMMUNICATION in GENERAL— containing an account of the performances of the different Locomotive Engines at, and subsequent to, the Liverpool Contest ; upwards of two hundred and sixty Experiments with Tables of the comparative value of Canals and Railroads, and the power of the present Locomotive Engines. By Nicholas Wood, Colliery Viewer, Member of the Institution of Civil Engineers, &c. Bvo. with plates. " In this, the able author has brought up his treatise to the date of the latest improvements in this nationally important plan. We consider the volume to be one of great general interest." — Lit. Gaz. "We must, injustice, refer the reader to the work itself, strongly assuring him that, whether he be a man of science, or one totally unacquainted with its technical difficulties, he will here receive instruction and pleasure, in a degree which we have seldom seen united before." — Monthly Rev. REPORTS on LOCOMOTIVE and FIXED ENGINES. By J. Stephenson and J. Walker, Civil Engineers. With an Account of the Liverpool and Manchester Railroad, by H. Booth. In Bvo. with plates. MILLWRIGHT and MILLER'S GUIDE. By Oliver Evans. New Edition, with additions and corrections, by the Professor of Mechanics in the Franklin Institute of Pennsylvania, and a description of an improved Merchant Flour-Mill, wilh engravings, by C. & O. Evans, Engineers. THE NATURE and PROPERTIES of the SUGAR CANE, with Practical Directions for its Culture, and the Manufacture of its various Products; detailing the improved Methods of Extracting, Boiling, Refining, and Distilling ; also Descriptions of the Best Machinery, and useful Directions for the general Management of Estates. By George Richardson Porter. " This volume contains a valuable mass of scientific and practical information, and is, indeed, a compendium of everything interesting relative to colonial agriculture and manufacture." — Intelligencer. "We can altogether recommend this volume as a most valuable addition to the library of the home West India merchant, as well as that of the resident planter." — Lit. Gazette. "This work may be considered one of the most valuable books that has yet issued from the press connected with colonial interests; indeed, we know of no greater service we could render West India proprietors, than in recommending the study of Mr. Porter's volume." — Spectator. " The work before us contains such valuable, scientific, and practical information, that we have no doubt it will find a place in the library of every planter and person connected with our sugar colonies." — Monthly Magazine. A TREATISE on MECHANICS. By James Renwick, Esq. Professor of Natural and Experimental Philosophy, Columbia College, N. Y. In Bvo. with numerous engravings. 



<£hemtstrg, Natural f^tstorg, an* i9hflo*ojritg. 

THE CHEMISTRY OF THE ARTS, on the basis of Gray's Operative Chemist, being an Exhibition of the Arts and Manufactures dependent ork Chemical Principles, with numerous Engravings, by ARTHUR L. PORTER, M. D. late Professor of Chemistry, &c. in the University of Vermont. In Bvo. With numerous Plates. The popular and valuable English work of Mr. Gray, which forms the groundwork of the present volume, was published in London in 1829, and designed to exhibit a systematic and practical view of the numerous Arts and Manufactures which involve the application of Chemical Science. The author himself, a skilful, manufacturing, as well as an able, scientific chemist, enjoying the multiplied advantages afforded by the metropolis of the greatest manufacturing nation on earth, was eminently qualified for so arduous an undertaking, and the popularity of the work in England, as well as its intrinsic merits, attest the fidelity and success with which it has been executed. In the work now offered to the American public, the practical character of the Operative Chemist has been preserved, and much extended by the addition of a great variety of original matter, by numerous corrections of the original text, and the adaptation of the whole to the state and wants of the Arts and Manufactures of the United States. Among the most considerable additions will be found full and extended treatises on the Bleaching of Cotton and Linen, on the various branches of Calico Printing, on the Manufacture of the Chloride of Lime, or Bleaching Powder, and numerous Staple Articles used in the Arts of Dying, Calico Printing, and various other processes of Manufacture, such as the Salts of Tin, Lead, Manganese, and Antimony; the most recent Improvements on the Manufacture of the Muriatic, Nitric, and Sulphuric Acids, the Chromates of Potash, the latest information on the comparative Value of Different Varieties of Fuel, on the Construction of Stoves, Fire-Places, and Stoving Rooms, on the Ventilation of Apartments, &c. <fee. The leading object has been to improve and extend the practical character of the Operative Chemist, and to supply, as the publishers flatter themselves, a deficiency which is felt by every artist and manufacturer, whose processes involve the principles of chemical science, the want of" a Systematic Work which should embody the most recent improvements in the chemical arts and manufactures, whether derived from the researches of scientific men, or the experiment and observations of the operative manufacturer and artisans themselves. CHEMICAL MANIPULATION. Instruction to Students on the Methods of performing Experiments of Demonstration or Research, with accuracy and success. By MICHAEL FARADAY, F. R. S. First American, from the second London edition, with Additions by J. It. MITCHELL, M.D. " After a very careful perusal of this work, we strenuously recommend it, as containing the most complete and excellent instructions for conducting chemical experiments. There are few persons, however great their experience, who may not gain information in many important particulars; and for ourselves, we beg most unequivocally to acknowledge that we have acquired many new and important hints on subjects of even every-day occurrence. — Philosophical Mag. "A work hitherto exceedingly wanted in the laboratory, equally useful to the proficient and to the student, and eminently creditable to the industry and skill of the author, and to the school whence it emanates."—Journal of Science and Jlrts. 

GEOLOGICAL MANUAL, by H. T. De la Beche, F. R. S., F. G. S., Mem. Geol. Soc. of France. In Bvo. With 104 Wood Cuts. ELEMENTS of PHYSICS, or NATURAL PHILOSOPHY, GENERAL and MEDICAL, explained independently of TECHNICAL MATHEMATICS, and containing New Disquisitions and Practical Suggestions. By Neill Arnott, M. D. Second American from the fourth London edition, with Additions by Isaac Hays, M. D. " Dr. Arnott's work has done for Physics as much as Locke's Essay did for the science of mind." — London University Magazine. " We may venture to predict that it will not be surpassed. — Times. " Dr. A. has not done less for Physics than Blackstone did for the Law." — Morning Herald. " Dr. A. has made Natural Philosophy as attractive as Button made Natural History." — French Critic " A work of the highest class amon^ the productions of mind." — Courier. " We regard the style and manner as quite admirable." — Morning Chronicle. " As interesting as novel-reading." — jlthenteum. " Never did philosophic hand wield a pen more calculated to win men to be wise and good."— Edinburgh Observer. " Of this valuable, or we might say, invaluable work, a second edition has been speedily demanded by the public voice." — Lit. Oaz. A FLORA of NORTH AMERICA, with 108 colored Plates. By W. P. C. Barton, M. D. In 3 vols. 4to. ARNOTT'S ELEMENTS of PHYSICS. Vol. 11. Part I. Containing Light and Heat. "Dr. Arnott's previous volume has been so well received, that it has almost banished all the flimsy productions called popular, which falrely pretend to strip science of its mysterious and repulsive aspect, and to exhibit a holyday apparel. The success of such a work shows most clearly that it is plain, but sound knowledge which the public want." — Monthly Review. AMERICAN ORNITHOLOGY, or NATURAL HISTORY of BIRDS, inhabiting the UNITED STATES, by Charles Lucien Bonaparte ; .designed as a continuation of Wilson's Ornithology, Vols. I. 11. and 111. *?* Gentlemen who possess Wilson, and are desirous of rendering the work complete, are informed that the edition of this work is very small, and that but a very limited number of copies remain unsold. Vol. IV. in the Press. A DISCOURSE on the REVOLUTIONS of the SURFACE of the GLOBE and the Changes thereby produced in the ANIMAL KINGDOM. By Baron G. Cuvier. Translated from the French, with Illustrations and a Glossary. In 12mo. With Plates. 1 One of the most scientific and important, yet plain and lucid works, which adorn the age Here is vast aid to the reader interested in the study of nature, and the lights which reason and investigation have thrown upon the formation of the universe."— JVeic Monthly Magazine. 



PHYSIOLOGICAL, MEDICINE AID ANATOMY. 

HISTORY OF CHRONIC PHLEGMASIJ3, OR INFLAMMATIONS, founded on Clinical Experience and Pathological Anatomy, exhibiting a View of the different Varieties and Complications of these Diseases, with their various Methods of Treatment. By F. J. V. Broussais, M. D. Translated from the French of the fourth edition, by Isaac Hays, M. D. and R. Eglesfeld Griffith, M. D. Members of the American Philosophical Society, of the Academy of Natural Science, Honorary Members of the Philadelphia Medical Society, &c. &c. In 2 vols. Bvo. EXAMINATION OF MEDICAL DOCTRINES AND SYSTEMS OF NOSOLOGY, preceded by Propositions containing the Substance of Physiological Medicine, by F. J. V. Broussais, Officer of the Royal Order of the Legion of Honor ; Chief Physician and First Professor in the Military Hospital for Instruction at Paris, &c. Third edition. Translated from the French, by Isaac Hays, M. D. and R. E. Griffith, M. D. In 2 vols. Bvo. In the press. A TREATISE ON PHYSIOLOGY, Applied to Pathology. By F. J. V. Broussais, M. D. Translated from the French, by Drs. Bell and La Roche. Bvo. Third American edition, with additions. " We cannot too strongly recommend the present work to the attention of our readers, and indeed of all those who wish to study physiology as it ought to be studied, in its application to the science of disease." "We may safely say that he has accomplished his task in a most masterly manner, and thus established his reputation as a most excellent physiologist and profound pathologist." — JWift American Med. and Surg. Journ. Jan. 1827. THE PRINCIPLES AND PRACTICE OF MEDICINE. By Samuel Jackson, M. D. Adjunct Professor of the Institutes and Practice of Mecicine in the University of Pennsylvania. Bvo. THE PRACTICE OF MEDICINE, upon the Principles of the Physiological Doctrine. By J. G. Coster, M. D. Translated from the French. An EPITOME of the PHYSIOLOGY, GENERAL ANATOMY, and PATHOLOGY of BICHAT. By Thomas Henderson, M. D. Professor of the Theory and Practice of Medicine in Columbia College, Washington City. Bvo. "The Epitome of Dr. Henderson ought and must find a place in the library of every physician desirous of useful knowledge for himself, or of bein? instrumental in imparting it to others, whose studies he is expected to superintend. — JV. Ji. Med. and Surg. Journ. No. io. A TREATISE on FEVER, considered in the spirit of the new medical Doctrine. By J. B. Boisseatj. Translated from the French. In the Press. 

DIRECTIONS for MAKING ANATOMICAL PREPARATIONS, formed on the basis of Pole, Marjolin and Breschet, and including 1 the new method of Mr. Swan, by Usher Parsons, M. D. Professor of Anatomy and Surgery. In 1 Vol. Bvo. with plates. A TREATISE on PATHOLOGICAL ANATOMY. By William E. Homer, M. D. Adj. Prof, of Anatomy in the University of Pennsylvania. "We can conscientiously commend it to the members of the profession, as a satisfactory, interesting, and instructive view of the subjects discussed, and as well adapted to aid them in forming a correct appreciation of the diseased conditions they are called on to relieve."— American Journal of the Medical Sciences, JVo. 9. By the same Author. A TREATISE on SPECIAL and GENERAL ANATOMY. Second edition, revised and corrected, in 2 Vols. Bvo. LESSONS in PRACTICAL ANATOMY, for the use of Dissectors. 2d edition, in 1 Vol. Bvo. SYSTEM of ANATOMY, for the use of Students of Medicine. By Caspar Wistar. Fifth edition, revised and corrected, by W. E. Homer, Adjunct Professor of Anatomy in the University of Pennsylvania. In 2 Vols. Bvo. ELEMENTS of GENERAL ANATOMY, or a description of the Organs comprising the Human Body. By P. A. Beclard, Professor of Anatomy to the Faculty of Medicine at Paris. Translated by J. Togno. TREATISE on SURGICAL ANATOMY. By Abraham Colles, Professor of Anatomy and Surgery, in the Royal College of Surgeons in Ireland, &c. Second American edition, with notes by J. P. Hopkinson, Demonstrator of Anatomy in the University of Pennsylvania, &,c. &c. A TREATISE on PATHOLOGICAL ANATOMY. By E. Geddings, M. D. Professor of Anatomy in the Medical College of South Carolina. In 2 vols. Bvo. (In the press.) ELEMENTS OF MYOLOGY. By E. Geddings, M. D. illustrated by a series of beautiful Engravings of the Muscles of the Human Body, on a plan heretofore unknown in this country. In the press. This work, in addition to an ample and accurate description of the general and special anatomy of the muscular system, will comprise illustrations of the subject from comparative anatomy and physiology, with an account of the irregularities, variations and anomalies, observed by the various ancient and modern anatomists, down to the present time. 



BOEBZCmE AND SURGERY, 

A TREATISE on FEVER. By Southwood Smith, M. D., Physician to the London Fever Hospital. " No work has been more lauded by the Reviews than the Treatise on Fevers, by Southwood Smith. Dr. Johnson, the editor of the Medico-Chirurgical Review, says, ' It is the best we have ever perused on the subject of fever, and in our conscience, we believe it the best that ever flowed from the pen of physician in any age or in any country.' "— Am. Med. Journ. An ESSAY on REMITTENT and INTERMITTENT DISEASES, including- generically Marsh Fever and Neuralgia — comprising under the former, various Anomalies, Obscurities, and Consequences, and under a new systematic View of the latter, treating of Tic Douloureux, Sciatica, Headache, Ophthalmia, Toothache, Palsy, and many other Modes and Consequences of this generic Disease ; by John Macculloch, M. D., F. R. S. &c. &c. " In rendering Dr. Macculloch's work more accessible to the profession, we are conscious that we are doing the state some service." — Med. Chir. Review. " We most strongly recommend Dr. Macculloch's treatise to the attention of our medical brethren, as presenting a most valuable mass of information, on a most important subject."— JV. A. Med. and Surg. Journal. A PRACTICAL SYNOPSIS OF CUTANEOUS DISEASES, from the most celebrated Authors, and particularly from Documents afforded by the Clinical Lectures of Dr. Biett, Physician to the Hospital of St. Louis, Paris. By A. Cazenave, M. D. and H. E. Schedel, M. D. " We can safely recommend this work to the attention of practitioners as containing much practical information, not only on the treatment, but also on the causes of cutaneous affections, as baing in fact the best treatise on diseases of the skin that has ever appeared." — American Journal of the Medical Sciences, JVo. 5. SURGICAL MEMOIRS OF THE RUSSIAN CAMPAIGN. Translated from the French of Baron Laurey. LECTURES ON INFLAMMATION, exhibiting a view of the General Doctrines, Pathological and Practical, of Medical Surgery. By John Thompson, M. D., F. R. S. E. Second American edition. THE INSTITUTES AND PRACTICE OF SURGERY ; being the Outlines of a Course of Lectures. By W. Gibson, M. D. Professor of Surgery in the University of Pennsylvania. 3d edition, revised, corrected, and enlarged. In 2 vols. Bvo. PRINCIPLES OF MILITARY SURGERY, comprising Observations on the Arrangements, Police, and Practice of Hospitals, and on the History, Treatment, and Anomalies of Variola and Syphilis ; illustrated with cases and dissections. By John Hennen, M. D., F. R. S. E. Inspector of Military Hospitals — first American from the third London edition, with the Life of the Author, by his son, Dr. John Hennen. "The value of Dr. Hennen's work is too well appreciated to need any praise of ours. We were only required then, to bring the third edition before the notice of our readers; and having done this, we shall merely add, that the volume merits a place in every library, and that no military surgeon ought to be without it." — Medical Gai. 

AMERICAN JOURNAL OF THE MEDICAL SCIENCES. Published Quarterly. And supported by the most distinguished Physicians in the United States, among which are Professors Bigelow, Charming, Chapman, Coxe, De Butls, Dewees, Dickson, Dudley, Francis, Gibson, Hare, Henderson, Homer, Hosack, Jackson, Macneven, Mott, Mussey, Physick, Potter, Sewall, Warren, and Worthington; Drs. Daniell, Drake, Emerson, Fearn, Geddings, Griffith, Hale, Hays, Hayward, Ives, Jackson, Moultrie, Ware, and Wright. It is published punctually on the first of November, February, May, and August. Each No. contains about 280 large Bvo. pages, and one or more plates — being a greater amount of matter than is furnished by any other Medical Journal in the United States. Price $5 per annum. The following Extracts show the estimation in which this Journal is held in Europe : — "Several of the American Journals are before us. * * * Of these the American Journal of the Medical Sciences is by far the better periodical ; it is, indeed, the best of the trans-atlantic medical publications ; and, to make a comparison nearer home, is in most respects superior to the great majority of European works of the same description."— The Lancet, Jan. 1831. " We need scarcely refer our esteemed and highly eminent cotemporary, [The American Journal of the Medical Sciences,] from whom we quote, to our critical remarks on the opinions of our own countrymen, or to the principles which influence us in the discharge of our editorial duties." " Our copious extracts from his unequalled publication, unnoticing multitudes of others which come before us, are the best proof of the esteem which we entertain for his talents and abilities." — London Medical and Surgical Journal, March, 1830. "The American Journal of the Medical Sciences is one of the most complete and best edited of the numerous periodical publications of the United States." — Bulletin dcs Sciences Medicalcs, Tom. XIV. PATHOLOGICAL and PRACTICAL RESEARCHES on DISEASES of the BRAIN and SPINAL CORD. By John Abeeckombie, M. D. "We have here a work of authority, and one which does credit to the author and his country." — North Amer. Med. and Surg. Journal. By the same Author. PATHOLOGICAL and PRACTICAL RESEARCHES on DISEASES of the STOMACH, the INTESTINAL CANAL, the LIVER, AND OTHER VISCERA OF THE ABDOMEN. "We have now closed a very long review of a very valuable work, and although we have endeavored to condense into our pages a great mass of important matter, we feel that our author has not yet received justice." — Medico- Chir urgical Review. A RATIONAL EXPOSITION of the PHYSICAL SIGNS of DISEASES of the LUNGS and PLEURA; Illustrating their Pathology and facilitating their Diagnosis. By Charles J. Williams, M. D. In Bvo. with plates. " If we are not greatly mistaken, it will lead to a better understanding, and a more correct estimate of the value of auscultation, than any thing that has yet appeared." — dm. Med. Journal. MANUAL of the PHYSIOLOGY of MAN ; or a concise Description of the Phenomena of his Organization. By P. Hutin. Translated from the French, with Notes, by J. Togno. In 12mo. 



MEDICINE. 

The PRACTICE of PHYSIC. By W. P. Dewees, M. D. Adjunct Professor of Midwifery, in the University of Pennsylvania, 2 Vols. Bvo. " We have no hesitation in recommending it as decidedly one of the best systems of medicine extant. The tenor of the work in general reflects the highest honor on Dr. Dewees's talents, industry, and capacity for the execution of the arduous task which he had undertaken. It is one of the most able and satisfactory works which modern times have produced, and will be a standard authority."—London Med. and Surg. Journal, Aug. 1830. DEWEES on the DISEASES of CHILDREN. 4th cd. In Bvo. The objects of this work are, Ist, to teach those who have the charge of children, either as parent or guardian, the most approved methods of securing and improving their physical powers. This is attempted bypointing out the duties which the parent or the guardian owes for this purpose, to this interesting, but helpless class of beings, and the manner by which their duties shall be fulfilled. And 2d, to render available a long experience to these objects of our affection when they become diseased. In attempting this, the author has avoided as much as possible, " technicality i" and has given, if he does not flatter himself too much, to each disease of which he treats, its appropriate and designating characters, with a fidelity that will prevent any two being confounded together, with the best mode of treating them, that either his own experience or that of others has suggested. DEWEES on the DISEASES of FEMALES. 3d edition, with Additions. In Bvo. A COMPENDIOUS SYSTEM OF MIDWIFERY ; chiefly designed to facilitate the Inquiries of those who may be pursuing this Branch of Study. In Bvo. with 13 Plates. sth edition, corrected and enlarged. By W. P. Dewees, M. D. The ELEMENTS OF THERAPEUTICS and MATERIA MEDICA. By N. Chapman, M. D. 2 vols. Bvo. sth edition, corrected and revised. MANUAL of PATHOLOGY: containing the Symptoms, Diagnosis, and Morbid Character of Diseases, &c. By L. Martinet. Translated, with Notes and Additions, by Jones Quain. Second American Edition, 12mo. "We strongly recommend M. Martinet's Manual to the profession, and esp cially to students; if the latter wish to study diseases to advantage, they should always have it at hand, both when at the bedside of the patient, and when making post mortem examinations." — American Journal of the Medical Sciences, No. I. CLINICAL ILLUSTRATIONS of FEVER, comprising a Report of the Cases treated at the London Fever Hospital in 1828-29, by Alexander Tweedie, M. D., Member of the Royal College of Physicians of London, &c. 1 vol. Bvo. "In short, the present work, concise, unostentatious as it is, would have led us to think that Dr. Tweedie was a man of clear judgment, unfettered by attachment to any fashionable hypothesis, that he was an energetic but judicious practitioner, and that, if he did not dazzle his readers with the brilliancy of theoretical speculations, he would command their assent to the solidity of his didactic precepts." — Med. Chir. Journal. 

The ANATOMY, PHYSIOLOGY, and DISEASES of the TEETH. By Thomas Bell, F.R.S., F.L.S. &c. In 1 vol. Bvo. With Plates. " Mr. Bell has evidently endeavored to construct a work of reference for the practitioner, and a text-book for the student, containing a 'plain and practical digest of the information at present, possessed on the subject, and results of the author's own investigations and experience.' " * * * "We must now take leave of Mr. Bell, whose work we have no doubt will become a class-book on the important subject of dental surgery." — Medico-Chirurgical Review. " We have no hesitation in pronouncing it to be the best treatise in the English language." — North American Medical and Surgical Journal, No. 19. AMERICAN DISPENSATORY. Ninth Edition, improved and greatly enlarged. By John Redman Coxe, M. D. Professor of Materia Medica and Pharmacy in the University of Pennsylvania. In 1 vol. Bvo. *** This new edition has been arranged with special reference to the recent Pharmacopoeias, published in Philadelphia and New- York. ELLIS' MEDICAL FORMULARY. The Medical Formulary, being a collection of prescriptions derived from the writings and practice of many of the most eminent Physicians in America and Europe. By Benjamin Ellis, M. D. 3d. edition. With Additions. "We would especially recommend it to our brethren in distant parts of the country, whose insulated situations may prevent them from having access to the many authorities which have been consulted in arranging the materials for this work." — Phil. Med. and Phys. Journal. MANUAL of MATERIA MEDICA and PHARMACY. By H. M. Edwards, M. D. and P. Vavasseur, M. D. comprising a concise Description of the Articles used in Medicine; their Physical and Chemical Properties ; the Botanical Characters of the Medicinal Plants ; the Formulae for the Principal Officinal Preparations of the American, Parisian, Dublin, &c. Pharmacopoeias ; with Observations on the proper Mode of combining and administering Remedies. Translated from the French, with numerous Additions and Corrections, and adapted to the Practice of Medicine and to the Art of Pharmacy in the United States. By Joseph Togno, M. D. Member of the Philadelphia Medical Society, and E. Durand, Member of the Philadelphia College of Pharmacy. "It contains all the pharmaceutical information that the physician can desire, and in addition, a larger mass of information, in relation to the properties, &c. of the different articles and preparations employed in medicine, than any of the dispensatories, and we think will entirely supersede all these publications in the library of the physician. — Am. Journ. of the Medical Sciences. MEMOIR on the TREATMENT of VENEREAL DISEASES without MERCURY, employed at the Military Hospital of the Val-de-Grace. Translated from the French of H. M. J. Desruelles, M. D. &c. To which are added, Observations by G. J. Guthrie, Esq. and various documents, showing the results of this Mode of Treatment, in Great Britain, France, Germany, and America. 1 vol. Bvo. 



PREPARING FOB PUBLICATION 

CAREY & LEA, 

CYCLOPAEDIA OF FlfAvll^A^ IyJ. JCi IJ l. l^ J. ill Xli , 

COMPRISING 

TREATISES ON THE NATURE AND TREATMENT OF DISEASES, MATERIA MEDICA AND THERAPEUTICS, MEDICAL JURISPRUDENCE, &c. 

EDITED BY 

JOHN FORBES, M.D. F.R.S. Physician to the Chichester Infirmary, &c. 

WITH THE ASSISTANCE OF 

JAMES APJOHN, M. D. M.R.I. A. Professor of Chemistry to the Royal College of Surgeons in Ireland. JAMES L. BAEDSLEY, M.D. Physician to the Manchester Royal Infirmary, Dispensary, &c. EDWARD BARLOW, M. D. Physician to the Bath United Hospital and Infirmary. R. H. BRABANT, M. D. Devizes. JOSEPH BROWN, M. D. Physician to the Sunderland and Bishopwearmouth Infirmary. THOMAS H. BURDER, M. D. Member of the Royal College of Physicians, London. JOHN BURNE, M. D. Physician to the Carey-street Dispensary. H. W. CARTER, M.D. F. R. S. E. Fellow of the Royal College of Physicians, London, Physician to the Kent and Canterbury Hospital. JOHN CHEYNE, M. D. F. R. S. E. M. R. I. A. Physician-General to the Forces in Ireland, &c. &c. JAMES CLARK, M. D. Physician to St. George's Infirmary, &c. &c. JOHN CLENDINNING, M. D. Fellow of the Royal College of Physicians, London. JOHN CRAMPTON, M. D. M.R.I. A. King's Professor of Materia Medica, Physician to Stevens's Hospital, &c. &c. Dublin. ANDREW CRAWFORD, M. D. Physician to the Hampshire County Hospital, Winchester. WILLIAM CUMIN, M. D. Glasgow. JAMES CUSACK, M.B. Steevens' Hospital, Dublin. JOHN DARWALL, M. D. Physician to the General Dispensary, Birmingham. D. D. DAVIS, M. D. M.R. S. L. Professor of Midwifery in the London University. JOHN ELLIOTSON, M. D. F. R. S. Physician to St. Thomas's Hospital. R. J. GRAVES, M. D. M. R. I. A. King's Professor of the Institutes of Medicine, Honorary Fellow of the King's and Queen's College of Physicians, Physician to the Meath Hospital and County of Dublin Infirmary. GEORGE GREGORY, M. D. Physician to the Small- Pox Hospital. MARSHALL HALL, M.D. F.R. S. E. Member of the Royal College of Physicians, London, &c. &c. 

ALEXANDER TWEEDIE, M.D. Physician to the London Fever Hospital, &c. 

THE 

JOHN CONOLLY, M. D. Professor of Medicine in the London University ,&c. 

FOLLOWING PHYSICIANS : 

Member 

THOMAS HANCOCK, M. D Liverpool, Member of the Royal College of Physicians, London. CHARLES HASTINGS, M. D. Physician to the Worcester General Infirmary. BISSET HAWKINS, M. D. Fellow of the Royal College of Physicians, Professor of Materia Medica and Therapeutics in King's College, Dublin. J. HOPE, M. D. Member of the Royal College of Physicians, London. ARTHUR JACOB, M. D. M. R.I. A. Professor of Anatomy to the Royal College of Surgeons in Ireland. ROBERT LEE, M. D. F. R. S. Physician to the British Lying-in Hospital. CHARLES LOCOCK, M. D. Physician to the Westminster General Lying-in Hospital, &c. &c. H. MARSH, M. D. M.R. I. A. Professor of the Principles and Practice of Medicine to the Royal College of Surgeons in Ireland, &c. Dublin. JONES QUAIN, M. B. Lecturer on Anatomy and Physiology in the Medical School, Aldersgate- Street. J. C. PRICHARD, M. D. F. R. S. Physician to the Infirmary and to St. Peter's Hospital, Bristol. ARCHIBALD ROBERTSON, M. D. Physician to the Northampton General Infirmary. P. M. ROGET, M. D. Sec. R. S. Consulting Physician to the Queen Charlotte's Lying-in Hospital and to the Northern Dispensary, &c. &c. JOHN SCOTT, M. D. Edinburgh. WILLIAM STOKES, M. D. Physician to the Meath Hospital. WILLIAM STROUD, M. D. Physician to the Northern Dispensary. A. T. THOMSON, M. D. F. L. S. Professor of Materia Medica in the London University. THOMAS THOMSON, M. D. F.R. S. L. & E. Regius Professor of Chemistry in the University of Glasgow, &c. &c. T. J. TODD, M. D. Physician to the Dispensary, Brighton. RICHARD TOWNSEND, A. B. M. D. M. R.I.A. Fellow of King and Queen's College of Physicians, Dublin. CHARLES J. B. WILLIAMS, M. D. London. &c. &c. &c. 

To adapt, the above work to the wants of this country, the publishers have engaged the assistance of many of our most eminent physicians, and they pledge themselves that no exertion shall be spared to render it worthy of patronage. It will be published in monthly numbers, price 50 cts. 112 pp. each. 



H. 

i 

i 

CYCLOPEDIA OF PRACTICAL MEDICINE. 

The want of a comprehensive work on subjects connected with Practical Medicine including Pathology and Pathological Anatomy, is one which has long existed in this country. The Medical Dictionaries heretofore published, and the Systems of Medicine in the hands of the student, may be said, without invidiousness, tc fall very far short of presenting the English reader with such a compendious survey of the actual state of British and Foreign Medicine as is absolutely required by him. Some of them are too limited and too superficial in their character ; others are too voluminous, too intricate in their arrangement, and too indiscriminate in their contents; and all are open to the serious objection of failing to represent the improvements and discoveries by which the scientific labors of the members of the medical profession, in various parts of the world, have been rewarded since the commencement of the present century. 

It is the object of the Cyclopaedia of Practical Medicine to supply these deficiencies, and to meet the acknowledged wants of the medical reader. Such ample arrangements have been mad' for effecting these important objects, as enable the Editors to la before the public the nature and plan of a publication in which they have endeavored, by dividing the labor of a work including subjects of great diversity, and all of practical importance ; by combining the valuable exertions of several contributors already known to the medical public ; by excluding mere technical anu verbal explanations, and all superfluous matter ; and by avoiding multiplied and injudicious divisions ; to furnish a book which will be comprehensive without diffuseness, and contain an account of whatever appertains to practical medicine, unembarrassed by disquisitions and subjects extraneous to it. 

In pursuance of this design, every thing connected with what is commonly called the Practice of Physic will be fully and clearly explained. The subject of Pathology will occupy particular attention, and ample information will be given with relation to Pathological Anatomy. 

Although the excellent works already published on the subjects of Materia Medica and Medical Jurisprudence can be so readily and advantageously consulted, as to make the details of those branches of science uncalled for in the Cyclopaedia, it belongs to the proposed plan to comprise such general notices of the application and use of medicinal substances as may be conveyed in a 



CYCLOPAEDIA OF PRACTICAL MEDICINE. 

general account of each class into which they have been divided, 'as of Tonics, Narcotics, &c; and to impart, under a few heads, as Toxicology, Suspended Animation, &c. such information connected with Medical Jurisprudence as is more strictly practical in its character. 

It is almost unnecessary to say that a work of this description will form a Library of Practical Medicine, and constitute a most desirable book of reference for the general practitioner, whose numerous avocations, and whose want of access to books, afford him little time and opportunity for the perusal of many original works, and who is often unable to obtain the precise information i which he requires at the exact time when he is in greatest need of it. 

The Student of Medicine, who is attending lectures, will, also, f by means of this work, be enabled, whatever order the lecturer j may follow, to refer, without difficulty, to each subject treated of ¦in the lectures of his teacher; and it is presumed that Lecturers on Medicine will see the advantage of recommending to their pupils a work of highly respectable character, the composition of original writers, and which, it is hoped, will neither disappoint the advanced student by its brevity and incompleteness, nor perplex ' those commencing their studies by an artificial arrangement. 

But, whilst the Editors have felt it to be their duty to prepare a safe and useful book of reference and text-book, it would be doing I injustice to those by whose co-operation they have been honored, not to avow that they have also been ambitious to render the work acceptable and interesting to readers who have leisure and inclination to study what may be termed the Philosophy of Medicine : whatever is truly philosophical in medicine being also useful, although the application of the science to the art requires much reflection and sound judgment. — For the assistance of those who desire to pursue a regular course of medical reading, ample directions ] will be given when the work is completed; and for those who may !be anxious to prosecute any particular subject to a greater extent jthan the limits of the Cyclopaedia permit, a list will be given, in an ] Appendix, of the best works relating to each. 

The means of accomplishing an undertaking of the importance •of which the Editors are fully sensible, will, doubtless, be appreciated after an inspection of the list of contributors who have already promised their co-operation* It is, of course, desirable that a work of this kind should be characterized by unity of de- 



CYCLOPiEDIA OF PRACTICAL MEDICINE. 

sign, but, at the same time, as each author will, generally speaking, contribute his knowledge and his opinions on the subjects which have occupied his chief attention, the superiority of the whole performance to any thing which the mere labor of compilation could accomplish will be unquestionable. To each important article the name of the author will be appended. 

The acknowledged want of such a publication, already alluded to, and the extensive encouragement which Dictionaries of a much greater extent have met with in France and Germany, although some of them are very unequal as regards the value of different parts, and encumbered with much that is absolutely useless, afford sufficient reason to hope for the success of a work in which what is valuable will, as much as possible, be separated from what is merely calculated to distract the attention, and to frustrate the inquiry, of those who study the science of medicine with a view of regulating and improving its practice. 

In order to insure this success, it is the desire, and will be the endeavor, of the Editors to make the Cyclopaedia of Practical Medicine not only obviously useful to those for whom it is more immediately intended, but so creditable to British Medical Science as to deserve and to obtain the patronage of all classes of the Medical Profession. 

In the American edition, all interesting details on the subjects of Materia Medica and Medical Jurisprudence, omitted in the original, will be supplied. — Much new matter in relation to American Surgery and Medical Practice will be introduced ; and for this ample materials have been promised. — Full explanations will be given of all medical terms, especially those which modern discoveries have introduced into the nomenclature of the science, and ( without a knowledge of which, many of the works of the present day are almost unintelligible. — At the termination of each article the most copious references will be given to the best writers on the subject, so as to enable the student who desires it, to pursue* his investigations with the least trouble and the greatest advantage — Finally, the whole work will be carefully revised, and suchadditions made as may tend to increase its value, and to render it/jp' what it is desired it should be — A complete Library of the Medical Sciences. 



Greenhow, Thomas, Cholera, as it..., WC 262 GBl3c 1832 Condition when received: The book had been repaired at some time in the past to include application of cloth-covered spine tape, thick linen tape hinges and excessive glue at the gutter. The pages were glued such that the text edges were obscured on the last 4 pages of text. Conservation treatment: The last 4 pages of text were humidified at the gutter using a steam pencil. The adhered text pages were separated at the gutter. Glue residue was further reduced using a methylcellulose poultice (A4M, Talas) with a Teflon tool. The 4 pages were reinforced at the gutter using usu mino paper (Japanese Paper Place) secured with wheat starch paste (zin shofu, BookMakers). Treatment carried out by Rachel-Ray Cleveland Conservator, National Library of Medicine 04-30-2008 









Greenhow, Thomas, Cholera, as it..., WC 262 GBl3c 1832 Condition when received: The book had been repaired at some time in the past to include application of cloth-covered spine tape, thick linen tape hinges and excessive glue at the gutter. The pages were glued such that the text edges were obscured on the last 4 pages of text. 

Conservation treatment: The last 4 pages of text were humidified at the gutter using a steam pencil. The adhered text pages were separated at the gutter. Glue residue was further reduced using a methylcellulose poultice (A4M, Talas) with a Teflon tool. The 4 pages were reinforced at the gutter using usu mino paper (Japanese Paper Place) secured with wheat starch paste (zin shofu, BookMakers). 

Conservation carried out by Rachel-Ray Cleveland NLM Paper Conservator, 02/2008